Health and Wellbeing
Jeanne Altmann • Elizabeth Armstrong • João Biehl • Anne C. Case • Dalton Conley • Janet M. Currie • Margaret Frye • Noreen Goldman • Sara F. McLanahan
“Cumulative Early Life Adversity Predicts Longevity in Wild Baboons,” written by Tung, J. (Duke University), Archie, E. (University of Notre Dame), Jeanne Altmann, and Alberts, S. (Duke University), was published in Nature Communications. In humans and other animals, harsh circumstances in early life predict morbidity and mortality in adulthood. Multiple adverse conditions are thought to be especially toxic, but this hypothesis has rarely been tested in a prospective, longitudinal framework, especially in long-lived mammals. Here, they use prospective data on 196 wild female baboons to show that cumulative early adversity predicts natural adult lifespan. Females who experience =3 sources of early adversity die a median of 10 years earlier than females who experience =1 adverse circumstances (median lifespan is 18.5 years). Females who experience the most adversity are also socially isolated in adulthood, suggesting that social processes partially explain the link between early adversity and adult survival. Their results provide powerful evidence for the developmental origins of health and disease and indicate that close ties between early adversity and survival arise even in the absence of health habit and health care-related explanations.
Elizabeth Armstrong continues her work on a book manuscript, titled How We Begin: The Origins of Fetal Personhood. The book explores the evolution of the belief that the fetus is a person in medicine, law and popular culture. Armstrong is also interested in cultural attitudes and beliefs about risk during pregnancy and childbirth and policies related to maternity care in the United States. She is conducting research on medical professional attitudes towards home birth in the U.S. and on popular practices around childbirth. She has investigated popular cultural practices regarding the placenta and is currently analyzing medical and scientific texts on placental form and function.
Elizabeth Armstrong is also working on a book manuscript entitled, Gender Inequality and Sexist Attitudes: Evidence from the World Values Survey, with Davis, A. (Princeton University, Sociology) and Meadow, T. (Columbia University). The World Values Survey is a global research project that explores people’s values and beliefs, their stability or change over time and their impact on social and political development of the societies in different countries of the world.
João Biehl’s main research centers on medical anthropology, the social studies of science and religion, global health, subjectivity, ethnography, social and critical theory (with a regional focus on Latin America and Brazil). His present research explores the social impact of large-scale treatment programs in resource-poor settings and the role of the judiciary in administering public health in Brazil.
João Biehl is currently preparing a manuscript, The Valley of Lamentation: The Mucker War in Postcolonial Brazil, which is a historical ethnography of the Mucker War, a religious war that that shattered German-Brazilian communities in the 19th century.
João Biehl is also writing a manuscript entitled, Patient-Citizen-Consumers: Claiming Pharmaceuticals and the Right to Health in Brazilian Courts. Biehl along with Nieburg, F (Federal University of Rio de Janeiro), and de L’Estoile, B. (French National Centre for Scientific Research).
João Biehl published "Patient-Citizen-Consumers: The Judicialization of Health and the Metamorphosis of Biopolitics," in Revista Lua Nova. Situated at the meeting points of Law and Medicine, the "judicialization of the right to health" is a contested and hotly debated phenomenon in Brazil. While government officials and some scholars argue that it is driven by urban elites and private interests, and used primarily to access high-cost drugs, empirical evidence refute narratives depicting judicialization as a harbinger of inequity and an antagonist of the public health system. This article's quantitative and ethnographic analysis suggests, instead, that low- -income people are working through the available legal mechanisms to claim access to medical technologies and care, turning the Judiciary into a critical site of biopolitics from below. These patient-citizen-consumers are no longer waiting for medical technologies to trickle down, and judicialization has become a key instrument to hold the State accountable for workable infrastructures.
In João Biehl’s publication, “The Postneoliberal Fabulation of Power: On Statecraft, Precarious Infrastructures, and Public Mobilization in Brazil,” published in American Ethnologist he states that in Brazil's hybrid government of social protection and market expansion, there is under way a fabulation of power, which ultimately serves to “de-poor” people seeking care, working infrastructures, and justice while also shoring up state politics as usual. This process became evident through the failure of a collaborative research project that he coordinated on right-to-health litigation. In rethinking that failure as an experiment in public ethnography, Biehl draw on core disagreements with public officials over the interpretation of our findings from a legal database. Analyzing these disagreements provides an entry point into the mechanisms of veridiction and falsification at work in Brazil, whose government sees itself as providing public goods beyond the minimum neoliberal state. Countering state mythology, public ethnography thus illuminates the improvised quality of postneoliberal democratic institutions and opens up new avenues for theorizing power and the political field.
João Biehl published “Theorizing Global Health,” in Medicine Anthropology Theory which reflects on the recent West African Ebola outbreak. This piece advocates for a critical and people-centered approach both to and within global health. Biehl discusses the current state of the field as well as critical theoretical responses to it, arguing that an ethnographic focus on evidence and efficacy at the local level raises rather than lowers the bar for thoughtful inquiry and action. The current moment calls less for the all-knowing hubris of totalizing analytical schemes than for a human science (and politics) of the uncertain and unknown. It is the immanent negotiations of people, institutions, technologies, evidence, social forms, ecosystems, health, efficacy, and ethics – in their temporary stabilization, production, excess, and creation – that animate the unfinishedness of ethnography and critical global health.
Adams, V. (University of California, San Francisco) and João Biehl’s paper, “The Work of Evidence in Critical Global Health,” published in Medicine Anthropology Theory examines the paradigms and values that undergird the ever-expanding field of global health. The richly textured ethnographic think pieces presented here tackle problems of evidence and efficacy as complex forms of ethical and theoretical engagement in contexts of neoliberalism, war, technological innovation, inequality, and structural violence. These works seek to contribute to a people-centered and politically relevant social theory for the twenty-first century.
João Biehl, Amon, J. (Human Rights Watch), Socal, M. (Johns Hopkins University), and Petryna, A. (University of Pennsylvania) published “The Challenging Nature of Gathering Evidence and Analyzing the Judicialization of Health in Brazil,” in Cadernos de Saúde Pública. The authors write to correct two errors described in the article, “Studies Published in Indexed Journals on Lawsuits for Medicines in Brazil: A Systematic Review,” written by Gomes & Amador, published in Cadernos de Saúde Pública.
João Biehl has a forthcoming book titled, Unfinished: The Anthropology of Becoming. This original, field-changing collection explores the plasticity and unfinishedness of human subjects and lifeworlds, advancing the conceptual terrain of an anthropology of becoming. People's becomings trouble and exceed ways of knowing and acting, producing new possibilities for research, methodology, and writing. The contributors creatively bridge ethnography and critical theory in a range of worlds on the edge, from war and its aftermath, economic transformation, racial inequality, and gun violence to religiosity, therapeutic markets, animal rights activism, and abrupt environmental change. Defying totalizing analytical schemes, these visionary essays articulate a human science of the uncertain and unknown and restore a sense of movement and possibility to ethics and political practice.
João Biehl, Socal, M. (Johns Hopkins University), and Amon’s, J. (Human Rights Watch), published “The Judicialization of Health and the Quest for State Accountability: Evidence from 1,262 Lawsuits for Access to Medicines in Southern Brazil,” in Health Human Rights Journal. The impact of increasing numbers of lawsuits for access to medicines in Brazil is hotly debated. Government officials and scholars assert that the “judicialization of health” is driven by urban elites and private interests, and is used primarily to access high-cost drugs. Using a systematic sample of 1,262 lawsuits for access to medicines filed against the southern Brazilian state of Rio Grande do Sul, they assess these claims, offering empirical evidence that counters prevailing myths and affirms the heterogeneity of the judicialization phenomenon. Their findings show that the majority of patient-litigants are in fact poor and older individuals who do not live in major metropolitan areas and who depend on the state to provide their legal representation, and that the majority of medicines requested were already on governmental formularies. Their data challenge arguments that judicialization expands inequities and weakens the universal health care system. Our data also suggest that judicialization may serve as a grassroots instrument for the poor to hold the state accountable. Failing to acknowledge regional differences and attempting to fit all data into one singular narrative may be contributing to a biased interpretation of the nature of judicialization, and limiting the understanding of its drivers, consequences, and implications at local levels.
In “How Can Urban Policies Improve Air Quality and Help Mitigate Global Climate Change: a Systematic Mapping Review,” written by João Biehl, Slovic, A. (University of São Paulo), de Oliveira, M. (University of São Paulo), and Ribeiro, H. (University of São Paulo) and published in Journal of Urban Health, the authors discuss how tackling climate change at the global level is central to a growing field of scientific research on topics such as environmental health, disease burden, and its resulting economic impacts. At the local level, cities constitute an important hub of atmospheric pollution due to the large amount of pollutants that they emit. As the world population shifts to urban centers, cities will increasingly concentrate more exposed populations. Yet, there is still significant progress to be made in understanding the contribution of urban pollutants other than CO2, such as vehicle emissions, to global climate change. It is therefore particularly important to study how local governments are managing urban air pollution. This paper presents an overview of local air pollution control policies and programs that aim to reduce air pollution levels in megacities. It also presents evidence measuring their efficacy. The paper argues that local air pollution policies are not only beneficial for cities but are also important for mitigating and adapting to global climate change. The results systematize several policy approaches used around the world and suggest the need for more in-depth cross-city studies with the potential to highlight best practices both locally and globally. Finally, it calls for the inclusion of a more human rights-based approach as a mean of guaranteeing of clean air for all and reducing factors that exacerbate climate change.
João Biehl, Socal, M. (Johns Hopkins University), and Amon, J. (Human Rights Watch), published “On the Heterogeneity and Politics of the Judicialization of Health in Brazil. Health and Human Rights,” in Health Human Rights. The author write in response to Octavio Luiz Motta Ferraz who raises three concerns:
1. that their use of the term “myth” to describe the popular narrative in Brazil about the “judicialization of health” is inaccurate;
2. that their data has limitations, and particularly that our claim that judicialization “largely serves the disadvantaged” in Rio Grande do Sul is not fully warranted;
3. that their findings “reaffirm” his view of what he calls “the Brazilian model of right to health litigation.”
about their article, “The Judicialization of Health and the Quest for State Accountability,” in which the authors examined a systematic sample of 1,262 lawsuits seeking access to medicines in the southern Brazilian state of Rio Grande do Sul.
Anne Case, Ardington, C. (University of Cape Town, South Africa), Bärnighausen, T. (Harvard University), and Menendez, A. (University of Chicago) published “Social Protection and Labor Market Outcomes of Youth in South Africa,” in ILR (Industrial and Labor Relations) Review Cornell University. They explored an Apartheid-driven spatial mismatch between workers and jobs leads to high job search costs for people living in rural areas of South Africa—costs that many young people cannot pay. In this article, the authors examine whether the arrival of a social grant—specifically a generous state-funded old-age pension given to men and women above prime age—enhances the ability of young men in rural areas to seek better work opportunities elsewhere. Based on eight waves of socioeconomic data on household living arrangements and household members’ characteristics and employment status, collected between 2001 and 2011 at a demographic surveillance site in KwaZulu-Natal, the authors find that young men are significantly more likely to become labor migrants when someone in their household becomes age-eligible for the old-age pension. But this effect applies only to those who have completed high school (matric), who are on average eight percentage points more likely to migrate for work when their households become pension eligible, compared with other potential labor migrants. The authors also find that, upon pension loss, it is the youngest migrants who are the most likely to return to their sending households, perhaps because they are the least likely to be self-sufficient at the time the pension is lost. The evidence is consistent with binding credit constraints limiting young men from poorer households from seeking more lucrative work elsewhere.
In Dalton Conley’s paper entitled, “Live Birth Sex Ratios and Father’s Geographic Origins in Jerusalem, 1964-1976,” co-authored with Groeger, J. (State University of New York (SUNY), Downstate Brooklyn), Opler, M. (New York University), Kleinhaus, K. (New York University), Perrin, M. (New York University), Calderon-Margalit, R. (Hebrew University-Hadassah School of Public Health, Jerusalem) et al, the authors’ objective is to examine whether ancestry influenced sex ratios of offspring in a birth cohort before parental antenatal sex selection influenced offspring sex. They measured the sex ratio as the percent of males according to countries of birth of paternal and maternal grandfathers in 91,459 live births from 1964 to 1976 in the Jerusalem Perinatal Study. Confidence limits (CI) were computed based on an expected sex ratio of 1.05, which is 51.4% male.
Of all live births recorded, 51.4% were male. Relative to Jewish ancestry (51.4% males), significantly more males (1,761) were born to Muslim ancestry (54.5, 95% CI?=?52.1–56.8, P?=?0.01). Among the former, sex ratios were not significantly associated with paternal or maternal age, education, or offspring's birth order. Consistent with a preference for male offspring, the sex ratio decreased despite increasing numbers of births over the 13-year period. Sex ratios were not affected by maternal or paternal origins in North Africa or Europe. However, the offspring whose paternal grandfathers were born in Western Asia included fewer males than expected (50.7, 50.1-51.3, P?=?0.02), whether the father was born abroad (50.7) or in Israel (50.8). This was observed for descendants of paternal grandfathers born in Lebanon (47.6), Turkey (49.9), Yemen & Aden (50.2), Iraq (50.5), Afghanistan (50.5), Syria (50.6), and Cyprus (50.7); but not for those from India (51.5) or Iran (51.9). The West Asian group showed the strongest decline in sex ratios with increasing paternal family size.
They conclude that a decreased sex ratio associated with ancestry in Western Asia is consistent with reduced ability to bear sons by a subset of Jewish men in the Jerusalem cohort. Lower sex ratios may be because of pregnancy stress, which may be higher in this subgroup. Alternatively, a degrading Y chromosome haplogroup or other genetic or epigenetic differences on male germ lines could affect birth ratios, such as differential exposure to an environmental agent, dietary differences, or stress. Differential stopping behaviors that favor additional pregnancies following the birth of a daughter might exacerbate these lower sex ratios.
Dalton Conley and Sotoudeh, R. published “Genotyping the Dead: Using Offspring as Proxy to Estimate the Genetic Correlation of Education and Longevity,” in the Proceedings of the National Academy of Sciences. In the work on the social determinants of health, it has long been recognized that, among the strongest (if not the strongest) predictor of morbidity and mortality, is educational attainment—that is, the number of years of formal schooling. To what extent the relationship between education and longevity is a causal one running from schooling to health has been of intense interest to social scientists. Of course, ill health can truncate a schooling career, but there is also adequate reason to suspect that formal schooling does indeed improve health and well-being through a number of channels ranging from improved impulse control to better ability to understand health risks to improved economic circumstances. The extent to which they can isolate the mechanisms behind this strong relationship will help them design better interventions to promote health and health equity (not to mention, to mitigate the adverse effects of ill health on education and its related outcomes).
Lee, B. (Columbia University) andDalton Conley published “Robust Null Findings on Offspring Sex and Political Orientation,” in Social Forces. In an earlier version of this paper, Lee and Conley deployed the European Social Survey (ESS) and the General Social Survey (GSS) to conduct the largest analysis to date examining the question of whether child sex affects parent political orientation. They found null effects in contrast to earlier, smaller studies. In the current issue, Hopcroft (2016) argues that their null findings may have been obtained due to sample restrictions and measurement error arising from the fact that they used the sex of the first child “residing” in home rather than the sex of the first “biological” child.
They believe that in their comment, Hopcroft largely restates the limitations already discussed in their original manuscript, adding only details of the GSS and ESS codebook for the readers. More importantly, she has confused identification issues (e.g., measurement error) with inference issues (e.g., sample restrictions) that the authors discussed in detail in three pages (Lee and Conley 2016, 1112–14). The goal of their systematic sample selection was to reduce the potential attenuation bias arising from measurement error. Further, by ignoring the period/country variations they showed, this critic missed one of the main points of our paper—they asked why they might observe contradictory findings in the U.K. and the United States in the first place. They concluded that such results are more likely due to publication bias (or possibly period heterogeneity) rather than to treatment effect heterogeneities or country differences. Nevertheless, they are open to the possibility that they made mistakes in their original paper. In the present response, they have decided to play devil’s advocate by taking the opportunity to revisit their case.
There seems to be a straightforward way to measure the sex of the first child; one can ask respondents about the sex/age and biological status of all children they have ever had and infer the sex of the first child from the resulting roster.
In “Assortative Mating and Differential Fertility by Phenotype and Genotype Across the 20th Century,” published in the Proceedings of the National Academy of Sciences, Dalton Conley, Laidley, T. (New York University), Belsky, D. (Duke University), Fletcher, J. (University of Wisconsin, Madison), Boardman, J. (University of Colorado), and Domingue, B. (Stanford University), describe dynamics in assortative mating and fertility patterns by polygenic scores associated with anthropometric traits, depression, and educational attainment across birth cohorts from 1920 to 1955. They find that, for example, increases in assortative mating at the phenotypic level for education are not matched at the genotypic level. They also show that genes related to height are positively associated with fertility and that, despite a widening gap between the more and less educated with respect to fertility, there is no evidence that this trend is associated with genes. These findings are important to their understanding of the roots of shifting distributions of health and behavior across generations in U.S. society.
This study asks two related questions about the shifting landscape of marriage and reproduction in U.S. society over the course of the last century with respect to a range of health and behavioral phenotypes and their associated genetic architecture: (i) Has assortment on measured genetic factors influencing reproductive and social fitness traits changed over the course of the 20th century? (ii) Has the genetic covariance between fitness (as measured by total fertility) and other traits changed over time? The answers to these questions inform our understanding of how the genetic landscape of American society has changed over the past century and have implications for population trends. They show that husbands and wives carry similar loadings for genetic factors related to education and height. However, the magnitude of this similarity is modest and has been fairly consistent over the course of the 20th century. This consistency is particularly notable in the case of education, for which phenotypic similarity among spouses has increased in recent years. Likewise, changing patterns of the number of children ever born by phenotype are not matched by shifts in genotype–fertility relationships over time. Taken together, these trends provide no evidence that social sorting is becoming increasingly genetic in nature or that dysgenic dynamics have accelerated.
Dalton Conley, Laidley, T. (New York University), Boardman, J. (University of Colorado), and Domingue, B. (Stanford University) published “Changing Polygenic Penetrance on Phenotypes in the 20th Century Among Adults in the U.S. Population,” in Scientific Reports. This study evaluates changes in genetic penetrance—defined as the association between an additive polygenic score and its associated phenotype—across birth cohorts. Situating their analysis within recent historical trends in the U.S., they show that, while height and BMI show increasing genotypic penetrance over the course of 20th Century, education and heart disease show declining genotypic effects. Meanwhile, they find genotypic penetrance to be historically stable with respect to depression. Their findings help inform their understanding of how the genetic and environmental landscape of American society has changed over the past century, and have implications for research which models gene-environment (GxE) interactions, as well as polygenic score calculations in consortia studies that include multiple birth cohorts.
Schmitz, L. (University of Michigan) and Dalton Conley published “The Long-Term Consequences of Vietnam-Era Conscription and Genotype on Smoking Behavior and Health,” in Behavior Genetics. Research is needed to understand the extent to which environmental factors moderate links between genetic risk and the development of smoking behaviors. The Vietnam-era draft lottery offers a unique opportunity to investigate whether genetic susceptibility to smoking is influenced by risky environments in young adulthood. Access to free or reduced-price cigarettes coupled with the stress of military life meant conscripts were exposed to a large, exogenous shock to smoking behavior at a young age. Using data from the Health and Retirement Study (HRS), they interact a genetic risk score for smoking initiation with instrumented veteran status in an instrumental variables (IV) framework to test for genetic moderation (i.e. heterogeneous treatment effects) of veteran status on smoking behavior and smoking-related morbidities. They find evidence that veterans with a high genetic predisposition for smoking were more likely to have been smokers, smoke heavily, and are at a higher risk of being diagnosed with cancer or hypertension at older ages. Smoking behavior was significantly attenuated for high-risk veterans who attended college after the war, indicating post-service schooling gains from veterans’ use of the GI Bill may have reduced tobacco consumption in adulthood.
Dalton Conley, Okbay, A. (Vrije Universiteit Amsterdam), Baselmans, B., De Neve, J.-E. (University of Oxford), Turley, P. (Massachusetts General Hospital), and Nivard, M. (Vrije Universiteit Amsterdam) et al. published “Genetic Associations with Subjective Well-Being Also Implicate Depression and Neuroticism,” in Nature Genetics. The authors conducted a genome-wide association study on subjective wellbeing (SWB; N = 298,420), depressive symptoms (DS; N = 161,460), and neuroticism (N = 170,910). They identified three variants associated with SWB, two with DS, and eleven with neuroticism, including two inversion polymorphisms. The two DS loci replicate in an independent depression sample. Joint analyses that exploit the high genetic correlations between the phenotypes strengthen the overall credibility of the findings, and allow them to identify additional variants. Across our phenotypes, loci regulating expression in central nervous system and adrenal/pancreas tissues are strongly enriched for association. The discovery of genetic loci associated with the three phenotypes they study has proven elusive; their findings illustrate the payoffs from studying them jointly.
In “Mortality Inequality: The Good News from a County-Level Approach,” published in the Journal of Economic Perspectives, Janet Currie and Schwandt, H. (Johns Hopkins University), find that life expectancy for the U.S. population has shown a strong increase since 1990. The rise in life expectancy at birth holds for both men and women. This development has not been driven solely by improvements in life expectancy at older ages. Mortality rates for those under one year of age, for the age group 1–4, and for every five-year age group above that level, declined for both males and females between 1990 and 2010. Particularly pronounced improvements in mortality occurred at younger ages, which tend to be age groups in which deaths occur predominantly among the poor. However, this overall decline in mortality rates has been accompanied by prominent recent studies highlighting that the gains have not been distributed. Indeed, several studies argue that when measured across educational groups and/or geographic areas, mortality gaps are not only widening, but that for some U.S. groups, overall life expectancy is even falling. It seems to have become widely accepted that inequality in life expectancy is increasing. Given that the number of years that one can expect to live, is such an important indicator of welfare, this finding has been heralded as yet another dimension in which overall societal inequality is increasing.
Janet Currie and Schwandt, H. published “Inequality in Mortality Decreased Among the Young While Increasing for Older Adults, 1990–2010,” in the American Association for the Advancement of Science. Looking at the many recent studies that point to increasing inequality in mortality in the United States over the past 20 years. These studies often use mortality rates in middle and old age. They used poverty level rankings of groups of U.S. counties as a basis for analyzing inequality in mortality for all age groups in 1990, 2000, and 2010. Consistent with previous studies, they found increasing inequality in mortality at older ages. For children and young adults below age 20, however, they found strong mortality improvements that were most pronounced in poorer counties, implying a strong decrease in mortality inequality. These younger cohorts will form the future adult U.S. population, so this research suggests that inequality in old-age mortality is likely to decline.
In the Journal of Health Economics, Janet Currie, MacLeod, W. (Columbia University), and Van, J. (City University of New York (CUNY), Hunter College) published “Provider Practice Style and Patient Health Outcomes: The Case of Heart Attacks.” When a patient arrives at the emergency room with acute myocardial infarction (AMI), the provider on duty must quickly decide how aggressively the patient should be treated. Using Florida data on all such patients from 1992 to 2014, they decompose practice style into two components: The provider's probability of conducting invasive procedures on the average patient (characterize as aggressiveness), and the responsiveness of the choice of procedure to the patient's characteristics. The authors show that within hospitals and years, patients with more aggressive providers have consistently higher costs and better outcomes. Since all patients benefit from higher utilization of invasive procedures, targeting procedure use to the most appropriate patients benefits these patients at the expense of the less appropriate patients. They also found that the most aggressive and responsive physicians are young, male, and trained in top 20 schools.
Margaret Frye’s third research project examines the relationship between perceived attractiveness and AIDS in Malawi. Using ethnographic data, Frye shows that attractive women are locally perceived to be more likely to be infected, and beautiful women are even blamed for the epidemic. Yet survey data shows that women who are perceived as less attractive are more likely to be infected. This work is a collaboration with Nina Gheihman, a Ph.D. student at Harvard, and Sophia Chae, a research scientist at Population Council.
Noreen Goldman, Glei, D. (Georgetown University), Risques, R. (University of Washington, Seattle), Rehkopf, D. (Stanford University), Dow, W. (University of California, Berkeley), Rosero-Bixby, L. (Centro Centroamericano de Población), and Weinstein, M. (Georgetown University) published “Predicting Survival from Telomere Length versus Conventional Predictors: A Multinational Population-Based Cohort Study,” in PLoS One. They state that telomere length has generated substantial interest as a potential predictor of aging-related diseases and mortality. Some studies have reported significant associations, but few have tested its ability to discriminate between decedents and survivors compared with a broad range of well-established predictors that include both biomarkers and commonly collected self-reported data. Their aim here was to quantify the prognostic value of leukocyte telomere length relative to age, sex, and 19 other variables for predicting five-year mortality among older persons in three countries. They used data from nationally representative surveys in Costa Rica (N = 923, aged 61+), Taiwan (N = 976, aged 54+), and the U.S. (N = 2672, aged 60+). The study used a prospective cohort design with all-cause mortality during five years post-exam as the outcome. They fit Cox hazards models separately by country, and assessed the discriminatory ability of each predictor. Age was, by far, the single best predictor of all-cause mortality, whereas leukocyte telomere length was only somewhat better than random chance in terms of discriminating between decedents and survivors. After adjustment for age and sex, telomere length ranked between 15th and 17th (out of 20), and its incremental contribution was small; nine self-reported variables (e.g., mobility, global self-assessed health status, limitations with activities of daily living, smoking status), a cognitive assessment, and three biological markers (C-reactive protein, serum creatinine, and glycosylated hemoglobin) were more powerful predictors of mortality in all three countries. Results were similar for cause-specific models (i.e., mortality from cardiovascular disease, cancer, and all other causes combined). Leukocyte telomere length had a statistically discernible, but weak, association with mortality, but it did not predict survival as well as age or many other self-reported variables. Although telomere length may eventually help scientists understand aging, more powerful and more easily obtained tools are available for predicting survival.
In Noreen Goldman’s article, “Will the Latino Mortality Advantage Endure?” published in Research on Aging, she writes that persons of Mexican origin and some other Latino groups in the United States have experienced a survival advantage compared with their non-Latino White counterparts, a pattern known as the Latino, Hispanic, or epidemiological paradox. However, high rates of obesity and diabetes among Latinos relative to Whites and continued increases in the prevalence of these conditions suggest that this advantage may soon disappear. Other phenomena, including high rates of disability in the older Latino population compared with Whites, new evidence of health declines shortly after migration to the United States, increasing environmental stressors for immigrants, and high-risk values of inflammatory markers among Latinos compared with Whites support this prediction. One powerful counterargument, however, is substantially lower smoking-attributable mortality among Latinos. Still, it is questionable as to whether smoking behavior can counteract the many forces at play that may impede Latinos from experiencing future improvements in longevity on a par with Whites.
Noreen Goldman, Cornman, J. (Jennifer C. Cornman Consulting), Glei, D. (Georgetown University), and Weinstein, M. (Georgetown University) published “Physiological Dysregulation, Frailty, and Risk of Mortality Among Older Adults,” in Research on Aging. This study examines whether frailty is associated with mortality independently of physiological dysregulation (PD) and, if so, which is the more accurate predictor of survival. Data come from the Social Environment and Biomarkers of Aging Study. They use Cox proportional hazard models to test the associations between PD, frailty, and 4- to 5-year survival. The authors use Harrell’s concordance index to compare predictive accuracy of the models. Both PD and frailty are significantly, positively, and independently correlated with mortality: Worse PD scores and being frail are associated with a higher risk of dying. The overall PD score is a more accurate predictor of survival than frailty, although model prediction improves when both measures are included. PD and frailty independently predict mortality, suggesting that the two measures may be capturing different aspects of the same construct and that both may be important for identifying individuals at risk for adverse health outcomes.
Sara McLanahan, Donnelly, L., Brooks-Gunn, J. Garfinkel, I. (Columbia University), Wagner, B. (Princeton University; Texas Tech University), and Jacobsen, W. (Pennsylvania State University) et al. used data from the Fragile Families and Child Wellbeing Study to examine whether neighborhood collective efficacy (a combination of social cohesion and control) was associated with improvements in adolescent mental health. They found that children who grew up in neighborhoods with high collective efficacy experienced fewer depressive and anxiety symptoms during adolescence than similar children from neighborhoods with low collective efficacy. Findings did not vary by family or neighborhood income, which indicates that neighborhood collective efficacy supports adolescent mental health across diverse populations and urban settings.