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Purpose: The aim was to examine differences in health care access at the intersections of urbanicity and sexual identity in California. Methods: We used the 2014-2017 Adult California Health Interview Survey paired with the sexual orientation special use research file to create dummy groups representing each dimension of urbanicity and sexual identity to compare access to health care outcomes. We calculated unadjusted proportions and estimated adjusted odds ratios of each dimension relative to urban heterosexual people using logistic regressions. Results: Relative to urban heterosexual people, urban gay/lesbian people had 1.651 odds of using the emergency room (ER). Urban bisexual people had 1.429 odds of being uninsured, 1.575 odds of delaying prescriptions, and 1.907 odds of using the ER. Rural bisexual people experienced similar access barriers having 1.904 odds of uninsurance and 2.571 odds of using the ER. Conclusions: Our study findings demonstrated disparate access to health care across sexual orientation and rurality. The findings are consistent with literature that suggests urban and rural sexual minority people experience health care differently and demonstrate that bisexual people experience health care differently than gay/lesbian people. These findings warrant further study to examine how social identities, such as race/ethnicity, interact with sexual orientation to determine health care access. Furthermore, these findings demonstrate the need to emphasize the health care access needs of sexual minority people in both rural and urban areas to eliminate health care access disparities.

Programs that provide affordable and stable housing may contribute to better child health and thus to fewer missed days of school. Drawing on a unique linkage of survey and administrative data, we use a quasi-experimental approach to examine the impact of rental assistance programs on missed days of school due to illness. We compare missed school days due to illness among children receiving rental assistance with those who will enter assistance within two years of their interview, the average length of waitlists for federal rental assistance. Overall, we find that children who receive rental assistance miss fewer days of school due to illness relative to those in the pseudo-waitlist group. We demonstrate that rental assistance leads to a reduction in the number of health problems among children and thus to fewer days of school missed due to illness. We find that the effect of rental assistance on missed school days is stronger for adolescents than for younger children. Additionally, race-stratified analyses reveal that rental assistance leads to fewer missed days due to illness among non-Hispanic White and Hispanic/Latino children; this effect, however, is not evident for non-Hispanic Black children, the largest racial/ethnic group receiving assistance. These findings suggest that underinvestment in affordable housing may impede socioeconomic mobility among disadvantaged non-Hispanic White and Hispanic/Latino children. In contrast, increases in rental assistance may widen racial/ethnic disparities in health among disadvantaged children, and future research should examine why this benefit is not evident for Black children.

Geographic disparities in adult mortality within the US have grown over the past several decades, but the reasons for these trends remain unclear. In this article, we examine trends in adult mortality (ages 55+) across US states from 1977 to 2017, paying close attention to the shifting geographic pattern of high- and low-mortality states. We find that states in the South tended to fall behind the rest of the country in the 1970s and 1980s, while states in the Great Plains and Mountain West tended to fall behind in the 1990s, 2000s, and 2010s. In contrast, states on the East and West Coasts have tended to see considerable improvement in mortality. We consider the role of state-level per-capita spending on public welfare programs in the mortality experience of states between 1977 and 2017. We use fixed effects models to show that greater state welfare generosity predicts greater yearly reductions in mortality. State shifts toward more generous welfare spending regimes may contribute to significant geographic divergences in adult mortality in the United States.

The past several decades have witnessed growing geographic disparities in life expectancy within the United States, yet the mortality experience of U.S. cities has received little attention. We examine changes in men’s life expectancy at birth for the 25 largest U.S. cities from 1990 to 2015, using mortality data with city of residence identifiers. We reveal remarkable increases in life expectancy for several U.S. cities. Men’s life expectancy increased by 13.7 years in San Francisco and Washington, DC, and by 11.8 years in New York between 1990 and 2015, during which overall U.S. life expectancy increased by just 4.8 years. A significant fraction of gains in the top-performing cities relative to the U.S. average is explained by reductions in HIV/AIDS and homicide during the 1990s and 2000s. Although black men tended to see larger life expectancy gains than white men in most cities, changes in socioeconomic and racial population composition also contributed to these trends.

Mexican immigrants enjoy a substantial mortality advantage over non-Hispanic whites in the US, although their health declines with greater duration of residence. Many previous studies have suggested this advantage reflects higher levels of social support among Mexicans in enclave communities with high co-ethnic density. As the Mexican-origin population in the US has grown, it has expanded outside traditional gateway cities in California and Texas to new destinations throughout the US, and it has become increasingly important to understand how settlement in new destinations impacts the health of Mexican immigrants. This study examines the mortality outcomes of Mexican immigrants in Traditional Gateways versus New and Minor Destinations in the US. Using a nationally-representative survey with mortality follow-up the analysis finds that Mexican immigrants in new and minor destinations have a significant survival advantage over their counterparts in traditional gateways. This advantage largely reflects the mortality benefits of living in communities with smaller and less-established Mexicans immigrant communities, a finding that runs in contrast to prior work on the protective effects of immigrant enclaves. The results suggest that future research must reevaluate the relationship between neighborhood ethnic composition, social support, and immigrant health.

Introduction Reducing racial/ethnic disparities in preterm birth is a priority for U.S. public health programs. The study objective was to quantify the relative contribution of geographic, sociodemographic, and health determinants to the black, non-Hispanic and white, non-Hispanic preterm birth disparity. Methods Cross-sectional 2016 U.S. birth certificate data (analyzed in 2018–2019) were used. Black–white differences in covariate distributions and preterm birth and very preterm birth rates were examined. Decomposition methods for nonlinear outcomes based on logistic regression were used to quantify the extent to which black–white differences in covariates contributed to preterm birth and very preterm birth disparities. Results Covariate differences between black and white women were found within each category of geographic, sociodemographic, and health characteristics. However, not all covariates contributed substantially to the disparity. Close to 38% of the preterm birth and 31% of the very preterm birth disparity could be explained by black–white covariate differences. The largest contributors to the disparity included maternal education (preterm birth, 11.3%; very preterm birth, 9.0%), marital status/paternity acknowledgment (preterm birth, 13.8%; very preterm birth, 14.7%), source of payment for delivery (preterm birth, 6.2%; very preterm birth, 3.2%), and hypertension in pregnancy (preterm birth, 9.9%; very preterm birth, 8.3%). Interpregnancy interval contributed a more sizable contribution to the disparity (preterm birth, 6.2%, very preterm birth, 6.0%) in sensitivity analyses restricted to all nonfirstborn births. Conclusions These findings demonstrate that the known portion of the disparity in preterm birth is driven by sociodemographic and preconception/prenatal health factors. Public health programs to enhance social support and preconception care, specifically focused on hypertension, may provide an efficient approach for reducing the racial gap in preterm birth.

We examine trends in the Hispanic longevity advantage between 1990 and 2010, focusing on the contribution of cigarette smoking. We calculate life expectancy at age 50 for Hispanics and non-Hispanic whites between 1990 and 2010. We use an indirect method to calculate the contribution of smoking to changes over time in life expectancy. Among women, the Hispanic advantage in life expectancy grows from 2.14 years in 1990 (95 % CI 1.99–2.30 years) to 3.53 years in 2010 (3.42–3.64 years). More than 40 % of this increase reflects widening differences in smoking-attributable mortality. The advantage for Hispanic men increases from 2.27 years (2.14–2.41 years) to 2.91 years (2.81–3.01 years), although smoking makes only a small contribution. Despite persistent disadvantage, US Hispanics have increased their longevity advantage over non-Hispanic whites since 1990, much of which reflects the continuing importance of cigarette smoking to the Hispanic advantage.

Objectives. Becoming widowed is a known risk factor for mortality. This article examines the magnitude of, explanations for, and variation in the association between widowhood and mortality. Previous research on widowhood mortality has revealed variation by socioeconomic status (SES), in that SES is not protective in widowhood, and by gender, such that men’s mortality increases more than women’s mortality after the death of spouse. Method. Using data from the Health and Retirement Study, we estimated Cox proportional hazard models to estimate the association between widowhood and mortality. Results. Becoming widowed is associated with a 48% increase in risk of mortality. Approximately one third of the increase can be attributed to selection, in that those who become widows are socioeconomically disadvantaged. In contrast to previous studies, SES is protective for widows. Widowhood mortality risk increases for men if their wives’ deaths were unexpected rather than expected; for women, the extent to which their husbands’ death was expected matters less. Discussion. Widowhood’s harmful association with mortality show how strongly social support and individual’s health and mortality are related. These findings support the larger literature on the importance of social support for health and longevity.

BACKGROUNDThe rate of mortality increase with age among adults is typically used as a measure of the rate of functional decline associated with aging or senescence. While black and white populations differ in the level of mortality, mortality also rises less rapidly with age for blacks than for whites, leading to the well-known black/white mortality "crossover".OBJECTIVEThis paper investigates black/white differences in the rate of mortality increase with age for major causes of death in order to examine the factors responsible for the black/white crossover.METHODSThe analysis considers two explanations for the crossover: selective survival and age misreporting. Mortality is modeled using a Gompertz model for 11 causes of death from ages 50-84 among blacks and whites by sex.RESULTSMortality increases more rapidly with age for whites than for blacks for nearly all causes of death considered. The all-cause mortality rate of mortality increase is nearly two percentage points higher for whites. The analysis finds evidence for both selective survival and age misreporting, although age misreporting is a more prominent explanation among women.CONCLUSIONSThe black/white mortality crossover reflects large differences in the rate of age-related mortality increase. Instead of reflecting the impact of specific causes of death, this pattern exists across many disparate disease conditions, indicating the need for a broad explanation.(ProQuest: ... denotes formulae omitted.)1. IntroductionHuman mortality rates begin to increase with advancing age starting around age 20 in most populations. Especially at older ages, age-related increases in the observed mortality rate are thought to reflect functional decline and processes associated with physiological aging. Gompertz (1825) originally noted that adult mortality increases exponentially as a function of age with remarkable consistency. That is, age-specific death rates increase at a nearly constant exponential rate for each year of age. Gompertz' model has enjoyed success as the most heavily used model of adult mortality, and remains a quintessential tool for demographers and gerontologists. Among the many attractive characteristics of the Gompertz model is an estimate of the percentage increase in mortality for each additional year of age, the Rate of Mortality Increase (RMI). Although this measure is assumed to be a species-typical indicator of physiological aging, human population subgroups exhibit significant differences in the rate of mortality increase (Horiuchi et al. 2003). Group differences in the rate of age- related mortality increase may reflect differences in accumulated risk over the life course or in the timing of the onset of specific diseases (Carey and Liedo 1995; Horiuchi and Wilmoth 1997; Luder 1993). In examining life course trajectories of mortality, comparing group differences in the rate of increase with age can supplement our understanding of differences in the level of mortality. One important comparison is blacks and whites in the United States. Although the vast majority of research on this topic focuses on black/white differences in the level of mortality, blacks and whites also differ in the slope of age-related increase (Elo and Drevenstedt 2004; Geronimus et al. 1996; Hayward et al. 2000). This leads to categorically distinct trajectories of mortality in the adult age range.Mortality profiles for the black and white populations in the United States differ considerably; blacks and whites experiences differences in the level and age-pattern of mortality and in the relative contribution of specific diseases. Studies examining the black mortality disadvantage throughout the life course also find that mortality increases more rapidly with age for whites than for blacks. Death rates for the two populations converge at older ages and mortality for whites begins to exceed that of blacks at the oldest ages (Manton et al. …

More than three decades of health disparities research in the United States has consistently found lower adult mortality risks among Hispanics than their non-Hispanic white counterparts, despite lower socioeconomic status among Hispanics. Explanations for the “Hispanic Paradox” include selective migration and cultural factors, though neither has received convincing support. This paper uses a large nationally representative survey of health and smoking behavior to examine whether smoking can explain life expectancy advantage of Hispanics over US-born non-Hispanics whites, with special attention to individuals of Mexican origin. It tests the selective migration hypothesis using data on smoking among Mexico-to-US migrants in Mexico and the United States. Both US-born and foreign-born Mexican-Americans exhibit a life expectancy advantage vis-à-vis whites. All other Hispanics only show a longevity advantage among the foreign-born, while those born in the United States are disadvantaged relative to whites. Smoking-attributable mortality explains the majority of the advantage for Mexican-Americans, with more than 60% of the gap deriving from lower rates of smoking among Mexican-Americans. There is no evidence of selective migration with respect to smoking; Mexicans who migrate to the US smoke at similar rates to Mexicans who remain in Mexico, with both groups smoking substantially less than non-Hispanic whites in the US. The results suggest that more research is needed to effectively explain the low burden of smoking among Mexican-Americans in the United States.

Although those identifying as “Hispanic or Latino” experience lower adult mortality than the more socioeconomically advantaged non-Hispanic white population, the ethnic category Hispanic conceals variation by country of origin, nativity, age, and immigration experience. The current analysis examines adult mortality differentials among 12 Hispanic subgroups by region of origin and nativity, and non-Hispanic whites, adjusting for socioeconomic and demographic characteristics. We use the National Health Interview Survey Linked Mortality Files pooled 1990–2009 to obtain sufficient sample of each subgroup to calculate mortality estimates by sex and age group (25–64, 65+). Among adults aged 65 and over, all foreign born subgroups have an advantage over non-Hispanic whites, and many USB subgroups exhibit an advantage in the adjusted model. Foreign-born Dominicans, Central/South Americans, and other Hispanics exhibit consistent advantages across models for both men and women, aged 25–64 and 65 and over, and both unadjusted and adjusted for socioeconomic covariates. Both US-born and foreign-born Mexicans between ages 25 and 64 have mortality disadvantaged relative to non-Hispanic whites, while older Mexicans exhibit clear advantages. Our results complicate the traditional formulation of the Hispanic Paradox and cast doubt on the singularity of the mortality experience of those of Hispanic origin.

The United States experiences lower life expectancy at birth than many other high-income countries. Although research has focused on mortality of the population older than 50 years, much of this life expectancy gap reflects mortality at younger ages,1 when mortality is dominated by injury deaths, and many decades of expected life are lost. This study estimated the contribution of 3 causes of injury death to the gap in life expectancy at birth between the United States and 12 comparable countries in 2012. We focused on motor vehicle traffic (MVT) crashes, firearm-related injuries, and drug poisonings, the 3 largest causes of US injury death responsible for more than 100000 deaths per year.2

Advanced maternal age is associated with negative offspring health outcomes. This interpretation often relies on physiological processes related to aging, such as decreasing oocyte quality. We use a large, population-based sample of American adults to analyze how selection and lifespan overlap between generations influence the maternal age–offspring adult health association. We find that offspring born to mothers younger than age 25 or older than 35 have worse outcomes with respect to mortality, self-rated health, height, obesity, and the number of diagnosed conditions than those born to mothers aged 25–34. Controls for maternal education and age at which the child lost the mother eliminate the effect for advanced maternal age up to age 45. The association between young maternal age and negative offspring outcomes is robust to these controls. Our findings suggest that the advanced maternal age–offspring adult health association reflects selection and factors related to lifespan overlap. These may include shared frailty or parental investment but are not directly related to the physiological health of the mother during conception, fetal development, or birth. The results for young maternal age add to the evidence suggesting that children born to young mothers might be better off if the parents waited a few years.

Background In many developed countries, immigrants live longer—that is, have lower death rates at most or all ages—than native-born residents. This article tests whether different levels of smoking-related mortality can explain part of the ‘healthy immigrant effect’ in the USA, as well as part of the related ‘Hispanic paradox’: the tendency for US Hispanics to outlive non-Hispanic Whites. Methods With data from vital statistics and the national census, we calculate lung cancer death rates in 2000 for four US subpopulations: foreign-born, native-born, Hispanic and non-Hispanic White. We then use three different methods—the Peto–Lopez method, the Preston–Glei–Wilmoth method and a novel method developed in this article—to generate three alternative estimates of smoking-related mortality for each of the four subpopulations, extrapolating from lung cancer death rates. We then measure the contribution of smoking-related mortality to disparities in all-cause mortality. Results Taking estimates from any of the three methods, we find that smoking explains >50% of the difference in life expectancy at 50 years between foreign- and native-born men, and >70% of the difference between foreign- and native-born women; smoking explains >75% of the difference in life expectancy at 50 years between US Hispanic and non-Hispanic White men, and close to 75% of the Hispanic advantage among women. Conclusions Low smoking-related mortality was the main reason for immigrants’ and Hispanics’ longevity advantage in the USA in 2000.

Life expectancy at birth in the United States (both sexes combined) rose from 70 years in 1965 to nearly 78 years in 2007. While this is a new milestone for low mortality among Americans, the United States lags significantly behind countries in Western Europe. Especially after age 50, mortality in the US remains substantially higher than in countries with similar levels of economic development, an unfavorable trend that has emerged in the past few decades (Crimmins, Preston, and Cohen 2010).1 Despite spending more per capita on health care than any other peer country, the health performance of the United States is comparatively poor, especially among older adults aged 50 to 80 (Ho and Preston 2010). A recent National Academy of Sciences panel was charged with identifying why US adult mortality is so high relative to its peers (Crimmins, Preston, and Cohen 2010). Although a number of causes were identified, the relatively poor health status of the United States remains a problem that American health policy has not sufficiently addressed. Levels of health and mortality are far from homogeneous across subpopulations in the United States. The experience of the country as a whole does not necessarily reflect the experience of individual subgroups. Health and mortality vary in a number of dimensions including race/ethnicity, socioeconomic status, sex, and geography. Geographic inequalities in adult mortality in the US appear to be greater on average than in Western Europe (Wilmoth, Boe, and Barbieri 2010). Along with varying mortality levels, regions within the US also have vastly different experiences in terms of environmental exposures, disease control, medical treatment and care, and behavioral risk (Geronimus et al. 1996; Hayward, Pienta, and McLaughlin 1997). Since the mid-twentieth century, the sections of the US with particularly high mortality have become increasingly concentrated in space and clustered in the South. The standard South US census region includes all states south of the Mason–Dixon line and westward to Texas and Oklahoma. The most disadvantaged region of the South is the so-called Central South, containing Alabama, Kentucky, Mississippi, and Tennessee. This region is distinctive for experiencing a large health and mortality disadvantage as well as relatively high poverty (Fenelon and Preston 2012). The southern disadvantage in resources is a more longstanding pattern; southern states that are more highly dependent on agriculture have been slower to rebound from economic recessions (Slesnick 1993; Tickamyer and Duncan 1990). As a result, poverty and rural isolation have historically had more profound effects on social and economic opportunities in the South among both whites and blacks (Friedman and Lichter 1998). Although regional differences in poverty have narrowed, some of the enduring disadvantages of southern states may reflect the institutionalization of black inequality (Karnig and McClain 1985). In contrast to economic inequality, the southern disadvantage related to health and mortality is a more recent occurrence. The current southern mortality disadvantage reflects diverging trends between the southern states and states in the Northeast, West, and Midwest over the second half of the twentieth century (Ezzati et al. 2008). In the early to mid-2000s, adult mortality rates in many southern states were 30–40 percent higher than top performers in other regions, particularly the Pacific Coast, Upper Midwest, and New England. This excess mortality translates into 3–4 fewer expected years of life at age 50 for the states that are worst off.2 This article seeks to explain the considerable geographic realignment in adult mortality that occurred in the US since 1965. Identifying the specific consequences of residing in a particular region for a person’s health and life expectancy is analytically difficult. Instead, the analysis examines the aggregate divergence in mortality between the southern states and states with more favorable mortality experience. The article also highlights the contribution of cigarette smoking to the increasing disadvantage of the southern states. Using US vital statistics between 1965 and 2004, the article compares observed mortality trends across states to trends in a counterfactual scenario in which the impact of smoking is removed. If smoking is an important contributor, the latter scenario should reveal substantially less divergence in mortality.

Tobacco use is the largest single cause of premature death in the developed world. Two methods of estimating the number of deaths attributable to smoking use mortality from lung cancer as an indicator of the damage from smoking. We reestimate the coefficients of one of these, the Preston/Glei/Wilmoth model, using recent data from U.S. states. We calculate smoking-attributable fractions for the 50 states and the United States as a whole in 2004, and estimate the contribution of smoking to the high adult mortality of the southern states. We estimate that 21% of deaths among men and 17% among women were attributable to smoking in 2004. Across states, attributable fractions range from 11% to 30% among men and from 7% to 23% among women. Smoking-related mortality also explains as much as 60% of the mortality disadvantage of southern states compared with other regions. At the national level, our estimates are in close agreement with those of the Centers for Disease Control and Prevention and Preston/Glei/Wilmoth, particularly for men, although we find greater variability by state than does CDC. We suggest that our coefficients are suitable for calculating smoking-attributable mortality in contexts with relatively mature epidemics of cigarette smoking.