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Background: Atrial fibrillation is responsible for over 400,000 hospitalizations in the United States (US) each year. This costs the US health system over 4 billion each year. New smartwatches can constantly monitor pulse, oxygen saturation, and even heart rhythm. The FDA has provided clearance for select smartwatches to detect arrhythmias, including atrial fibrillation. Findings: These devices are not currently widely implemented as diagnostic tools. In this review, we delve into the mechanism of how smartwatches work as healthcare tools and how they capture health data. Additionally, we analyze the reliability of the data collected by smartwatches and the accuracy of their sensors in monitoring health parameters. Moreover, we explore the accessibility of smartwatches as healthcare tools and their potential to promote selfcare among individuals. Finally, we assess the outcomes of using smartwatches in healthcare, including the limited studies on the clinical effects and barriers to uptake by the community. Conclusion: Although smartwatches are accurate for the detection of atrial fibrillation, they still face many hurdles, including access to aging populations and trust in the medical community. [ABSTRACT FROM AUTHOR]

Between 2002 and 2017, concentrations of fine particulate matter (PM2.5) decreased 37% in the United States. Environmental economic theory generally assumes that environmental improvement is associated with a decrease in the marginal damage of emissions. In this case, the marginal damages of PM2.5 precursor emissions (NH3, NOX, primary PM2.5, and SO2) increased substantially. I calculate the change in the marginal damages of emissions between 2002 and 2017, finding increases, on average, of 30% for NH3, 46% for NOX, 61% for primary PM2.5, and 36% for SO2. The increase in marginal damages is especially large in the southeastern United States, with values more than double over this time period. The key factors that influence this change in marginal damages are the shape of the concentration-response (C-R) function that was adopted for these calculations between PM2.5 exposure and mortality (positive effect), the increase in the real value of a statistical life (positive effect), the increased population (positive effect), the aging of the population (positive effect), the decreased age-specific mortality rates (negative effect), and the geographic distribution of emissions (mixed effect). Between 32 and 65% of the increase in marginal damages is attributable to the shape of the C-R function and the decreased concentration of PM2.5. The C-R function adopted here indicates that the marginal effect of concentration reductions is higher at lower concentrations. Thus, at the lower PM2.5 concentrations resulting from improvements over 15 years, there would be a larger reduction in mortality from each additional unit of pollution reduction. [ABSTRACT FROM AUTHOR]

The warnings of potential climate migration first appeared in the scientific literature in the late 1970s when increased recognition that disintegrating ice sheets could drive people to migrate from coastal cities. Since that time, scientists have modeled potential climate migration without integrating other population processes, potentially obscuring the demographic amplification of this migration. Climate migration could amplify demographic change--enhancing migration to destinations and suppressing migration to origins. Additionally, older populations are the least likely to migrate, and climate migration could accelerate population aging in origin areas. Here, we investigate climate migration under sea-level rise (SLR), a single climatic hazard, and examine both the potential demographic amplification effect and population aging by combining matrix population models, flood hazard models, and a migration model built on 40 y of environmental migration in the United States to project the US population distribution of US counties. We find that the demographic amplification of SLR for all feasible Representative Concentration Pathway-Shared Socioeconomic Pathway (RCP-SSP) scenarios in 2100 ranges between 8.6-28 M [5.7-53 M]--5.3 and 18 times the number of migrants (0.4-10 M). We also project significant aging of coastal areas as youthful populations migrate but older populations remain, accelerating population aging in origin areas. As the percentage of the population lost due to climate migration increases, the median age also increases--up to 10+ y older in some highly impacted coastal counties. Additionally, our population projection approach can be easily adapted to investigate additional or multiple climate hazards. [ABSTRACT FROM AUTHOR]

The aging demographic presents a significant challenge and opportunity for health care systems worldwide.1 The number of people in the United States 65 years and older is projected to reach approximately 95 million by 2060.2 Current health care models often operate in silos, lacking continuity and integration.3 This is particularly problematic for the growing older population with multimorbidity.4,5 [ABSTRACT FROM AUTHOR]

The United States is undergoing a demographic transition in which the proportion of individuals aged 65 years and above in total population is increasing. The age-crime relationship is a well-tested theory in criminology. A commonly accepted theory that has been unanimously supported by empirical evidence is that the propensity to commit crime decreases with age. But recent data from the FBI depicts an increase in crimes committed by the elderly. Notwithstanding the increasing trend in arrests among the elderly, we test the hypothesis that population ageing decreases total crime rates, violent crime rates, property crime rates, and their six sub-categories, namely, murder, rape, robbery, aggravated assault, larceny, and motor vehicle theft. We control for expenditures on police force (% of GDP), income inequality, national income, unemployment rate, poverty rate, and population density. The multiple break test, the bounds testing approach to cointegration analysis, and causality analysis are applied. The long-run results reject the hypothesis. Population ageing is found to increase crime rates in the United States. The results further indicate a positive correlation between population ageing and share of crimes committed by the elderly in total crimes in the United States. [ABSTRACT FROM AUTHOR]

The 2021 American Rescue Plan included the temporary expansion of the Child Tax Credit (CTC)--the largest individual income tax credit program in the United States--for most families with children. In the context of the COVID-19 pandemic, how did the public perceive this social policy benefit for families, especially in relation to other traditional social programs? By focusing on the CTC, an understudied policy area, and presenting original survey data, this paper first shows that, while the majority of respondents favored the CTC, levels of support for these benefits were lower than support for other social programs. Second, the paper suggests that, compared to older people and people with disabilities, Americans view families as part of the "undeserving" population. Third, by presenting panel data, we show that there is no change in levels of CTC support even among recipients of these benefits. Overall, these findings shed light on important challenges to the development and implementation of family policy in the USA, as well as the possibility of recalibrating the US liberal welfare state. [ABSTRACT FROM AUTHOR]

Background: The prevalence of caregiving in the United States has increased from 16.6% to 19.2% during the period between 2015 and 2020. Caregivers play a critical public health role post-pandemic and as the population ages. However, caregiving can be detrimental to the health of caregivers. Many studies have shown that communication and connectedness are effective forms of health intervention for caregivers, but how this can be achieved requires further investigation. Objective: This study aimed to investigate the indirect effect of caregiving on problems of alcohol drinking through psychological distress. Moreover, this study aimed to provide initial evidence of the distinct effects of online and offline communication and connectedness on caregivers' well-being. Methods: The predictions were evaluated by examining responses to the Health Information National Trends Survey 2020 (n = 3,865). A mediation analysis was conducted to test the mediating effect of psychological distress on the association between caregiving and alcohol drinking. A second-level moderation analysis was performed. The online communication and connectedness, social media use for health, and the offline type, marital or romantic partnership, were tested as moderators to lessen the psychological distress of caregiving. Results: A competitive mediation was identified. We found a positive indirect effect from caregiving to alcohol drinking mediated by psychological distress (bp =.0017, p <.05) but a negative direct effect from caregiving to alcohol drinking (bp = -.0340, p <.05). Furthermore, the study reported a strongly positive effect of moderated moderation on the linkage from caregiving to psychological distress. The negative impact of caregiving on mental distress was greater among those who used social media less, particularly those without a romantic or marital partner. Conclusions: The findings indicate that caregivers experience more mental distress, which leads to risky behavior. This study highlights the crucial role of both online and offline connectedness in mitigating the adverse consequences of caregiving. [ABSTRACT FROM AUTHOR]

As the population in affluent countries has been experiencing rapid aging, understanding its impact on the regional economy has become an important research topic. In this study, we investigate whether regional population aging has affected the economy in the United States. Using instrumental variables based on age structure, we have identified significant positive impacts on employment growth and negative impacts on the population growth rate. Additionally, there was no significant impact on local wages but a positive impact on rent levels. This can be interpreted as evidence that a higher proportion of the elderly population actually enhances local production and consumption amenity levels, as suggested by the spatial equilibrium model. These results imply that regional population aging may not have a significant negative impact on the regional economy. [ABSTRACT FROM AUTHOR]

There is marked geographic variation in cardiac rehabilitation (CR) initiation, ranging from 10% to 40% of eligible patients at the state level. The potential causes of this variation, such as patient access to CR centers, are not well studied. The authors sought to determine how access to CR centers affects CR initiation in Medicare beneficiaries. The authors used Medicare files to identify CR-eligible Medicare beneficiaries and calculate CR initiation rates at the hospital referral region (HRR) level. We used linear regression to evaluate the percent variation in CR initiation accounted for by CR access across HRRs. We then employed geospatial hotspot analysis to identify CR deserts, or counties in which patient load per CR center is disproportionately high. A total of 1,133,657 Medicare beneficiaries were eligible for CR from 2014 to 2017, of whom 263,310 (23%) initiated CR. The West North Central Census Division had the highest adjusted CR initiation rate (35.4%) and the highest density of CR programs (6.58 per 1,000 CR-eligible Medicare beneficiaries). Density of CR programs accounted for 21.2% of geographic variation in CR initiation at the HRR level. A total of 40 largely urban counties comprising 14% of the United States population age ≥65 years had disproportionately low CR access and were identified as CR deserts. A substantial proportion of geographic variation in CR initiation was related to access to CR programs, with a significant amount of the U.S. population living in CR deserts. These data invite further study on interventions to increase CR access. [Display omitted] [ABSTRACT FROM AUTHOR]

This article discusses the recent trends in default surrogate statutes across the United States. Default surrogate statutes provide healthcare decision-makers for patients who have not appointed one themselves. The article highlights the increase in the number of states with default surrogate statutes and the recognition of distant family members and non-relatives as possible decision-makers. It also mentions the expansion of healthcare worker roles in working with patients and their default surrogates. These statutes aim to ensure that the wishes and values of the aging population are followed and provide a safety net for adults without appointed healthcare decision-makers. [Extracted from the article]

The percentage of U.S. residents 65 years and older was 17% in 2020, and this number is expected to rise due to the aging of the baby boomer generation.1Although life expectancy fell between 2020 and 2021, the proportion of U.S. residents older than 65 years continues to increase.2This age group often has more medical comorbidities and prescription medications, increasing the demand for primary care access. Domestic migration (U.S. residents moving within the country) of this retirement-aged population further strains the primary care workforce in underserved areas. The percentage of U.S. residents 65 years and older was 17% in 2020, and this number is expected to rise due to the aging of the baby boomer generation. 1 Although life expectancy fell between 2020 and 2021, the proportion of U.S. residents older than 65 years continues to increase. 2 This age group often has more medical comorbidities and prescription medications, increasing the demand for primary care access. Domestic migration (U.S. residents moving within the country) of this retirement-aged population further strains the primary care workforce in underserved areas. [ABSTRACT FROM AUTHOR]

Objectives I work from a gendered life-course perspective to examine the association between older parents' fertility history (i.e. timing and parity) and their risk of cognitive impairment in the United States. Methods I analyze nationally representative data from 9 waves over 16 years of the Health and Retirement Study (2000–2016). The sample includes 14,543 respondents (6,108 men and 8,435 women) aged 50 and older at the baseline survey. I examine the relationship between parity, age at first birth, and age at last birth with risk of cognitive impairment using nonlinear discrete-time hazard models. Results Adjusting for the effects of full covariates, there are U-shaped relationships between women's age at last birth and risk of cognitive impairment and between women's parity and risk of cognitive impairment. In the sensitivity tests, the relationships remain robust when sampling weights are applied, or mortality selection is corrected. Discussion Fertility timing and parity are likely factors associated with the risk of cognitive impairment for older women. Understanding fertility history and its impact on cognition can help identify the most vulnerable subpopulations, so that more effective interventions can be made to improve cognitive functioning among older adults. [ABSTRACT FROM AUTHOR]

Objectives Latinos are the fastest aging racial/ethnic minority group in the United States. One limitation to understanding the diverse experiences of older Latinos is the lack of nationally representative data necessary to examine factors contributing to changes in population-level health over time. This is needed to provide a more comprehensive picture of the demographic characteristics that influence the health and well-being of older Latinos. Methods We utilized the steady-state design of the Health and Retirement Study (HRS) from 1992 to 2016 to examine the demographic and health characteristics of five entry birth cohorts of older Latinos aged 51–56 years (n = 2,882). Adjusted Wald tests were used to assess statistically significant differences in demographic and health characteristics across the HRS birth cohorts. Results Cross-cohort comparisons of demographic and health characteristics of older Latinos indicate significant change over time, with later-born HRS birth cohorts less likely to identify as Mexican-origin, more likely to identify as a racial "other," and more likely to be foreign-born. In addition, we find that later-born cohorts are more educated and exhibit a higher prevalence of hypertension, diabetes, and obesity. Discussion Increasing growth and diversity among the older U.S. Latino population make it imperative that researchers document changes in the demographic composition and health characteristics of this population as it will have implications for researchers, policymakers, health care professionals, and others seeking to anticipate the needs of this rapidly aging population. [ABSTRACT FROM AUTHOR]

Introduction: The United States Society of Critical Care Medicine has announced a shortage of all critical care intensivists due to the increased need for critical care for the aging population with comorbidities and improved life expectancy. This shortage has led to tele-ICU programs that have allowed intensivists to care for patients simultaneously remotely. Methods: This study aimed to assess the potential for the hospital implementation of tele-ICU to determine its overall healthcare cost-effectiveness. The methodology was a review that followed a systematic search approach utilizing 42 sources. Results: The study findings showed that tele-ICU contributed to reduced hospital LOS by 36% and positive financial outcomes of return of investment and cost-effectiveness. These reduced LOS stay times have allowed for savings up to $11.5 million. Discussion: The Tele-ICU program's implementation has positively impacted financial and clinical areas, reducing mortality and reduced hospital LOS. Furthermore, it has reduced improved patient safety, care quality, and decreased ventilator days, contributing to a cost-efficient technology. [ABSTRACT FROM AUTHOR]

Objectives Multimorbidity, also referred to as multiple chronic conditions (MCCs), is the concurrent presence of 2 or more chronic health conditions. Increasing multimorbidity represents a substantial threat to the health of aging populations. Recent trends suggest greater risk of poor health and mortality among later-born cohorts, yet we are unaware of work examining cohort differences in multimorbidity among aging U.S. adults. Methods We examine intercohort variation in MCC burden in adults aged 51 years and older using 20 years (n = 33,598; 1998–2018) of repeated assessment drawn from the Health and Retirement Study. The index of MCCs included 9 chronic conditions (heart disease, hypertension, stroke, diabetes, arthritis, lung disease, cancer excluding skin cancer, high depressive symptoms, and cognitive impairment). We used linear mixed models with various approaches to estimate age/period/cohort effects to model intercohort patterns in MCC burden. We also explored variation in the specific conditions driving cohort differences in multimorbidity. Results More recent cohorts had greater MCC burden and developed multimorbidity at earlier ages than those born to prior generations. The burden of chronic conditions was patterned by life-course sociodemographic factors and childhood health for all cohorts. Among adults with multimorbidity, arthritis and hypertension were the most prevalent conditions for all cohorts, and there was evidence that high depressive symptoms and diabetes contributed to the observed cohort differences in multimorbidity risk. Discussion Our results suggest increasing multimorbidity burden among more recently born cohorts of aging U.S. adults and should inform policy to address diminishing health in aging populations. [ABSTRACT FROM AUTHOR]

We apply a semiparametric approach to 19 metropolitan areas in the US to relate normalized house prices to the age distribution within each area. We find that, although the elderly population has a negative impact on house prices in most areas, the shape of the estimated age response function differs between areas. We further find via probit and logit regressions that the age-response function is more likely to become inverted U-shaped as the population of an area becomes more aged, which is also suggestive of the negative impact of aging. These results indicate that the impact of the elderly population becomes more negative as the population ages. [ABSTRACT FROM AUTHOR]

Affordable housing has declined in recent decades, yet limited research has examined the demographic and economic changes influencing place‐level affordability—especially outside of large metros. In this study I examine the effects of county‐level population growth and decline, population aging, and natural amenity development on rates of affordable housing, income, and housing costs across four types of counties. While declines in affordability from 1990 to 2016 were universal between rural and urban counties, population growth is associated with decreases in affordability in rural counties but increased affordability in large metros counties due to estimated decreases in housing costs. Population aging is estimated to improve affordability in large and small metro counties, despite the associated decrease in income and housing costs across all county types. The effects of aging vary greatly between owners and renters. Natural amenity development, despite its theoretical importance, is not associated with changes in affordability for rural counties. [ABSTRACT FROM AUTHOR]

Objectives To investigate the slowdown in mortality improvement in the United States, United Kingdom, and comparator countries observed in the first decade of the twenty-first century and critically evaluate proposed explanations. Methods Change-point analysis to identify the year of change in comparison of national mortality trends and linear spline models in the investigation of subnational differences using data from the Human Mortality Database, Global Burden of Disease cause-specific data, and, for the United Kingdom, national statistics data. Consideration of the impact of using different methods to estimate overall mortality is also concluded together with a review of methodological assumptions made in previous studies. Results The results confirm the slowdown in mortality improvement observed in the early twenty-first century but indicate that proposed explanations for this are inadequate on a range of counts. Discussion Mortality improvement slowed down in the early twenty-first century but the explanations advanced, such as opioid use in the United States or influenza epidemics and austerity programs in the United Kingdom, seem unlikely to account for this. Further research considering longer-term life course and cohort influences is needed. [ABSTRACT FROM AUTHOR]

A policy imperative in light of population aging in the United States is to increase employment among older workers. However, age discrimination, especially in hiring, can impede efforts to encourage older people to work longer. This commentary reviews evidence on age discrimination and laws prohibiting age discrimination, and discusses recent court rulings that affect the strength of these laws. Based on this review, the commentary proposes a number of policy changes to reduce age discrimination in hiring, including: increasing damages under the Age Discrimination in Employment Act (ADEA) to match the larger damages that some states allow; amending the ADEA to clarify that claims based on statistical differences in the effects of employer policies ("disparate impact claims") are allowed for hiring discrimination, and that the standard for establishing discrimination is not that age was the determining factor in creating the disparity (the "but for" age criterion), rather that it was simply a contributing factor; amending the ADEA to allow intersectional claims regarding age and other group membership – especially regarding discrimination against older women; extending affirmative action for federal contractors to older workers; and considering strengthening the Americans with Disabilities Act (ADA). [ABSTRACT FROM AUTHOR]

Objectives This study reports the findings of the first cross-national survey experiment on the effects of information on the expected retirement age. Given the drawbacks of unrealistic retirement expectations, the study examines the impacts of nonpartisan information about future demographic aging and forecasted pension benefit levels. Methods An online survey experiment was conducted in the United States, Germany, and Spain in 2018 using an internet access panel. We assigned respondents to 2 random treatments: one citing the change in the projected share of the population older than 65 years (demographic treatment) and another citing the projected change in pension replacement rates (benefits treatment), both for 2015–2040. Treatment effects on the expected retirement age are reported. Results The benefits treatment has a strong influence on retirement expectations. In the United States, respondents informed of the expected decline in pension replacement rates expect to retire 2 years later than respondents not informed of the decline. In Spain, this treatment leads to an approximately 9-month postponement of expected retirement, while no significant effect is found in Germany. In addition, the demographic treatment does not affect retirement expectations in the countries studied. Respondents in all countries informed of future population aging do not show different expected retirement ages than respondents not given this information. Discussion People's retirement expectations are sensitive to information on future changes in pension generosity but not to information on population aging. The results suggest information campaigns focused on declining pension replacement rates may help extend working lives. [ABSTRACT FROM AUTHOR]

The art and science of diabetes care, education, and management has evolved significantly over the last few decades. Yet, the United States is experiencing an escalation in the number of diabetes cases. Diabetes is a highly prevalent health condition in the aging population with more than 9 million (26.8%) people 65 years of age and older having diabetes and over 50% with pre-diabetes. In older patients, it is imperative to know the type of diabetes a person has is accurately diagnosed to ensure the correct treatment is used. Pharmacists need to individualize treatment goals and develop optimal therapy plans that focus beyond glycemic management and consider cardiovascular (CV), renal, weight, and hypoglycemic risks and benefits for effective and efficacious care in older patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Population aging, caused by an increase in life expectancy and decrease in fertility rates, has created changes and challenges in various spheres, including the labor market. Though health deteriorates with age, more and more older adults choose to stay in the labor force and work into late life. OBJECTIVE: Understanding the effects of various work conditions on the health of older workers is crucial for designing policies and interventions to ensure healthy late life and maintain a productive workforce. To contribute to this endeavor, this study investigates the relationship between long working hours (LWH) and mortality among older populations. METHODS: The study uses the Cox proportional hazards regression model to investigate data from the Health and Retirement Survey (HRS) between the years 1992–2016, a longitudinal nationally representative dataset from the United States. RESULTS: The results indicate that working 50 hours or more per week is not associated with an increased risk of mortality, for the full sample (1.45 [95% CI: 0.86, 2.45]), for both genders (females 0.51 [95% CI: 0.06, 4.28], males 1.45 [95% CI: 0.81, 2.61]), and for immigrants (female immigrants 0.55 [95% CI: 0.06, 4.75], male immigrants 1.44 [95% CI: 0.79, 2.62]). CONCLUSIONS: This analysis confirms and extends the findings of earlier studies by taking into consideration the potential impact of many demographic, socioeconomic, work-related and health-related factors. [ABSTRACT FROM AUTHOR]

Like many other wealthy nations, the United States is experiencing substantial population ageing, particularly among Whites, whose median age is over a decade older than Blacks' and Hispanics'. To date, analyses of this demographic divergence have been limited to national and state levels; we know little about its manifestation at smaller scales. This study introduces three micro‐level measures of the joint distribution of age and race, demonstrating that Whites are older than their non‐White neighbours in most integrated neighbourhoods, with notable variation across regional and local characteristics. Racial age gaps significantly predict subsequent declines in neighbourhoods' White population, indicating that racial change has an under‐studied age dimension. Meanwhile, neighbourhoods with relatively younger Whites are rare, clustered in coastal metros, and linked to gentrification. Drawing on theories of multidimensional heterogeneity, I suggest that local consolidation of age and racial differences may undermine stable integration and reinforce inequality. [ABSTRACT FROM AUTHOR]

Background: Standardized methods are needed to investigate intake patterns of processed meat subtypes, considering health concerns surrounding processed meat intake.Objectives: The objectives of this study were to create a standardized method of disaggregating processed meat into processed red meat and processed poultry and describe intake patterns of the US population aged ≥2 y.Methods: Two researchers independently manually disaggregated processed meat from the Food Patterns Equivalents Database into processed red meat and processed poultry based on available information from the Foods and Nutrient Database for Dietary Studies. We created an SAS program (called Processed Meat Categories) to mimic the manual coding. We used the program to describe intake patterns and trends over time of processed red meat and processed poultry using 24-h recalls from 2007-2008 through 2017-2018 NHANES data with SAS survey-weighted procedures for complex surveys.Results: The SAS program had high agreement with the manual code (Pearson concordance correlation ≥0.95). Of the US population aged ≥2 y, 46.8% (95% CI: 45.3, 48.2%) reported consuming any processed meat, 42.5% (95% CI: 41.0, 43.9%) reported consuming processed red meat, and 11.3% (95% CI: 10.2, 12.4%) reported consuming processed poultry. Most [74.1 ± 0.13% (SEM)] processed meat reported was red meat compared with poultry, and 32.1 ± 0.01% of total red meat and 13.7 ± 0.01% of total poultry reported were processed. Prevalence of processed poultry intake increased from 9.5% (95% CI: 8.9, 10.1%) in 2007-2010 to 11.3% (95% CI: 10.2, 12.4%) in 2015-2018 (P < 0.0001), but mean intake amount did not change. Prevalence of processed red meat intake did not change over time, but mean intake decreased from 0.8 ± 0.03 ounce-equivalents in 2007-2010 to 0.7 ± 0.02 ounce-equivalents (P = 0.0058) in 2015-2018.Conclusions: The Processed Meat Categories SAS program is a tool available for researchers to standardize estimates of processed meat subtypes for future dietary patterns research. Intake of total processed meat did not change in the United States, but intake amount of processed red meat decreased and the prevalence of processed poultry consumers increased. [ABSTRACT FROM AUTHOR]

Objectives The prevalence of dementia in the United States seems to have declined over the last few decades. We investigate trends and their underlying mechanisms in cognitive functioning (CF) across 7 decades of birth cohorts from the Greatest Generation to Baby Boomers. Methods Data come from 30,191 participants of the 1996–2014 Health and Retirement Study. CF is measured as a summary score on a 35-point cognitive battery of items. We use generalized linear models to examine the trends in CF and explanatory variables across birth cohorts. Then, Karlson–Holm–Breen decomposition method is used to evaluate the contribution of each explanatory variable to the trend of CF. Results CF has been improving from the Greatest Generation to Late Children of Depression and War Babies, but then significantly declines since the Early-Baby Boomers and continues into Mid-Baby Boomers. This pattern is observed universally across genders, race/ethnicities, education groups, occupations, income, and wealth quartiles. The worsening CF among Baby Boomers does not originate from childhood conditions, adult education, or occupation. It can be attributed to lower household wealth, lower likelihood of marriage, higher levels of loneliness, depression and psychiatric problems, and more cardiovascular risk factors (e.g. obesity, physical inactivity, hypertension, stroke, diabetes, and heart disease). Discussion The worsening CF among Baby Boomers may potentially reverse past favorable trends in dementia as they reach older ages and cognitive impairment becomes more common if no effective interventions and policy responses are in place. [ABSTRACT FROM AUTHOR]

Mass incarceration and the aging prison population in the United States is an ethical crisis, understudied in empirical bioethics research. In this article, I share one woman's narrative to illustrate how older Black women describe accessing healthcare while incarcerated and identify sites for bioethical exploration. I argue that, due to the punitive nature of prison healthcare interactions, wherein women are seen as inmates first and patients second, healthcare providers are caught in a trap of competing ethical commitments to their patients and the state. As the prison population ages, these challenges will become more acute. Feminist bioethics has a critical role to play in imagining new possibilities for accessing, giving, and receiving care in the carceral context. [ABSTRACT FROM AUTHOR]

• US adult vaccination is projected to prevent 65 million disease cases over 30 years. • The averted societal costs of cases would outweigh vaccination costs by about $49 billion. • With an increase in vaccination coverage, 33 million more disease cases could be avoided. • The coverage increase would result in $13 billion additional societal cost savings. This exploratory study estimates the economic value of the current vaccination program and increased coverage against four preventable diseases in older adults in the United States (US). A population-based, age-structured economic model was used to conduct a cost-benefit analysis of vaccination against influenza, pertussis, herpes zoster, and pneumococcal disease among US adults aged 50 years and older, accounting for aging of the population. The model used separate decision trees for each disease to project the discounted number of vaccinated individuals, number of disease cases, and direct medical and indirect costs (2018 US$) over a 30-year period. Benefit-cost ratios (BCRs) and net present values were calculated for two primary analyses comparing current vaccination coverage versus no vaccination and comparing increased coverage versus current coverage. Key parameter values were varied in deterministic sensitivity analyses. Current adult vaccination coverage (vs. no vaccination) is estimated to result in nearly 65 million averted disease cases, $185 billion averted costs of cases, and $136 billion in incremental vaccination costs over a 30-year period from a societal perspective (BCR = 1.4). Increased vaccination coverage (vs. current coverage) is associated with over 33 million additional averted disease cases, $96 billion additional averted costs of cases, and nearly $83 billion in incremental vaccination costs, resulting in a societal BCR of 1.2 over 30 years. Deterministic sensitivity analyses demonstrated that results were most sensitive to disease incidence, vaccine efficacy, and productivity costs for time required for vaccination. Study results highlight the economic value of vaccination programs for older adults in the US and indicate that efforts to further increase vaccination coverage may be warranted and economically justifiable. [ABSTRACT FROM AUTHOR]

The elderly population in the United States is projected to almost double by the year 2050. In addition, the numbers of diabetics are rising, along with its most common complication, diabetic retinopathy (DR). To effectively treat DR within the elderly population, it is essential first to consider the retinal changes that occur due to aging, such as decreased blood flow, retinal thinning, and microglial changes, and understand that these changes can render the retina more vulnerable to oxidative and ischemic damage. Given these considerations, as well as the pathogenesis of DR, specific pathways could play a heightened role in DR progression in elderly patients, such as the polyol pathway and the vascular endothelial growth factor (VEGF) axis. Current ocular treatments include intravitreal corticosteroids, intravitreal anti-VEGF agents, laser photocoagulation and surgical interventions, in addition to better control of underlying diabetes with an expanding range of systemic treatments. While using therapeutics, it is also essential to consider how pharmacokinetics and pharmacodynamics change with aging; oral drug absorption can decrease, and ocular drug metabolism might affect the dosing and delivery methods. Also, elderly patients may more likely be nonadherent to their medication regimen or appointments than younger patients, and undertreatment with anti-VEGF drugs often leads to suboptimal outcomes. With a rising number of elderly DR patients, understanding how aging affects disease progression, pharmacological metabolism, and adherence are crucial to ensuring that this population receives adequate care. [ABSTRACT FROM AUTHOR]

The age distribution of a population is a product of a century of demographic history. This paper describes how the history of births, deaths, and migrations has fashioned the US age distribution in 2018. It also shows how that history, combined with contemporary processes, was actively producing changes in the age distribution between 2013 and 2018. Changes in survivorship, migration, and births all contributed to population aging during this period, with a declining growth rate of births the leading contributor. Using a novel approach, the paper demonstrates how the inertia reflected in changing age distributions sheds light on the future population of the United States. Massive growth in the population above age 70 will occur by 2033 if recent age patterns of age‐specific mortality and migration are maintained. [ABSTRACT FROM AUTHOR]

Objectives Family is largely overlooked in research on factors associated with place of death among older adults. We determine if family caregiving at the end of life is associated with place of death in the United States and Europe. Method We use the Harmonized End of Life data sets developed by the Gateway to Global Aging Data for the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Health and Retirement Study (HRS). We conducted multinomial logistic regression on 7,113 decedents from 18 European countries and 3,031 decedents from the United States to determine if family caregiving, defined based on assistance with activities of daily living, was associated with death at home versus at a hospital or nursing home. Results Family caregiving was associated with reduced odds of dying in a hospital and nursing home, relative to dying at home in both the United States and Europe. Care from a spouse/partner or child/grandchild was both more common and more strongly associated with place of death than care from other relatives. Associations between family caregiving and place of death were generally consistent across European welfare regimes. Discussion This cross-national examination of family caregiving indicates that family-based support is universally important in determining where older adults die. In both the United States and in Europe, most care provided during a long-term illness or disability is provided by family caregivers, and it is clear families exert tremendous influence on place of death. [ABSTRACT FROM AUTHOR]

As US society ages, pressures on local government planning and service delivery increase. We conducted a national survey of 1474 US local governments in 2013 to measure the range of services local governments provide and how these relate to local planning processes, public engagement and local government attitudes and motivators. We differentiate measures of public engagement and cross-agency collaboration, and control for built environment, demographic structure, socio-economics and metro status to explain what differentiates communities that provide more services. Our regression models find communities with more cross-agency collaboration (for service delivery, information and trust) and more engagement of older adults and families with children, provide more services to meet their needs. Capacity constraints do not differentiate level of service delivery. Local governments with conservative councils provide fewer services for children and seniors. Communities with increasing senior populations, and suburbs with increasing child populations provide fewer services targeted to their needs. [ABSTRACT FROM AUTHOR]

This study examines the impacts of population aging on a wide range of economic indicators from a regional perspective. Many countries, including the United States, are experiencing demographic aging. This may have a dramatic impact on both the national and sub-national economies. However, there is little consensus about its impact on local sub-national economies. This study uses regional variation in age structure to explain economic outcomes at the metropolitan statistical areas (MSAs) level. In order to identify causal effects, Mahalanobis distances were calculated to identify the matched cities as instrumental variables. The study finds that regions with older age structures tend to have higher growth rates of GDP per capita and lower growth rates of unemployment, but such positive effects are likely to fade away in the long run. Additionally, there is no significant impact of age composition on income. The choice of variables is critical as it can lead to mixed results. The results are robust before, during and after the economic recession. Quantile regression is also used to explore potential heterogeneous effects among MSAs. The results show that MSAs, regardless of their size, are uniformly affected by the age structure. [ABSTRACT FROM AUTHOR]

Background: Excess death estimates quantify the full impact of the coronavirus disease 2019 (COVID-19) pandemic. Widely reported U.S. excess death estimates have not accounted for recent population changes, especially increases in the population older than 65 years.Objective: To estimate excess deaths in the United States in 2020, after accounting for population changes.Design: Surveillance study.Setting: United States, March to August 2020.Participants: All decedents.Measurements: Age-specific excess deaths in the United States from 1 March to 31 August 2020 compared with 2015 to 2019 were estimated, after changes in population size and age were taken into account, by using Centers for Disease Control and Prevention provisional death data and U.S. Census Bureau population estimates. Cause-specific excess deaths were estimated by month and age.Results: From March through August 2020, 1 671 400 deaths were registered in the United States, including 173 300 COVID-19 deaths. An average of 1 370 000 deaths were reported over the same months during 2015 to 2019, for a crude excess of 301 400 deaths (128 100 non-COVID-19 deaths). However, the 2020 U.S. population includes 5.04 million more persons aged 65 years and older than the average population in 2015 to 2019 (a 10% increase). After population changes were taken into account, an estimated 217 900 excess deaths occurred from March through August 2020 (173 300 COVID-19 and 44 600 non-COVID-19 deaths). Most excess non-COVID-19 deaths occurred in April, July, and August, and 34 900 (78%) were in persons aged 25 to 64 years. Diabetes, Alzheimer disease, and heart disease caused the most non-COVID-19 excess deaths.Limitation: Provisional death data are underestimated because of reporting delays.Conclusion: The COVID-19 pandemic resulted in an estimated 218 000 excess deaths in the United States between March and August 2020, and 80% of those deaths had COVID-19 as the underlying cause. Accounting for population changes substantially reduced the excess non-COVID-19 death estimates, providing important information for guiding future clinical and public health interventions.Primary Funding Source: National Cancer Institute. [ABSTRACT FROM AUTHOR]

Extreme heat is one of the most pressing climate risks in the United States and is exacerbated by a warming climate and aging population. Much work in heat health has focused only on temperature-based metrics, which do not fully measure the physiological impact of heat stress on the human body. The U.S. Climate Reference Network (USCRN) consists of 139 sites across the United States and includes meteorological parameters that fully encompass human tolerance to heat, including relative humidity, wind, and solar radiation. Hourly and 5-min observations from USCRN are used to develop heat exposure products, including heat index (HI), apparent temperature (AT), and wet-bulb globe temperature (WBGT). Validation of this product is conducted with nearby airport and mesonet stations, with reanalysis data used to fill in data gaps. Using these derived heat products, two separate analyses are conducted. The first is based on standardized anomalies, which place current heat state in the context of a long-term climate record. In the second study, heat events are classified by time spent at various levels of severity of conditions. There is no consensus as to what defines a heat event, so a comparison of absolute thresholds (i.e., ≥30.0°, 35.0°, and 40.0°C) and relative thresholds (≥90th, 95th, and 98th percentile) will be examined. The efficacy of the product set will be studied using an extreme heat case study in the southeastern United States. While no heat exposure metric is deemed superior, each has their own advantages and caveats, especially in the context of public communication. [ABSTRACT FROM AUTHOR]

Population aging is one of the most important social trends of the 21st century and in the United States, the number of people aged ≥65 is projected to increase by nearly 50% in the next 15 years. Most biomedical and public health efforts have focused on reducing harmful risk factors when targeting chronic disease—an approach that has contributed greatly to prevention and treatment programs. However, evidence suggests that the number of years lost to disability is increasing and historic gains we have made in life expectancy are eroding, and even reversing in some groups. As our society ages and grapples with these issues, expanding the focus to include resilience, as well as psychosocial assets in our prevention and treatment programs might help inform the multidisciplinary response effort we need. Here we synthesize research evaluating associations between different dimensions of psychological well-being (e.g., purpose in life, optimism, life satisfaction) and social well-being (e.g., structural, functional, quality) with chronic conditions. We also evaluate evidence around three biopsychosocial pathways hypothesized to underlie these associations. These factors are meaningful, measurable, and potentially modifiable; thus, further pursuing this line of inquiry might unveil innovative paths to enhancing the health of our rapidly aging society. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this study was to employ simulations to model the probability of mortality from COVID-19 (i.e. coronavirus) for older adults in the United States given at best and at worst cases. Methods This study first examined current epidemiological reports to better understand the risk of mortality from COVID-19. Past epidemiological studies from severe acute respiratory syndrome were also examined given similar virology. Next, at best and at worst mortality cases were considered with the goal of estimating the probability of mortality. To accomplish this for the general population, microdata from the National Health Interview Survey pooled sample (2016, 2017, and 2018 public-use NHIS with a sample of 34,881 adults at least 60 years of age) were utilized. Primary measures included age and health status (diabetes, body mass index, and hypertension). A logit regression with 100,000 simulations was employed to derive the estimates and probabilities. Results Age exhibited a positive association for the probability of death with an odds ratio (OR) of 1.22 (p <.05, 95% confidence interval [CI]: 1.05–1.42). A positive association was also found for body mass index (BMI) (OR 1.03, p <.01, 95% CI: 1.02–1.04) and hypertension (OR 1.36, p <.01, 95% CI: 1.09–1.66) for the at best case. Diabetes was significant but only for the at best case. Discussion This study found mortality increased with age and was notable for the 74–79 age group for the at best case and the 70–79 age group of the at worst case. Obesity was also important and suggested a higher risk for mortality. Hypertension also exhibited greater risk but the increase was minimal. Given the volume of information and misinformation, these findings can be applied by health professionals, gerontologists, social workers, and local policymakers to better inform older adults about mortality risks and, in the process, reestablish public trust. [ABSTRACT FROM AUTHOR]

Background: The incidence of glioblastoma increases significantly with age. With the growing and aging population, there is a lack of comprehensive analysis of recent glioblastoma incidence trend in the United States. This study aims to provide in-depth description of the patterns of incidence trends and to examine the age-period-cohort effects to the trends of glioblastoma specific to elderly patients.Methods: The incidence rates were age-adjusted and reported per 100,000 population. We calculated the annual percent change (APC) in incidence using the Joinpoint Regression Program and conducted an age-period-cohort analysis of elderly glioblastoma reported between 2000 and 2017 to the Surveillance Epidemiology and End Results (SEER) 18 registry database.Results: The overall incidence rate of elderly patients with glioblastoma was 13.16 per 100,000 (95% CI, 12.99-13.32) from 2000 to 2017. Non-Hispanic whites (20,406, 83.6%) made up the majority. The incidence rate of male was about 1.62 times that of female. The trend of incidence remained stable and there was a non-significant increasing tendency for all elderly patients (APC 0.3, 95% CI, - 0.1 to 0.7, p = 0.111). There was a significantly increasing incidence trend for non-Hispanic white (APC 0.6, 95% CI, 0.2 to 1.1, p = 0.013), supratentorial location (APC 0.7, 95% CI, 0.2 to 1.3, p = 0.016), tumor size < 4 cm (APC 2.5, 95% CI, 1.4 to 3.6, p < 0.001), and a significantly decreasing trend for overlapping/NOS location (APC -0.9, 95% CI, - 1.6 to - 0.2, p = 0.012), and unknown tumor size (APC -4.9, 95% CI, - 6.6 to - 3.3, p < 0.001). The age-period-cohort analysis showed the effect of age on incidence trends (p< 0.001, Wald test), while did not indicate the period and cohort effects of the incidence trends of glioblastoma (p = 0.063 and p =0.536, respectively, Wald test).Conclusion: The overall incidence of glioblastoma in the elderly population remained stable between 2000 and 2017. Period and cohort effects were not evident in the trend of glioblastoma incidence. Future population-based studies exploring the difference in the trend of glioblastoma incidence by specific molecular subgroups are warranted to further our understanding of the etiology of glioblastoma. [ABSTRACT FROM AUTHOR]

The other two respondents have carefully articulated many objections to David Imbroscio's essay, responding to its arguments on its own terms. Rather than another point-by-point response, I offer a counternarrative that looks toward the future. In my view, ending exclusionary zoning (EZ) is an important element in a campaign to avoid some of the suffering low-income people in the United States will experience as the global climate emergency becomes increasingly acute, the national population ages, and the entrenched power of right-wing libertarians sustains inequality. Parochial actions like EZ will further complicate responses to these challenges. My response argues that for these reasons, Imbroscio's essay is neither ethical nor logical. [ABSTRACT FROM AUTHOR]

Twenty-first-century North American opera houses have attempted to bring in new audiences to make up for a declining and aging population of subscribers through means both traditional and unorthodox. The San Francisco Opera's SF Lab Initiative (2015–2018) was created with such goals in mind. Alternative forms of programming, which I categorize as auxiliary programming, have gained traction as a marketing and aesthetic strategy in recent years, and ultimately signal a dramatic shift in approaches to regional opera production in the United States. While scholars have explored the creation and funding of contemporary operatic productions in the United States, little attention has been given to forms of programming beyond the operatic mainstage. Using interviews with company members and analysis of advertising and reception of the events, I examine the SFO Lab programming as a site of negotiation between operatic convention and experimentation. Based on a populist vision of operatic access, the SF Opera Lab re-contextualized rather than eliminated class and intellectual hierarchies. More broadly, this application of experimental performativity contributes to discourses about Pan-American experimentalism(s) and demonstrates the ways in which a focus on local encounters can yield broad applications for genres and/or scenes beyond opera in the United States. [ABSTRACT FROM AUTHOR]

The HIV/AIDS crisis of the 1980s and 1990s was catastrophic, both in the scope of morbidity and mortality, as well as in the lasting implications for those who survived. As the introduction of effective antiretroviral treatment restructured the perception of HIV, which is now a manageable, chronic disease, the pattern of psychological sequelae that long-term survivors may experience has become a growing field of inquiry. We present the case of a 59-year-old male who was diagnosed with HIV in 1991, a time when the diagnosis carried a terminal prognosis and the United States had seen over 150,000 AIDS-related deaths. Although the patient ultimately survived, he experienced a cascade of psychological symptoms over the subsequent 29 years, with detriment to emotional, interpersonal, and occupational domains. During his initial evaluation, the source of these symptoms was initially overlooked due to the lack of adequate screening for trauma- and stressor-related symptoms secondary to his experiences during the HIV/AIDS crisis. Once the source of the symptoms was identified, utilization of targeted psychotherapy resulted in substantial improvement. Although there are existing formulations regarding psychological syndromes in this context, including Survivor Guilt, Lazarus Syndrome, and AIDS Survivor Syndrome, there is currently insufficient literature to adequately characterize this presentation, and, with an aging population of long-term HIV survivors, further characterization of the syndrome to facilitate accurate screening and assessment is paramount in ensuring appropriate treatment in this population. [ABSTRACT FROM AUTHOR]

The rural United States is sometimes viewed as a paragon of stability, but demographic change has been a constant. Rural and small-town America is diverse, dynamic, and relational to (rather than separate from) urban places. Dominant demographic trends in the rural U.S. over recent decades include depopulation (driven by population aging and youth out-migration), increasing ethnoracial diversity (especially as linked to Hispanic population growth), and in-migration to select areas associated with metropolitan adjacency (i.e., exurban growth), retirement destinations, and natural amenities. This special issue of Population Research and Policy Review assembled a group of papers focused squarely on the changing demography of rural and small-town America in the early twenty-first century that address issues of broad interest to demographers: population growth and decline, fertility, mortality, migration, ethnoracial composition, and economic inequality. The prospect is for a rural America marked by ever more diversity and inequality within and between places. Our hope is that these articles, and the broader spectrum of scholarship on rural demography they represent, will inspire the next generation of research in this area. [ABSTRACT FROM AUTHOR]

Abstract: Over the last 2 decades, affirmative diagnoses of osteoarthritis (OA) in the United States have tripled due to increasing rates of obesity and an aging population. Hemp-derived cannabidiol (CBD) is the major nontetrahydrocannabinol component of cannabis and has been promoted as a potential treatment for a wide variety of disparate inflammatory conditions. Here, we evaluated CBD for its ability to modulate the production of proinflammatory cytokines in vitro and in murine models of induced inflammation and further validated the ability of a liposomal formulation to increase bioavailability in mice and in humans. Subsequently, the therapeutic potential of both naked and liposomally encapsulated CBD was explored in a 4-week, randomized placebo-controlled, double-blinded study in a spontaneous canine model of OA. In vitro and in mouse models, CBD significantly attenuated the production of proinflammatory cytokines IL-6 and TNF-α while elevating levels of anti-inflammatory IL-10. In the veterinary study, CBD significantly decreased pain and increased mobility in a dose-dependent fashion among animals with an affirmative diagnosis of OA. Liposomal CBD (20 mg/day) was as effective as the highest dose of nonliposomal CBD (50 mg/day) in improving clinical outcomes. Hematocrit, comprehensive metabolic profile, and clinical chemistry indicated no significant detrimental impact of CBD administration over the 4-week analysis period. This study supports the safety and therapeutic potential of hemp-derived CBD for relieving arthritic pain and suggests follow-up investigations in humans are warranted. [ABSTRACT FROM AUTHOR]

This study presents a large-scale study of public library services to older adults in the United States. A random sampling method was used to identify public libraries (n=226) for the study. Results suggest that libraries serve their aging communities in multiple ways. Some libraries provide a plethora of specialized programs focused on the specific needs of older adults. Others extend core library services to ensure they are accessible to older adults. Others invest in infrastructure and staff development to prepare for an aging society. Some do not provide any specialized programs or services for older adults. There is great unevenness in terms of library services for older adults across the nation. The discussion suggests additional work needed to better understand this unevenness, and to address it. [ABSTRACT FROM AUTHOR]

In view of the demographic profile of the older adults in the United States, in the next two decades, cities and communities need to adapt the form, environment, and transportation systems to accommodate the growing aging population. In this article, I review two streams of literature in the mobility among the older population: the mobility/living environment and wellbeing; the relationship between living environment and mobility. I argue that two streams of literature should be combined to inform an interdisciplinary dialogue and a new agenda for future research. [ABSTRACT FROM AUTHOR]

Objective: Depression is prevalent among adolescents, affecting about 11% of the United States population ages 12–17. It is therefore pertinent to better understand the factors associated with adolescent depression in order to prevent the development of symptoms and minimise negative psychosocial and developmental outcomes. Methods: We utilised a self-report survey among 84 adolescents to examine the associations between reassurance seeking, empathy, cognitive coping strategies, and depressive symptoms, among high-school students. Results: Female sex and high reassurance seeking were significantly associated with depressive symptoms. Discussion: Our study suggests that regular screening for reassurance seeking and depressive symptoms among adolescents, as well as ongoing psychosocial education for parents, teachers, and administrators, may help to identify those in need of intervention. [ABSTRACT FROM AUTHOR]

Objectives Asian Americans are the fastest-growing minority group in the United States, yet little is known about their functional mobility. To overcome such a gap, this study examined the association between demographic/economic characteristics and functional limitations for middle-aged and older Asian Indians, Chinese, and Filipinos. Method This study utilized microdata from the National Health Interview Survey pooled sample (2010–2016 IPUMS NHIS with a sample size of 6,767 Asians). Logit regressions were used to examine factors associated with functional limitations. Measures include age, gender, currently married, education (categorized as less than high school, high school, some college, college, advanced degree), birth and citizenship status, household income, home ownership, types of health insurance (e.g., Medicaid, Medicare, private), and geographic region (i.e., Northeast, Midwest, South, and West). Results Chinese (odds ratio [OR] 0.57, p <.01) and Filipinos (OR 0.74, p <.05) had lower odds for any functional limitations relative to Asian Indians. Currently married and individuals with a higher income were also associated with reduced odds for limitations in the overall analysis. As for the subgroup analysis, there was a positive association between age and the presence of any functional limitations for Asian Indians (OR 1.05, p <.01), Chinese (OR 1.08, p <.01), and Filipinos (OR 1.03, p <.01). In terms of gender, Asian Indian men were less likely (OR 0.51, p <.01), whereas Filipino men were more likely to have limitations (OR 1.09, p <.05). Discussion Asian Indians appeared to have a poorer health profile for limitations in dressing, eating, walking, or working when compared with Chinese and Filipinos. A pronounced difference at older ages was also apparent for Asian Indians by gender and the likelihood of having any limitations increased much faster for Asian Indian women. For Chinese, there was a dramatic increase in functional limitations after age 75 (particularly for women) and the predicted probability for this subgroup approximated 20%. For Filipinos, men were more likely to have limitations. These findings raise interesting questions about the on-set of disability by age and gender for Asian subgroups. [ABSTRACT FROM AUTHOR]

Background: Globally, the prevalence of chronic disease continues to rise and is likely to grow further over the coming decades due to population ageing. Since older age is associated closely with development of chronic disease, it stands to reason that demographic changes will increase the proportion of older workers with chronic disease. The aim of the present study was to determine how chronic diseases affect employment status in Korea and the USA.Methods: The study was based on National Health and Nutrition Survey data (2007-2014) obtained by the Korean and American Centers for Disease Control and Prevention. A total of 44,693 subjects were categorized into two geographical groups: Korea (29,260 subjects) and the USA (15,433 subjects). A chi-square test was used to compare the groups in terms of socio-demographic factors, health-related factors, and chronic disease. Multivariate logistic regression analysis was conducted to determine the effect of five chronic diseases (hypertension, diabetes, dyslipidemia, cardiovascular disease, and cancer) on employment status.Results: There were 29,260 Korean and 15,433 American respondents. Chronic disease increased the risk of unemployment in Korea markedly (Odds ratio [OR] range, 1.17-2.47). Cardiovascular disease and cancer had the most profound negative effect on Korean unemployment (OR = 2.47 and 2.03, respectively). The risk of unemployment was generally 2-3-fold lower in the USA (OR range, 0.5-1.04).Conclusions: Chronic disease had a significant impact on economic activity in Korea, but a smaller impact in the USA. This difference may be related to different health insurance schemes and cultural approaches to people with diseases in the two countries. It is important to explore factors that limit economic participation by people with chronic diseases, and to identify social policies that will overcome these factors. Further between-country studies are needed to identify social solutions to the socio-economic burden of chronic illness. [ABSTRACT FROM AUTHOR]