Browsing by Subject "Disparities"
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Item A cohort perspective of U.S. adult mortality(2011-05) Masters, Ryan Kelly; Hummer, Robert A.; Hayward, Mark D.; Powers, Daniel A.; Umberson, Debra J.; Krueger, Patrick M.This dissertation advances a cohort perspective to analyze trends in racial and educational disparities in U.S. adult mortality. The project is organized around three themes. First, I emphasize that recent temporal changes in U.S. adult mortality risk are rooted in cohort forces. Unfortunately, much of the mortality literature has failed to account for the fact that the sociohistorical conditions of U.S. cohorts have changed dramatically, and these changes have tremendous implications for population health and mortality trends. My work clearly shows the pitfalls of omitting these cohort effects from analyses of U.S. adult mortality risk. Second, I illustrate that because exposure to social and health conditions have changed over time, resources in adulthood are growing increasingly important in shaping U.S. adult mortality risk. In this regard, my findings also highlight growing disparities in U.S. mortality across race/ethnic gender groups. Third, I advance a cohort theory of U.S. mortality, drawing from both “fundamental cause” theory and a life course perspective of mortality but couching them in a cohort framework to highlight the importance of historical changes in U.S. social and health contexts in both childhood and adulthood. This cohort perspective is then used to analyze three central topics in the U.S. mortality literature: the black-white crossover in older-adult mortality, the growing educational gap in U.S. adult mortality, and the origins and persistence of black-white inequalities in U.S. adult mortality. I estimate hierarchical age-period-cohort cross-classified random effects models using National Health Interview Survey-Linked Mortality Files between 1986 and 2006 to simultaneously analyze age, period, and cohort patterns of U.S. adult mortality rates. I find (1) the black-white crossover is a cohort-specific phenomenon, (2) educational disparities in U.S. adult mortality rates are growing across birth cohorts, not time periods, and (3) racial disparities in U.S. adult mortality rates stem from cumulative racial stratification across both cohorts and the life course. Such findings have direct consequences for both mortality theories and policy recommendations. Only by considering the disparate sociohistorical conditions that U.S. cohorts have endured across their life courses can we fully understand and address current and future health disparities in the United States.Item Educational differentials in U.S. adult mortality : trends and causes(2014-12) Sasson, Isaac; Weinreb, Alexander; Hayward, Mark D; Hummer, Robert A; Powers, Daniel A; Tuljapurkar, Shripad; Umberson, Debra JAs life expectancy at birth in the United States approaches eighty years of age, educational differentials in adult mortality are greater than ever. One of the key sociological insights of our time is that these two processes are fundamentally interrelated. As society gains greater social capacity to control health and disease socioeconomic status (SES) becomes increasingly important for shaping healthy social environments and lifestyles, which reduce the risk of mortality. Of all SES indicators, educational attainment is perhaps the single most important predictor of mortality in the United States. Not only do low-educated Americans have shorter lifespans compared to their college-educated counterparts, on average, but they have recently suffered absolute declines in life expectancy. However, debates surrounding the extent, causes, and even validity of those trends continue. This dissertation makes several unique contributions to our understanding of lifespan inequality by educational attainment in the United States. First, using vital statistics data, it documents trends in life expectancy and lifespan variation—a unique dimension of lifespan inequality—by educational attainment for black and white Americans of both genders from 1990 to 2010. Second, it decomposes those trends by age and cause of death in order to understand the proximate causes of the educational disparity in adult mortality. Third, it evaluates the extent to which changes in the composition of education groups account for the rising education-mortality gradient. The findings reveal that the gap in life expectancy at age 25 between the low educated (having fewer than twelve years of schooling) and the college educated has doubled among men and more than tripled among women over the study period; that life expectancy declined among low-educated white men and women (by 0.6 and 3.1 years, respectively); and that much of these trends is attributed to an increase in premature deaths from smoking-related diseases and external causes. While both sides of the selection-causation debate have merit, changes in group composition do not fully account for the increase in mortality among low-educated Americans, for whom economic circumstances have worsened. Overall, the association between educational attainment and adult mortality is pervasive, enduring, and increasing in magnitude.Item Prescription asthma medication expenditures: Are there social disparities?(2005-05) Khosla, Ankur; Xu, Tom K.; Arif, Ahmed; Borders, TyroneThis study estimates the national averages for total, out-of-pocket, and out-of-pocket proportion of total expenditures on prescription asthma medications by adult asthmatic patients using 2000 MEPS data. Additionally, using these estimates disparities were identified among age, race/ethnicity, and poverty level groups. The use of a two part empirical model to evaluate those expenditures was employed in conjunction with the Anderson Behavioral Theoretical Model. The significance of several predisposing, need, and enabling factors in predicting the likelihood and level of expenditures indicate that disparities exist among prescription asthma expenditures. Specifically, differences exist in the out-of-pocket and total spending between the elderly and non-elderly on prescription asthma medications. Additionally, differences exist in the out-of-pocket and out-of-pocket proportion of total expenditures between blacks and whites.Item The relationships between age, gender, and race and rate of immune recovery and life expectancy among patients living with HIV(2016-08) Nduaguba, Sabina Onyinye; Wilson, James P.; Ford, Kentya C.; Lawson, Kenneth ADespite medical advancement transforming HIV disease from a death sentence to a chronic illness, not all patients living with HIV (PLWH) experience the best health outcomes. The purpose of this study was to identify disparities (age, gender, and ethnicity) in health outcomes among patients living with HIV who reside in Texas. HIV surveillance data from the Texas Department of State Health Services was used to identify patients diagnosed with HIV between 1996 and 2013. This cohort was divided into 4 subcohorts according to year of HIV diagnosis; 1996-1997, 1998-2006, 2007-2010, and 2011-2013. The primary outcomes were rate of immune recovery, AIDS diagnosis, and death. Hierarchical linear models and survival analyses were used to assess the relationships between age, gender, and ethnicity and rate of immune recovery and AIDS diagnosis and death. A total of 70,996 patients were included in the study; 7,206, 36,286, 15,628, and 11,876 in the 1996-1997, 1998-2006, 2007-2010, and 2011-2013 subcohorts respectively. The results showed that age, gender, and ethnicity were not statistically associated with rate of immune recovery (p>0.01) but tended towards lower rate of immune recovery with increasing age and in males and Hispanics. Age was associated with clinical progression to AIDS and death (p<0.01) in all 4 subcohorts. Male gender was associated with clinical progression to AIDS in all subcohorts except the 2011-2013 subcohort but there was no relationship between gender and death in the 4 subcohorts. Compared to Hispanics, the risk of an AIDS diagnosis was lower in Blacks across all 4 subcohorts. After controlling for covariates, the relationship was lost in the 1996-1997 and 2011-2013 subcohorts. There was no clear difference in the risk of an AIDS diagnosis between Blacks and Whites. Compared to Whites and Hispanics, Blacks had higher risk of death in the 1996-1997 and 1998-2006 subcohorts. However, there was no relationship between ethnicity and death in the 2007-2010 and 2011-2013 subcohorts after controlling for covariates. In conclusion, the results of the survival analyses suggests some clinical relevance of differential rates of immune recovery, which presents an opportunity for early intervention before long-term outcomes like AIDS diagnosis and death occur.