Mortality differences by parental social class from childhood to adulthood

STUDY OBJECTIVE: To examine mortality differences by parental social class and cause of death from age 5 to age 34. DESIGN: Register-based follow up study based on census records for 1985 and 1990 linked with death records for the period 1987-95. SETTING AND SUBJECTS: The study covers all males and females in non-manual and manual classes in Finland aged 5-34 years in 1987-95 (8135 deaths). Parental social class is defined on the basis of the occupation of the head of household at the time the child was 0-14 years. MAIN OUTCOME MEASURES: All cause mortality, mortality from diseases, mortality from accidents and violence, and alcohol related mortality during the period 1987-95. MAIN RESULTS: At ages 5-14 there is no systematic gradient in mortality by parental social class. Both absolute and relative differences increase with age. The relative rate of male all cause mortality among manual class descendants at ages 25-29 compared with that of upper non-manual class descendants is 1.60 (95% CI 1.37, 1.86). At ages 30-34 the relative rate among males is 1.95 (95 % CI 1.58, 2.42) and among females 1.47 (95% CI 1. 03, 2.10). Among males alcohol related causes of death account for 70% of the excess mortality of sons of manual class parents compared with sons of upper non-manual class parents at ages 25-34. At ages 25-34, both among females and males, the contribution of diseases to the mortality difference increases. CONCLUSIONS: Parental social class has an impact on mortality after childhood mainly through health related behaviours and lifestyles up to age 34.     

Physical activity from childhood to adulthood: a 21-year tracking study

BACKGROUND: The aim of this study was to investigate stability of physical activity from childhood and adolescence to adulthood in multiple age cohorts, and analyze how well adult physical activity can be predicted by various physical activity variables measured in childhood and adolescence. METHODS: The data were drawn from the Cardiovascular Risk in Young Finns Study. The study was started in 1980, when cohorts of randomly sampled boys and girls aged 3, 6, 9, 12, 15, and 18 years (total of 2309 subjects) were examined for the first time. The measurements were repeated in 1983, 1986, 1989, 1992, and 2001. In 2001, the subjects (n =1563, 68%) were aged 24, 27, 30, 33, 36, and 39 years, respectively. Physical activity was measured by means of a short self-report questionnaire that was administered individually in connection with a medical examination. On the basis of a questionnaire, a physical activity index (PAI) was calculated. There were no significant differences in the 1980 PAI between participants and dropouts in 2001. RESULTS: Spearmans rank order correlation coefficients for the 21-year tracking period varied from 0.33 to 0.44 in males, and from 0.14 to 0.26 in females. At shorter time intervals the correlation was higher. On average, the tracking correlation was lower in females than in males. Persistent physical activity, defined as a score in the most active third of the PAI in two or three consecutive measurements, increased the odds that an individual would be active in adulthood. Odds ratios for 3-year continuous activity versus continuous inactivity varied from 4.30 to 7.10 in males and 2.90 to 5.60 in females. The corresponding odds ratios for 6-year persistence were 8.70 to 10.80 and 5.90 to 9.40. CONCLUSIONS: It was concluded that a high level of physical activity at ages 9 to 18, especially when continuous, significantly predicted a high level of adult physical activity. Although the correlations were low or moderate, we consider it important that school-age physical activity appears to influence adult physical activity, and through it, the public health of the general population.     

Utility of childhood BMI in the prediction of adulthood disease: comparison of national and international references

OBJECTIVE: To determine whether the U.S. Centers for Disease Control and Prevention (CDC; CDC Reference) or International Obesity Task Force (IOTF; IOTF Reference) BMI cut-off points for classifying adiposity status in children are more effective at predicting future health risk. RESEARCH METHODS AND PROCEDURES: The sample (N=1709) included 4- to 15-year-old (at baseline) boys and girls from the Bogalusa Heart Study. Overweight and obesity status were determined using both the CDC Reference and IOTF Reference BMI cut-off points at baseline. The ability of childhood overweight and obesity, determined from the two BMI classification systems, to predict obesity and metabolic disorders in young adulthood (after a 13- to 24-year follow-up) was then compared. RESULTS: Independently of the classification system employed to determine adiposity based on childhood BMI, the odds of being obese and having all of the metabolic disorders in young adulthood were significantly (p<0.05) higher in the overweight and obese groups by comparison with the nonoverweight groups. Childhood overweight and obesity, determined by both the CDC Reference and IOTF Reference, had a low sensitivity and a high specificity for predicting obesity and metabolic disorders in young adulthood. Overweight and obesity as determined by the CDC Reference were slightly more sensitive and slightly less specific than the corresponding values based on the IOTF Reference. DISCUSSION: Overweight and obesity during childhood, as determined by both the CDC and IOTF BMI cut-off points, are strong predictors of obesity and coronary heart disease risk factors in young adulthood. The differences in the predictive capacity of the CDC Reference and IOTF Reference are, however, minimal.     

Racial differences in access to kidney transplantation

Previous work has documented large differences between black and white populations in overall kidney transplantation rates and in transplantation waiting times. This article examines access to transplantation using three measures: time from renal failure to transplant; time from renal failure to wait listing; and time from wait listing to transplantation. This study concludes the following First, no matter what measure of transplant access is used, black end stage renal disease (ESRD) beneficiaries fare worse than white, Asian-American, or Native American ESRD beneficiaries. Second, because the rate of renal failure exceeds the number of cadaver organs, access to kidney transplantation will deteriorate in future years for all races.     

The contribution of childhood circumstances, current circumstances and health behaviour to educational health differences in early adulthood

Background  

The life course approach emphasises the contribution of circumstances in childhood and youth to adult health inequalities. However, there is still a lot to know of the contribution of living conditions in childhood and youth to adult health inequalities and how later environmental and behavioural factors are connected with the effects of earlier circumstances. This study aims to assess a) how much childhood circumstances, current circumstances and health behaviour contribute to educational health differences and b) to which extent the effect of childhood circumstances on educational health differences is shared with the effects of later living conditions and health behaviour in young adults.     

Racial differences in access to high-quality cardiac surgeons

OBJECTIVES: Racial differences in access to cardiac artery bypass graft (CABG) surgery are well documented. This study extends the literature by examining racial differences in access to high-quality cardiac surgeons. METHODS: The analyses included 11,296 CABG surgeries in New York State in 1996. Regression techniques were used to identify significant associations between a patient's race, health maintenance organization (HMO) enrollment, and the quality of the surgeon performing the surgery, measured by the surgeon's risk-adjusted mortality rate (RAMR). RESULTS: Non-Whites were more likely than Whites to have access to surgeons of higher RAMR, by 11.7% among HMO enrollees (1-tailed P < .1) and by 5.4% among fee-for-service enrollees (1-tailed P < .05). CONCLUSIONS: Even when racial minorities do gain access to CABG services, they are more likely that non-Whites to receive care from lower-quality providers.     

Racial differences in women's desires to be thin

The goal of this research was to attempt to understand why white women are more prone to develop eating disorders than black women. Using self-reports, we found that white women chose a significantly thinner ideal body size than did black women, and expressed more concern than black women with weight and dieting. White women also experienced greater social pressure to be thin than did black women. White men indicated less desire than black men to date a woman with a heavier than ideal body size, and white men felt they would more likely be ridiculed than did black men if they did date a woman who was larger than the ideal. The results suggest that black women experience eating disorders less than white women at least in part because they experience less pressure to be thin. © 1995 by John Wiley & Sons, Inc.     

Racial inequalities in childhood asthma

Mortality and hospital admission rates for asthma are higher in Maoris and Pacific Islander children than in European children. These ethnic differences are not explained by ethnic differences in asthma prevalence, the characteristics of the disease or admission criteria. There are major ethnic differences in asthma drug management both in the community and at the time of discharge from hospital. In particular Polynesians were less likely to receive prophylactic therapy and this factor probably accounts for ethnic differences in mortality and admission rates. Possible explanations for the ethnic differences in medical management are discussed.     

Racial differences in illness behavior

Using data on 359 white and 126 black respondents who were interviewed in their home as part of an omnibus health care study in a rural southern county during 1978, the illness behavior (i.e., dentist, physician, and hospital utilization measures) of blacks and whites are compared and contrasted. Zero-order racial differences in illness behavior disappeared after controlling for the predisposing, enabling, and need characteristics identified in Andersen's generic access model. Further multivariate analysis, however indicates that while there are no racial differences in illness behavior after the predisposing, enabling, and need characteristics of the individual are taken into consideration, there are significant differences between blacks and whites in the effects of these characteristics, at least in terms of discretionary health services utilization. This provides some support for recent speculation that blacks might respond differently than whites regarding the use of and access to health services because of separate cultural traditions.Dr. Wolinsky is Associate Professor in the Department of Hospital and Health Care Administration, and Director of the Doctoral Program in Health Services Research, Center for Health Services Education and Research, Saint Louis University Medical Center.This research was suported in part by grants from the Eastern Carolina Health Systems Agency, the East Carolina University School of Medicine, and the East Carolina University Department of Sociology and Anthropology.The author thanks Marty E. Zusman, who directed the larger Health Care Study from which these data are taken, and Douglas E. Hough, William D. Marder, and Barbara A. Corry, whose comments and suggestions improved this paper. The views expressed in this paper are those of the author and do not necessarily represent the official position or policy of any of the above mentioned institutions.     

Racial differences in tamoxifen metabolism

PURPOSE: A recent study indicates that black women may have a higher risk/benefit ratio from tamoxifen than white women. Several reports in the literature indicate that racial differences in the risks/benefits from other pharmaceutical agents may be partially due to racial differences in drug metabolism. Thus, we explore the hypothesis that the racial difference in the tamoxifen risk/benefit ratio may be due, in part, to racial differences in tamoxifen metabolism.METHODS: We conducted a pilot study in which we recruited 6 white and 4 black breast cancer patients from the Baltimore, Maryland area. All patients were taking tamoxifen for at least 30 days. Each provided a blood sample that was used to measure tamoxifen metabolites by high performance liquid chromatography.RESULTS: Our results indicate that the black women had significantly higher levels of the tamoxifen metabolite, N-desmethyltamoxifen (N-DMT) than the white women (0.585 μg/ml vs 0.199 μg/ml, p < 0.05). There were no differences in the serum levels of tamoxifen in black and white women (0.809 vs 0.699, p > 0.1).CONCLUSIONS: These data suggest that both black and white breast cancer patients reach steady state tamoxifen levels, but that black women are more likely to metabolize tamoxifen to N-DMT or to maintain higher levels of N-DMT (i.e., less excretion of N-DMT) than white women. N-DMT is thought to be less effective in breast cancer treatment than tamoxifen. N-DMT also has been associated with excess proliferation in breast cancer cells. Thus, it is possible that the relatively high tamoxifen risk/benefit in black women occurs because tamoxifen is readily converted to N-DMT in black women, but not in white women. Although the data reported here are from a pilot study, it is important to note that significant racial differences in tamoxifen metabolism were observed with only a few participants. We urge other investigators to confirm these findings using a large population of breast cancer patients.     

Racial differences in abortion-seeking.

This retrospective analysis of 772 abortion patients' files revealed differential referral sources for Black and white patients—a differential that was also found to exist in the length of gestation at the time of the abortion. Black patients were more likely than white patients to have a later and more costly procedure. This difference was maintained regardless of referral source or income level. Some speculative comments are offered with respect to this racial difference in abortion-seeking.     

Racial/ethnic differences in children's access to care

OBJECTIVES: This study explored reasons for racial and ethnic differences in children's usual sources of care. METHODS: Data from the 1996 Medical Expenditure Panel Survey were examined by means of logistic regression techniques. RESULTS: Black and Hispanic children were substantially less likely than White children to have a usual source of care. These differences persisted after control for health insurance and socioeconomic status. Control for language ability, however, eliminated differences between Hispanic and White children. CONCLUSIONS: Results suggest that the marked Hispanic disadvantage in children's access to care noted in earlier studies may be related to language ability.     

Racial, ethnic, and gender differences in smoking cessation associated with employment and joblessness through young adulthood in the US

The dynamics of labor force participation and joblessness during young adulthood influence access to social and material resources and shape exposure to different sources of psychosocial strain. Differences in these dynamics by race, ethnicity, and gender are related to changes in a behavioral determinant of poor health (tobacco use) for young adults aging into midlife. Using discrete-time hazards models, we estimate the relationship between labor force participation in the past year and smoking cessation for US adults (ages 14-21 years in 1979) followed in a population-representative sample until 1998 (i.e. the National Longitudinal Survey of Youth). We assess the unique role of racial, ethnic and gender differences in exposure, vulnerability, and reactivity to employment and joblessness by controlling for social and economic resources obtained through working and by controlling for early life factors that select individuals into certain labor force and smoking trajectories. There are three main findings: (1) joblessness is more strongly associated with persistent daily smoking among women than among men; (2) fewer social and economic resources for women out of the labor force compared to employed women explains their lower cessation rates; and (3) lower cessation among unemployed women compared to employed women can only partially be explained by these resources. These findings illustrate how differential access to work-related social and economic resources is an important mediator of poor health trajectories. Contextual factors such as social norms and psychosocial strains at work and at home may play a unique role among European American men and women in explaining gender differences in smoking.     

Racial differences in Urban children's environmental exposures to lead.

OBJECTIVES: This study explored whether differences in environmental lead exposures explain the racial disparity in children's blood lead levels. METHODS: Environmental sources of lead were identified for a random sample of 172 urban children. RESULTS: Blood lead levels were significantly higher among Black children. Lead-contamination of dust was higher in Black children's homes, and the condition of floors and interior paint was generally poorer. White children were more likely to put soil in their mouths and to suck their fingers, whereas Black children were more likely to put their mouths on window sills and to use a bottle. Major contributors to blood lead were interior lead exposures for Black children and exterior lead exposures for White children. CONCLUSIONS: Differences in housing conditions and exposures to lead-contaminated house dust contribute strongly to the racial disparity in urban children's blood lead levels.