The “Long-arm” of chronic conditions in childhood: Evidence from Canada using linked survey-administrative data

The objective of this study was to investigate the relationship between health conditions in childhood (ages 4–11), and health and socioeconomic outcomes in adulthood (ages 21–33). This study takes advantage of a new linkage between the National Longitudinal Survey of Children and Youth (NLSCY) and administrative tax data from the T1 Family File (T1FF) from Statistics Canada. The NLSCY includes rich longitudinal information on child development, while the T1FF includes administrative tax information on each child in adulthood (e.g., income, social assistance). The primary measures of child health relate to the diagnosis of a chronic condition, affecting the child’s physical or mental/developmental health. The results suggest that mental/developmental health conditions in childhood more negatively influence adult health and socioeconomic conditions, compared to physical health conditions. Interaction models reveal modest heterogenous effects; for example, there is some evidence of a cushioning effect from higher household income in childhood, as well as an exacerbating negative effect from lower birth weight for mental/developmental health conditions. Using a covariate decomposition approach to explore underlying pathways, the results reveal that associations between health in early life and outcomes in adulthood are partially explained by differences in cognitive skills (i.e., mathematics test scores) in adolescence (ages 16–17). Results may encourage policy investments to mitigate the occurrence of health conditions in childhood and to ensure timely access to educational supports and health services for children with chronic conditions.     

Height, health, and income in the US, 1984–2005

Height has been associated with better physical health when outcomes such as diabetes, heart disease, and obesity are considered, yet stature is rarely used in predicting comorbidities or as a proxy for physical health when analyzing outcomes such as income. Since height is a more exogenous measure than variables likely to be affected by lifestyle changes, such as obesity, observing labor market outcomes based on height may be revealing. In addition, gender and racial differences must be taken into account when analyzing the effects of height on physical health and labor market outcomes. This study utilizes the 1984--2005 samples of the Behavioral Risk Factor Surveillance System in estimating trends in height over time by gender and race, and in analyzing the relationship between height and physical health and labor market outcomes in the United States. Trends show that height has not changed substantially at a time when physical health, as indicated by the incidence of obesity, Type II diabetes, and cholesterol, has deteriorated, and earnings disparities across racial gaps persist. Results at mean values for males indicate that being 10cm taller is associated with a 14-47% increase in obesity, an 8-13% reduction in cholesterol prevalence, and a $1874-2306 income premium. For females, results indicate that being 10cm taller is associated with an 8-18% reduction in cholesterol, a 14% reduction in diabetes for white females, and an $891-2243 earnings premium.     

Socioeconomic status during childhood and health status in adulthood: the Wrocław growth study

It has been widely observed that socioeconomic status (SES) is associated with frequency of cardiovascular disease. Both men and women of low socioeconomic position have increased risk of cardiovascular disease morbidity and premature death. In this study the relationship between SES in childhood, and health status at the age of 50 years was examined. Socioeconomic status in childhood was measured using objective (father's educational level and number of children in the family) and subjective (self-assessed SES in childhood declared in early adulthood) indicators. Data from the Wroclaw Growth Study were completed when subjects were 50 years old, and information concerning health status was added. The results indicated that the objective, universally used measures of SES in childhood such as father's educational level and size of family did not show any essential relationships with health outcomes in adulthood, both for men and women. By contrast, retrospective, self-assessed SES (as better, average or worse as compared with peers) in childhood was significantly associated with the appearance of cardiovascular disease among women aged 50 years. Women who at the beginning of their adult life declared better socioeconomic condition in childhood were significantly healthier at the age of 50 years (OR=3.43; p=0.02). Moreover, this appeared to be independent of BMI, SES and life-style in adulthood. For men, retrospective self-assessed SES showed no relation to health status at the age of 50 years. The gender differences in the relationships between self-assessed SES in childhood and health status in adulthood are explained by possible selective premature mortality among men from lower childhood SES and/or sex differences in cognitive abilities.     

Prevention and treatment of type 2 diabetes in youth

Parallel to the increase in obesity worldwide, there has been a rise in the prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents. The etiology of T2DM in youth, similar to adults, is multifactorial including genetic and environmental factors, among them obesity, sedentary lifestyle, family history of the disease, high-risk ethnicity and insulin resistance phenotype playing major roles. Treatment of T2DM should not have a glucocentric approach; it should rather target improving glycemia, dyslipidemia, hypertension, weight management and the prevention of short- and long-term complications. Prevention strategies, especially in high-risk groups, should focus on environmental change involving participation of families, schools, the food and entertainment industries and governmental agencies. Presently, limited pharmacotherapeutic options need to be expanded both for childhood T2DM and obesity. The coming decades will prove very challenging for healthcare providers battling socioeconomic waves conducive to obesity and T2DM. Evidence-based research and clinical experience in pediatrics, possibly modeled after adult trials, need to be developed if this public health threat is to be contained.     

The Humanistic Burden of Type 1 Diabetes Mellitus in Europe: Examining Health Outcomes and the Role of Complications

AimsDiagnoses of Type 1 Diabetes Mellitus (T1DM) in Europe appear to be on the rise. Therefore it is imperative that researchers understand the potential impact that increases in prevalence could have on the affected individuals as well as on society as a whole. Accordingly this study examined the humanistic and economic burden of T1DM in patients relative to those without the condition across a number of health outcomes including health status, work productivity loss, activity impairment, and healthcare resource use.MethodsSurvey data from a large, representative sample of EU adults (The EU National Health and Wellness Survey) were examined.ResultsResults suggest that overall burden is higher for those diagnosed with T1DM than respondents without diabetes and that burden increases as complications associated with T1DM increase.ConclusionsTaken together, these results suggest that treatment strategies for T1DM should balance clinical, humanistic, and economic burden and patients should be educated on the role of complications in disease outcomes.     

The relationship between early-life conditions in the home country and adult outcomes among child immigrants in the United States

We examine the impact of health and economic conditions at birth on the adult outcomes of child immigrants using the Children of Immigrants Longitudinal Study. Our sample consists of children from 39 countries who were brought to the United States before the age of 13. We estimate immigrant outcomes as a function of the infant mortality rate (IMR) and GDP per capita of their home country in the year of birth, controlling for birth-year, year-of-arrival and country-of-birth fixed effects, as well as demographic characteristics. IMR has a significant negative impact on English reading ability and GPA in middle school. IMR significantly decreases first job prestige, years of schooling, working hours and log earnings. Some of these effects appear to be working through the lower middle school GPA. IMR does not influence self-rated health or labor market participation in adulthood, and there is no statistically significant relationship between GDP per capita and adult outcomes. Detrimental effects of IMR are significantly lower for children who arrived younger and whose parents have high school degree or above. Our estimates are of economic significance: the impact of being born in 1975 versus 1976 in Nicaragua in terms of the impact of IMR on earnings is equal to the gender effect on earnings. Our results cannot be explained by selection on observables: the pre-migration characteristics of children and parents are not associated significantly with the health and economic conditions at birth. Also, several tests show that our results cannot be explained by potential selection on unobservables.     

Stature and long-term labor market outcomes: Evidence using Mendelian randomization

We use the Young Finns Study (N = ∼2000) on the measured height linked to register-based long-term labor market outcomes. The data contain six age cohorts (ages 3, 6, 9, 12, 15 and 18, in 1980) with the average age of 31.7, in 2001, and with the female share of 54.7. We find that taller people earn higher earnings according to the ordinary least squares (OLS) estimation. The OLS models show that 10 cm of extra height is associated with 13% higher earnings. We use Mendelian randomization, with the genetic score as an instrumental variable (IV) for height to account for potential confounders that are related to socioeconomic background, early life conditions and parental investments, which are otherwise very difficult to fully account for when using covariates in observational studies. The IV point estimate is much lower and not statistically significant, suggesting that the OLS estimation provides an upward biased estimate for the height premium. Our results show the potential value of using genetic information to gain new insights into the determinants of long-term labor market success.     

Socioeconomic status dependent medical complexities in children with sickle cell disease in Saudi Arabia

A look into the associations of socioeconomic status (SES) with prevalence of various complications in sickle cell disease (SCD) is necessary, for an improvement of societal norms, governmental health policies and strategies. We therefore studied the influence of SES indices on certain hematological and clinical parameters in children with SCD in Saudi Arabia. We included 32 female and 33 male patients aged 5–16 years, who were classified based upon their family income. Family monthly income was divided into 4 categories from lowest to highest, with socioeconomic class1 having low earnings of <5000 SAR; the middle income class divided further into class 2 with earnings >5000–10,000 SAR, and class 3 with earnings >10,000–15,000 SAR; and the higher income class 4 with earnings of >15,000 SAR. The assessment indices used were, the frequency of vaso-occlusive crisis (VOC), adverse events, and hematological parameters. A higher percentage of children affected with the disease were from class1, which is the low socio-economic class. It was found that the percentage of frequency of VOC pain crisis, and adverse events was higher in social class 1 patients than in the classes 2, 3, and 4. Also, the age group 5–10 years appeared more susceptible to adverse events and VOC. Our findings suggest the need to conduct future larger studies, to deduce the modifying influence of disparity in SES on certain clinical and hematological indices in children with SCD.     

The influence of early conditions on health status among elderly Puerto Ricans

The demographic origins of aging in Puerto Rican and other Latin American and Caribbean (LAC) countries may have important implications for the profile of health status and mortality of elderly people. For this article we tested a general conjecture about the relation between early childhood conditions and adult health status among Puerto Rican elderly using a rich data set recently collected through an island-wide survey (N = 4,293). We examined the association between markers of early nutritional status, self-reports of health and on socioeconomic conditions during early childhood, and the prevalence of 3 conditions during adult ages: obesity, diabetes, and cardiovascular diseases. Although we found that obesity and diabetes are associated with markers of early malnutrition, that heart disease is associated with early deprivations and selected early childhood conditions, the evidence we were able to tease out from the data provides only fragile support for the conjecture.     

The public health implications of maternal care trade-offs

The socioeconomic and ethnic characteristics of parents are some of the most important correlates of adverse health outcomes in childhood. However, the relationships between ethnic, economic, and behavioral factors and the health outcomes responsible for this pervasive finding have not been specified in child health epidemiology. The general objective of this paper is to propose a theoretical approach to the study of maternal behaviors and child health in diverse ethnic and socioeconomic environments. The specific aims are: (a) to describe a causal pathway between the utility that women obtain through work outside the home and through child care and disease hazard rates in childhood using an optimization model; (b) to specify the influence of ethnic and socioeconomic factors on model constraints; (c) to use the model as a tool to learn about how different combinations of maternal wage labor and child care time might influence child health outcomes in diverse social contexts; (d) to identify parameters that will require measurement in future research; (e) to discuss research strategies that will enable us to obtain these measurements; and (f) to discuss the implications of the model for biostatistical modeling and public health intervention. Optimization models are powerful heuristic tools for understanding how ethnic, environmental, family, and personal characteristics can place important constraints on both the quality and quantity of care that women can provide to their children. They provide a quantitative appreciation for the difficult trade-offs that most women face between working in order to purchase basic goods that children cannot do without (e.g., food, clothing, shelter, health insurance), and increasing offspring well-being through child care (e.g., training in social skills, affection, protection from environmental hazards, help with homework). The research was funded by a Faculty Scholars Award from the William T. Grant Foundation to A. Magdalena Hurtado. A. Magdalena Hurtado, Ph.D., is an associate professor in the Department of Anthropology, University of New Mexico. Her research interests include the origins of the sexual division of labor, epidemiology of indigenous peoples, disease susceptibility, the development and intergenerational transmission of antigens and immune defense, immune function and allergic sensitization, and trauma. She also works on public health interventions, biological capital and poverty, and land tenure and human rights in native communities of South America. Carol Lambourne, M.Sc., is a doctoral candidate in the Department of Anthropology, University of New Mexico. Her research interests are evolutionary models of child and adolescent development, life history theory, family composition and investment patterns, pubertal timing and psychosexual maturation, juvenile stress, and infanticide. Kim Hill, Ph.D., is a professor in the Department of Anthropology, University of New Mexico. His research interests are modern hunter-gatherers, including extensive fieldwork in lowland South America. Current topics of interest include human evolution, economic strategies, life history theory, the evolution of cooperation, and the emergence of social norms enforced by punishment. He is also involved in economic development, health and education projects with lowland South American native populations. Karen Kessler received her M.S. in Anthropology from the University of New Mexico in 1996. Her research interests are the application of mathematical modeling to the prevention of diabetes and other causes of morbidity and mortality in historical populations.     

Socioeconomic status, height, and obesity in children

The substantial increase in the prevalence of child obesity over recent decades and its association with a number of negative health and economic outcomes suggests its strong potential as an influence on the lifecourse development of health and productivity. This paper evaluates interactive effects between family socioeconomic status (SES) and height on child obesity in the United States. Using the 1999-2006 National Health and Nutrition Examination Surveys (NHANES), the results of this paper confirm previous findings that taller children exhibit greater propensity towards obesity as measured by body mass index (BMI) and that obesity is inversely related to family SES as measured by poverty status. The analysis adds to the existing literature by showing that the magnitude of the SES-obesity association is larger in taller children. Age and sex patterns are evaluated that suggest the SES-height interaction persists through childhood and adolescence in males but is only evident in females during adolescence. Interaction effects are also shown to be most evident in white males and Hispanic females. Policy implications are discussed and directions for future work are suggested.     

Does obesity influence labour market outcomes among working-age adults? Evidence from Canadian longitudinal data

Although a negative association between obesity and labour market outcomes is commonly reported in many studies, the causal nature of this relationship remains unclear. Using nationally representative longitudinal data from the last six confidential master files (2000/2001–2010/2011) of the National Population Health Survey, we examine the association between obesity and employment participation and earnings among working-age adults in Canada. After controlling for demographic and socioeconomic characteristics, lifestyle factors and time-invariant individual heterogeneity, our results show that obesity is not significantly associated with employment participation but is associated with reduced hourly wage rate and annual income among women by about 4% and 4.5%, respectively. The corresponding results for men show that obesity is associated with about 2% reduction in wage rate and income, but significant at 10% level. However, after controlling for the potential reverse causality bias using the lagged measure of obesity, the effect of obesity on wage rate and income became positive or statistically non-significant. Our findings suggest that obesity is not causally associated with negative labour market outcomes among working-age men in Canada. For working-age women, we find limited evidence of negative labour market outcomes.     

Immigration and the cost of ethnic subordination: the case of Israeli society

This study focuses on earnings disadvantages experienced by three ethnic groups of Jewish immigrants in Israel. Data were obtained from the 2011 Income Survey gathered by the Israel Central Bureau of Statistics. The findings reveal that when compared to Israeli-born, all ethnic groups are disadvantaged in earnings attainment in the first generation. The earnings disadvantages of immigrants as compared to Israeli-born decrease with the passage of time and become negligible in the second generation. To disentangle the impact on earnings penalty of ethnic origin from that of immigrant status, a procedure for decomposing mean differences between groups is introduced. The analysis reveals that earnings disadvantage among Ashkenazim and Soviet immigrants can be attributed to immigrant status but not to ethnicity. By contrast, earnings penalties among Sephardim immigrants can be attributed to both ethnicity and immigrant status. The implications of the long-lasting effect of ethnicity versus the short-term effect of immigrant status are discussed.     

The influence of early conditions on health status among elderly Puerto Ricans

Abstract

The demographic origins of aging in Puerto Rican and other Latin American and Caribbean (LAC) countries may have important implications for the profile of health status and mortality of elderly people. For this article we tested a general conjecture about the relation between early childhood conditions and adult health status among Puerto Rican elderly using a rich data set recently collected through an island‐wide survey (N=4,293). We examined the association between markers of early nutritional status, self‐reports of health and on socioeconomic conditions during early childhood, and the prevalence of 3 conditions during adult ages: obesity, diabetes, and cardiovascular diseases. Although we found that obesity and diabetes are associated with markers of early malnutrition, that heart disease is associated with early deprivations and selected early childhood conditions, the evidence we were able to tease out from the data provides only fragile support for the conjecture.     

Periodontal Disease in Type 1 Diabetes Mellitus: Influence of Pubertal Stage and Glycemic Control

ObjectiveThough gingivitis is common in children with type 1 diabetes mellitus (T1DM), the overall periodontal health in T1DM during the pubertal stage is less well-characterized. The study was undertaken to explore the possible influence of puberty and metabolic derangement on periodontal health in T1DM.MethodsIn this cross-sectional study, 110 subjects between 10-18 years with T1DM and 52 healthy siblings of similar age were evaluated for pubertal stage, glycosylated hemoglobin (HbA1c), and periodontal health. Simplified oral hygiene index (OHIS), gingival index (GI), plaque index (PI), bleeding on probing (BOP), and probing depth (PPD) were evaluated at 4 sites per tooth as per 6 Ramfjord index teeth used to assess periodontal disease (PD).ResultsPD not merely gingivitis was significantly higher in T1DM (84/110, 76.36%) than the control group (28/52, 53.8%) (P = .004). Irrespective of pubertal status, children with T1DM had worse GI, PI, BOP, and PPD than nondiabetic subjects, although OHIS was better in diabetes. In both T1DM and nondiabetic subjects, pubertal subjects showed significantly worse OHIS, PPD, BOP, and GI than prepubertal subjects. PD was correlated with pubertal stage, age, and HbA1c, although less strongly with the duration of diabetes. In logistic regression, pubertal stage was a stronger predictor of PD (OR = 14.26) than age (OR = 2.22), and HbA1c (OR = 1.5) rather than the presence of diabetes and its duration.ConclusionsThough pubertal status, age, and poor glycemic control rather than the presence of diabetes and its duration are associated with gingivitis and other forms of PD, puberty had a more profound effect in the pathogenesis of PD in T1DM.     

Deterioration of plasticity and metabolic homeostasis in the brain of the UCD-T2DM rat model of naturally occurring type-2 diabetes

The rising prevalence of type-2 diabetes is becoming a pressing issue based on emerging reports that T2DM can also adversely impact mental health. We have utilized the UCD-T2DM rat model in which the onset of T2DM develops spontaneously across time and can serve to understand the pathophysiology of diabetes in humans. An increased insulin resistance index and plasma glucose levels manifested the onset of T2DM. There was a decrease in hippocampal insulin receptor signaling in the hippocampus, which correlated with peripheral insulin resistance index along the course of diabetes onset (r = − 0.56, p < 0.01). T2DM increased the hippocampal levels of 4-hydroxynonenal (4-HNE; a marker of lipid peroxidation) in inverse proportion to the changes in the mitochondrial regulator PGC-1α. Disrupted energy homeostasis was further manifested by a concurrent reduction in energy metabolic markers, including TFAM, SIRT1, and AMPK phosphorylation. In addition, T2DM influenced brain plasticity as evidenced by a significant reduction of BDNF–TrkB signaling. These results suggest that the pathology of T2DM in the brain involves a progressive and coordinated disruption of insulin signaling, and energy homeostasis, with profound consequences for brain function and plasticity. All the described consequences of T2DM were attenuated by treatment with the glucagon-like peptide-1 receptor agonist, liraglutide. Similar results to those of liraglutide were obtained by exposing T2DM rats to a food energy restricted diet, which suggest that normalization of brain energy metabolism is a crucial factor to counteract central insulin sensitivity and synaptic plasticity associated with T2DM.     

Entry Body Mass and Earnings: Once Penalized,Ever Penalized?

It has previously been reported that an individual’s body mass index (BMI) contemporaneously penalizes wages for women, but has no effect and sometimes rewards wages for men. In young adults, we estimate the association of BMI status with initial wages to assess whether initial BMI at the beginning of an individual’s career affects initial and later earnings. We pooled data from 388 men and 305 women, aged 20–40 years, with BMI information for the first year of employment, using the Korean Labor and Income Panel Study. A labor market penalty for a higher BMI among women was found only for overweight or obese segments, particularly those with relatively higher monthly wages. Meanwhile, a higher BMI in underweight or normal weight segments could reward employment probability for women and monthly wages for men. Such rewards of relatively higher monthly wages were also estimated for men in the overweight segment. Our findings suggest discrimination as one factor penalizing higher BMI in the labor market.     

Relative Contributions of Geographic,Socioeconomic, and Lifestyle Factors to Quality of Life,Frailty, and Mortality in Elderly

Background

To date, few studies address disparities in older populations specifically using frailty as one of the health outcomes and examining the relative contributions of individual and environmental factors to health outcomes.

Methodology/Principal Findings

Using a data set from a health survey of 4,000 people aged 65 years and over living in all regions of Hong Kong, we examined regional variations in self-rated health, frailty, and four-year mortality, and analyzed the relative contributions of lifestyle, socioeconomic status, and geographical location of residence to these outcomes using path analysis. We hypothesize that lifestyle, socioeconomic status, and regional characteristics directly and indirectly through interactions contribute to self-rated physical and psychological health, frailty, and four-year mortality.District variations directly affect self-rated physical health, and also exert an effect through socioeconomic position as well as lifestyle factors. Socioeconomic position in turn directly affects self-rated physical health, as well as indirectly through lifestyle factors. A similar pattern of interaction is observed for self-rated mental health, frailty, and mortality, although there are differences in different lifestyle factors and district associations. Lifestyle factors also directly affect physical and mental components of health, frailty, and mortality. The magnitude of direct district effect is comparable to those of lifestyle and socioeconomic position.

Conclusions/Significance

We conclude that district variations in health outcomes exist in the Hong Kong elderly population, and these variations result directly from district factors, and are also indirectly mediated through socioeconomic position as well as lifestyle. Provision and accessibility to health services are unlikely to play a significant role. Future studies on these district factors would be important in reducing health disparities in the older population.     

Weight Status Continuity and Change From Adolescence to Young Adulthood: Examining Disease and Health Risk Conditions

This study examined weight status during adolescence and young adulthood, and young adult health condition diagnosis. Data are from 10,439 African‐American, Hispanic, and white men and women participating in the National Longitudinal Study of Adolescent Health during Waves 1 (adolescence: ages 12–19) and 3 (young adulthood: ages 19–26). Categories were created differentiating individuals based on their weight status during adolescence and young adulthood: (i) obese during adolescence and young adulthood (i.e., continuously obese), (ii) obese during adolescence only, (iii) obese during young adulthood only, and (iv) never obese. Multilevel random intercept regression models were used to examine the impact of obesity category, sex, and race/ethnicity on young adult asthma, diabetes, high cholesterol, and high blood pressure. Continuous obesity increased the likelihood for young adult disease and health risk conditions compared to individuals who were never obese. Obesity isolated to adolescence (Wave 1) increased the likelihood for high cholesterol and high blood pressure, whereas obesity isolated to young adulthood (Wave 3) also increased the likelihood for diabetes—all increases were relative to nonobese weight status during both periods. Associations varied in direction and degree when sex and race/ethnicity were considered. Findings clarify some of the mixed understandings regarding the associations between age of onset and stability of obesity, and health outcomes with important public health implications. Although results indicate obesity isolated to a single developmental period does have health repercussions, obesity experienced continuously during adolescence and young adulthood greatly intensified risk across all health conditions.     

Early socioeconomic status,social mobility and cognitive trajectories in later life: A life course perspective

Using the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2008 to 2018 accompanied by the growth curve model, we examined the association between early socioeconomic status, social mobility, and divergent cognitive trajectories in later life within a society undergoing significant transformation. The study confirmed a positive relationship between socioeconomic status in early life and cognitive ability in later life. However, socioeconomic status in adulthood is associated with better cognitive ability in old age compared to that in childhood. Meanwhile, upward social mobility mitigates the negative correlation between socioeconomic disadvantage in early life and cognitive ability in later life. In addition, the inequality in socioeconomic status at earlier stages resulted in heterogeneous cognitive trajectories, with the double cumulative disadvantage effect resulting from education being particularly noteworthy. Thus, Chinese health policy should focus on the earlier stages of life, actively promoting inclusive family policies and improving the family's role in protecting childhood from an adverse environment. Simultaneously, education and employment fairness should be strengthened to accelerate social mobility and enhance the “Health Repair Mechanism” of the second life course.