Regional differences in fatal drug overdose deaths among Black and White individuals in the United States, 2012-2021.

BACKGROUND AND OBJECTIVES: The current study examines regional differences in Black/White fatal drug overdoses. METHODS: Black/White overdose mortality data (2012-2021; N = 537,085) were retrieved from CDC WONDER. We used death counts and corresponding Census Bureau population estimates by the decedent's age and race/ethnicity to calculate mortality rate ratios. RESULTS: From 2012 to 2021, there were 537,085 reported overdose deaths among White (85%) and Black (15%) individuals in the United States. In the South, Black individuals had lower fatal drug overdose deaths than their same-aged White counterparts. In the Northeast, Midwest, and West regions, Black individuals had around 10%-60% lower likelihood of overdoses among younger ages (15-24, 25-34, 35-44) but about 60%-300% higher likelihood of overdoses among older adults (55-64). Increases in overdose deaths during the pandemic (2020-2021) led to changes in Black/White overdose death patterns, whereas Black individuals of all ages in the Midwest and West regions had approximately 15%-425% higher likelihood of fatal overdoses than their same-aged White counterparts. Sex-stratified analysis suggests that Black females in the South had overdose death rates around 50% lower than same-aged White females, and overdose deaths were relatively equal for Black and White females in the Midwest-patterns not seen among males. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: The findings indicate that the Black/White overdose mortality gap changed after the COVID-19 pandemic across all regions and age cohorts, with state and regional variations in magnitude. Behavioral interventions and policies to curb drug overdose deaths among populations most impacted should consider regional, sex, and age-related differences.

The Role of Substance Use Disorders on Suicidal Ideation, Planning, and Attempts: A Nationally Representative Study of Adolescents and Adults in the United States, 2020.

Few nationally representative studies examine suicidality and substance use during 2020; as such, we explored the role of substance use disorders (SUDs) on suicidality among adults and adolescents in 2020. Data were derived from N = 26,084 adult participants, representing 240 million U.S. adults weighted, and N = 5,723 adolescent participants, representing 25 million U.S. adolescents (12-17 years.). Separate logistic regressions for adults and adolescents were used to assess the association of DSM-5 SUDs, related factors, and suicidal thoughts and behaviors (ideation, planning, and attempts). In 2020, adults with SUDs were nearly 4 times more likely to seriously consider suicide (aOR = 3.94, 95% CI: 3.19, 4.86), 3 times more likely to make a suicide plan (aOR = 3.09, 95% CI: 2.25, 4.25), and nearly 4 times more likely to attempt suicide (aOR = 3.77, 95% CI: 2.29, 6.19) than adults without SUDs. Adolescents with SUDs were 4 times more likely to consider suicide (aOR = 3.69, 95% CI: 2.47, 5.51), 5 times as likely to make a suicide plan (aOR = 5.14, 95% CI: 3.25, 8.13) and to attempt suicide (aOR = 5.27, 95% CI: 2.91, 9.53) than adolescents without SUDs. Adult females and individuals experiencing poverty were twice as likely to attempt suicide than adult males and individuals not living in poverty. Adolescent females were 3-5 times more likely to seriously consider, plan, and attempt suicide than adolescent males. Interventions to curb suicidality among individuals with SUDs are crucial.

Age differences in Allostatic Load among adults in the United States by rural-urban residence.

•Rural residence is associated with allostatic load levels by age groups.•Allostatic load is higher among rural adults with the exception of the oldest age group.•Evidence of a rural-urban convergence in allostatic load levels among oldest old.•These rural disadvantages remained strong even when accounting for covariates.•The study of allostatic load can improve our understanding of rural disparities.

Serious Psychological Distress, Substance Use Disorders, and Social Issues Among Men and Women in the United States During the COVID-19 Pandemic.

PURPOSE: This study assesses the association between SUD, economic hardship, gender, and related risk and protective factors on serious psychological distress (SPD) during the COVID-19 pandemic. DESIGN: Quantitative cross-sectional design. SETTING: National Survey on Drug Use and Health (NSDUH). SAMPLE: Data were from the NSDUH (2020) N = 25,746, representing 238,677,123 US adults, who identified as 18 or older and either male or female. MEASURES: SPD measured as scoring a 13 or more on the Kessler (K6) distress scale. SUDs were determined using DSM5 criteria. Sociodemographic and socioeconomic variables included in analyses. ANALYSIS: Logistic regressions evaluated the association between gender, protective, and risk factors on SPD. RESULTS: After controlling for sociodemographic and related factors of SPD, having a SUD was the strongest correlate of SPD. Other significant correlates of SPD included female gender and an income level at or below the federal poverty threshold. Gender stratified regressions illustrated that religiosity, self-identifying as Black, and high levels of education were protective against SPD for women but not men. Poverty level was more associated with SPD for women than men. CONCLUSION: In the United States, individuals with SUDs were nearly four times more likely to report SPD than those without SUDs, controlling for economic hardship and markers of social support during 2020. Effective social interventions to reduce SPD among individuals with SUDs are needed.

Trends in Deaths From Falls Among Adults Aged 65 Years or Older in the US, 1999-2020.

This study examines trends in deaths from falls among adults aged 65 years or older by sex and by race and ethnicity between 1999 and 2020 in the US.

Implications of Spanish interviews in health surveys as collected in the United States: The case of Self-Reported Health.

This is an original investigation of self-reported health status among Hispanic adults from 1997 to 2018 in the United States (US). Previous research has shown there is a widening gap in poor/fair self-reported health between Hispanics who answer health surveys in English and those who answer in Spanish that cannot be explained by demographic/socioeconomic characteristics, assimilation or region of residence. Using data from the National Health Interview Survey (1997-2018), this study explores the patterns underlying the recent increase in self-reported health among Hispanic adults in the United States by estimating the percent of the population reporting poor/fair health status by language of interview and place of birth. Central to this study is the use of 'regular' as a translation to "fair" which has been poised to be a non-equivalent translation. This investigation reveals that the increase is highly concentrated among non-US born Hispanic adults who answer health surveys in Spanish with increase in reports of "regular" health status driving this trend. The results presented in this short communication underscore the importance of language of interview when collecting key measures of health often employed to study health disparities.

English-Spanish Gap in Poor/Fair Self-Reported Health Increased for Hispanic Adults in the United States Between 1997 and 2018.

Historically, Hispanic adults that answer health surveys in Spanish report worse health than those who answer in English. This paper documents a growing English-Spanish gap in self-reported health (SRH) among Hispanic adults in the United States between 1997 and 2018. Data are from the 1997-2018 National Health Interview Survey (NHIS). The analytic sample consisted of 189,024 Hispanic adults older than 18 with valid information for the variables considered in the study. Descriptive analyses indicate that Hispanic adults who answer the NHIS in Spanish report worse health than English respondents do across the period of analysis. Multivariable logistic regression analysis was used to study the English-Spanish gap in SRH and to track its evolution over the last 22 years. At baseline, Spanish respondents exhibited significantly worse levels of SRH than those who answered in English and this gap persisted across time and older cohorts. The gap was still present when demographic/socioeconomic characteristics and assimilation are considered. In the majority of the cases, there is a significant interaction between language of interview, and period and cohort indicators. The English-Spanish gap in self-reported health is not explained by demographic/socioeconomic characteristics or assimilation. It may be possible that there are differences in how Hispanic adults understand health categories items across different languages with differences observed depending on how self-reported health is operationalized.

Migration is the driving force of rapid aging in Puerto Rico: A Research Brief.

The combined effects of declining fertility and increased longevity have accelerated population aging in different parts of the world. Unlike other countries, Puerto Rico is also experiencing unprecedented levels of working-age out-migration. The full impact of high out-migration on Puerto Rican demography is not fully understood. Placing Puerto Rico's aging process in an international context is useful in identifying the role out-migration is having on the accelerated aging of the Puerto Rican society. Using the World Population Prospects 2019 estimates, we compared the pattern of rapid aging found for Puerto Rico with the trajectories of six other countries with the highest population of 65+ in the World, Europe, and the Caribbean from 1960 to 2020. Prior to 2010, the aging process in Puerto Rico was comparable to the other countries. After 2010, the percent of the population over 65 years in Puerto Rico nearly doubled from 11% to 21%. The nearly doubling of the percent of older adults is not observed in any of the comparison countries. We find that the rapid aging of Puerto Rico, changing from a linear trend to an exponential one, is a result of accelerating levels of out-migration, which is concentrated in the working-age population.

A longitudinal analysis of the relationship between housing insecurity and physical health among midlife and aging adults in the United States.

Rationale: A large body of work demonstrates the impact of housing instability on health by exploring the effects of evictions and homelessness on psychological wellbeing of young adults and children. However, limited research leverages national longitudinal data to examine whether and how experiences of a range of housing insecurity events, rather than just eviction or homelessness, affect physical health among midlife and older adults. Objective: The current study examines (1) prevalence of housing insecurity among midlife and older adults by age and race, (2) linkages between housing insecurity experiences and facets of physical health, and (3) age and race moderations on these effects. Method: This study employs regression models to examine whether experiences of housing insecurity affect self-rated physical health and chronic physical conditions among midlife and older adults (N = 2598) leveraging two waves of the National Study of Midlife in the United States (MIDUS). Results: Models revealed that housing insecurity experiences predicted poorer self-rated physical health and additional chronic conditions, even when controlling for previous physical health. Moderation analyses indicated that housing insecurity has a stronger relationship with chronic conditions among midlife adults as compared to older adults, and among Black adults as compared to white adults. These results suggest that experiences of housing insecurity leave adults vulnerable to compromised physical health, and that housing insecurity experiences may be particularly detrimental to the health of midlife Black adults. Conclusions: This research adds to the extant literature by introducing a comprehensive measure of housing insecurity experiences, and contributes to a life course perspective regarding how housing insecurity can affect physical health. This research has implications for policy that addresses housing insecurity as a public health concern, especially in the aftermath of the 2008 recession and the economic and housing crisis caused by the COVID-19 pandemic.

Aging and the Left Behind: Puerto Rico and Its Unconventional Rapid Aging.

Puerto Rico is aging more rapidly than almost any country, with 2020 estimates placing its population share of adults older than 65 as being the 10th highest in the world. Unlike most locales, Puerto Rico's aging is driven by both (a) the culmination of long-running fertility and mortality trends and (b) high levels of outmigration of working-age adults, which contributes both directly (removal of young people) and indirectly (reduced births) to its pace of population aging. This article offers an overview of the main issues surrounding population aging in Puerto Rico. Policymakers and government leaders must plan for Puerto Rico's unconventional population aging, which will exacerbate traditional concerns about the sustainability of government services and long-term economic prospects. Additional concerns emerge related to reduced social support networks and their impact on caregiving dynamics and implications for health. Puerto Rico's unique history and political relationship with the United States present challenges and benefits for its aging population. Research on aging in Puerto Rico and public health policies must adapt to the needs of the country's aging society.

A general pattern of health erosion in the United States? An examination of self-reported health status from 1997 - 2018.

Purpose: Recent research has found a general pattern of health erosion in self-assessed pain and allostatic load among adults in the United States (US). It remains to be determined if self-reported health status, hereafter SRH, also follows this pattern. The aim of this study was to examine whether a general pattern of health erosion is found in SRH among adults in the United States (US). Methods: Data from the National Health Interview Survey 1997-2018 were used to study sex, educational attainment, and racial/ethnic patterns in SRH by age, period and cohort among adults in the US. The analytic sample consisted of respondents aged 18 years or older at the moment of interview with valid information in the age, sex, education, race/ethnicity and health status question (n = 669,501). Estimates for the percent population reporting poor/fair health were produced by age, period and cohort to study trends in health status by sex, educational attainment and race/ethnicity. All estimates were weighted to account for complex survey design. Results: No discernible pattern of health erosion, or improvement, is observed in the age, period or cohort analyses of the percent of the population reporting poor/fair SRH by sex, educational attainment or race/ethnicity. Conclusions: The analysis indicates that self-reported health does not follows the general pattern of health erosion found in self-assessed pain and allostatic load in the US. The percent of the population reporting poor/fair health status has remained relatively stable between 1997 and 2018. Further research is required to determine whether self-reported health is an appropriate metric to track population health in the US.

The 2020 US Census Differential Privacy Method Introduces Disproportionate Discrepancies for Rural and Non-White Populations.

The recently finalized changes to the disclosure avoidance policies of the U.S. Census Bureau for the 2020 census, grounded in differential privacy, have faced increasing criticism from demographers and other social scientists. Scholars have found that estimates generated via Census-released test data are accurate for aggregate total population statistics of larger spatial units (e.g. counties), but introduce considerable discrepancies for estimates of subgroups. At present, the ramifications of this new approach remain unclear for rural populations. In this brief, we focus on rural populations and evaluate the ability of the finalized differential privacy algorithm to provide accurate population counts and growth rates from 2000 to 2010 across the rural-urban continuum for the total, non-Hispanic white, non-Hispanic Black, Hispanic or Latino/a, and non-Hispanic American Indian population. We find the method introduces significant discrepancies relative to the prior approach into counts and growth rate estimates at the county level for all groups except the total and non-Hispanic white population. Further, discrepancies increase dramatically as we move from urban to rural. Thus, the differential privacy method likely introduced significant discrepancies for rural and non-white populations into 2020 census tabulations.

U.S. Immigrants Have Highly Heterogeneous Perceptions of How Selected They Are on Health.

Measuring immigrant health selection is crucial for understanding population health in immigrant-receiving countries. Recently, studies have measured health selection using respondents' perceptions of their health in comparison with those in their home countries. Yet we do not know how well this measure captures health selection. Using the New Immigrant Survey, the authors visualize respondents' self-reported levels of health selection stratified by self-rated health and by sending country. The visualization indicates that immigrants from the same country who rate their health the same still give very different answers when asked to compare their health with those in their home countries. These variations were observed for immigrants from all top five sending countries and at every level of self-reported health but are much larger among those who rate their health less favorably. Overall, the present findings signal that U.S. immigrants have highly heterogeneous perceptions of how selected they are.

What do time-use patterns tell us about the validity of self-reported health?

OBJECTIVE: This short communication investigates the usefulness of time-use measures to validate subjective health measures such as self-reported health (SRH). It does this by examining time-use patterns and SRH among middle-age adults in the United States distinguished by race/ethnicity and with additional attention to differences in responses based on language of interview for Hispanics. METHODS: Data for this study come from the 2013-2016 American Time Use Survey. We calculated average time-use for personal care; housework; paid work; leisure; volunteering/travel; caregiving; and education for every racial/ethnic group differentiating by SRH for 27,063 adults aged 25-64 years. A series of ANOVAs were computed to assess differences in time-use by SRH. RESULTS: Non-Hispanic whites and non-Hispanic Blacks who reported poor/fair SRH spent more time in personal care and leisure, and less time in paid work, volunteering/travel, caregiving and education, in comparison to those who reported Excellent/Very Good/Good SRH. Among Hispanics, differences by SRH were found for personal care, paid work, leisure and volunteering/travel. Hispanics who answered in English displayed partially similar patterns in SRH found for non-Hispanic whites and Blacks. Hispanics who answered in Spanish demonstrated differences in SRH in the areas of paid work, leisure and education, diverging from the other groups. CONCLUSIONS: Time-use differences by health status are consistent between non-Hispanic whites, non-Hispanic blacks, but not so for Hispanics. To some extent, Hispanics who answered in English have more comparable patterns to non-Hispanic whites and non-Hispanic Blacks than Spanish respondents. Caution should be exercised when self-reported health measures are used to compare diverse samples collected with surveys that are administered in different languages.

Health status among NEET adolescents and young adults in the United States, 2016-2018.

Adolescents and young adults not employed or in education/training (NEET) could be at higher risk of adverse health outcomes. Approximately 4.6 million Americans aged between 16 and 24 fall in this group. However, differences in health between NEET and non-NEET population remain unaddressed. This study examines the association of NEET status and poor/fair self-reported health status (SRH), among adolescents and young adults in the United States. Data for this study come from the 2016-2018 National Survey on Drug Use and Health (NSDUH). Our analytical sample consisted of 53,690 respondents. We used logistic regression models to investigate the association between NEET and health status in the United States, while controlling for potential covariates. Approximately 14% of our analytical sample was classified as NEET. NEET report poor/fair health status at higher rates than their counterparts who remained in school and/or had a job (11.30% vs. 5.62%). The NEET population was older, had a higher proportion of non-Hispanic Blacks, engaged in more smoking but in less alcohol drinking than non-NEET. In our initial model, NEET were more likely report poor/fair SRH than their non-NEET counterparts (OR = 2.14; p < 0.001). This difference remains strong when demographic and socioeconomic characteristics are accounted for in our empirical models (OR = 1.93, p < 0.001). In our fully specified model, which accounts for health behaviors, NEET continue to have higher odds of reporting poor/fair SRH (OR = 1.77, p < 0.001). Our analyses suggest that NEET populations report worse health than non-NEETs. The health of this population may improve if interventions to reinsert them into either education or employment are effectively deployed.

Telomere Shortening and Accelerated Aging in US Military Veterans.

A growing body of literature on military personnel and veterans' health suggests that prior military service may be associated with exposures that increase the risk of cardiovascular disease (CVD), which may differ by race/ethnicity. This study examined the hypothesis that differential telomere shortening, a measure of cellular aging, by race/ethnicity may explain prior findings of differential CVD risk in racial/ethnic groups with military service. Data from the first two continuous waves of the National Health and Nutrition Examination Survey (NHANES), administered from 1999-2002 were analyzed. Mean telomere length in base pairs was analyzed with multivariable adjusted linear regression with complex sample design, stratified by sex. The unadjusted mean telomere length was 225.8 base shorter for individuals with prior military service. The mean telomere length for men was 47.2 (95% CI: -92.9, -1.5; p < 0.05) base pairs shorter for men with military service after adjustment for demographic, socioeconomic, and behavioral variables, but did not differ significantly in women with and without prior military service. The interaction between military service and race/ethnicity was not significant for men or women. The results suggest that military service may contribute to accelerated aging as a result of health damaging exposures, such as combat, injury, and environmental contaminants, though other unmeasured confounders could also potentially explain the results.