Relationships, race/ethnicity, gender, age, and living kidney donation evaluation willingness.

Racial/ethnic and gender disparities in living donor kidney transplantation are large and persistent but incompletely explained. One previously unexplored potential contributor to these disparities is differential willingness to donate to recipients in specific relationships such as children, parents, and friends. We collected and analyzed data from an online sample featuring an experimental vignette in which respondents were asked to rate their willingness to donate to a randomly chosen member of their family or social network. Results show very large differences in respondents' willingness to donate to recipients with different relationships to them, favoring children, spouses/partners, siblings, and parents, and disfavoring friends, aunts/uncles, and coworkers. Evidence suggesting an interactive effect between relationship, respondent race/ethnicity, respondent or recipient gender, was limited to a few cases. At the p < 0.05 level, the parent-recipient gender interaction was statistically significant, favoring mothers over fathers, as was other/multiracial respondents' greater willingness to donate to friends compared to Whites. Additionally, other interactions were significant at the p < 0.10 level, such as Hispanics' and women's higher willingness to donate to parents compared to Whites and men respectively, women's lower willingness to donate to friends compared to men, and Blacks' greater willingness to donate to coworkers than Whites. We also examined differences by age and found that older respondents were less willing to donate to recipients other than their parents. Together these results suggest that differential willingness to donate by relationship group may be a moderately important factor in understanding racial/ethnic and gender disparities in living donor kidney transplantation.

Life Events and Loneliness Transitions Among Middle-Aged and Older Adults Around the World.

OBJECTIVES: Adult loneliness is a substantial social problem and a growing point of concern for policymakers around the world. We assess whether the predictors of loneliness onset among middle-aged and older adults vary from country to country in a large array of settings across world regions. Taking a life course perspective, we focus on common life events in our focal age range, including changes in partnership, coresidence, work, and health, and we test whether changes in them have comparable prospective associations with loneliness onset in different countries. METHODS: We draw on respondent-level data from a diversity of world regions surveyed in 7 harmonized cross-national studies in 20 countries, representing 47% of the global population over the age of 50. Our innovative longitudinal approach estimates prospective transition probability models that examine how each life event predicts the transition into loneliness. RESULTS: Despite substantial variation in the prevalence of loneliness and life events across the range of countries in our sample, our results highlight consistency in the predictors of loneliness transitions. Family and household changes like divorce, coresidence, and especially widowhood are paramount predictors of loneliness transition across settings, with changes in work and health playing more minor and less universal roles. DISCUSSION: The results demonstrate the importance that family and household connections play in determining loneliness at these ages. These findings suggest that addressing late-life loneliness may require a focus on key life events, especially those concerning changes in families and households.

Lost support, lost skills: Children's cognitive outcomes following grandparental death.

OBJECTIVE: This study examines the implications of grandparental death for cognitive skills in middle childhood. METHOD: This study uses data from the Future of Families and Child Wellbeing Study (N = 2479) to estimate ordinary least squares regression models of the associations between grandparental death and subsequent cognitive skills among children in middle childhood. RESULTS: Experiencing a grandparental death between ages 5 and 9 is associated with boys' lower reading, verbal, and math scores at age 9, with associations most notable for Black and Hispanic boys; grandparental death before age 5 has minimal influence on boys' cognitive skills at age 9. There is little indication that grandparental death adversely affects girls' cognitive skills. CONCLUSION: The numerous and persistent implications of grandparental death for boys' cognitive skills merit greater recognition of grandparental death as a source of family instability, stress, and ultimately inequality in child development.

AYA-UNITE: Lessons Learned on Intervention Development Promoting Social and Physical Health of Adolescent/Young Adult Cancer Survivors.

Adolescent/young adult cancer survivors (AYACS) struggle with poor psychosocial health related to social disruptions due to cancer diagnosis, impacting long-term goal achievement and overall health. In particular, social health promotion is overlooked in AYACS' care. AYA-UNITE, a sociobehavioral exercise intervention pilot for AYACS 15-21 years of age at cancer diagnosis, was designed to foster AYACS' social and physical health. AYA-UNITE was a 12-week group-based virtual exercise program incorporating strength training and aerobic activity. In this brief report, we account AYA-UNITE's conceptual design, lessons learned through AYA-UNITE intervention development, and opportunities for improvement in implementing effective AYACS psychosocial interventions (NCT03778658).

The Care Gap in Later Life Across European Countries.

OBJECTIVES: Do adults without kin experience a care gap where they need help with activities of daily living but get no help from any source? We examine the prevalence of the care gap across Europe, and test whether those without partners or children substitute for their lack of close kin with help from broader networks, or whether they disproportionately experience care gaps. METHODS: Using data from the Survey on Health, Ageing and Retirement in Europe, we estimate the care gap in 28 European countries and Israel, how it varies, and who provides help for respondents with different family structures. RESULTS: The care gap is substantial, with 6.1% of all respondents ages 50 and above reporting a gap. It is highest in Western and Eastern Europe and lowest in Southern Europe and Israel. Respondents without partners or children are significantly more likely to have care gaps than those with close kin. However, respondents without close kin draw more often on more diverse networks of friends and relatives and use nursing home care. DISCUSSION: Our study introduces the concept of the care gap and shows that although it is most common among unpartnered adults without children it is also quite common for those with immediate family. A broader network partially but not completely substitutes for care gaps among those without immediate family. Our results offer new insights into the demand for public care services in countries with diverse welfare states.

Social network interventions to reduce race disparities in living kidney donation: Design and rationale of the friends and family of kidney transplant patients study (FFKTPS).

INTRODUCTION: Racial/ethnic disparities in living donor kidney transplantation (LDKT) are a persistent challenge. Although nearly all directed donations are from members of patients' social networks, little is known about which social network members take steps toward living kidney donation, which do not, and what mechanisms contribute to racial/ethnic LDKT disparities. METHODS: We describe the design and rationale of the Friends and Family of Kidney Transplant Patients Study, a factorial experimental fielding two interventions designed to promote LKD discussions. Participants are kidney transplant candidates at two centers who are interviewed and delivered an intervention by trained center research coordinators. The search intervention advises patients on which social network members are most likely to be LKD contraindication-free; the script intervention advises patients on how to initiate effective LKD discussions. Participants are randomized into four conditions: no intervention, search only, script only, or both search and script. Patients also complete a survey and optionally provide social network member contact information so they can be surveyed directly. This study will seek to enroll 200 transplant candidates. The primary outcome is LDKT receipt. Secondary outcomes include live donor screening and medical evaluations and outcomes. Tertiary outcomes include LDKT self-efficacy, concerns, knowledge, and willingness, measured before and after the interventions. CONCLUSION: This study will assess the effectiveness of two interventions to promote LKD and ameliorate Black-White disparities. It will also collect unprecedented information on transplant candidates' social network members, enabling future work to address network member structural barriers to LKD.

Testing the Differential Access Hypothesis That Black Kidney Transplant Candidates Perceive Social Network Access to Fewer Potential Living Donors Than White Candidates.

INTRODUCTION: Many studies of Black-White disparities in living donor kidney transplantation hypothesize that they were partially due to Black-White differences in candidate social network access to healthy, willing donors. This differential access hypothesis has not been tested using directly measured social network data. RESEARCH QUESTIONS: Do black kidney transplant candidates have perceived lower social network access to health and/or willing living donors than white candidates? DESIGN: A cross-sectional survey that measured the social network members was collected in 2015. Black-White differences in patient counts of perceived healthy and/or willing potential donors in social networks, and individual network members' probability of being perceived healthy and/or willing, were compared using logistic and negative binomial regression models. RESULTS: The survey included 66 kidney transplant candidates reporting on 1474 social network members at a large Southeastern US transplant center in 2015. Black and White patients had similar access to perceived healthy, likely potential donors (86% vs 87% had 1 or more, P = .92; 5.91 vs 4.13 mean counts, P = .20) and perceived healthy, agreed potential donors (56% vs 48%, P = .54; 1.77 vs 1.74, P = .97). Black patients' network members were individually more likely to be perceived healthy and likely potential donors (26% vs 21%, P = .04), and White patients' network members were more likely to have agreed (13% vs 9%, P = .03), but these differences were statistically insignificant in demographically adjusted models. CONCLUSION: Black and White transplant candidates perceived access to similar numbers of potential donors in their social networks. This result does not support the differential access hypothesis.

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.

Mourning in a Pandemic: The Differential Impact of COVID-19 Widowhood on Mental Health.

OBJECTIVES: The death of a spouse is an established predictor of mental health decline that foreshadows worsening physical health and elevated mortality. The millions widowed by COVID-19 worldwide may experience even worse health outcomes than comparable pre-pandemic widows given the particularities of dying, mourning, and grieving during a pandemic defined by protracted social isolation, economic precarity, and general uncertainty. If COVID-19 pandemic bereavement is more strongly associated with mental health challenges than pre-pandemic bereavement, the large new cohort of COVID-19 widow(er)s may be at substantial risk of downstream health problems long after the pandemic abates. METHODS: We pooled population-based Survey of Health, Ageing and Retirement in Europe data from 27 countries for two distinct periods: (1) pre-pandemic (Wave 8, fielded October 2019-March 2020; N = 46,266) and (2) early pandemic (COVID Supplement, fielded June-August 2020; N = 55,796). The analysis used a difference-in-difference design to assess whether a spouse dying from COVID-19 presents unique mental health risks (self-reported depression, loneliness, and trouble sleeping), compared with pre-pandemic recent spousal deaths. RESULTS: We find strong associations between recent spousal death and poor mental health before and during the pandemic. However, our difference-in-difference estimates indicate those whose spouses died of COVID-19 have higher risks of self-reported depression and loneliness, but not trouble sleeping, than expected based on pre-pandemic associations. DISCUSSION: These results highlight that the millions of COVID-19 widow(er)s face extreme mental health risks, eclipsing those experienced by surviving spouses pre-pandemic, furthering concerns about the pandemic's lasting impacts on health.

Analytic Advances in Social Networks and Health in the Twenty-First Century.

The study of social networks is increasingly central to health research for medical sociologists and scholars in other fields. Here, we review the innovations in theory, substance, data collection, and methodology that have propelled the study of social networks and health from a niche subfield to the center of larger sociological and scientific debates. In particular, we contextualize the broader history of network analysis and its connections to health research, concentrating on work beginning in the late 1990s, much of it in this journal. Using bibliometric and network visualization approaches, we examine the subfield's evolution over this period in terms of topics, trends, key debates, and core insights. We conclude by reflecting on persistent challenges and areas of innovation shaping the study of social networks and health and its intersection with medical sociology in the coming years.

Population Aging, Demographic Metabolism, and the Rising Tide of Late Middle Age to Older Adult Loneliness around the World.

This study examines how population aging will shape a crucial aspect of mental health and social well-being - loneliness. Drawing on theories of demographic metabolism, United Nations' population estimates and projections, and survey data covering approximately 50% of the world's population aged 50 and above living in 27 countries, we estimate the role of population aging in shaping cross-national differences in loneliness from 1990 to 2050. We use survey data to estimate the prevalence of late middle age and older adult loneliness by age and sex, and then apply these rates to the evolving age and sex distributions of the populations. Our results highlight massive increases in loneliness at ages 50 and above with a tripling of the number of lonely adults in these age groups in our sample countries from 104.9 million in 1990 to 333.5 million in 2050, increasing variability across countries in the share of their populations composed of lonely adults 50 and above, and the feminization of global later life loneliness with an increasing share of lonely adults in these age ranges being women. These results illustrate the power of demographic modeling to advance understandings of national profiles of mental health and social well-being.

Bereavement From COVID-19, Gender, and Reports of Depression Among Older Adults in Europe.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has left older adults around the world bereaved by the sudden death of relatives and friends. We examine if COVID-19 bereavement corresponds with older adults' reporting depression in 27 countries and test for variations by gender and country context. METHOD: We analyze the Survey of Health, Ageing and Retirement in Europe COVID-19 data collected between June and August 2020 from 51,383 older adults (age 50-104) living in 27 countries, of whom 1,363 reported the death of a relative or friend from COVID-19. We estimate pooled multilevel logit regression models to examine if COVID-19 bereavement is associated with self-reported depression and worsening depression, and we test whether national COVID-19 mortality rates moderate these associations. RESULTS: COVID-19 bereavement is associated with significantly higher probabilities of both reporting depression and reporting worsened depression among older adults. Net of one's own personal loss, living in a country with the highest COVID-19 mortality rate is associated with women's reports of worsened depression but not men's. However, the country's COVID-19 mortality rate does not moderate associations between COVID-19 bereavement and depression. DISCUSSION: COVID-19 deaths have lingering mental health implications for surviving older adults. Even as the collective toll of the crisis is apparent, bereaved older adults are in particular need of mental health support.

The Physical, Mental, and Social Health of Middle-Aged and Older Adults Without Close Kin in Canada.

OBJECTIVES: We examine whether adults aged 45 and older lacking a partner and children are disadvantaged in terms of physical, mental, and social aspects of health. Then we test whether the importance of family structure for these outcomes varies by age, gender, and educational attainment. METHODS: We examine aging and social network modules from the Canadian General Social Survey to estimate associations between family structure and physical, mental, and social health, with the last measured as communication with relatives and friends, civic participation, and loneliness. RESULTS: Results show that middle-aged and older adults without partners have lower levels of physical and mental health and higher levels of loneliness than those with partners. Those without partners and children (the "kinless") interact less with relatives than those who have children but not partners, but more with friends, showing some substitution. In terms of civic participation, kinless middle-aged and older adults have significantly lower odds of this type of engagement than peers with close kin. Our interaction models find some differences by age, gender, and education, which vary by the outcome. DISCUSSION: Our results highlight some concerns about the well-being of kinless adults in Canada, especially as related to physical and mental health and two aspects of social health, loneliness, and civic participation. We find some substitution occurring, whereby middle-aged and older adults without family are interacting more with friends than comparable peers, but such substitution is marginal.

Racial/ethnic and prior willingness disparities in potential living kidney donors' self-assessed responses to advancing American kidney health regulation.

BACKGROUND: Racial/ethnic disparities in living donor kidney transplantation (LDKT) are large, and rates of LDKT may be limited by indirect costs of living donation. A 2019 Executive Order- Advancing American Kidney Health (AAKH)- sought to remove indirect costs through an expanded reimbursement program. We examine how potential living kidney donors in the U.S. believe regulation stemming from the AAKH initiative will impact their living donor evaluation likelihood, how these beliefs vary by minority race/ethnicity and prior willingness to be evaluated, and how differences are explained by ability to benefit or knowledge and attitudes. METHODS: Data from a 2019 online survey (Families of Renal Patients Survey) were used. Respondents are U.S. adult (> 18 years) members of the Qualtrics Survey Panel who reported having relatives with weak or failing kidneys (N = 590). Respondents' likelihood to be evaluated for living kidney donation are measured by self-report. Prior willingness is measured by past donation-related actions and current attitudes. Ability to benefit is measured by self-reported labor force participation and financial strain. Transplant knowledge is measured by self-report and a knowledge test, and transplant-related attitudes are measured by self-report. Average marginal effects of minority race/ethnicity and prior willingness for response to each provision in fully-adjusted models were estimated. Formal tests of mediation were conducted using the Karlson, Holm, and Breen (KHB) mediation model. Stata/MP 14.2 was used to conduct all analyses. RESULTS: Majorities of all groups report favorable responses to the provisions stipulated in AAKH regulation. Responses to provisions are significantly associated with race/ethnicity and prior willingness, with racial/ethnic minorities and those not previously willing to be evaluated less likely to report favorable responses to these provisions. Prior willingness differences are partially explained by group differences in ability to benefit and transplant-related knowledge and attitudes, but racial/ethnic differences largely are not. CONCLUSIONS: Regulation stemming from the AAKH initiative is likely to effectively promote LDKT, but may also exacerbate racial/ethnic disparities. Therefore, the regulation may need to be supplemented by efforts to address non-financial obstacles to LDKT in racial/ethnic minority communities in order to ensure equitable increases in LDKT rates and living donor support.

Brexit and the European National Health Service England Workforce: A Quantitative Analysis of Doctors' Perceived Professional Impact and Intentions to Leave the United Kingdom.

Background: Although survey data suggest that Brexit has negatively influenced European doctors' decisions to remain in the United Kingdom, this is the first quantitative study to use multivariate analysis to explore this relationship. Objective: To assess how Brexit relates to doctors' migration intentions in relation to their feelings that Brexit has impacted their professional life, national identity, and demographic factors. Method: We collected data from 59 self-reported EU/EEA/European identifying doctors working in the UK. We weighted results to the English National Health Service population in terms of gender, professional grade level and ethnicity and ran weighted regression analyses of respondents' plans (leaving, considering, not considering) and whether they reported Brexit influencing their decision-making. We then examined how stating that Brexit affected their career, national identity, and sex and age related to doctors' intentions to leave or stay. Findings: The more doctors agreed that Brexit had impacted their professional lives, the more likely they were to state they intended to leave the UK. We found doctors with increased levels of British identity less likely to leave than those with reduced British identity. Interestingly, we found that those with higher levels of European identity were less likely to leave but more sharply likely to consider leaving compared to those with lower levels of European identity. Conclusions: Respondents reported large professional impacts of Brexit. To retain these individuals in the British medical system, the NHS should provide financial and legal assistance for those applying for settled status and financial and other incentives comparable to what doctors could receive in EU health systems.

Opioid misuse and family structure: Changes and continuities in the role of marriage and children over two decades.

BACKGROUND: The opioid crisis is widely felt in the United States. Scholarly attention to the crisis focuses on macro-level processes and largely neglects meso-level explanations such as family structure for opioid use behaviors. We hypothesize that married adults and adults with coresident children are at lower risk of misusing prescription pain relievers (PPR), using heroin, and using needles to inject heroin relative to adults from other family structures. METHOD: We used National Survey on Drug Use and Health data from 2002-2018 to test our hypotheses with multivariable logistic regression. RESULTS: We found that married adults have a lower predicted probability of each opioid use behavior relative to nonmarried adults across the study period. We also found that the presence of children is associated with reductions in all three outcomes especially for never married adults. CONCLUSION: Individuals from all family structures are vulnerable to the opioid crisis, but never married adults without coresident children ("disconnected adults") are especially susceptible to temporal fluctuations and drive the temporal trends in PPR misuse and heroin use. These findings suggest that ongoing demographic trends where disconnected adults are a growing population may result in future rises in opioid use disorders and mortality because of divestment from U.S. social safety nets. Future research should examine the role of U.S. policies that make disconnected adults especially vulnerable to developing opioid use disorders.

Measuring Older Adult Loneliness Across Countries.

OBJECTIVES: The topic of older adult loneliness commands increasing media and policy attention around the world. Are surveys of aging equipped to measure it? We assess the measurement of loneliness in large-scale aging studies in 31 countries by describing the available measures, testing correlations between them, and documenting their construct validity. METHODS: We use data from several "sister studies" of aging adults around the world. In each country, we document available loneliness measures, test for measurement reliability by examining correlations between different measures of loneliness, and assess how these correlations differ by gender and age group. We then evaluate construct validity by estimating correlations between loneliness measures and theoretically hypothesized constructs related to loneliness: living alone and not having a spouse. RESULTS: There is substantial heterogeneity in available measures of loneliness across countries. Within countries with multiple measures, the correlations between measures are high (range 0.384-0.777, median 0.636). Although we find several statistically significant differences in these correlations by gender and age, the differences are small (gender: range -0.098 to 0.081, median -0.026; age group: range -0.194 to 0.092, median -0.003). Correlations between loneliness measures and living alone and being without a spouse are all positive, almost universally statistically significant, and similar in magnitude across countries, supporting construct validity. DISCUSSION: This article establishes that even single-item measures of loneliness contribute meaningful information in diverse settings. Similar to the measurement of self-rated health, there are nuances to the measurement of older adult loneliness in different contexts, but it has reliable and consistent measurement properties within many countries.

National Profiles of Coronavirus Disease 2019 Mortality Risks by Age Structure and Preexisting Health Conditions.

BACKGROUND AND OBJECTIVES: Although individual age and preexisting health conditions are well-documented risk factors for coronavirus disease 2019 (COVID-19) mortality, it is unclear whether these 2 factors capture unique dimensions of risk for epidemic severity at the national level. In addition, no studies have examined whether national distributions of these factors are associated with epidemic experiences to date. RESEARCH DESIGN AND METHODS: Drawing on surveys of older adults from 42 countries and estimated case fatality ratios by age and preexisting health conditions, we document and compare national profiles of COVID-19 mortality risks among older adults. We develop 2 measures of national risk profiles: one based on age structures and another based on distributions of preexisting health conditions. Our analysis compares these constructs and documents their associations with national COVID-19 mortality rates. RESULTS: National profiles of COVID-19 mortality risk based on age structure and preexisting health conditions are moderately uncorrelated, capturing different aspects of risk. Both types of national risk profiles correlate meaningfully with countries' COVID-19 mortality experiences to date. DISCUSSION AND IMPLICATIONS: Measures of population age structure are readily available for every country in the world, while cross-national measures of older adult population health are more limited. In the COVID-19 crisis, these factors give different pictures of the countries with high and low risks of COVID-19 mortality. Moreover, our results suggest that both types of national risk profiles based on population health reflect current COVID-19 mortality severity in several countries, highlighting the need for more cross-national comparative data on older adult population health.