Significant impacts of the COVID-19 pandemic on race/ethnic differences in US mortality.

The coronavirus 2019 (COVID-19) pandemic triggered global declines in life expectancy. The United States was hit particularly hard among high-income countries. Early data from the United States showed that these losses varied greatly by race/ethnicity in 2020, with Hispanic and Black Americans suffering much larger losses in life expectancy compared with White people. We add to this research by examining trends in lifespan inequality, average years of life lost, and the contribution of specific causes of death and ages to race/ethnic life-expectancy disparities in the United States from 2010 to 2020. We find that life expectancy in 2020 fell more for Hispanic and Black males (4.5 and 3.6 y, respectively) compared with White males (1.5 y). These drops nearly eliminated the previous life-expectancy advantage for the Hispanic compared with the White population, while dramatically increasing the already large gap in life expectancy between Black and White people. While the drops in life expectancy for the Hispanic population were largely attributable to official COVID-19 deaths, Black Americans saw increases in cardiovascular diseases and "deaths of despair" over this period. In 2020, lifespan inequality increased slightly for Hispanic and White populations but decreased for Black people, reflecting the younger age pattern of COVID-19 deaths for Hispanic people. Overall, the mortality burden of the COVID-19 pandemic hit race/ethnic minorities particularly hard in the United States, underscoring the importance of the social determinants of health during a public health crisis.

Socioeconomic and race/ethnic differences in immunosenescence: Evidence from the Health and Retirement Study.

BACKGROUND: The COVID-19 pandemic has highlighted the urgent need to understand variation in immunosenescence at the population-level. Thus far, population patterns of immunosenescence have not well described. METHODS: We characterized measures of immunosenescence from the 2016 Venous Blood Study from the nationally representative U.S Health and Retirement Study (HRS) of individuals ages 50 years and older. RESULTS: Median values of the CD8+:CD4+, EMRA:Naïve CD4+ and EMRA:Naïve CD8+ ratios were higher among older participants and were lower in those with additional educational attainment. Generally, minoritized race and ethnic groups had immune markers suggestive of a more aged immune profile: Hispanics had a CD8+:CD4+ median value of 0.37 (95 % CI: 0.35, 0.39) compared to 0.30 in non-Hispanic Whites (95 % CI: 0.29, 0.31). Non-Hispanic Blacks had the highest median value of the EMRA:Naïve CD4+ ratio (0.08; 95 % CI: 0.07, 0.09) compared to non-Hispanic Whites (0.03; 95 % CI: 0.028, 0.033). In regression analyses, race/ethnicity and education were associated with large differences in the immune ratio measures after adjustment for age and sex. CONCLUSIONS: Lower educational attainment and minoritized racial ethnic status were associated with higher levels of immunosenescence. This population variation may have important implications for both risk of age-related disease and vulnerability to emerging pathogens (e.g., SARS-CoV-2).

Demographic science aids in understanding the spread and fatality rates of COVID-19.

Governments around the world must rapidly mobilize and make difficult policy decisions to mitigate the coronavirus disease 2019 (COVID-19) pandemic. Because deaths have been concentrated at older ages, we highlight the important role of demography, particularly, how the age structure of a population may help explain differences in fatality rates across countries and how transmission unfolds. We examine the role of age structure in deaths thus far in Italy and South Korea and illustrate how the pandemic could unfold in populations with similar population sizes but different age structures, showing a dramatically higher burden of mortality in countries with older versus younger populations. This powerful interaction of demography and current age-specific mortality for COVID-19 suggests that social distancing and other policies to slow transmission should consider the age composition of local and national contexts as well as intergenerational interactions. We also call for countries to provide case and fatality data disaggregated by age and sex to improve real-time targeted forecasting of hospitalization and critical care needs.

What Were the Information Voids? A Qualitative Analysis of Questions Asked by Dear Pandemic Readers between August 2020-August 2021.

In the current infodemic, how individuals receive information (channel), who it is coming from (source), and how it is framed can have an important effect on COVID-19 related mitigation behaviors. In light of these challenges presented by the infodemic, Dear Pandemic (DP) was created to directly address persistent questions related to COVID-19 and other health topics in the online environment. This is a qualitative analysis of 3806 questions that were submitted by DP readers to a question box on the Dear Pandemic website between August 30, 2020 and August 29, 2021. Analyses resulted in four themes: the need for clarification of other sources; lack of trust in information; recognition of possible misinformation; and questions on personal decision-making. Each theme reflects an unmet informational need of Dear Pandemic readers, which may be reflective of the broader informational gaps in our science communication efforts.This study highlights the role of an ad hoc risk communication platform in the current environment and uses questions submitted to the Dear Pandemic question box to identify informational needs of DP readers over the course of the COVID-19 pandemic. These findings may help clarify how organizations addressing health misinformation in the digital space can contribute to timely, responsive science communication and improve future communication efforts.

Dear Pandemic: Nurses as key partners in fighting the COVID-19 infodemic.

The COVID-19 pandemic and subsequent proliferation of misinformation have created parallel public health crises. Social media offers a novel platform to amplify evidence-based communication to broader audiences. This paper describes the application of science communication engagement on social media platforms by an interdisciplinary team of female scientists in a campaign called Dear Pandemic. Nurses are trusted professionals trained in therapeutic communication and are central to this effort. The Dear Pandemic campaign now has more than 97,000 followers with international and multilingual impact. Public health strategies to combat misinformation and guide individual behavior via social media show promise, and require further investment to support this novel dissemination of science communication.

Forecasting spatial, socioeconomic and demographic variation in COVID-19 health care demand in England and Wales.

BACKGROUND: COVID-19 poses one of the most profound public health crises for a hundred years. As of mid-May 2020, across the world, almost 300,000 deaths and over 4 million confirmed cases were registered. Reaching over 30,000 deaths by early May, the UK had the highest number of recorded deaths in Europe, second in the world only to the USA. Hospitalization and death from COVID-19 have been linked to demographic and socioeconomic variation. Since this varies strongly by location, there is an urgent need to analyse the mismatch between health care demand and supply at the local level. As lockdown measures ease, reinfection may vary by area, necessitating a real-time tool for local and regional authorities to anticipate demand. METHODS: Combining census estimates and hospital capacity data from ONS and NHS at the Administrative Region, Ceremonial County (CC), Clinical Commissioning Group (CCG) and Lower Layer Super Output Area (LSOA) level from England and Wales, we calculate the number of individuals at risk of COVID-19 hospitalization. Combining multiple sources, we produce geospatial risk maps on an online dashboard that dynamically illustrate how the pre-crisis health system capacity matches local variations in hospitalization risk related to age, social deprivation, population density and ethnicity, also adjusting for the overall infection rate and hospital capacity. RESULTS: By providing fine-grained estimates of expected hospitalization, we identify areas that face higher disproportionate health care burdens due to COVID-19, with respect to pre-crisis levels of hospital bed capacity. Including additional risks beyond age-composition of the area such as social deprivation, race/ethnic composition and population density offers a further nuanced identification of areas with disproportionate health care demands. CONCLUSIONS: Areas face disproportionate risks for COVID-19 hospitalization pressures due to their socioeconomic differences and the demographic composition of their populations. Our flexible online dashboard allows policy-makers and health officials to monitor and evaluate potential health care demand at a granular level as the infection rate and hospital capacity changes throughout the course of this pandemic. This agile knowledge is invaluable to tackle the enormous logistical challenges to re-allocate resources and target susceptible areas for aggressive testing and tracing to mitigate transmission.

Socioeconomic status and central adiposity as determinants of stress-related biological responses relevant to cardiovascular disease risk.

Stress-related processes have been implicated in the associations between lower socioeconomic status (SES), central adiposity, and cardiovascular disease risk. This study analysed the impact of SES and central adiposity on cardiovascular, inflammatory and neuroendocrine stress responses, and associations with cytomegalovirus (CMV) infection in a sample of 537 men and women aged 53-76 years (mean 62.89 years). SES was defined by grade of employment (higher, intermediate, and lower categories), and central adiposity was indexed by waist-hip ratio (WHR). Cardiovascular, inflammatory and cortisol responses were monitored during administration of a standardized mental stress testing protocol and salivary cortisol was measured repeatedly over the day. Lower SES was associated with raised systolic and diastolic blood pressure (BP), plasma interleukin (IL-6), fibrinogen, C-reactive protein, and salivary cortisol, and a large WHR accentuated SES differences in fibrinogen, C-reactive protein, and likelihood of CMV seropositivity, independently of general adiposity indexed by body mass index. During mental stress testing, return to resting levels (recovery) following behavioural challenge in systolic and diastolic BP and heart rate was impaired among lower SES participants, particularly those with large WHR. Lower SES participants had greater cortisol concentrations across the day, but this pattern did not vary with WHR. These findings extend the evidence relating lower SES to stress-related biological risk factors for cardiovascular disease, and indicate that central adiposity may augment these effects.

Trends in the Relationship Between Obesity and Disability, 1988-2012.

Rising obesity rates, coupled with population aging, have elicited serious concern over the impact of obesity on disability in later life. Prior work showed a significant increase in the association between obesity and disability from 1988 to 2004, calling attention to disability as a cost of longer lifetime exposure to obesity. It is not known whether this trend has continued. We examined functional impairment and impairment in activities of daily living (ADL) (defined as severe or moderate to severe) for adults aged 60 years or older (n = 16,770) over 3 time periods in the National Health and Nutrition Examination Survey. The relative odds of impairment for obese individuals versus normal-weight individuals significantly increased from period 1 (1988-1994) to period 2 (1999-2004) for all outcomes. In period 3 (2005-2012), this association remained stable for functional and severe ADL impairment and decreased for moderate-to-severe ADL impairment. The fraction of population disability attributable to obesity followed a similar trend. The trend of an increasing association between obesity and disability has leveled off in more recent years, and is even improving for some measures. These findings suggest that public health and policy concerns that obesity would continue to become more disabling over time have not been borne out.

US exceptionalism? International trends in midlife mortality.

BACKGROUND: Rising midlife mortality in the USA has raised concerns, particularly the increase in 'deaths of despair' (due to drugs, alcohol and suicide). Life expectancy is also stalling in other countries such as the UK, but how trends in midlife mortality are evolving outside the USA is less understood. We provide a synthesis of cause-specific mortality trends in midlife (25-64 years of age) for the USA and the UK as well as other high-income and Central and Eastern European (CEE) countries. METHODS: We document trends in midlife mortality in the USA, UK and a group of 13 high-income countries in Western Europe, Australia, Canada and Japan, as well as seven CEE countries from 1990 to 2019. We use annual mortality data from the World Health Organization Mortality Database to analyse sex- and age-specific (25-44, 45-54 and 55-64 years) age-standardized death rates across 15 major cause-of-death categories. RESULTS: US midlife mortality rates have worsened since 1990 for several causes of death including drug-related, alcohol-related, suicide, metabolic diseases, nervous system diseases, respiratory diseases and infectious/parasitic diseases. Deaths due to homicide, transport accidents and cardiovascular diseases have declined since 1990 but saw recent increases or stalling of improvements. Midlife mortality also increased in the UK for people aged 45-54 year and in Canada, Poland and Sweden among for those aged 25-44 years. CONCLUSIONS: The USA is increasingly falling behind not only high-income, but also CEE countries, some of which were heavily impacted by the post-socialist mortality crisis of the 1990s. Although levels of midlife mortality in the UK are substantially lower than those in the USA overall, there are signs that UK midlife mortality is worsening relative to that in Western Europe.

Physical health effects of the housing boom: quasi-experimental evidence from the health and retirement study.

OBJECTIVES: We examined the impact of the dramatic increases in housing prices in the United States in the 1990s and early 2000s on physical health outcomes among a representative sample of middle-aged and older Americans. METHODS: Using a quasi-experimental design, we exploited geographic and time variation in housing prices using third-party valuation estimates of median single-family detached houses from 1988 to 2007 in each of 2400 zip codes combined with Health and Retirement Study data from 1992 to 2006 to test the impact of housing appreciation on physical health outcomes. RESULTS: Respondents living in communities in which home values appreciated more rapidly had fewer functional limitations, performed better on interviewer-administered physical tasks, and had smaller waist circumference. CONCLUSIONS: Our results indicate that increases in housing wealth were associated with better health outcomes for homeowners in late middle age and older. The recent sharp decline in housing values for this group may likewise be expected to have important implications for health and should be examined as data become available.

Fibrinogen may mediate the association between long sleep duration and coronary heart disease.

Long sleep duration has been associated with increased risk of cardiovascular disease (CVD) and all-cause mortality. Inflammation and coagulation have been hypothesized as possible physiological pathways to explain this association, although specific biomarkers have not been studied. Using longitudinal data from 3942 postmenopausal women in the Women's Health Initiative observational study and clinical trials, we investigated whether fibrinogen, an acute-phase inflammatory protein involved in blood clotting, mediates the associations between sleep duration and coronary heart disease (CHD) and mortality among women. Fibrinogen levels were associated positively with self-reported long sleep duration (9+ h per night), CHD and all-cause mortality, even after adjustment for a range of sociodemographic characteristics, cardiovascular risk factors and comorbidities.Compared with self-reported 7-8 h per night sleep duration, self-reported long sleep duration was associated with increased odds of CHD [odds ratio (OR) = 2.05, 95% confidence interval (CI): 1.02-4.11]. Adjustment for fibrinogen levels reduced the increased odds of CHD associated with long sleep by approximately 8 percentage points (OR = 1.97, 95% CI: 0.98-3.97). A similar reduction in the OR was observed with mortality. For both outcomes there is support for partial mediation of 6-7%, suggesting that fibrinogen may be a mechanism through which long sleep duration is associated with CHD and mortality.

Comparing trends in mid-life 'deaths of despair' in the USA, Canada and UK, 2001-2019: is the USA an anomaly?

OBJECTIVES: In recent years, 'deaths of despair' due to drugs, alcohol and suicide have contributed to rising mid-life mortality in the USA. We examine whether despair-related deaths and mid-life mortality trends are also changing in peer countries, the UK and Canada. DESIGN: Descriptive analysis of population mortality rates. SETTING: The USA, UK (and constituent nations England and Wales, Northern Ireland and Scotland) and Canada, 2001-2019. PARTICIPANTS: Full population aged 35-64 years. OUTCOME MEASURES: We compared all-cause and 'despair'-related mortality trends at mid-life across countries using publicly available mortality data, stratified by three age groups (35-44, 45-54 and 55-64 years) and by sex. We examined trends in all-cause mortality and mortality by causes categorised as (1) suicides, (2) alcohol-specific deaths and (3) drug-related deaths. We employ several descriptive approaches to visually inspect age, period and cohort trends in these causes of death. RESULTS: The USA and Scotland both saw large relative increases and high absolute levels of drug-related deaths. The rest of the UK and Canada saw relative increases but much lower absolute levels in comparison. Alcohol-specific deaths showed less consistent trends that did not track other 'despair' causes, with older groups in Scotland seeing steep declines over time. Suicide deaths trended slowly upward in most countries. CONCLUSIONS: In the UK, Scotland has suffered increases in drug-related mortality comparable with the USA, while Canada and other UK constituent nations did not see dramatic increases. Alcohol-specific and suicide mortalities generally follow different patterns to drug-related deaths across countries and over time, questioning the utility of a cohesive 'deaths of despair' narrative.

Dear Pandemic: A topic modeling analysis of COVID-19 information needs among readers of an online science communication campaign.

BACKGROUND: The COVID-19 pandemic was accompanied by an "infodemic"-an overwhelming excess of accurate, inaccurate, and uncertain information. The social media-based science communication campaign Dear Pandemic was established to address the COVID-19 infodemic, in part by soliciting submissions from readers to an online question box. Our study characterized the information needs of Dear Pandemic's readers by identifying themes and longitudinal trends among question box submissions. METHODS: We conducted a retrospective analysis of questions submitted from August 24, 2020, to August 24, 2021. We used Latent Dirichlet Allocation topic modeling to identify 25 topics among the submissions, then used thematic analysis to interpret the topics based on their top words and submissions. We used t-Distributed Stochastic Neighbor Embedding to visualize the relationship between topics, and we used generalized additive models to describe trends in topic prevalence over time. RESULTS: We analyzed 3839 submissions, 90% from United States-based readers. We classified the 25 topics into 6 overarching themes: 'Scientific and Medical Basis of COVID-19,' 'COVID-19 Vaccine,' 'COVID-19 Mitigation Strategies,' 'Society and Institutions,' 'Family and Personal Relationships,' and 'Navigating the COVID-19 Infodemic.' Trends in topics about viral variants, vaccination, COVID-19 mitigation strategies, and children aligned with the news cycle and reflected the anticipation of future events. Over time, vaccine-related submissions became increasingly related to those surrounding social interaction. CONCLUSIONS: Question box submissions represented distinct themes that varied in prominence over time. Dear Pandemic's readers sought information that would not only clarify novel scientific concepts, but would also be timely and practical to their personal lives. Our question box format and topic modeling approach offers science communicators a robust methodology for tracking, understanding, and responding to the information needs of online audiences.

Sociodemographic Differences in Population-Level Immunosenescence in Older Age.

Background: The COVID-19 pandemic has highlighted the urgent need to understand variation in immunosenescence at the population-level. Thus far, population patterns of immunosenescence are not well described. Methods: We characterized measures of immunosenescence from newly released venous blood data from the nationally representative U.S Health and Retirement Study (HRS) of individuals ages 56 years and older. Findings: Median values of the CD8+:CD4+, EMRA:Nave CD4+ and EMRA:Nave CD8+ ratios were higher among older participants and were lower in those with additional educational attainment. Generally, minoritized race and ethnic groups had immune markers suggestive of a more aged immune profile: Hispanics had a CD8+:CD4+ median value of 0.37 (95% CI: 0.35, 0.39) compared to 0.30 in Whites (95% CI: 0.29, 0.31). Blacks had the highest median value of the EMRA:Nave CD4+ ratio (0.08; 95% CI: 0.07, 0.09) compared to Whites (0.03; 95% CI: 0.028, 0.033). In regression analyses, race/ethnicity and education were associated with large differences in the immune ratio measures after adjustment for age and sex. For example, each additional level of education was associated with roughly an additional decade of immunological age, and the racial/ethnic differences were associated with two to four decades of additional immunological age. Interpretation: Our study provides novel insights into population variation in immunosenescence. This has implications for both risk of age-related disease and vulnerability to novel pathogens (e.g., SARS-CoV-2). Funding: This study was partially funded by the U.S. National Institutes of Health, National Institute on Aging R00AG062749. AEA and GAN acknowledge support from the National Institutes of Health, National Institute on Aging R01AG075719. JBD acknowledges support from the Leverhulme Trust (Centre Grant) and the European Research Council grant ERC-2021-CoG-101002587. Research in context: Evidence before this study: Alterations in immunity with chronological aging have been consistently demonstrated across human populations. Some of the hallmark changes in adaptive immunity associated with aging, termed immunosenescence, include a decrease in nave T-cells, an increase in terminal effector memory cells, and an inverted CD8:CD4 T cell ratio. Several studies have shown that social and psychosocial exposures can alter aspects of immunity and lead to increased susceptibility to infectious diseases.Add value of this study: While chronological age is known to impact immunosenescence, there are no studies examining whether social and demographic factors independently impact immunosenescence. This is important because immunosenescence has been associated with greater susceptibility to disease and lower immune response to vaccination. Identifying social and demographic variability in immunosenescence could help inform risk and surveillance efforts for preventing disease in older age. To our knowledge, we present one of the first large-scale population-based investigations of the social and demographic patterns of immunosenescence among individuals ages 50 and older living in the US. We found differences in the measures of immunosenescence by age, sex, race/ethnicity, and education, though the magnitude of these differences varied across immune measures and sociodemographic subgroup. Those occupying more disadvantaged societal positions (i.e., minoritized race and ethnic groups and individuals with lower educational attainment) experience greater levels of immunosenescence compared to those in less disadvantaged positions. Of note, the magnitude of effect of sociodemographic factors was larger than chronological age for many of the associations.Implications for practice or policy and future research: The COVID-19 pandemic has highlighted the need to better understand variation in adaptive and innate immunity at the population-level. While chronological age has traditionally been thought of as the primary driver of immunological aging, the magnitude of differences we observed by sociodemographic factors suggests an important role for the social environment in the aging human immune system.

Lessons Learned From Dear Pandemic, a Social Media-Based Science Communication Project Targeting the COVID-19 Infodemic.

The World Health Organization has identified excessive COVID-19 pandemic-related information as a public health crisis, calling it an "infodemic." Social media allows misinformation to spread quickly and outcompete scientifically grounded information delivered via other methods. Dear Pandemic is an innovative, multidisciplinary, social media-based science communication project whose mission is to educate and empower individuals to successfully navigate the overwhelming amount of information circulating during the pandemic. This mission has 2 primary objectives: (1) to disseminate trustworthy, comprehensive, and timely scientific content about the pandemic to lay audiences via social media and (2) to promote media literacy and information-hygiene practices, equipping readers to better manage the COVID-19 infodemic within their own networks. The volunteer team of scientists publishes 8-16 posts per week on pandemic-relevant topics. Nearly 2 years after it launched in March 2020, the project has a combined monthly reach of more than 4 million unique views across 4 social media channels, an email newsletter, and a website. We describe the project's guiding principles, lessons learned, challenges, and opportunities. Dear Pandemic has emerged as an example of a promising new paradigm for public health communication and intervention. The contributors deliver content in ways that are personal, practical, actionable, responsive, and native to social media platforms. The project's guiding principles are a model for public health communication targeting future infodemics and can bridge the chasm between the scientific community and the practical daily decision-making needs of the general public.

Reliability of self-rated health in US adults.

General self-rated health (SRH) is widely used to study trends and inequalities in population health. Recently, there has been an increased interest in understanding the measurement properties of SRH. This study evaluated for the first time the test-retest reliability of SRH among US adults. Analyses were based on a nationally representative sample of 9,235 adults interviewed in the 2005-2008 National Health and Nutrition Examination Survey (NHANES). Respondents reported SRH on 2 occasions (about 1 month apart). Kappa statistics, polyserial correlations, and agreement tabulations were used to assess reliability across population subgroups; regression models tested the association of sociodemographic factors and the stability of the rating. Nearly 40% of respondents changed their health rating between interviews, indicating moderate test-retest reliability of SRH. Reliability differed significantly by sociodemographic characteristics: Racial/ethnic minorities and adults with less education had lower reliability of SRH judgments. Health events between interviews did not influence consistency, but conditional on a rating change, they increased the odds of downgrading one's health. The results suggest that 1) there is a substantial amount of error in individuals' self-assessment of health and 2) reliability is worse for disadvantaged sociodemographic groups, potentially biasing estimates of health inequalities among US adults.

Overweight adults may have the lowest mortality--do they have the best health?

Numerous recent studies have found that overweight adults experience lower overall mortality than those who are underweight, normal-weight, or obese. These highly publicized findings imply that overweight may be the optimal weight category for overall health via its association with longevity-a conclusion with important public health implications. In this study, the authors examined the association between body mass index (BMI; (weight (kg)/height (m)(2))) and 3 markers of health risks using a nationally representative sample of US adults aged 20-80 years (n = 9,255) from the National Health and Nutrition Examination Survey (2005-2008). Generalized additive models, a type of semiparametric regression model, were used to examine the relations between BMI and biomarkers of inflammation, metabolic function, and cardiovascular function (C-reactive protein, hemoglobin A(1c), and high density lipoprotein cholesterol, respectively). The association between BMI and each biomarker was monotonic, with higher BMI being consistently associated with worse health risk profiles at all ages, in contrast to the U-shaped relation between BMI and mortality. Prior results suggesting that the overweight BMI category corresponds to the lowest risk of mortality may not be generalizable to indicators of health risk.