Race/Ethnic and Educational Disparities in the Association Between Pathogen Burden and a Laboratory-Based Cumulative Deficits Index.

BACKGROUND: Disparities in adult morbidity and mortality may be rooted in patterns of biological dysfunction in early life. We sought to examine the association between pathogen burden and a cumulative deficits index (CDI), conceptualized as a pre-clinical marker of an unhealthy biomarker profile, specifically focusing on patterns across levels of social disadvantage. METHODS: Using the data from the National Health and Nutrition Examination Survey 2003-2004 wave (aged 20-49 years), we examined the association of pathogen burden, composed of seven pathogens, with the CDI. The CDI comprised 28 biomarkers corresponding to available clinical laboratory measures. Models were stratified by race/ethnicity and education level. RESULTS: The CDI ranged from 0.04 to 0.78. Nearly half of Blacks were classified in the high burden pathogen class compared with 8% of Whites. Among both Mexican Americans and other Hispanic groups, the largest proportion of individuals were classified in the common pathogens class. Among educational classes, 19% of those with less than a high school education were classified in the high burden class compared with 7% of those with at least a college education. Blacks in the high burden pathogen class had a CDI 0.05 greater than those in the low burden class (P < 0.05). Whites in the high burden class had a CDI only 0.03 greater than those in the low burden class (P < 0.01). DISCUSSION: Our findings suggest there are significant social disparities in the distribution of pathogen burden across race/ethnic groups, and the effects of pathogen burden may be more significant for socially disadvantaged individuals.

Investigating pathogen burden in relation to a cumulative deficits index in a representative sample of US adults.

Pathogen burden is a construct developed to assess the cumulative effects of multiple, persistent pathogens on morbidity and mortality. Despite the likely biological wear and tear on multiple body systems caused by persistent infections, few studies have examined the impact of total pathogen burden on such outcomes and specifically on preclinical markers of dysfunction. Using data from two waves of the National Health and Nutrition Examination Survey, we compared three alternative methods for measuring pathogen burden, composed of mainly persistent viral infections, using a cumulative deficits index (CDI) as an outcome: single pathogen associations, a pathogen burden summary score and latent class analyses. We found significant heterogeneity in the distribution of the CDI by age, sex, race/ethnicity and education. There was an association between pathogen burden and the CDI by all three metrics. The latent class classification of pathogen burden showed particularly strong associations with the CDI; these associations remained after controlling for age, sex, body mass index, smoking, race/ethnicity and education. Our results suggest that pathogen burden may influence early clinical indicators of poor health as measured by the CDI. Our results are salient since we were able to detect these associations in a relatively young population. These findings suggest that reducing pathogen burden and the specific pathogens that drive the CDI may provide a target for preventing the early development of age-related physiological changes.

The precious and the precocious: understanding cumulative disadvantage and cumulative advantage over the life course.

The explanation of increasing heterogeneity and inequality within aging cohorts is a central concern of the life-course perspective and common ground for demographers, economists, historians, sociologists, and psychologists alike. Income and wealth inequality among the aged is one area of shared interest where cross-disciplinary fertilization is occurring. While indices of aged economic inequality applied across different data sets replicate the level of inequality among the elderly, theoretical and methodological concerns are focused more and more on identifying and specifying the long-term interactions between institutional and life-course processes producing this outcome. Institutional mechanisms incorporated in opportunity structures such as labor markets and pensions stratify the availability of resources and rewards, and they interact with life-course processes related to labor force history and job mobility to produce complex patterns of cumulative advantage and cumulative disadvantage. However, the examination of long-term mechanisms of stratification requires finer-grained observations of work, employer, and pension histories than current data-collection strategies afford. Two biases--the steady worker bias and the one pension bias--are inherent in most longitudinal data bases and hamper progress in our understanding of the production of aged inequality.

Retirement reason versus retirement process: examining the reasons for retirement typology.

Studies have often used reason for retirement as an indicator of the pathway leading to retirement. We discuss the conceptual basis for the retirement-reason typology and evaluate the distinctiveness of various reasons for labor force exit by predicting them in a standard model-based analysis. Data are from the 1982 Social Security New Beneficiary Study, and the analysis is limited to men. A number of factors in the model-based analysis have distinctive effects on exit for particular retirement reasons, but health limits increase the likelihood of all types of retirement. We conclude that reasons for retirement only partially capture distinctive retirement processes.

Nursery Neurobiologic Risk Score: important factor in predicting outcome in very low birth weight infants.

We developed a nursery Neurobiologic Risk Score (NBRS) based on potential mechanisms of brain cell injury in preterm infants and correlated it with developmental outcome at the corrected ages of 6, 15, and 24 months. The NBRS was determined at 2 weeks of age and at the time of discharge from intensive care in 58 preterm infants with birth weights less than or equal to 1500 gm. The NBRS correlated significantly with the Bayley Scales of Infant Development, Mental Development Index (MDI) (r = -0.61 to -0.40) and Psychomotor Development Index (PDI) (r = -0.59 to -0.46), and with abnormal neurologic examination findings (r = 0.59 to 0.73) at the three testing periods. Although 12 of the 13 items composing the NBRS individually correlated with one or more outcome variables, seven items (infection, blood pH, seizures, intraventricular hemorrhage, assisted ventilation, periventricular leukomalacia, and hypoglycemia) accounted for almost all of the explained variance. Logistic regression of individual items demonstrated intraventricular hemorrhage to be the most important item for predicting the MDI at 24 months; pH was the most influential item for predicting the PDI at every testing period. A shorter, revised NBRS that included only the seven significant items demonstrated as strong a correlation with developmental outcome as the original NBRS. A revised 2-week score of greater than or equal to 5 or a discharge score of greater than or equal to 6 demonstrated 100% specificity and had a 100% positive predictive value for an abnormal outcome at 24 months of age in this group of infants. We conclude that the NBRS identifies during the intensive care nursery stay those infants at highest risk for an abnormal outcome related to nursery events. In addition, analysis of NBRS items provides insight into the relative importance of individual factors for influencing mental, motor, and neurologic outcome.

Labor-force participation of older married women.

This article utilizes the 1969, 1971, and 1973 waves of the Longitudinal Retirement History Study (LRHS) to examine stopping work by working wives of respondents. Different patterns of labor-force participation reveal that younger wives of respondents were more likely to work than were older wives. Most wives did not reenter the labor force after leaving it. The determinants of stopping or continuing work in 1969-73 for those wives who worked in 1969 were also examined. Although the patterns were somewhat different for younger wives, two factors stand out: Coverage of the wife by a private pension plan and providing for children or elderly parents have substantial effects on the probability of continuing work.