Budgetary Consequences of High Medical Spending Across Age and Social Status: Evidence from the Consumer Expenditure Surveys.

BACKGROUND AND OBJECTIVES: This study examines high medical spending among younger, midlife, and older households. RESEARCH DESIGN AND METHODS: We investigate high medical spending using data from the 2010 through March 2018 Consumer Expenditures Surveys (n = 92,951). We classify and describe high medical spenders relative to others within three age groups (household heads age 25-44, 45-64, and 65+) using finite mixture models and multinomial logistic regression, respectively. We then use hierarchical linear models to estimate the effects of high medical spending on nonmedical spending. RESULTS: Among younger households, high medical spending is positively associated with higher education and increased spending on housing and food. Among older households, high medical spending is associated with lower education and decreased nonmedical spending. DISCUSSION AND IMPLICATIONS: Earlier in the life course, high medical spending is more likely to indicate an investment in future household well-being, while at older ages, high medical spending is likely to indicate medical consumption.

Association of Blood Chemistry Quantifications of Biological Aging With Disability and Mortality in Older Adults.

Quantification of biological aging has been proposed for population surveillance of age-related decline in system integrity and evaluation of geroprotective therapies. However, methods of quantifying biological aging have been little studied in geriatric populations. We analyzed three clinical-biomarker-algorithm methods to quantify biological aging. Klemera-Doubal method Biological Age and homeostatic dysregulation algorithms were parameterized from analysis of U.S. National Health and Nutrition Examination Surveys (NHANES) data (N = 36,207) based on published methods. Levine method Biological Age was adapted from published analysis of NHANES data. Algorithms were applied to biomarker data from the Duke Established Populations for Epidemiologic Studies of the Elderly (Duke-EPESE) cohort of older adults (N = 1,374, aged 71-102 years, 35% male, 52% African American). We tested associations of biological aging measures with participant reported Activities of daily living (ADL), instrumental activities of daily living (IADL) dependencies, and mortality. We evaluated the sensitivity of results to the demographic composition of reference samples and biomarker sets used to develop biological aging algorithms. African American and white Duke-EPESE participants with more advanced biological aging reported dependence in more ADLs and IADLs and were at increased risk of death over follow-up through 2017. Effect sizes were similar across algorithms, but were strongest for Levine method Biological Age (per-quintile increase in ADL incidence rate ratio = 1.25, 95% confidence interval [1.17-1.37], IADL incidence rate ratio = 1.23 [1.15-1.32], mortality hazard ratio = 1.12 [1.08-1.16]). Results were insensitive to demographic composition of reference samples, but modestly sensitive to the biomarker sets used to develop biological aging algorithms. Blood-chemistry-based quantifications of biological aging show promise for evaluating the effectiveness of interventions to extend healthy life span in older adults.

U.S. Immigration Policy Regimes and Physical Disability Trajectories Among Mexico-U.S. Immigrants.

OBJECTIVES: Although immigration policies have shifted dramatically over the course of U.S. history, few have examined their role as a source of health heterogeneity among immigrants. We address this gap by evaluating whether exposure to U.S. Immigration Policy Regimes (IPRs) corresponds with later-life disability disparities among Mexico-U.S. migrant women and men, and assess the degree to which observed differences may also be associated with immigration policies and occupational composition. METHOD: We analyze 8 waves of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (3,044 individuals and 14,474 observations from 1993/1994-2013). Using hierarchical linear models, we estimate trajectories of physical disability associated with gender, occupation, and IPR. RESULTS: We find differences in disability trajectories by IPR. Associations are not different between men and women, and are not mediated by occupational composition. We also observe an additive effect for certain occupations among women, but not among men. DISCUSSION: Findings demonstrate that exposure to different IPRs is associated with disparate disability trajectories among Mexico-U.S. migrants. Future research is needed to contextualize the role of IPRs amid other mechanisms of gendered racialization that powerfully contribute to cumulative health differences across the life course.

Dynamic Associations of Network Isolation and Smoking Behavior.

Prevailing social network frameworks examine the association between peer ties and behaviors, such as smoking, but the role of social isolates is poorly understood. Some theories predict isolated adolescents are protected from peer influence that increases smoking, while others suggest isolates are more likely to initiate smoking because they lack the social control provided by peer friendships. Building on a growing literature that seeks to explain these contradictions by moving beyond a homogeneous understanding of isolation, we identify the relationship between smoking and three distinct dimensions of isolation: avoided (adolescents who do not receive ties), withdrawn (adolescents who do not send ties), and externally oriented (adolescents who claim close out-of-grade friends). We examine the coevolutionary effects of these dimensions and cigarette smoking using an autoregressive latent trajectory model (ALT) with PROSPER Peers, a unique, longitudinal network dataset. These data include students (47% male and 86% white) from rural Iowa and Pennsylvania, ranging successively from grades 6-12 in eight waves of data. We find avoided isolation is associated with decreased subsequent smoking in high school. Smoking increases subsequent avoided and withdrawn isolation, but decreases external orientation.