Validation of a geospatial aggregation method for congressional districts and other US administrative geographies.

Stakeholders need data on health and drivers of health parsed to the boundaries of essential policy-relevant geographies. US Congressional Districts are an example of a policy-relevant geography which generally lack health data. One strategy to generate Congressional District heath data metric estimates is to aggregate estimates from other geographies, for example, from counties or census tracts to Congressional Districts. Doing so requires several methodological decisions. We refine a method to aggregate health metric estimates from one geography to another, using a population weighted approach. The method's accuracy is evaluated by comparing three aggregated metric estimates to metric estimates from the US Census American Community Survey for the same years: Broadband Access, High School Completion, and Unemployment. We then conducted four sensitivity analyses testing: the effect of aggregating counts vs. percentages; impacts of component geography size and data missingness; and extent of population overlap between component and target geographies. Aggregated estimates were very similar to estimates for identical metrics drawn directly from the data source. Sensitivity analyses suggest the following best practices for Congressional district-based metrics: utilizing smaller, more plentiful geographies like census tracts as opposed to larger, less plentiful geographies like counties, despite potential for less stable estimates in smaller geographies; favoring geographies with higher percentage population overlap.

Young Adults and Adverse Childhood Events: A Potent Measure of Cardiovascular Risk.

INTRODUCTION: While cardiovascular disease is the leading cause of death, its determinants include unhealthy behaviors and clinical risk factors and are recognized as the "actual causes" of death. Risk likely accumulates over the life course, and adverse childhood experiences may increase the risk of "actual causes" of death. The objectives of the study are to determine the prevalence and test the association of adverse childhood experiences among unhealthy behaviors and risk factors as a primordial risk factor among young adults. METHODS: Data were extracted from the 2009 and 2011 Behavioural Risk Factor Surveillance System. Individuals ages 18-99 years provided complete information on adverse childhood experiences, health behaviors, and risk factors. Adverse childhood experiences were categorized and evaluated as cumulative burden. Multivariable logistic models, including stratified analysis for young adults, tested the association of adverse childhood experiences burden with unhealthy behaviors and risk factors. RESULTS: Among 45,482 study participants, 52% report one adverse childhood experience and 25% report 2 adverse childhood experience categories. Among the total study population, 37% report violence/emotional abuse, 34% report neglect, and 12% report sexual abuse. Even one adverse childhood experience is strongly associated with hypertension, dyslipidemia, and diabetes, and while the association increases in a dose-response (P trend < .001) for all, it is especially more pronounced among the younger adults, with minimal attenuation of effects in the fully adjusted models. CONCLUSION: The prevalence of adverse childhood experiences in this study population is high. Even one adverse childhood experience is strongly and independently associated with cardiovascular risk factors, with implications for primordial prevention. Future studies are needed to develop screening and treatment strategies targeted to this high-risk group, especially among young adults.

Grandparental education, parental education and adolescent blood pressure.

BACKGROUND: Maternal and paternal education could affect childhood blood pressure differently. Grandparental education might also play a role. Disentangling their contribution to childhood blood pressure may shed light on the persistence of disparities and potential windows of intervention. METHODS: Using 5604 participants from a Chinese birth cohort born in 1997 and followed-up until ~13years (68% of follow-up), we examined the associations of parental education and grandparental education with age-, sex, and height-specific blood pressure z-scores or prehypertension status. RESULTS: Parental education was inversely associated with adolescent systolic (-0.11 z-score, equivalent to -1.17mmHg, 95% confidence interval (CI) -0.19 to -0.04 for grade ≥12 compared with grade ≤9) and diastolic blood pressure (-0.07 z-score, equivalent to -0.79mmHg, 95% CI -0.11 to -0.04). The magnitude of association was similar for maternal or paternal education. Grandparental education was not associated with adolescent blood pressure. No association with prehypertension was found. CONCLUSIONS: In an economically developed non-Western setting, both maternal and paternal, but not grandparental, education was associated with adolescent blood pressure. Blood pressure may be responsive to contemporary family socioeconomic conditions that may be scrutinized for suitable interventions.

Pathways from parental educational attainment to adolescent blood pressure.

OBJECTIVES: Lower parental education is associated with higher adolescent blood pressure (BP). We examined the contribution of modifiable risk factors from infancy to adolescence that could potentially explain the link between parental education and SBP and DBP in the offspring. METHODS: In a prospective Chinese birth cohort, 'Children of 1997' of 5604 adolescents (68% follow-up), we analyzed the relation between parental educational attainment and sex-specific, age-specific and height-specific BP z-scores at ∼13 years. Using mediation analysis, we examined the contribution of household income at birth (both absolute income and relative income deprivation), exposures during infancy (breastfeeding and early life second-hand smoking), lifestyles during childhood (diet, physical activity and screen-time), weight or BMI status during fetal, infancy, childhood and puberty, pubertal stage as well as parental BMI. RESULTS: We found that adolescent BMI, but not birth weight or infant growth or childhood BMI, mediated the inverse association of parental education with adolescent SBP (proportion mediated: 24%), followed by maternal BMI (proportion mediated: 18%). Factors explaining the link between parental education and DBP were less clear. Absolute income, breastfeeding, childhood diet and physical activity, pubertal stage and paternal BMI did not mediate the association between parental education and adolescent BP. CONCLUSION: Low parental education is a risk factor for high SBP and, to a lesser extent, DBP in adolescents. Important mediators of this relation include adolescent and maternal body weight.

Can social policy influence socioeconomic disparities? Korean War GI Bill eligibility and markers of depression.

PURPOSE: The Korean War GI Bill provided socioeconomic benefits to veterans; however, its association with health is unclear; we hypothesize GI Bill eligibility is associated with fewer depressive symptoms and smaller disparities. METHODS: Data from 246 Korean War GI Bill eligible veterans and 240 nonveterans from the Health and Retirement Study were matched on birth year, southern birth, race, height, and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78 years) was assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale, dichotomized to reflect elevated depressive symptoms. Regression analyses were stratified into low (at least one parent < 8 years schooling/missing data, n = 167) or high (both parents ≥ 8 years schooling, n = 319) childhood socioeconomic status (cSES) groups. RESULTS: Korean War GI Bill eligibility predicted fewer depressive symptoms among individuals from low cSES backgrounds [ß = -0.64, 95% confidence interval (CI) = (-1.18, -0.09), P = .022]. Socioeconomic disparities were smaller among veterans than nonveterans for number of depressive symptoms [ß = -0.76, 95% CI = (-1.33, -0.18), P = .010] and elevated depressive symptoms [ß = -11.7, 95% CI = (-8.2, -22.6), P = .035]. CONCLUSIONS: Korean War GI Bill eligibility predicted smaller socioeconomic disparities in depression markers.

Elderly breast and colorectal cancer patients' clinical course: patient and contextual influences.

BACKGROUND: The social and medical environments that surround people are each independently associated with their cancer course. The extent to which these characteristics may together mediate patients' cancer care and outcomes is not known. METHODS: Using multilevel methods and data, we studied elderly breast and colorectal cancer patients (level I) within urban social (level II: ZIP code tabulation area) and health care (level III: hospital service area) contexts. We sought to determine (1) which, if any, observable social and medical contextual attributes were associated with patient cancer outcomes after controlling for observable patient attributes, and (2) the magnitude of residual variation in patient cancer outcomes at each level. RESULTS: Numerous patient attributes and social area attributes, including poverty, were associated with unfavorable patient cancer outcomes across the full clinical cancer continuum for both cancers. Health care area attributes were not associated with patient cancer outcomes. After controlling for observable covariates at all 3 levels, there was substantial residual variation in patient cancer outcomes at all levels. CONCLUSIONS: After controlling for patient attributes known to confer risk of poor cancer outcomes, we find that neighborhood socioeconomic disadvantage exerts an independent and deleterious effect on residents' cancer outcomes, but the area supply of the specific types of health care studied do not. Multilevel interventions targeted at cancer patients and their social areas may be useful. We also show substantial residual variation in patient outcomes across social and health care areas, a finding potentially relevant to traditional small area variation research methods.