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1.
PLoS One ; 16(9): e0256085, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34469440

RESUMO

Researchers and journalists have argued that work-related factors may be partly responsible for disproportionate COVID-19 infection and death rates among vulnerable groups. We evaluate these issues by describing racial and ethnic differences in the likelihood of work-related exposure to COVID-19. We extend previous studies by considering 12 racial and ethnic groups and five types of potential occupational exposure to the virus: exposure to infection, physical proximity to others, face-to-face discussions, interactions with external customers and the public, and working indoors. Most importantly, we stratify our results by occupational standing, defined as the proportion of workers within each occupation with at least some college education. This measure serves as a proxy for whether workplaces and workers employ COVID-19-related risk reduction strategies. We use the 2018 American Community Survey to identify recent workers by occupation, and link 409 occupations to information on work context from the Occupational Information Network to identify potential COVID-related risk factors. We then examine the racial/ethnic distribution of all frontline workers and frontline workers at highest potential risk of COVID-19, by occupational standing and by sex. The results indicate that, contrary to expectation, White frontline workers are often overrepresented in high-risk jobs while Black and Latino frontline workers are generally underrepresented in these jobs. However, disaggregation of the results by occupational standing shows that, in contrast to Whites and several Asian groups, Latino and Black frontline workers are overrepresented in lower standing occupations overall and in lower standing occupations associated with high risk, and thus may be less likely to have adequate COVID-19 protections. Our findings suggest that greater work exposures likely contribute to a higher prevalence of COVID-19 among Latino and Black adults and underscore the need for measures to reduce potential exposure for workers in low standing occupations and for the development of programs outside the workplace.


Assuntos
COVID-19/epidemiologia , Grupos de Populações Continentais , Exposição Ocupacional/efeitos adversos , Ocupações , SARS-CoV-2 , Adulto , Grupos Étnicos , Feminino , Humanos , Masculino , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Local de Trabalho
2.
Nat Med ; 27(9): 1629-1635, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34188224

RESUMO

Brazil has been heavily affected by coronavirus disease 2019 (COVID-19). In this study, we used data on reported total deaths in 2020 and in January-April 2021 to measure and compare the death toll across states. We estimate a decline in 2020 life expectancy at birth (e0) of 1.3 years, a mortality level not seen since 2014. The reduction in life expectancy at age 65 (e65) in 2020 was 0.9 years, setting Brazil back to 2012 levels. The decline was larger for males, widening by 9.1% the female-male gap in e0. Among states, Amazonas lost 60.4% of the improvements in e0 since 2000. In the first 4 months of 2021, COVID-19 deaths represented 107% of the total 2020 figures. Assuming that death rates would have been equal to 2019 all-cause rates in the absence of COVID-19, COVID-19 deaths in 2021 have already reduced e0 in 2021 by 1.8 years, which is slightly larger than the reduction estimated for 2020 under similar assumptions.


Assuntos
COVID-19/epidemiologia , COVID-19/mortalidade , Expectativa de Vida , Brasil/epidemiologia , Causas de Morte , Feminino , Humanos , Masculino , SARS-CoV-2 , Fatores Sexuais
4.
Artigo em Inglês | MEDLINE | ID: mdl-34075511

RESUMO

This study quantifies the magnitude and persistence of differences in adverse birth outcomes between descendants of foreign-born and US-born women by race/ethnicity. Using 1978-2015 California birth records, I linked records of infants to those of their mothers to create an intergenerational sample (N = 501,323 second generation mothers and 633,102 third generation daughters). Prevalence of low birthweight and preterm birth were calculated in both generations by race/ethnicity, and foreign-born status. An initial foreign-born advantage in birth outcomes is present among most racial/ethnic groups with the exception of foreign-born Asian women. In the subsequent generation, the foreign-origin advantage diminishes for most groups and a foreign-origin disadvantage in low birthweight emerges for descendants of Asian women. Findings largely persist after adjustment for sociodemographic and healthcare-related characteristics. These results underscore the importance of disaggregating by race, ethnicity, and foreign origin when possible to better understand perinatal health disparities in the population.

5.
PLoS One ; 16(3): e0247804, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33730061

RESUMO

Latinos in the US live significantly longer than non-Latino whites, but spend more years disabled. Differentials in socioeconomic status account for part, but not all, of the difference in older age disability between Latinos and whites. We hypothesize that a factor often ignored in the literature-the fact that Latinos, on average, have more physically strenuous jobs than non-Latino whites-contributes to the higher Latino risk of functional limitations at older ages. We use longitudinal data from the 1998-2014 Health and Retirement Study (HRS) comprising 17,297 respondents. Compared to US-born whites, Latinos, especially Latino immigrants, report substantially higher levels of physical effort at work. Latino-black differences are much smaller than Latino-white differences. As hypothesized, physical work effort is strongly related to functional limitations. However, differentials in physical work effort for Latinos and whites in their fifties and early sixties are weakly related to Latino-white differentials in FL at later ages.

6.
Proc Natl Acad Sci U S A ; 118(5)2021 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-33446511

RESUMO

COVID-19 has resulted in a staggering death toll in the United States: over 215,000 by mid-October 2020, according to the Centers for Disease Control and Prevention. Black and Latino Americans have experienced a disproportionate burden of COVID-19 morbidity and mortality, reflecting persistent structural inequalities that increase risk of exposure to COVID-19 and mortality risk for those infected. We estimate life expectancy at birth and at age 65 y for 2020, for the total US population and by race and ethnicity, using four scenarios of deaths-one in which the COVID-19 pandemic had not occurred and three including COVID-19 mortality projections produced by the Institute for Health Metrics and Evaluation. Our medium estimate indicates a reduction in US life expectancy at birth of 1.13 y to 77.48 y, lower than any year since 2003. We also project a 0.87-y reduction in life expectancy at age 65 y. The Black and Latino populations are estimated to experience declines in life expectancy at birth of 2.10 and 3.05 y, respectively, both of which are several times the 0.68-y reduction for Whites. These projections imply an increase of nearly 40% in the Black-White life expectancy gap, from 3.6 y to over 5 y, thereby eliminating progress made in reducing this differential since 2006. Latinos, who have consistently experienced lower mortality than Whites (a phenomenon known as the Latino or Hispanic paradox), would see their more than 3-y survival advantage reduced to less than 1 y.


Assuntos
Afro-Americanos , COVID-19/epidemiologia , Hispano-Americanos , Expectativa de Vida/etnologia , Idoso , Grupo com Ancestrais do Continente Europeu , Previsões , Disparidades nos Níveis de Saúde , Humanos , Pandemias , Estados Unidos/epidemiologia
7.
medRxiv ; 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33236022

RESUMO

Researchers and journalists have argued that work-related factors may be partly responsible for disproportionate COVID-19 infection and death rates among vulnerable groups. We evaluate these claims by examining racial and ethnic differences in the likelihood of work-related exposure to COVID-19. We extend previous studies by considering 12 racial and ethnic groups and five types of potential occupational exposure to the virus: exposure to infection, physical proximity to others, face-to-face discussions, interactions with external customers and the public, and working indoors. Most importantly, we stratify our results by occupational status, defined as the proportion of workers within each occupation with some college education. This measure serves as a proxy for whether workplaces and workers employ significant COVID-19-related risk reduction strategies. We use the 2018 American Community Survey to identify recent workers by occupation, and link 409 occupations to information on work context from the Occupational Information Network to identify potential COVID-related risk factors. We then examine the racial/ethnic distribution of all frontline workers and frontline workers at highest potential risk of COVID-19, by occupational status and by sex. The results indicate that, contrary to expectation, White frontline workers are often overrepresented in high-risk jobs while Black and Latino frontline workers are generally underrepresented in these jobs. However, disaggregation of the results by occupational status shows that, in contrast to Whites and several Asian groups, Latino and Black frontline workers are overrepresented in lower status occupations overall and in lower status occupations associated with high risk, and are thus less likely to have adequate COVID-19 protections. Our findings suggest that greater work exposures likely contribute to a higher prevalence of COVID-19 among Latino and Black adults and underscore the need for measures to reduce potential exposure for workers in low status occupations and for the development of programs outside the workplace.

8.
medRxiv ; 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32995806

RESUMO

COVID-19 has resulted in a staggering death toll in the US: over 180,000 by the end of August 2020, according to the National Center for Health Statistics. Black and Latino Americans have experienced a disproportionate burden of COVID-19 morbidity and mortality, reflecting persistent structural inequalities that increase risk of exposure to COVID-19 and mortality risk for those infected. We estimate life expectancy at birth and at age 65 for 2020, for the total US population and by race and ethnicity, using four scenarios of deaths - one in which the COVID-19 pandemic had not occurred and three including COVID-19 mortality projections produced by the Institute for Health Metrics and Evaluation. Our most likely estimate indicates a reduction in US life expectancy at birth of 1.41 years. This decline results in a life expectancy of 77.2 years, a value last observed in 2003. We also project a 1.08-year reduction in life expectancy at age 65. The Black and Latino populations are estimated to experience declines in life expectancy at birth of 2.69 and 3.66 years, respectively, both of which are several times the 0.84-year reduction for whites. These projections imply an increase of over 50% in the Black-white life expectancy gap, from 3.6 to 5.5 years, thereby eliminating twenty years of progress made in reducing this differential. Latinos, who have consistently experienced lower mortality than whites (a phenomenon known as the Latino or Hispanic paradox), would see their more than three-year survival advantage almost eliminated.

9.
Epidemiology ; 31(5): 649-658, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32482947

RESUMO

BACKGROUND: Foreign-born women have heavier infants than US-born women, but it is unclear whether this advantage persists across generations for all races and ethnicities. METHODS: Using 1971-2015 Florida birth records, we linked records of female infants within families to assess intergenerational changes in birthweight and prevalence of low birthweight by grandmother's race/ethnicity and foreign-born status. We also assessed educational gradients in low birthweight in two generations. RESULTS: Compared with daughters of US-born black women, daughters of foreign-born black women had substantially higher birthweights (3,199 vs. 3,083 g) and lower prevalence of low birthweight (7.8% vs. 11.8%). Daughters of foreign-born Hispanic women had moderately higher birthweights (3,322 vs. 3,268 grams) and lower prevalence of low birthweight (4.5% vs. 6.2%) than daughters of US-born Hispanic women. In the next generation, a Hispanic foreign-origin advantage persisted in low birthweight prevalence (6.1% vs. 7.2%), but the corresponding black foreign-origin advantage was almost eliminated (12.2% vs. 13.1%). Findings were robust to adjustment for sociodemographic and medical risk factors. In contrast to patterns for other women, the prevalence of low birthweight varied little by maternal education for foreign-born black women. However, a gradient emerged among their US-born daughters. CONCLUSIONS: The convergence of birthweight between descendants of foreign-born and US-born black women is consistent with theories positing that lifetime exposure to discrimination and socioeconomic inequality is associated with adverse health outcomes for black women. The emergence of a distinct educational gradient in low birthweight prevalence between generations underscores hypothesized adverse effects of multiple dimensions of disadvantage.


Assuntos
Afro-Americanos , Peso ao Nascer , Emigrantes e Imigrantes , Avós , Hispano-Americanos , Afro-Americanos/estatística & dados numéricos , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Estados Unidos/epidemiologia
10.
Soc Sci Med ; 255: 112983, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32353650

RESUMO

Measures of physical functioning are among the strongest predictors of mortality, but no previous study has assessed whether the predictive value of such measures varies by race/ethnicity, as has been done for the simple self-rated health question. The current study tests whether the relationship between two measures of physical functioning (the number of self-reported functional limitations and measured walking speed) and mortality is weaker (has a lower hazard ratio) for Latinos and blacks than for whites. Data were drawn from the 1998-2014 waves of the Health and Retirement Study, with mortality follow-up through 2016. We used Cox hazard models with household random effects to test for interactions between race/ethnicity and these measures of physical functioning and verified earlier findings for self-rated health. The number of self-reported functional limitations is significantly related to mortality for all racial/ethnic groups, but has a substantially lower hazard ratio for blacks and Latinos than for whites, as hypothesized. This hazard ratio remains lower for blacks and Latinos after adjustment for sociodemographic characteristics and health conditions. These findings suggest that the higher rates of functional limitations observed among Latinos and blacks compared with whites may reflect a history of strenuous physical work, inadequately controlled pain, lower leisure-time physical activity, or untreated/under-treated mobility problems that can lead to reduced physical performance without necessarily having a substantial effect on mortality risk. On the other hand, we do not detect significant racial/ethnic differences in the association between measured walking speed and subsequent mortality. This may be the result of the smaller sample size for the walking speed tests, the more nuanced nature of the continuous walking speed measure, or the fact that the walking speed test captures only a subset of the limitations included in the self-reports.


Assuntos
Afro-Americanos , Hispano-Americanos , Idoso , Grupos Étnicos , Grupo com Ancestrais do Continente Europeu , Humanos , Autorrelato
11.
J Gerontol B Psychol Sci Soc Sci ; 75(3): 630-639, 2020 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-30388248

RESUMO

OBJECTIVES: Both performance-based and self-reported measures of physical functioning are predictors of mortality. There has been relatively little research examining whether their changes predict mortality. This study examines whether 5-year changes in performance-based and self-reported measures of functioning predict subsequent mortality. METHOD: Data are from the 2006 wave of the Social Environment and Biomarkers of Aging Study, 2011 wave of the Taiwan Longitudinal Study of Aging, and mortality follow-up through 2015. Gompertz proportional hazard models predict mortality from changes in ability to complete performance-based tests and changes in performance-based and self-reported functioning. RESULTS: Incident inability to complete at least one performance-based test of functioning is associated with twice the risk of subsequent 4-year mortality. Conditional on the baseline measurement, a one standard deviation (SD) decline in grip strength is associated with a 61% increased risk of 4-year mortality; a one-SD decline in walking speed and a one-SD increase in self-reported limitations are both associated with around a 40% increased risk of 4-year mortality. Conditional on the most recent measurement of functioning, prior change is not significantly associated with subsequent mortality. DISCUSSION: Repeated measures of performance-based and self-reported functioning are valuable in that they provide an updated measurement of functioning.


Assuntos
Atividades Cotidianas , Envelhecimento/fisiologia , Força da Mão/fisiologia , Nível de Saúde , Limitação da Mobilidade , Mortalidade , Autorrelato , Velocidade de Caminhada/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Inquéritos Epidemiológicos , Humanos , Estudos Longitudinais , Masculino , Prognóstico , Risco , Taiwan
12.
J Adolesc Health ; 62(5): 570-576, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29415821

RESUMO

PURPOSE: The common practice of sending an explanation of benefits to policyholders may inadvertently disclose sensitive services to the parents of dependents, making confidentiality a potential barrier to reproductive health care. This study compares the reproductive health-care utilization of young adult dependents and young adult policyholders using nationally representative data collected after full implementation of the Affordable Care Act. METHODS: Data from 2,108 young adults aged 18-25 years in the 2015 National Health Interview Survey were analyzed. Logistic regressions predicted utilization of two preventive services (general doctor visit and flu vaccination) and four reproductive health services (HIV testing, obstetrician/gynecologist visit, hormonal contraceptive use, and Pap testing) from the insurance type of the young adult (dependent, privately insured policyholder, or Medicaid). RESULTS: In unadjusted analyses, young adult dependents had lower utilization of HIV tests than their peers who were privately insured or Medicaid policyholders. Young women dependents had lower utilization of Pap tests than young women on Medicaid. Once controls were included, young adult dependents did not have significantly lower odds of obtaining reproductive health care than privately insured policyholders. Dependent young men still had marginally lower odds of ever having an HIV test (adjusted odds ratio = .65, p = .08) and dependent young women still had marginally lower odds of ever having a Pap test (adjusted odds ratio = .58, p = .06) than comparable Medicaid policyholders. CONCLUSIONS: Despite confidentiality concerns, young adults insured as dependents have utilization of several reproductive health services similar to that of comparable young adult policyholders.


Assuntos
Seguro Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços de Saúde Reprodutiva/estatística & dados numéricos , Adolescente , Adulto , Confidencialidade/psicologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Medicaid/estatística & dados numéricos , Patient Protection and Affordable Care Act , Estados Unidos , Adulto Jovem
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