Economic distress and growing educational disparities in life expectancy: Weathering, high effort coping, and despair

经济困境和预期寿命方面日益扩大的教育差距：风化、努力应对和绝望

• 批准号: 10433969
• 负责人: Arline T Geronimus
• 金额: $ 37.57万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10433969
• 关键词: Accounting; Age; Aging; Alcohol abuse; Alcoholic Liver Diseases; American; Analysis of Variance; Area; Autoimmune Diseases; Automation; Behavioral; Biological; Biological Aging; Cardiovascular Diseases; Caring; Cause of Death; Censuses; Cessation of life; Child; Chronic Disease; Community Surveys; Commuting; Country; County; Data; Data Sources; Death Rate; Development; Diabetes Mellitus; Disease; Distress; Drug abuse; Economics; Epigenetic Process; Evaluation; Excess Mortality; Exclusion; Gender; Genomics; Geography; Health; Health Care Costs; Health Services; Health behavior; Health trends; Household; Human; Income; Inequality; Kidney Diseases; Life Cycle Stages; Life Expectancy; Life Tables; Light; Link; Locales; Malignant Neoplasms; Mechanics; Mediating; Medical; Methodology; Methods; Modeling; Obesity; Occupations; Opioid; Overdose; Parents; Pattern; Pharmaceutical Preparations; Physiological; Play; Policies; Policy Developments; Population; Probability; Public Health; Race; Research Personnel; Risk Factors; Role; Sampling; Smoking; Standardization; Stress; Structure; Suicide; System; Testing; Time; United States Public Health Service; Vital Statistics; Weather; Woman; age group; biopsychosocial; body system; cohort; coping; design; disability; early onset; educationally disadvantaged; falls; geographic difference; health care availability; health equity; healthy aging; men; middle age; mortality; opioid mortality; panel study of income dynamics; population health; social; socioeconomic disparity; socioeconomics; stressor; telomere; theories; therapy development; trend; years of life lost

PROJECT SUMMARY: Researchers have used a variety of data sources and methodologies to independently document two disturbing trends: a halt to universal gains in life expectancy (LE) across US subpopulations, and a subsequent rise in educational inequality in LE since 1990—both of which take us further from achieving the high-priority national public health objective of population health equity. The timing of growing LE inequities suggests that the stagnating or deteriorating economic prospects of moderate income households in light of jobs lost to globalization and automation play an important role. Yet, this hypothesis has yet to be rigorously empirically tested. The impact of globalization and automation has varied geographically. We propose to leverage this geographic variation to study the cumulative effect of persistent and structural economic distress on mortality and growing educational inequities in LE. Another important question concerns the mechanisms through which LE disparities linked to exogenous economic trends have grown. Over time, which specific causes of death increased among the less educated or decreased among the more educated, or both? How might this vary by race, gender, age-group or locale? Beyond the accounting mechanics, we will also consider how different causes of death follow different biopsychosocial trajectories over the life course, conceptually guided by the weathering hypothesis. Weathering theorizes that cumulative and stress-mediated wear and tear on cellular integrity leads to accelerated biological aging, the dysregulation of important body systems by midlife, and the early onset of chronic diseases of aging, health-induced disability, and excess death, with their associated personal, familial, and societal tolls and increased health care costs. Growing inequity in LE is hypothesized to reflect the weathering effects of deepening and prolonged structural inequity and the cumulative physiological effects of the persistent high-effort coping such inequity entails over the life course. Our empirical approach is designed to test propositions predicted by the weathering hypothesis and also to test the strength of common competing hypotheses that have been forwarded to explain increased educational inequity in LE between 1990 and 2015. These competing hypotheses include focusing on the roles of smoking, obesity, medical care, and also on “deaths of despair,” such as opioid deaths and suicide. Placing specific causes of death that may have risen among the educationally disadvantaged in perspective with other causes of death that may have also increased, and considering them within a biologically plausible theoretical framework, is critical to the evaluation of the social, economic, public health, and health services policies that are likely to promote or impede health equity nationally and subnationally going forward.

项目摘要：研究人员使用了各种数据源和方法独立 记录两个令人惊讶的趋势：在美国亚群中停止预期寿命（LE）的普遍增长， 自1990年以来，LE的教育不平等现象随后增加，这两项都使我们无法实现 人口健康公平的高优先国家公共卫生目标。不断增长的不平等时机 表明，根据 失去全球化和自动化的工作起着重要作用。然而，这个假设尚未严格 经验测试。全球化和自动化的影响在地理上各不相同。我们建议 利用这种地理差异来研究持续和结构性经济困扰的累积效应 关于LE的死亡率和不断增长的教育不平等。另一个重要的问题涉及机制 通过与外在经济趋势相关的LE分布已经增长。随着时间的流逝，哪个特定 在受教育程度较高的教育或两者兼而有之受过较少教育或减少的死亡原因？如何 这种情况可能因种族，性别，年龄段还是地区差异？除了会计机制之外，我们还将考虑 在概念上，死亡的不同原因如何遵循不同的生物心理社会轨迹 在风化假设的指导下。风化理论意味着累积和压力介导的磨损以及 细胞完整性的撕裂会导致生物学衰老加速，通过 中年，以及衰老，健康诱发的残疾的慢性疾病的早期发作，并超过死亡 相关的个人，家庭和社会通行费，并增加医疗保健成本。 LE的不平等越来越不平等 假设反映了加深和延长结构不平等的风化影响以及 持续的高位应对这种不平等的累积物理影响需要在生活过程中。 我们的经验方法旨在测试通过风化假设预测的建议，并测试 转发以解释增加教育的共同竞争假设的力量 1990年至2015年之间的LE不平等。这些相互竞争的假设包括关注吸烟的作用， 肥胖，医疗保健以及“绝望死亡”，例如阿片类药物死亡和自杀。具体放置 死亡原因可能在教育上与其他原因有关 死亡可能也增加了，并在生物学上合理的理论上考虑了死亡 框架对于评估社会，经济，公共卫生和卫生服务政策至关重要 可能会在全国和下的下降促进或阻碍健康公平。