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: 9764234
• 负责人: Arline T Geronimus
• 金额: $ 38.21万
• 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 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9764234
• 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：研究人员使用各种数据源和方法独立地 记录了两个令人不安的趋势：美国亚人群预期寿命（LE）的普遍增长停止， 自 1990 年以来 LE 教育不平等现象随之加剧——这两者都使我们距离实现目标更进一步 人口健康公平这一高度优先的国家公共卫生目标 LE 不平等现象日益严重的时机。 表明中等收入家庭的经济前景停滞或恶化 全球化和自动化导致的就业岗位流失发挥着重要作用，但这一假设尚未得到严格验证。 我们建议，全球化和自动化的影响因地域而异。 利用这种地理差异来研究持续性和结构性经济困境的累积效应 关于 LE 的死亡率和日益严重的教育不平等的另一个重要问题涉及机制。 随着时间的推移，与外生经济趋势相关的 LE 差异不断扩大，具体情况如下。 受教育程度较低的人的死亡原因增加，或受教育程度较高的人的死亡原因减少，或两者兼而有之？ 这是否会因种族、性别、年龄组或地区而异？ 除了会计机制之外，我们还将考虑 从概念上讲，不同的死亡原因在生命历程中如何遵循不同的生物心理社会轨迹 以风化假说为指导，风化理论认为累积和压力介导的磨损和 细胞完整性的破坏会导致加速生物衰老，重要身体系统的失调 中年时期，以及衰老、健康引起的残疾和过度死亡等慢性疾病的早期发病，及其 相关的个人、家庭和社会损失以及医疗保健费用的增加是 LE 中日益增长的不平等现象。 褪色反映了结构性不平等加深和长期的风化效应以及 一生中持续付出巨大努力应对这种不平等所带来的累积生理效应。 我们的实证方法旨在测试风化假设预测的命题，并测试 为解释教育增加而提出的共同竞争假设的强度 1990 年至 2015 年间 LE 的不平等。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。 与其他原因相比，教育弱势群体的死亡原因可能增加 死亡人数也可能增加，并在生物学上合理的理论范围内考虑它们 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。 可能会促进或阻碍全国和次国家范围内的健康发展。