Inequalities in US Life Expectancy by Area Unemployment Level, 1990-2010

This study examined the association between unemployment and life expectancy in the United States during 1990-2010. 

Census-based unemployment rates were linked to US county-level mortality data. Life expectancies were calculated by age, sex, race, and unemployment level during 1990-2010. Differences in life expectancy were decomposed by age and cause of death. 

Life expectancy was consistently lower in areas with higher unemployment rates. In 2006-2010, those in areas with high unemployment rates (≥9%) had a life expectancy of 76.9 years, compared with 80.7 years for those in areas with low unemployment rates (<3%). The association between unemployment and life expectancy was stronger for men than for women. 

Life expectancy ranged from 69.9 years among black men in high unemployment areas to 90.0 years among Asian/Pacific Islander women in low unemployment areas. Disparities persisted over time. In 1990-1992, life expectancy was 4.7 years shorter in high unemployment than in low unemployment areas. In 2006-2010, the life expectancy difference between the lowest and highest unemployment areas decreased to 3.8 years. Heart disease, cancer, homicide, unintentional injuries, diabetes, HIV/AIDS, and liver cirrhosis contributed most to the lower life expectancy in high unemployment areas. High unemployment areas recorded larger gains in life expectancy than low unemployment areas, contributing to the narrowing gap during 1990-2010.

Below:  Life expectancy at birth by sex and area unemployment level, United States, 1990–2010

Below:  Survivorship by age, race, and unemployment level, United States, 1990–2010

Below:  Conditional probability of survival between ages of 25 and 64 years by unemployment level, United States, 1990–2010

Full article at:   http://goo.gl/FI27Gt

By:  Singh GK1, Siahpush M2.

• 1US Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD 20857, USA.
• 2Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, College of Public Health, Omaha, NE 68198-4365, USA.
• Scientifica (Cairo). 2016;2016:8290435. doi: 10.1155/2016/8290435. Epub 2016 Mar 17. 

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Criminal Justice System Contact & Mortality among Offenders with Mental Illness in British Columbia

BACKGROUND:

Persons with mental illness are over-represented in prison populations around the world. They are more vulnerable to arrest and more likely to experience repeated encounters with the criminal justice system. Whether criminal justice involvement, in and of itself, is associated with higher mortality, particularly among offenders with mental illness, is unknown.

METHODS:

The authors conducted a mediation analysis of mortality rates in a cohort of 79,088 offenders from British Columbia using administrative records spanning 2001-2010, where the mediating variable was the individual-level rate of criminal sentencing.

RESULTS:

During 339,506 person-years of follow-up, there were 1841 deaths. The diagnosis of mental illness had no direct association with higher mortality after adjustment for confounders (HR=0.98, 95% CI 0.86 to 1.06). However, mental illness had an indirect association with mortality that was mediated through more frequent criminal justice involvement (HR=1.02, 95% CI 1.01 to 1.04).

CONCLUSIONS:

These findings support the hypothesis that offenders with mental illness experience higher mortality that is mediated by higher rates of criminal justice contact. The results of our study indicate that criminal justice diversion programmes are further warranted because they may contribute to the prevention of mortality among offenders with mental illness.

Purchase full article at:   http://goo.gl/QheVNV

By:  McCandless LC1, Stewart LC1, Rempel ES1, Venners SA1, Somers JM1.

• 1Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. 

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Pain and Mortality Risk in a Cohort of HIV-Infected Persons with Alcohol Use Disorders

Pain has been associated with increased risk for mortality in some studies. We analyzed data from a cohort study [HIV-longitudinal interrelationships of viruses and ethanol (HIV-LIVE)] of HIV-infected persons with alcohol use disorders enrolled 2001-2003 to explore whether reporting moderate or greater pain interference was associated with mortality. 

The main independent variable was pain that at least moderately interfered with work based on a single question from the SF-12. Primary analyses dichotomized at "moderately" or above. Cox proportional hazards models assessed the association between pain interference and death adjusting for demographics, substance use, CD4 count, HIV viral load and co-morbidities. Although significant in unadjusted models (HR = 1.58 (95 % CI 1.03-2.41; p value = 0.04)), after adjusting for confounders, ≥ moderate pain interference was not associated with an increased risk of death [aHR = 1.30 (95 % CI 0.81-2.11, p value = 0.28)]. 

Among HIV-infected persons with alcohol use disorders, we did not detect a statistically significant independent association between pain interference and risk of death after adjustment for potential confounders.

Purchase full article at: http://goo.gl/bOLGsa

By: Tsui JI1, Cheng DM2,3, Quinn E4, Bridden C2, Merlin JS5, Saitz R2,6, Samet JH2,6.

• 1Section of General Internal Medicine, Department of Medicine, University of Washington School of Medicine and Harborview Hospital, 401 Broadway, 5th Floor, Seattle, WA, 98122, USA. tsuij@uw.edu.
• 2Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University and Boston Medical Center, Boston, MA, USA.
• 3Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
• 4Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA.
• 5Division of Infectious Diseases, University of Alabama School of Medicine, Birmingham, AL, USA.
• 6Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA. 

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