Maryam Moghani Lankarani

Race and Urbanity Alter the Protective Effect of Education but not Income on Mortality

Background Although the effects of socioeconomic status (SES) on mortality are well established, these effects may vary based on contextual factors such as race and place. Using 25-year follow-up data of a nationally representative sample of adults in the U.S., this study had two aims: (1) to explore separate, additive, and multiplicative effects of race and place (urbanity) on mortality and (2) to test the effects of education and income on all-cause mortality based on race and place. Methods The Americans’ Changing Lives (ACL) Study followed Whites and Blacks 25 years and older from 1986 until 2011. The focal predictors were baseline SES (education and income) collected in 1986. The main outcome was time until death due to all causes from 1986 until 2011. Age, gender, behaviors (smoking and exercise), and health (chronic medical conditions, self-rated health, and depressive symptoms) at baseline were potential confounders. A series of survey Cox proportional hazard models were used to test protective effects of education and income on mortality based on race and urbanity. Results Race and place had separate but not additive or multiplicative effects on mortality. Higher education and income were protective against all-cause mortality in the pooled sample. Race and urbanity significantly interacted with baseline education but not income on all-cause mortality, suggesting that the protective effect of education but not income depend on race and place. While the protective effect of education were fully explained by baseline health status, the effect of income remained significant beyond health. Conclusion In the U.S., the health return associated with education depends on race and place. This finding suggests that populations differently benefit from SES resources, particularly education. Differential effect of education on employment and health care may explain the different protective effect of education based on race and place. Findings support the “diminishing returns” hypothesis for Blacks.

Race, Depressive Symptoms, and All-Cause Mortality in the United States

Purpose Despite the well-established association between baseline depressive symptoms and risk of all cause-mortality, limited information exists on racial differences in the residual effects of baseline depressive symptoms above and beyond socioeconomic status (SES) and physical health on this link. The current study compared Blacks and Whites for the residual effects of depressive symptoms over SES and health on risk of long-term all-cause mortality in the U.S. Methods Data were obtained from the Americans’ Changing Lives Study, a nationally representative longitudinal cohort of U.S. adults with up to 25 years of follow-up. The study followed 3,361 Blacks and Whites for all-cause mortality between 1986 and 2011. The main predictor of interest was baseline depressive symptoms measured at 1986 using an 11-item Center for Epidemiological Studies-Depression scale. Covariates included baseline demographics (age and gender), SES (education and income), and health [chronic medical conditions (CMCs), self-rated health (SRH), and body mass index (BMI)] measured at 1986. Race (Black versus White) was the focal moderator. We ran a series of Cox proportional hazard models in the pooled sample and also stratified by race. Results In the pooled sample, higher depressive symptoms at baseline were associated with higher risk of all-cause mortality except when the CMC, SRH, and BMI were added to the model. In this later model, race interacted with baseline depressive symptoms, suggesting a larger effect of depressive symptoms on mortality among Whites compared to Blacks. Among Whites, depressive symptoms were associated with increased risk of mortality, after controlling for SES but not after controlling for health (CMC, SRH, and BMI). Among Blacks, depressive symptoms were not associated with mortality before health was introduced to the model. After controlling for health, baseline depressive symptoms showed an inverse association with all-cause mortality among Blacks. Although the effect of baseline depressive symptoms on mortality disappeared after controlling for health among Whites, SRH did not interfere (confound) with the effect of depressive symptoms on mortality among Blacks. Conclusion The effect of depressive symptoms on increased risk of all-cause mortality, which existed among Whites, could not be found for Blacks. In addition, race may modify the roles that SES and health play regarding the link between depressive symptoms and mortality over a long period of time.

Education and Alcohol Consumption among Older Americans; Black-White Differences.

Purpose Although the link between education and alcohol consumption is known, limited information exists on racial differences in this link. We conducted the current study to test Black–White differences in the association between education and alcohol consumption among older adults in the U.S. Methods This cross-sectional survey enrolled 1,493 Black (n = 734) and White (n = 759) older adults (age 66 or more) in U.S. Data came from the Religion, Aging, and Health Survey, 2001. Race, demographics, socioeconomics, and alcohol consumption were measured. Independent variable was education level. Outcome was alcohol consumption. Race was the focal moderator. Logistic regression was used for data analysis. Results Education was positively associated with ever drinking in the pooled sample. However, race interacted with education level on drinking, suggesting a smaller effect of education on drinking for Blacks compared to Whites. Among Whites, high-school graduation and college graduation were associated with increased odds of ever drinking, net of covariates. Among Blacks, high-school graduation, but not college graduation, was associated with ever drinking. Conclusion Blacks and Whites differ in how socioeconomic status (i.e., education) shapes behaviors, especially health behaviors (i.e., drinking). How race modifies consequences and correlates of social determinants of health is not yet clear. College graduation may result in the same level of change to the social network and income of race group members. Weaker effect of education on health of Blacks may be due to the structural role of race and racism that has resulted in lower job availability and pay for Blacks.

Cross-country differences in the association between diabetes and disability

PurposeThis study tested possible cross-country differences in the associations between diabetes and activities of daily living (ADLs), and possible confounding / mediating effects of socio-economic status, obesity, and exercise.MethodsData came from Research on Early Life and Aging Trends and Effects (RELATE). The study included a total number of 25,372 community sample of adults who were 40 years or older. We used data from community based surveys in seven countries including China, Mexico, Barbados, Brazil, Chile, Cuba, and Uruguay. Demographics (age and gender), socio-economic status (education and income), obesity, exercise, and ADL (bath, dress, toilet, transfer, heavy, shopping, meals) were measured. Self-reported data on physician diagnosis of diabetes was the independent variable. We tested if diabetes is associated with ADL, before and after adjusting for socio-economics, obesity, and exercise in each country.ResultsBased on Model I (age and gender adjusted model), diabetes was associated with limitation in at least one ADL in Mexico, Barbados, Brazil, Chile, Cuba, and Uruguay, but not China. Based on Model II that also controlled for education and income, education explained the association between diabetes and limitation in ADL in Mexico and Uruguay. Based on Model III that also controlled for exercise and obesity, in Cuba and Brazil, exercise explained the link between diabetes and limitation in performing ADLs. Thus, the link between diabetes and ADL was independent of our covariates only in Chile and Barbados.ConclusionsThere are cross-country differences in the link between diabetes and limitation in ADL. There are also cross-country differences in how socio-economic status, obesity, and exercise explain the above association.

Depressive Symptoms Are Associated with More Hopelessness among White than Black Older Adults.

Background Hopelessness is a core component of depression. Our information is, however, very limited on ethnic variations in the magnitude of the link between depression and hopelessness. Using a national sample of older adults in United States, we compared Blacks and Whites for the magnitude of the association between depressive symptoms and hopelessness. Methods With a cross-sectional design, we used baseline data of the Religion, Aging, and Health Survey, 2001. Linear regression models were used for data analysis. Depressive symptoms (CES-D) and hopelessness were conceptualized as independent and dependent variables in different models, respectively. Demographic factors (age and gender), socioeconomic status (education and marital status), and health (self-rated health) were covariates. Ethnicity was the moderator. Results In the pooled sample, higher depressive symptoms were predictive of hopelessness, above and beyond all covariates. We also found significant interactions suggesting that the association between depressive symptoms and hopelessness is weaker among Blacks compared to Whites. In ethnic-specific models, there were significant associations between depressive symptoms and hopelessness among Whites but not Blacks. Conclusion Depressive symptoms accompany more hopelessness among Whites than Blacks. This finding may explain why Blacks with depression have a lower tendency to commit suicide. Future research should test whether or not Whites with depression better respond to psychotherapies and cognitive behavioral therapies that focus on hope enhancement. This finding may explain differential correlates of depression based on race and ethnicity.

Stressful Life Events and Risk of Depression 25 Years Later: Race and Gender Differences

Background Although stressful life events (SLEs) predict subsequent risk of developing a major depressive episode (MDE), limited information exists on whether or not race and gender alters the predictive role of SLE on risk of MDE over a long-term period. The current study explored race and gender differences in the long-term predictive role of SLE at baseline (1986) on subsequent risk of MDE 25 years later (2011) in a nationally representative cohort in the United States. Methods Using a life course epidemiological approach, this longitudinal study borrowed data from the Americans’ Changing Lives (ACL) Study 1986–2011. Main predictor of interest was baseline SLE over the last 3 years measured at 1986. Main outcome was risk of MDE [Composite International Diagnostic Interview (CIDI)] 25 years later (2011). Covariates included demographics, socioeconomics, depressive symptoms [Center for Epidemiological Studies-Depression Scale (CES-D)], chronic medical conditions, and health behaviors measured at baseline (1986). Gender and race were the focal moderators. We employed logistic regressions in the pooled sample, and specific to race and gender, to test whether or not SLE × race and SLE × gender interactions are significant. Results In the pooled sample, baseline SLE (1986) predicted risk of MDE 25 years later (2011). We also found a gender by SLE interaction, suggesting a stronger predictive role of SLE for subsequent clinical depression for men compared to women. Race did not modify the predictive role of SLE on subsequent risk of MDE 25 years later. Conclusion How SLE predicts MDE 25 years later differs for men and women, with a stronger predictive role for men compared to women. More research is needed to better understand the complex links between gender, sex, stress, and depression.

The Association Between Obesity and Weight Loss Intention Weaker Among Blacks and Men than Whites and Women.

IntroductionAlthough obesity is associated with weight loss intention, the magnitude of this association may differ across various populations. Using a nationally representative data of the USA, this study tested the variation of the association between obesity and weight loss intention based on race and gender.MethodsData came from the National Survey of American Life (NSAL), 2001–2003, which enrolled 5810 nationally representative sample of adults (3516 African-Americans, 1415 Caribbean Blacks, and 879 non-Hispanic Whites). Socio-demographics, body mass index (BMI), and weight loss intention were measured. We fitted logistic regression models in the pooled sample with weight loss intention as the outcome, obesity (BMI > 30) as the predictor, while the effect of covariates was controlled. To test our moderation hypotheses, we entered race × obesity and gender × obesity interactions to the model.ResultsAlthough the association between obesity and weight loss intention was significant among both race and gender groups, the magnitude of the association between obesity and weight loss intention was larger for women than men and Whites than Blacks. This finding suggests that individuals with obesity have less intention for weight loss if they are Black or men.ConclusionThe link between obesity and weight loss intention depends on race and gender. Weight loss intention may not increase in response to obesity among Blacks and men, compared to Whites and women. Healthy weight programs in the USA may benefit from tailoring based on race and gender.

Survey of the level of anti-HBs antibody titer in vaccinated Iranian general dentists.

Hepatitis B is an infectious disease to which dentists are susceptible. The main aim of this study was to determine the level of antibody titer and immunity in vaccinated Iranian general dentists. A total of 861 general dentists were invited to participate in this study; 598 persons who could recall their history of vaccination and consented to have blood samples taken were recruited. Demographic and work-related data were recorded, and anti-Hepatitis B surface antigen (anti-HBs-Ag) evaluations were measured using the enzyme-linked immunosorbent assay (ELISA). Of the 598 participants, 35 (5.9%) were nonimmune (anti-HBs <10 IU/l), 101 (16.9%) were relatively immune (anti-HBs = 10-99 IU/l), and 462 (77.3%) were completely immune (anti-HBs > or =100 IU/l). Only 218 (36.5%) of the dentists knew their HBs antibody titer. Fourteen (2.3%) persons reported receiving one dose and 65 (10.9%) had received two doses. The number of those who had received the three recommended doses totaled 519 (86.8%), 491 (82.1%) of them receiving their vaccine on schedule. Age, city, pack-years of smoking, years of smoking, and the interval between the last vaccination and the commencement of the study had a significant relationship to the antibody titer level, whereas sex, marital status, place of practice, smoking, and vaccination schedule were not related. Only 36.5% of the general dentists had checked their antibody titer. We, therefore, recommend that dentists, as a potential high-risk group, should know their level of anti-HBs antibody titer so that those who require revaccination can get treatment.

Discrimination and psychological distress: Gender differences among Arab Americans

Background Despite the existing knowledge on the association between discrimination and poor mental health, very few studies have explored gender differences in this association in Arab Americans. Objective The current study aimed to investigate whether gender moderates the association between the experience of discrimination and psychological distress in a representative sample of Arab Americans in Michigan. Methods Using data from the Detroit Arab American Study (DAAS), 2003, this study recruited Arab Americans (337 males, 385 females) living in Michigan, United States. The main independent variable was discrimination. The main outcome was psychological distress. Covariates included demographic factors (age), socioeconomic status (education, employment, and income), and immigration characteristics (nativity and years living in United States). Gender was the focal moderator. We used multivariable regression with and without discrimination × gender interaction term. Results In the pooled sample, discrimination was positively associated with psychological distress [B = 0.62, 95% confidence interval (CI) = 0.22–1.03, p = 0.003]. We found a significant gender × discrimination interaction in the pooled sample (B = 0.79, 95% CI = 0.01–1.59, p = 0.050), suggesting a stronger association in males than females. In our gender-specific model, higher discrimination was associated with higher psychological distress among male (B = 0.87, 95% CI = 0.33–1.42, p = 0.002) but not female (B = 0.18, 95% CI = −0.43 to 0.78, p = 0.567) Arab Americans. Conclusion While discrimination is associated with poor mental health, a stronger link between discrimination and psychological symptoms may exist in male compared to female Arab Americans. While efforts should be made to universally reduce discrimination, screening for discrimination may be a more salient component of mental health care for male than female Arab Americans.

Does Multi‑morbidity Mediate the Effect of Socioeconomics on Self‑rated Health? Cross‑country Differences

Background: This study explored cross-country differences in how multi-morbidity explains the effects of socioeconomic characteristics on self-rated health. Methods: The study borrowed data from the Research on Early Life and Aging Trends and Effects. Participants were 44,530 individuals (age > 65 years) who were sampled from 15 countries (i.e. United States, China, India, Russia, Costa Rica, Puerto Rico, Mexico, Argentina, Barbados, Brazil, Chile, Cuba, Uruguay, Ghana and South Africa). Multi-morbidity was measured as number of chronic medical conditions. In Model I, main effects of socioeconomic factors on self-rated health were calculated using country-specific logistic regressions. In Model II, number of chronic conditions were also added to the models to find changes in coefficients for demographic and socioeconomic factors. Results: In the United States, number of chronic medical conditions explained the effect of income on subjective health. In Puerto Rico, number of chronic medical conditions explained the effect of marital status on subjective health. In Costa Rica, Argentina, Barbados, Cuba, and Uruguay, number of chronic medical conditions explained gender disparities in subjective health. In China, Mexico, Brazil, Russia, Chile, India, Ghana and South Africa, number of chronic medical conditions did not explain the effect of demographic or socioeconomic factors on subjective health. Conclusions: Multi-morbidity explains the effect of demographic and socioeconomic factors on subjective health in some but not other countries. Further research is needed.