Ryan K. Masters

The impact of obesity on US mortality levels: The importance of age and cohort factors in population estimates

OBJECTIVES To estimate the percentage of excess death for US Black and White men and women associated with high body mass, we examined the combined effects of age variation in the obesity-mortality relationship and cohort variation in age-specific obesity prevalence. METHODS We examined 19 National Health Interview Survey waves linked to individual National Death Index mortality records, 1986-2006, for age and cohort patterns in the population-level association between obesity and US adult mortality. RESULTS The estimated percentage of adult deaths between 1986 and 2006 associated with overweight and obesity was 5.0% and 15.6% for Black and White men, and 26.8% and 21.7% for Black and White women, respectively. We found a substantially stronger association than previous research between obesity and mortality risk at older ages, and an increasing percentage of mortality attributable to obesity across birth cohorts. CONCLUSIONS Previous research has likely underestimated obesitys impact on US mortality. Methods attentive to cohort variation in obesity prevalence and age variation in obesitys effect on mortality risk suggest that obesity significantly shapes US mortality levels, placing it at the forefront of concern for public health action.

Educational Differences in U.S. Adult Mortality A Cohort Perspective

We use hierarchical cross-classified random-effects models to simultaneously measure age, period, and cohort patterns of mortality risk between 1986 and 2006 for non-Hispanic white and non-Hispanic black men and women with less than a high school education, a high school education, and more than a high school education. We examine all-cause mortality risk and mortality risk from heart disease, lung cancer, and unpreventable cancers. Findings reveal that temporal reductions in black and white men’s and women’s mortality rates were driven entirely by cohort changes in mortality. Findings also demonstrate that disparate cohort effects between education groups widened the education gap in all-cause mortality risk and mortality risk from heart disease and lung cancer across this time period. Educational disparities in mortality risk from unpreventable cancers, however, did not change. This research uncovers widening educational differences in adult mortality and demonstrates that a cohort perspective provides valuable insights for understanding recent temporal changes in U.S. mortality risk.

Education and the Gender Gaps in Health and Mortality

The positive associations between education and health and survival are well established, but whether the strength of these associations depends on gender is not. Is the beneficial influence of education on survival and on self-rated health conditioned by gender in the same way, in opposite ways, or not at all? Because women are otherwise disadvantaged in socioeconomic resources that are inputs to health, their health and survival may depend more on education than will men’s. To test this hypothesis, we use data from the National Health Interview Survey-Linked Mortality Files (NHIS-LMF). We find that education’s beneficial influence on feeling healthy and on survival are conditional on gender, but in opposite ways. Education has a larger effect on women’s self-rated health than on men’s, but a larger effect on men’s mortality. To further examine the mortality results, we examine specific causes of death. We find that the conditional effect is largest for deaths from lung cancer, respiratory disease, stroke, homicide, suicide, and accidents. Because women report worse health but men’s mortality is higher, education closes the gender gap in both health and mortality.

Uncrossing the U.S. Black-White Mortality Crossover: The Role of Cohort Forces in Life Course Mortality Risk

In this article, I examine the black-white crossover in U.S. adult all-cause mortality, emphasizing how cohort effects condition age-specific estimates of mortality risk. I employ hierarchical age-period-cohort methods on the National Health Interview Survey-Linked Mortality Files between 1986 and 2006 to show that the black-white mortality crossover can be uncrossed by factoring out period and cohort effects of mortality risk. That is, when controlling for variations in cohort and period patterns of U.S. adult mortality, the estimated age effects of non-Hispanic black and non-Hispanic white U.S. adult mortality risk do not cross at any age. This is the case for both men and women. Further, results show that nearly all the recent temporal change in U.S. adult mortality risk was cohort driven. The findings support the contention that the non-Hispanic black and non-Hispanic white U.S. adult populations experienced disparate cohort patterns of mortality risk and that these different experiences are driving the convergence and crossover of mortality risk at older ages.

Long-Term Trends in Adult Mortality for U.S. Blacks and Whites: An Examination of Period- and Cohort-Based Changes

Black–white differences in U.S. adult mortality have narrowed over the past five decades, but whether this narrowing unfolded on a period or cohort basis is unclear. The distinction has important implications for understanding the socioeconomic, public health, lifestyle, and medical mechanisms responsible for this narrowing. We use data from 1959 to 2009 and age-period-cohort (APC) models to examine period- and cohort-based changes in adult mortality for U.S. blacks and whites. We do so for all-cause mortality among persons aged 15–74 as well as for several underlying causes of death more pertinent for specific age groups. We find clear patterns of cohort-based reductions in mortality for both black men and women and white men and women. Recent cohort-based reductions in heart disease, stroke, lung cancer, female breast cancer, and other cancer mortality have been substantial and, save for breast cancer, have been especially pronounced for blacks. Period-based changes have also occurred and are especially pronounced for some causes of death. Period-based reductions in blacks’ and whites’ heart disease and stroke mortality are particularly impressive, as are recent period-based reductions in young men’s and women’s mortality from infectious diseases and homicide. These recent period changes are more pronounced among blacks. The substantial cohort-based trends in chronic disease mortality and recent period-based reductions for some causes of death suggest a continuing slow closure of the black-white mortality gap. However, we also uncover troubling signs of recent cohort-based increases in heart disease mortality for both blacks and whites.

A population-based analysis of increasing rates of suicide mortality in Japan and South Korea, 1985–2010

BackgroundIn the past two decades, rates of suicide mortality have declined among most OECD member states. Two notable exceptions are Japan and South Korea, where suicide mortality has increased by 20 % and 280 %, respectively.MethodsPopulation and suicide mortality data were collected through national statistics organizations in Japan and South Korea for the period 1985 to 2010. Age, period of observation, and birth cohort membership were divided into five-year increments. We fitted a series of intrinsic estimator age-period-cohort models to estimate the effects of age-related processes, secular changes, and birth cohort dynamics on the rising rates of suicide mortality in the two neighboring countries.ResultsIn Japan, elevated suicide rates are primarily driven by period effects, initiated during the Asian financial crisis of the late 1990s. In South Korea, multiple factors appear to be responsible for the stark increase in suicide mortality, including recent secular changes, elevated suicide risks at older ages in the context of an aging society, and strong cohort effects for those born between the Great Depression and the aftermath of the Korean War.ConclusionIn spite of cultural, demographic and geographic similarities in Japan and South Korea, the underlying causes of increased suicide mortality differ across these societies—suggesting that public health responses should be tailored to fit each country’s unique situation.

Mortality from Suicide, Chronic Liver Disease, and Drug Poisonings among Middle-Aged U.S. White Men and Women, 1980–2013

Abstract Recent increases in all-cause mortality rates among the middle-aged U.S. white population have been explained in terms of elevated levels of midlife distress. This brief report provides evidence against this explanation for recent mortality trends among U.S. white men and women. Official mortality rates for U.S. white men and women aged 45–54 from suicide, chronic liver disease, drug poisonings, and other “extrinsic” causes of death (i.e., causes external to the body) between 1980 and 2013 are examined. Results suggest that recent increases in extrinsic mortality among the middle-aged U.S. white population are overwhelmingly driven by rapid increases in drug-related mortality. The contributions of chronic liver disease and suicide to U.S. white men’s and women’s mortality levels have been fairly stable for the past 30 years. Further, large gender differences in extrinsic mortality trends are observed. These two findings are inconsistent with the explanation that distress among the middle-aged U.S. white population is a common cause driving trends in U.S. white mortality.

The effects of New York City’s coordinated public health programmes on mortality through 2011

Background In 2003, New York City (NYC) implemented a series of coordinated policies designed to reduce non-communicable disease. Methods We used coarsened exact matching (CEM) of individuals living inside and outside NYC between the years of 1992-2000 and 2002-10 to estimate difference-in-difference survival time models, a quasi-experimental approach. We also fitted age-period-cohort (APC) models to explore mortality impacts by gender, race, age, borough and cause of death over this same time period. Results Both CEM and APC models show that survival gains were large in the pre-2003 era of health policy reform relative to the rest of the USA, but small afterwards. There is no clear link between any policy and changes in mortality by age, gender, ethnicity, borough, or cause of death. Conclusions NYCs gains in survival relative to the rest of the nation were not linked to the citys innovative and coordinated health policy efforts.

Fitting Age-Period-Cohort Models Using the Intrinsic Estimator: Assumptions and Misapplications

We thank Demography’s editorial office for the opportunity to respond to te Grotenhuis et al.’s commentary regarding the methods used and the results presented in our earlier paper (Masters et al. 2014). In this response, we briefly reply to three general themes raised in the commentary: (1) the presentation and discussion of APC results, (2) the fitting of full APC models to data for which a simpler model holds, and (3) the variation in the estimated age, period, and cohort coefficients produced by the intrinsic estimator (IE) (i.e., the “nonuniqueness property” of the IE, as referred to by Pelzer et al. (2015)). Demography (2016) 53:1253–1259 DOI 10.1007/s13524-016-0481-y

The relationship between education and health among incarcerated men and women in the United States

BackgroundThis paper contributes to research on the education-health association by extending the scope of inquiry to adult inmates. Not only are inmates excluded from most nationally representative studies of health but they also represent a highly select group in terms of both education and health. As such, our study provides new information about the health of incarcerated populations and it extends the generalizability of the education-health association beyond the non-institutionalized population.MethodsWe use a prison-level fixed-effects regression model with the 2004 Survey of Inmates in State Correctional Facilities (n = 287 facilities) to evaluate the effects of education on a standardized morbidity scale of 11 lifetime and current health conditions among incarcerated men (n = 10,493) and women (n = 2,797).ResultsEducation prior to incarceration is negatively associated with lifetime health problems for both women and men and the association is stronger among women. Among inmates who enter prison with less than a GED level of education, attaining a GED in prison is associated with better current health outcomes for men, but not women.ConclusionsThe generalization of the education-health association among prisoners further highlights the fundamental nature of education as a health promotive resource. Discussed are the implications for the education-health literature in general and health promotion efforts among incarcerated adults specifically.