Can Early Disadvantage Be Overcome? A Life Course Approach to Understanding How Disadvantage, Education, and Social Integration Impact Mortality into Middle Adulthood Among a Black American Cohort.
Can Early Disadvantage Be Overcome? A Life Course Approach to Understanding How Disadvantage, Education, and Social Integration Impact Mortality into Middle Adulthood Among a Black American Cohort.
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DOI：
10.1007/s11121-022-01408-x
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发表时间：
2023-07
影响因子：
3.5
通讯作者：
Bugbee, Brittany A
中科院分区：
文献类型：
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作者：
Green, Kerry M;Doherty, Elaine E;Bugbee, Brittany A
健康公平研究已经确定了健康的基本社会原因，其中许多因素对美国黑人造成了不成比例的影响，例如早年的社会经济条件、邻里劣势和种族歧视。然而，生命历程因素在美国黑人过早死亡中的作用尚未在成年后期的前瞻性样本中得到广泛测试。为了更好地了解不同生命阶段的社会因素如何影响死亡率，本研究考察了伍德劳恩队列 (N = 1242) 中生命历程中的贫困、邻里劣势和歧视对死亡率的影响，以及可能缓冲其影响的因素（即教育、社会融合），这是一个自 1966 年以来跟踪的美国城市黑人社区队列。从生命历程的角度来看，我们分析了 58 岁之前的死亡数据，以及 6 岁、 16岁、32岁和42岁。在58岁时，原始队列中有204人（16.4%）死亡，死亡年龄范围从9岁到58.98岁（平均值 = 42.9）。针对混杂因素进行调整的 Cox 比例风险模型显示，根据贫困的时间和持续时间，死亡风险存在统计学上的显着差异；那些从不贫困或仅在生命早期贫困的人在 43-58 岁时的死亡风险低于那些从童年到成年一直贫困的人。对于那些在生命早期没有经历过贫困的人来说，高中以上的教育和高度的社会融合可以降低更多的死亡风险。研究结果对整个生命过程中死亡预防工作的时机和内容具有影响。
Health equity research has identified fundamental social causes of health, many of which disproportionately affect Black Americans, such as early life socioeconomic conditions, neighborhood disadvantage, and racial discrimination. However, the role of life course factors in premature mortality among Black Americans has not been tested extensively in prospective samples into later adulthood. To better understand how social factors at various life stages impact mortality, this study examines the effect of life course poverty, neighborhood disadvantage, and discrimination on mortality and factors that may buffer their effect (i.e., education, social integration) among the Woodlawn cohort (N = 1242), a community cohort of urban Black Americans followed since 1966. Taking a life course perspective, we analyze mortality data for deaths through age 58 years old, as well as data collected at ages 6, 16, 32, and 42. At age 58, 204 (16.4%) of the original cohort have died, with ages of death ranging from 9 to 58.98 (mean = 42.9). Cox proportional hazard models adjusting for confounders show statistically significant differences in mortality risk based on timing and persistence of poverty; those who were never poor or poor only in early life had lower mortality risk at ages 43–58 than those who were persistently poor from childhood to adulthood. Education beyond high school and high social integration were shown to reduce the risk of mortality more for those who did not experience poverty early in their life course. Findings have implications for the timing and content of mortality prevention efforts that span the full life course.