Understanding the Accumulation of Health-Related Inequities Over the Life Course Using the Mean Cumulative Count
Year: 2023
Type: article
Abstract: Understanding how health inequities develop over time is necessary to inform interventions, but methods for doing so are underutilized. We provide an example of the accumulation of stressful life events using the mean cumulative count (MCC), which estimates the expected number of events per person as a function of time, allowing for censoring and competing events. Data came from the National Longitudinal Survey of Youth 1997, a nationally representative data set. To compare the MCC with standard practice, we present the proportions of persons experiencing 1, 2, and ≥3 stressful events and the cumulative probability of experiencing at least 1 event by the end of follow-up. Our sample included 6,522 individuals aged 18-33 years who were followed for a median of 14 years. Using the MCC, by age 20 years the expected number of encounters was 56 events per 100 participants for Black non-Hispanic persons, 47 per 100 for White non-Hispanic persons, and 50 per 100 for Hispanic persons. By age 33 years, inequities grew to 117, 99, and 108 events per 100 persons, respectively. The MCC revealed that inequities in stressful events accumulate over the course of early adulthood, partially driven by repeat events; this information was not evident from conventional approaches. This method can be used to identify intervention points for disrupting the accumulation of repeat events to improve health equity.
Source: American Journal of Epidemiology
DOI: 10.1093/aje/kwad123
Institution: University of North Carolina at Chapel Hill
Language: English
Subfield: Health
Field: Social Sciences
Domain: Social Sciences
Open Access status: bronze
Funders: National Institutes of Health, University of North Carolina at Chapel Hill, National Institute on Aging, National Institute on Drug Abuse, National Institute of Environmental Health Sciences, National Institute of Child Health and Human Development, National Institute on Minority Health and Health Disparities, Eunice Kennedy Shriver National Institute of Child Health and Human Development, School of Medicine, University of North Carolina at Chapel Hill, Carolina Population Center, University of North Carolina at Chapel Hill
Awards: G1017297203, G1120543537, G1134027726, G1871174730, G3441743100, Mass Probation: Probation’s Individual and Community Effects on Mental Health Disparities, Carolina Population Center, G7543807521, Population Research Training, UNC Center for Environmental Health and Susceptibility, Collaborative Justice-Involved Research and Training Program on Substance Use and HIV at Brown University Health
OpenAlex ID: W4377565627