Although the greater longevity of married people as compared with unmarried persons has been demonstrated repeatedly, there have been very few studies of a comparative nature. We use log-linear rate models to analyze marital-status-specific death rates for a large number of developed countries. The results indicate that divorced persons, especially divorced men, have the highest death rates among the unmarried groups of the respective genders; the excess mortality of unmarried persons relative to the married has been generally increasing over the past two to three decades; and divorced and widowed persons in their twenties and thirties have particularly high risks of dying, relative to married persons of the same age. In addition, the analysis suggests that a selection process is operating with regard to single and divorced persons: the smaller the proportion of persons who never marry or who are divorced, the higher the resulting death rates.

Increasingly, researchers and health specialists are obtaining information on chronic illnesses from self-reports. This study validates self-reports of two major health conditions, hypertension and diabetes, based on a recent survey in Taiwan (SEBAS 2000). These data, based on a large, nationally representative sample of respondents aged 54 and older, include both self-reported health information and a physical examination. Average blood pressure readings, laboratory measures of glycosylated hemoglobin, and information on whether the respondent was taking medication for hypertension or diabetes are used to validate respondents' reports of high blood pressure and diabetes. The resulting comparisons reveal that self-reports vastly underestimate the prevalence of hypertension, but yield a reasonably accurate estimate of the prevalence of diabetes. Significant correlates of the accuracy of the self-reports include age, education, time of the most recent health exam, and cognitive function.

No abstract

COVID-19 has resulted in a staggering death toll in the United States: over 215,000 by mid-October 2020, according to the Centers for Disease Control and Prevention. Black and Latino Americans have experienced a disproportionate burden of COVID-19 morbidity and mortality, reflecting persistent structural inequalities that increase risk of exposure to COVID-19 and mortality risk for those infected. We estimate life expectancy at birth and at age 65 y for 2020, for the total US population and by race and ethnicity, using four scenarios of deaths—one in which the COVID-19 pandemic had not occurred and three including COVID-19 mortality projections produced by the Institute for Health Metrics and Evaluation. Our medium estimate indicates a reduction in US life expectancy at birth of 1.13 y to 77.48 y, lower than any year since 2003. We also project a 0.87-y reduction in life expectancy at age 65 y. The Black and Latino populations are estimated to experience declines in life expectancy at birth of 2.10 and 3.05 y, respectively, both of which are several times the 0.68-y reduction for Whites. These projections imply an increase of nearly 40% in the Black−White life expectancy gap, from 3.6 y to over 5 y, thereby eliminating progress made in reducing this differential since 2006. Latinos, who have consistently experienced lower mortality than Whites (a phenomenon known as the Latino or Hispanic paradox), would see their more than 3-y survival advantage reduced to less than 1 y.

On the basis of recent data for Mexico, the largest source of migrants to the United States, we found generally weak support for the healthy migrant hypothesis.

SUMMARY We evaluate two software packages that are available for fitting multilevel models to binary response data, namely VARCL and ML3, by using a Monte Carlo study designed to represent quite closely the actual structure of a data set used in an analysis of health care utilization in Guatemala. We find that the estimates of fixed effects and variance components produced by the software packages are subject to very substantial downward bias when the random effects are sufficiently large to be interesting. In fact, the fixed effect estimates are no better than the estimates obtained by using standard logit models that ignore the hierarchical structure of the data. The estimates of standard errors appear to be reasonably accurate and superior to those obtained by ignoring clustering, although one might question their utility in the presence of large biases. We conclude that alternative estimation procedures need to be developed and implemented for the binary response case.

The hypothesis that the S allele of the 5-HTTLPR serotonin transporter promoter region is associated with increased risk of depression, but only in individuals exposed to stressful situations, has generated much interest, research, and controversy since first proposed in 2003. Multiple meta-analyses combining results from heterogeneous analyses have not settled the issue. To determine the magnitude of the interaction and the conditions under which it might be observed, we performed new analyses on 31 datasets containing 38 802 European-ancestry subjects genotyped for 5-HTTLPR and assessed for depression and childhood maltreatment or other stressful life events, and meta-analyzed the results. Analyses targeted two stressors (narrow, broad) and two depression outcomes (current, lifetime). All groups that published on this topic prior to the initiation of our study and met the assessment and sample size criteria were invited to participate. Additional groups, identified by consortium members or self-identified in response to our protocol (published prior to the start of analysis1) with qualifying unpublished data were also invited to participate. A uniform data analysis script implementing the protocol was executed by each of the consortium members. Our findings do not support the interaction hypothesis. We found no subgroups or variable definitions for which an interaction between stress and 5-HTTLPR genotype was statistically significant. In contrast, our findings for the main effects of life stressors (strong risk factor) and 5-HTTLPR genotype (no impact on risk) are strikingly consistent across our contributing studies, the original study reporting the interaction, and subsequent meta-analyses. Our conclusion is that if an interaction exists in which the S allele of 5-HTTLPR increases risk of depression only in stressed individuals, then it is not broadly generalizable, but must be of modest effect size and only observable in limited situations.

Despite a social structure where elderly persons often live with their children and social interaction is likely to be more family-centered than in western countries, data from Taiwan suggest that participation in social activities outside the family may have a bigger impact on cognitive function than social contacts with family or non-relatives.