shakaihoshotaroの備忘録

社会保障に関するメモ帳

Kang et al. (2016) 婚姻状況と死亡率:幼少期の家族構成に着目して

婚姻状況と死亡率に関連があることは知られているが,その関連が幼少期の家族構成によってどう調整されるのかはよくわかっていない.分析の結果は,妻や夫と死別した場合には死亡確率が高まり,また幼少期に生物学的な両親と暮らしている場合には死亡確率が低くなる.交差項に着目すると,死別した人の死亡確率は幼少期に両親と暮らしていた場合の方が高いことがわかった.この点を著者らは興味深いとしており,幼少期に両親と暮らしていると死別に対して耐えられない傾向があるのではとしている(過去の家族構成に準拠した相対的剥奪?).データについて,GSSとNational Death Index がリンクできるっていうのは個人特定は問題ないと考えられているということだろうか.

Kang, J., Kim, J., & Lee, M.-A. (2016). Marital status and mortality: Does family structure in childhood matter? Social Science & Medicine, 159, 152–160. 

Abstract
It is well known that marital status is significantly associated with mortality risk. Little is known, however, regarding whether and how the effects of marital status are moderated by one’s own family structure in childhood. The purposes of this study are to examine whether marital status (i.e., family structure in adulthood) and living with both biological parents in childhood (i.e., family structure in childhood) are associated with mortality risk, and whether and how the effects of marital status vary depending on family structure in childhood and gender. We analyze the risk of death in five waves of the General Social Survey (GSS) from 1994 through 2002 after linking the GSS data to death certificate data from the National Death Index through 2008. The findings indicate that being widowed increases the risk of mortality, while living with both parents in childhood lowers it. Interestingly, analysis of the interaction between marital status and family structure in childhood reveals that the disadvantage of widowhood in terms of mortality is significantly stronger for those who lived with both parents in childhood than for those who did not. Subsample analysis by gender shows that the moderating effect of living with both parents is largely equal across men and women, though statistically more robust for men. These findings suggest that living with both parents during childhood may increase vulnerability to marital disruptions due to unwanted life events such as spousal loss. Childhood advantages, ironically, may form more stressful contexts of spousal loss by lowering one’s adaptability or immunity to adulthood hardships, especially when the hardships in adulthood are characteristically opposite from the childhood advantages.

Barbabella et al. (2016) どういう人が外国人ケアワーカーを雇っているか

先進国ではケアの担い手が不足する現象が広くみられるなか,移民や外国人ケアワーカーに着目し,社会経済的な地位が外国人ケアワーカーを雇うか否かを予測するかを検証した論文(イタリアで).イタリアの介護労働市場がよくわからないが,各人がケアワーカーを雇うということなのだろうか.分析結果は,介護給付と教育レベルの高い人は外国人ケアワーカを雇う傾向にある.介護サービス受給の社会経済的格差が確認できる.

Barbabella, F., Chiatti, C., Rimland, J. M., Melchiorre, M. G., Lamura, G., Lattanzio, F., & Up-Tech Research Group. (2016). Socioeconomic Predictors of the Employment of Migrant Care Workers by Italian Families Assisting Older Alzheimer’s Disease Patients: Evidence From the Up-Tech Study. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 71(3), 514–25. 

Background: The availability of family caregivers of older people is decreasing in Italy as the number of migrant care workers (MCWs) hired by families increases. There is little evidence on the influence of socioeconomic factors in the employment of MCWs.

Method: We analyzed baseline data from 438 older people with moderate Alzheimer’s disease (AD), and their family caregivers enrolled in the Up-Tech trial. We used bivariate analysis and multilevel regressions to investigate the association between independent variables—education, social class, and the availability of a care allowance—and three outcomes—employment of a MCW, hours of care provided by the primary family caregiver, and by the family network (primary and other family caregivers).

Results: The availability of a care allowance and the educational level were independently associated with employing MCWs. A significant interaction between education and care allowance was found, suggesting that more educated families are more likely to spend the care allowance to hire a MCW.

Discussion: Socioeconomic inequalities negatively influenced access both to private care and to care allowance, leading disadvantaged families to directly provide more assistance to AD patients. Care allowance entitlement needs to be reformed in Italy and in countries with similar long-term care and migration systems.

Azose et al. (2016) 移民の不確実性を考慮した確率的人口予測

出生率,死亡率,移民を考慮した確率的人口予測を行った論文.少子高齢化グローバル化に伴う移民増が世界的に進行する中で,人口予測は様々な政策決定に影響を及ぼしている.これまでの人口予測では移民についてdeterministicに扱ってきたが,本論文ではprobabilisticに扱って推計を行っているのが貢献.結果は,多くの国で移民の増減に関する不確実性が人口予測の不確実性の大きな要因となっている.また,北アメリカやヨーロッパでは予測区間が70%程広くなった.アフリカやアジアについては変わらなかったそう.

Azose, J. J., Ševčíková, H., & Raftery, A. E. (2016). Probabilistic population projections with migration uncertainty. Proceedings of the National Academy of Sciences, 113(23), 6460–6465. 

Abstract
We produce probabilistic projections of population for all countries based on probabilistic projections of fertility, mortality, and migration. We compare our projections to those from the United Nations’ Probabilistic Population Projections, which uses similar methods for fertility and mortality but deterministic migration projections. We find that uncertainty in migration projection is a substantial contributor to uncertainty in population projections for many countries. Prediction intervals for the populations of Northern America and Europe are over 70% wider, whereas prediction intervals for the populations of Africa, Asia, and the world as a whole are nearly unchanged. Out-of-sample validation shows that the model is reasonably well calibrated.

Currie and Schwandt (2016) 貧富間の死亡率格差

死亡率格差を扱ったキュリー大先生の論文.社会科学者がサイエンスに論文載せるというのは凄いこと.貧困層と非貧困層では死亡率が有意に異なるという死亡率格差がアメリカでは久しく言われているが,そうした研究の多くは中・高年齢層をターゲットにしていた.それ以外の年齢層はどうなのというモチベーションで分析を行ったのが本論文.若いコーホートでは貧富間の死亡率格差は縮まっているそう.

Currie, J., Schwandt, H., Chetty, R., Stepner, M., Abraham, S., Lin, S., … Crimmins, E. M. (2016). Inequality in mortality decreased among the young while increasing for older adults, 1990-2010. Science (New York, N.Y.), 352(6286), 708–12.  

 Abstract

Many recent studies point to increasing inequality in mortality in the U.S. over the past twenty years. These studies often use mortality rates in middle and old age. Here we study inequality in mortality for all age groups in 1990, 2000, and 2010. Our analysis is based on groups of counties ranked by their poverty levels. Consistent with previous studies, we find increasing inequality in mortality at older ages. For children and young adults below age 20, however, we find strong mortality improvements that are most pronounced in poorer counties, implying a strong decrease in mortality inequality. These younger cohorts will form the future adult U.S. population, so this research suggests that inequality in old age mortality is likely to decline in future.

Mokdad et al. (2016) 世界の若年層の疾病,死因,リスク要因について

若年層の疾病,死因,リスク要因について大規模に記述した論文.例によって医学系の論文なので著者がやたら多い.若年層の健康はあまり着目されていないそうで,そうした事情がモチベーションになっているという.結果は,色々と出ているが,死因については年齢層で異なっている.10-14ではHIV/AIDS,道路傷害,溺死が多く,15-19では交通傷害がトップだそうだ.20-24では女性に限って母体異常がトップ.188ヶ国のデータを用いているが,社会的・マクロ変数を考慮したマルチレベルモデリングでどの程度死因の分散が説明できるかも追加的に知りたいところである.既にこうした研究はやられていると思うが.

Mokdad, A. H., Forouzanfar, M. H., Daoud, F., Mokdad, A. A., El Bcheraoui, C., Moradi-Lakeh, M., … Atun, R. (2016). Global burden of diseases, injuries, and risk factors for young people’s health during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 387(10036), 2383–2401. 

Summary

Background

Young people's health has emerged as a neglected yet pressing issue in global development. Changing patterns of young people's health have the potential to undermine future population health as well as global economic development unless timely and effective strategies are put into place. We report the past, present, and anticipated burden of disease in young people aged 10–24 years from 1990 to 2013 using data on mortality, disability, injuries, and health risk factors.

Methods

The Global Burden of Disease Study 2013 (GBD 2013) includes annual assessments for 188 countries from 1990 to 2013, covering 306 diseases and injuries, 1233 sequelae, and 79 risk factors. We used the comparative risk assessment approach to assess how much of the burden of disease reported in a given year can be attributed to past exposure to a risk. We estimated attributable burden by comparing observed health outcomes with those that would have been observed if an alternative or counterfactual level of exposure had occurred in the past. We applied the same method to previous years to allow comparisons from 1990 to 2013. We cross-tabulated the quantiles of disability-adjusted life-years (DALYs) by quintiles of DALYs annual increase from 1990 to 2013 to show rates of DALYs increase by burden. We used the GBD 2013 hierarchy of causes that organises 306 diseases and injuries into four levels of classification. Level one distinguishes three broad categories: first, communicable, maternal, neonatal, and nutritional disorders; second, non-communicable diseases; and third, injuries. Level two has 21 mutually exclusive and collectively exhaustive categories, level three has 163 categories, and level four has 254 categories.

Findings

The leading causes of death in 2013 for young people aged 10–14 years were HIV/AIDS, road injuries, and drowning (25·2%), whereas transport injuries were the leading cause of death for ages 15–19 years (14·2%) and 20–24 years (15·6%). Maternal disorders were the highest cause of death for young women aged 20–24 years (17·1%) and the fourth highest for girls aged 15–19 years (11·5%) in 2013. Unsafe sex as a risk factor for DALYs increased from the 13th rank to the second for both sexes aged 15–19 years from 1990 to 2013. Alcohol misuse was the highest risk factor for DALYs (7·0% overall, 10·5% for males, and 2·7% for females) for young people aged 20–24 years, whereas drug use accounted for 2·7% (3·3% for males and 2·0% for females). The contribution of risk factors varied between and within countries. For example, for ages 20–24 years, drug use was highest in Qatar and accounted for 4·9% of DALYs, followed by 4·8% in the United Arab Emirates, whereas alcohol use was highest in Russia and accounted for 21·4%, followed by 21·0% in Belarus. Alcohol accounted for 9·0% (ranging from 4·2% in Hong Kong to 11·3% in Shandong) in China and 11·6% (ranging from 10·1% in Aguascalientes to 14·9% in Chihuahua) of DALYs in Mexico for young people aged 20–24 years. Alcohol and drug use in those aged 10–24 years had an annual rate of change of >1·0% from 1990 to 2013 and accounted for more than 3·1% of DALYs.

Interpretation

Our findings call for increased efforts to improve health and reduce the burden of disease and risks for diseases in later life in young people. Moreover, because of the large variations between countries in risks and burden, a global approach to improve health during this important period of life will fail unless the particularities of each country are taken into account. Finally, our results call for a strategy to overcome the financial and technical barriers to adequately capture young people's health risk factors and their determinants in health information systems.

Zhang et al.(2016) ライフコースでみる認知障害の人種間格差

BlacksはWhitesに比べて高齢期に認知障害となりやすいという.この格差をライフコースの視点で分析した論文.幼少期の経験や環境等のライフコース要因を考慮したうえでも人種間格差は大きくあるようだ.

Zhang, Z., Hayward, M. D., & Yu, Y.-L. (2016). Life Course Pathways to Racial Disparities in among Older Americans. Journal of Health and Social Behavior, 57(2), 184–199.  

Abstract

Blacks are especially hard hit by cognitive impairment at older ages compared to whites. Here, we take advantage of the Health and Retirement Study (1998–2010) to assess how this racial divide in cognitive impairment is associated with the racial stratification of life course exposures and resources over a 12-year period among 8,946 non-Hispanic whites and blacks ages 65 and older in 1998. We find that blacks suffer from a higher risk of moderate/severe cognitive impairment at baseline and during the follow-up. Blacks are also more likely to report childhood adversity and to have grown up in the segregated South, and these early-life adversities put blacks at a significantly higher risk of cognitive impairment. Adulthood socioeconomic status is strongly associated with the risk of cognitive impairment, net of childhood conditions. However, racial disparities in cognitive impairment, though substantially reduced, are not eliminated when controlling for these life course factors.

Göpffarth et al.(2016) 医療費が地域によって異なるのはなぜか

ドイツでは地域によって医療費が大きく異なるそうで,その要因を分析した論文.健康状態やデモグラフィック要因等が効いているようだ.

Göpffarth, D., Kopetsch, T., & Schmitz, H. (2016). Determinants of Regional Variation in Health Expenditures in Germany. Health Economics, 25(7), 801–815. 

Summary
Health care expenditure in Germany shows clear regional differences. Such geographic variations are often seen as an indicator for inefficiency. With its homogeneous health care system, low co-payments and uniform prices, Germany is a particularly suited example to analyse regional variations. We use data for the year 2011 on expenditure, utilization of health services and state of health in Germany's statutory health insurance system. This data, which originate from a variety of administrative sources and cover about 90% of the population, are enriched with a wealth of socio-economic variables, data on pollutants, prices and individual preferences. State of health and demography explains 55% of the differences as measured by the standard deviation while all control variables account for a total of 72% of the differences at county level. With other measures of variation, we can account for an even greater proportion. A higher proportion of variation than usually supposed can thus be explained. Whilst this study cannot quantify inefficiencies, our results contradict the thesis that regional variations reflect inefficiency.