Sean Clouston | SUNY: Stony Brook University (original) (raw)

Papers by Sean Clouston

The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2013

We describe and compare the expected performance trajectories of older adults on the Mini-Mental ... more We describe and compare the expected performance trajectories of older adults on the Mini-Mental Status Examination (MMSE) across six independent studies from four countries in the context of a collaborative network of longitudinal studies of aging. A coordinated analysis approach is used to compare patterns of change conditional on sample composition differences related to age, sex, and education. Such coordination accelerates evaluation of particular hypotheses. In particular, we focus on the effect of educational attainment on cognitive decline.

The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2013

We describe and compare the expected performance trajectories of older adults on the Mini-Mental ... more We describe and compare the expected performance trajectories of older adults on the Mini-Mental Status Examination (MMSE) across six independent studies from four countries in the context of a collaborative network of longitudinal studies of aging. A coordinated analysis approach is used to compare patterns of change conditional on sample composition differences related to age, sex, and education. Such coordination accelerates evaluation of particular hypotheses. In particular, we focus on the effect of educational attainment on cognitive decline.

American Journal of Public Health, 2013

Context: Colorectal cancer is a major cause of mortality in the United States, with 52,857 deaths... more Context: Colorectal cancer is a major cause of mortality in the United States, with 52,857 deaths estimated in 2012. To explore further the social inequalities in colorectal cancer mortality, we used fundamental cause theory to consider the role of societal diffusion of information and socioeconomic status.

Journal of Craniofacial Surgery, 2015

The Asher-McDade system is a 5-point ordinal scale frequently used to rate the components of naso... more The Asher-McDade system is a 5-point ordinal scale frequently used to rate the components of nasolabial appearance, including nasal form and nasal symmetry, in unilateral cleft lip and palate. Although reference photographs illustrating this scale have been identified for the frontal and right profile view, no reference photographs exist for the basal view. The aim of this study was to identify reference photographs for nasal form and nasal symmetry from the basal view to illustrate this scale and facilitate its use. Four raters assessed nasolabial appearance (form and symmetry) on basal view photographs of 50 children (average age 8 years) with a repaired cleft lip. Intraclass correlation coefficients show fair to moderate inter-rater reliability. Cronbach α indicated strong agreement between raters (0.77 nasal form; 0.78 nasal symmetry; 0.80 overall), along with low duplicate measurement error and strong internal consistency between the measures. The photographs with the highest agreement among raters were selected to illustrate each point on the 5-point scale for nasal form and for nasal symmetry, resulting in the selection of 10 reference photographs. The basal view reference photograph set developed from this study may complement existing reference photograph sets for other views and facilitate rating tasks.

The Journal of craniofacial surgery, 2015

Obtaining an esthetic and functional primary surgical repair in patients with complete cleft lip ... more Obtaining an esthetic and functional primary surgical repair in patients with complete cleft lip and palate (CLP) can be challenging because of tissue deficiencies and alveolar ridge displacement. This study aimed to describe surgeons' assessments of presurgical deformity and predicted surgical outcomes in patients with complete unilateral and bilateral CLP (UCLP and BCLP, respectively) treated with and without nasoalveolar molding (NAM). Cleft surgeon members of the American Cleft Palate-Craniofacial Association completed online surveys to evaluate 20 presurgical photograph sets (frontal and basal views) of patients with UCLP (n = 10) and BCLP (n = 10) for severity of cleft deformity, quality of predicted surgical outcome, and likelihood of early surgical revision. Five patients in each group (UCLP and BCLP) received NAM, and 5 patients did not receive NAM. Surgeons were masked to patient group. Twenty-four percent (176/731) of surgeons with valid e-mail addresses responded to ...

American journal of epidemiology, 2014

We aimed to examine the relationship between socioeconomic status (SES) and suicide associated wi... more We aimed to examine the relationship between socioeconomic status (SES) and suicide associated with the introduction and diffusion of selective serotonin reuptake inhibitors (SSRIs). Negative binomial regression was used to estimate county-level suicide rates among persons aged 25 years or older using death certificate data collated by the National Center for Health Statistics from 1968 to 2009; SES was measured using the decennial US Census. The National Health and Nutrition Examination Survey and the Medical Expenditure Panel Survey were used to measure SSRI use. Once SSRIs became available in 1988, a 1% increase in SSRI usage was associated with a 0.5% lower suicide rate. Prior to the introduction of SSRIs, SES was not related to suicide. However, with each 1% increase in SSRI use, a 1-standard deviation (SD) higher SES was associated with a 0.6% lower suicide rate. In 2009, persons living in counties with SES 1 SD above the national average were 13.6% less likely to commit suici...

Epidemiologic Reviews, 2013

On average, older people remember less and walk more slowly than do younger persons. Some researc... more On average, older people remember less and walk more slowly than do younger persons. Some researchers argue that this is due in part to a common biologic process underlying age-related declines in both physical and cognitive functioning. Only recently have longitudinal data become available for analyzing this claim. We conducted a systematic review of English-language research published between 2000 and 2011 to evaluate the relations between rates of change in physical and cognitive functioning in older cohorts. Physical functioning was assessed using objective measures: walking speed, grip strength, chair rise time, flamingo stand time, and summary measures of physical functioning. Cognition was measured using mental state examinations, fluid cognition, and diagnosis of impairment. Results depended on measurement type: Change in grip strength was more strongly correlated with mental state, while change in walking speed was more strongly correlated with change in fluid cognition. Examining physical and cognitive functioning can help clinicians and researchers to better identify individuals and groups that are aging differently and at different rates. In future research, investigators should consider the importance of identifying different patterns and rates of decline, examine relations between more diverse types of measures, and analyze the order in which age-related declines occur.

Social Science & Medicine, 2014

This study examines how associations between socioeconomic status (SES) and lung and pancreatic c... more This study examines how associations between socioeconomic status (SES) and lung and pancreatic cancer mortality have changed over time in the U.S. The fundamental cause hypothesis predicts as diseases become more preventable due to innovation in medical knowledge or technology, individuals with greater access to resources will disproportionately benefit, triggering the formation or worsening of health disparities along social cleavages. We examine socioeconomic disparities in mortality due to lung cancer, a disease that became increasingly preventable with the development and dissemination of knowledge of the causal link between smoking cigarettes and lung cancer, and compare it to that of pancreatic cancer, a disease for which there have been no major prevention or treatment innovations. County-level disease-specific mortality rates for those !45 years, adjusted for sex, race, and age during 1968e2009 are derived from death certificate and population data from the National Center for Health Statistics. SES is measured using five county-level variables from four decennial censuses, interpolating values for intercensal years. Negative binomial regression was used to model mortality. Results suggest the impact of SES on lung cancer mortality increases 0.5% per year during this period. Although lung cancer mortality rates are initially higher in higher SES counties, by 1980 persons in lower SES counties are at greater risk and by 2009 the difference in mortality between counties with SES one SD above compared to one SD below average was 33 people per 100,000. In contrast, we find a small but significant reverse SES gradient in pancreatic cancer mortality that does not change over time. These data support the fundamental cause hypothesis: social conditions influencing access to resources more greatly impact mortality when preventative knowledge exists. Public health interventions and policies should facilitate more equitable distribution of new health-enhancing knowledge and faster uptake and utilization among lower SES groups.

Colorectal cancer is the second most deadly form of cancer in the United States. As of 2008, 5.4%... more Colorectal cancer is the second most deadly form of cancer in the United States. As of 2008, 5.4% of all Americans will be diagnosed with colorectal cancer. Developments in prevention and treatment, achieved mostly since 1980, have caused a rapid decline in mortality rates among the general population. However, this decline has been accompanied by a simultaneous increase in racial disparities. Fundamental cause' theory posits that these disparities emerge as new preventive knowledge or treatment regimens for a particular disease are used more quickly by people with more education and economic resources, who are better positioned to benefit from new health-enhancing knowledge (Link and Phelan 2005). The objective of this paper is to analyze the effects of socioeconomic status and race as fundamental causes' of colorectal cancer mortality trends in the United States from 1968 to 2005. Data used come from two sources: the Surveillance, Epidemiology, and End Results Data collect...

Contemporary studies in disparities of cancer mortality have noted an association between persist... more Contemporary studies in disparities of cancer mortality have noted an association between persistent negative health outcomes and social conditions. Fundamental cause theory posits that social and economic inequalities persist because individuals with more social and economic resources are better able to avoid health risks and to attenuate the consequences of disease. The history of Hodgkin's lymphoma, for which a cure was first found in 1968 with large-scale testing completed in 1970, presents a unique opportunity to follow the impact of the fundamental causes of disease over time for a cancer where survival outcomes in the US have recently aligned across race and gender. Internationally, recovery rates vary strongly by socioeconomic status. Currently in the US, 5-year survival rates are: 84.0% for white men; 86.7% for white women; 78.5% for black men; and 87.1% for black women (19962002 rates). It is expected that, historically, these outcomes were more disparate. Using death ...

American Journal of Epidemiology

We aimed to examine the relationship between socioeconomic status (SES) and suicide associated wi... more We aimed to examine the relationship between socioeconomic status (SES) and suicide associated with the introduction and diffusion of selective serotonin reuptake inhibitors (SSRIs). Negative binomial regression was used to estimate county-level suicide rates among persons aged 25 years or older using death certificate data collated by the National Center for Health Statistics from 1968 to 2009; SES was measured using the decennial US Census. The National Health and Nutrition Examination Survey and the Medical Expenditure Panel Survey were used to measure SSRI use. Once SSRIs became available in 1988, a 1% increase in SSRI usage was associated with a 0.5% lower suicide rate. Prior to the introduction of SSRIs, SES was not related to suicide. However, with each 1% increase in SSRI use, a 1–standard deviation (SD) higher SES was associated with a 0.6% lower suicide rate. In 2009, persons living in counties with SES 1 SD above the national average were 13.6% less likely to commit suicide than those living in counties with SES 1 SD below the national average—a difference of 1.9/100,000 adults aged ≥25 years. Higher SSRI use was associated with lower suicide rates among US residents aged ≥25 years; however, SES inequalities modified the association between SSRI use and suicide.

American journal of public health, 2013

Context: Colorectal cancer is a major cause of mortality in the United States, with 52,857 deaths... more Context: Colorectal cancer is a major cause of mortality in the United States, with 52,857 deaths estimated in 2012. To explore further the social inequalities in colorectal cancer mortality, we used fundamental cause theory to consider the role of societal diffusion of information and socioeconomic status.

The journals of gerontology. Series B, Psychological sciences and social sciences, 2013

We describe and compare the expected performance trajectories of older adults on the Mini-Mental ... more We describe and compare the expected performance trajectories of older adults on the Mini-Mental Status Examination (MMSE) across six independent studies from four countries in the context of a collaborative network of longitudinal studies of aging. A coordinated analysis approach is used to compare patterns of change conditional on sample composition differences related to age, sex, and education. Such coordination accelerates evaluation of particular hypotheses. In particular, we focus on the effect of educational attainment on cognitive decline.

Social science & medicine (1982), 2014

This study examines how associations between socioeconomic status (SES) and lung and pancreatic c... more This study examines how associations between socioeconomic status (SES) and lung and pancreatic cancer mortality have changed over time in the U.S. The fundamental cause hypothesis predicts as diseases become more preventable due to innovation in medical knowledge or technology, individuals with greater access to resources will disproportionately benefit, triggering the formation or worsening of health disparities along social cleavages. We examine socioeconomic disparities in mortality due to lung cancer, a disease that became increasingly preventable with the development and dissemination of knowledge of the causal link between smoking cigarettes and lung cancer, and compare it to that of pancreatic cancer, a disease for which there have been no major prevention or treatment innovations. County-level disease-specific mortality rates for those !45 years, adjusted for sex, race, and age during 1968e2009 are derived from death certificate and population data from the National Center for Health Statistics. SES is measured using five county-level variables from four decennial censuses, interpolating values for intercensal years. Negative binomial regression was used to model mortality. Results suggest the impact of SES on lung cancer mortality increases 0.5% per year during this period. Although lung cancer mortality rates are initially higher in higher SES counties, by 1980 persons in lower SES counties are at greater risk and by 2009 the difference in mortality between counties with SES one SD above compared to one SD below average was 33 people per 100,000. In contrast, we find a small but significant reverse SES gradient in pancreatic cancer mortality that does not change over time. These data support the fundamental cause hypothesis: social conditions influencing access to resources more greatly impact mortality when preventative knowledge exists. Public health interventions and policies should facilitate more equitable distribution of new health-enhancing knowledge and faster uptake and utilization among lower SES groups.

Vaccine, 2014

Background: Socioeconomic inequalities in vaccination can reduce the ability and efficiency of gl... more Background: Socioeconomic inequalities in vaccination can reduce the ability and efficiency of global efforts to reduce the burden of disease. Vaccination is particularly critical because the poorest children are often at the greatest risk of contracting preventable infectious diseases, and unvaccinated children may be clustered geographically, jeopardizing herd immunity. Without herd immunity, these children are at even greater risk of contracting disease and social inequalities in associated morbidity and mortality are amplified. Methods: Data on vaccination for children under five came from the most recent Demographic and Health Survey in Madagascar (2008Madagascar ( -2009. Vaccination status was available for diptheria, pertussis, tetanus, hepatitis B, measles, tuberculosis, poliomyelitis, and H. influenza type-B. Multilevel logistic regression was used to analyze childhood vaccination by parental socioeconomic status while accounting for shared district, cluster, and household variation. Maps were created to serve as a roadmap for efforts to increase vaccination. Findings: Geographic variation in vaccination rates was substantial. Districts that were less covered were near other districts with limited coverage. Most districts lacked herd immunity for diphtheria, pertussis, poliomyelitis and measles. Full herd immunity was reached in a small number of districts clustered near the capital. While within-district variation in coverage was substantial; parental education and wealth were independently associated with vaccination. Interpretation: Socioeconomic inequalities in vaccination reduce herd immunity and perpetuate inequalities by allowing infectious diseases to disproportionately affect the most vulnerable populations. Findings indicated that most districts had low immunization coverage rates and unvaccinated children were geographically clustered. The result was inequalities in vaccination and reduced herd immunity. To further improve coverage, interventions must take a multilevel approach that focuses on both supply-and demand-side barriers to delivering vaccination to underserved regions, and to the poorest children in those regions.

Objectives. We used the fundamental cause hypothesis as a framework for understanding the creatio... more Objectives. We used the fundamental cause hypothesis as a framework for understanding the creation of health disparities in colorectal cancer mortality in the United States from 1968 to 2005. Methods. We used negative binomial regression to analyze trends in county-level gender-, race-, and age-adjusted colorectal cancer mortality rates among individuals aged 35 years or older. Results.

Abstract On average, older people remember less and walk more slowly than do younger persons. Som... more Abstract On average, older people remember less and walk more slowly than do younger persons. Some researchers argue that this is due in part to a common biologic process underlying age-related declines in both physical and cognitive functioning. Only recently have longitudinal data become available for analyzing this claim.

Social science & medicine (1982), Jan 1, 2012

International journal of epidemiology, Jan 1, 2012

Conclusions In all three birth cohorts, substantial educational benefit remained after adjustment... more Conclusions In all three birth cohorts, substantial educational benefit remained after adjustment for adolescent cognition and parental social class, offsetting an effect equivalent of 0.5 to 1.5 standard deviations lower adolescent cognition. We also find that the likelihood of earning a university degree depends in part on adolescent cognition, gender and parental social class. We conclude that inequalities in adult cognition derive in part from educational experiences after adolescence.

The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2013

We describe and compare the expected performance trajectories of older adults on the Mini-Mental ... more We describe and compare the expected performance trajectories of older adults on the Mini-Mental Status Examination (MMSE) across six independent studies from four countries in the context of a collaborative network of longitudinal studies of aging. A coordinated analysis approach is used to compare patterns of change conditional on sample composition differences related to age, sex, and education. Such coordination accelerates evaluation of particular hypotheses. In particular, we focus on the effect of educational attainment on cognitive decline.

The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 2013

We describe and compare the expected performance trajectories of older adults on the Mini-Mental ... more We describe and compare the expected performance trajectories of older adults on the Mini-Mental Status Examination (MMSE) across six independent studies from four countries in the context of a collaborative network of longitudinal studies of aging. A coordinated analysis approach is used to compare patterns of change conditional on sample composition differences related to age, sex, and education. Such coordination accelerates evaluation of particular hypotheses. In particular, we focus on the effect of educational attainment on cognitive decline.

American Journal of Public Health, 2013

Context: Colorectal cancer is a major cause of mortality in the United States, with 52,857 deaths... more Context: Colorectal cancer is a major cause of mortality in the United States, with 52,857 deaths estimated in 2012. To explore further the social inequalities in colorectal cancer mortality, we used fundamental cause theory to consider the role of societal diffusion of information and socioeconomic status.

Journal of Craniofacial Surgery, 2015

The Asher-McDade system is a 5-point ordinal scale frequently used to rate the components of naso... more The Asher-McDade system is a 5-point ordinal scale frequently used to rate the components of nasolabial appearance, including nasal form and nasal symmetry, in unilateral cleft lip and palate. Although reference photographs illustrating this scale have been identified for the frontal and right profile view, no reference photographs exist for the basal view. The aim of this study was to identify reference photographs for nasal form and nasal symmetry from the basal view to illustrate this scale and facilitate its use. Four raters assessed nasolabial appearance (form and symmetry) on basal view photographs of 50 children (average age 8 years) with a repaired cleft lip. Intraclass correlation coefficients show fair to moderate inter-rater reliability. Cronbach α indicated strong agreement between raters (0.77 nasal form; 0.78 nasal symmetry; 0.80 overall), along with low duplicate measurement error and strong internal consistency between the measures. The photographs with the highest agreement among raters were selected to illustrate each point on the 5-point scale for nasal form and for nasal symmetry, resulting in the selection of 10 reference photographs. The basal view reference photograph set developed from this study may complement existing reference photograph sets for other views and facilitate rating tasks.

The Journal of craniofacial surgery, 2015

Obtaining an esthetic and functional primary surgical repair in patients with complete cleft lip ... more Obtaining an esthetic and functional primary surgical repair in patients with complete cleft lip and palate (CLP) can be challenging because of tissue deficiencies and alveolar ridge displacement. This study aimed to describe surgeons' assessments of presurgical deformity and predicted surgical outcomes in patients with complete unilateral and bilateral CLP (UCLP and BCLP, respectively) treated with and without nasoalveolar molding (NAM). Cleft surgeon members of the American Cleft Palate-Craniofacial Association completed online surveys to evaluate 20 presurgical photograph sets (frontal and basal views) of patients with UCLP (n = 10) and BCLP (n = 10) for severity of cleft deformity, quality of predicted surgical outcome, and likelihood of early surgical revision. Five patients in each group (UCLP and BCLP) received NAM, and 5 patients did not receive NAM. Surgeons were masked to patient group. Twenty-four percent (176/731) of surgeons with valid e-mail addresses responded to ...

American journal of epidemiology, 2014

We aimed to examine the relationship between socioeconomic status (SES) and suicide associated wi... more We aimed to examine the relationship between socioeconomic status (SES) and suicide associated with the introduction and diffusion of selective serotonin reuptake inhibitors (SSRIs). Negative binomial regression was used to estimate county-level suicide rates among persons aged 25 years or older using death certificate data collated by the National Center for Health Statistics from 1968 to 2009; SES was measured using the decennial US Census. The National Health and Nutrition Examination Survey and the Medical Expenditure Panel Survey were used to measure SSRI use. Once SSRIs became available in 1988, a 1% increase in SSRI usage was associated with a 0.5% lower suicide rate. Prior to the introduction of SSRIs, SES was not related to suicide. However, with each 1% increase in SSRI use, a 1-standard deviation (SD) higher SES was associated with a 0.6% lower suicide rate. In 2009, persons living in counties with SES 1 SD above the national average were 13.6% less likely to commit suici...

Epidemiologic Reviews, 2013

On average, older people remember less and walk more slowly than do younger persons. Some researc... more On average, older people remember less and walk more slowly than do younger persons. Some researchers argue that this is due in part to a common biologic process underlying age-related declines in both physical and cognitive functioning. Only recently have longitudinal data become available for analyzing this claim. We conducted a systematic review of English-language research published between 2000 and 2011 to evaluate the relations between rates of change in physical and cognitive functioning in older cohorts. Physical functioning was assessed using objective measures: walking speed, grip strength, chair rise time, flamingo stand time, and summary measures of physical functioning. Cognition was measured using mental state examinations, fluid cognition, and diagnosis of impairment. Results depended on measurement type: Change in grip strength was more strongly correlated with mental state, while change in walking speed was more strongly correlated with change in fluid cognition. Examining physical and cognitive functioning can help clinicians and researchers to better identify individuals and groups that are aging differently and at different rates. In future research, investigators should consider the importance of identifying different patterns and rates of decline, examine relations between more diverse types of measures, and analyze the order in which age-related declines occur.

Social Science & Medicine, 2014

This study examines how associations between socioeconomic status (SES) and lung and pancreatic c... more This study examines how associations between socioeconomic status (SES) and lung and pancreatic cancer mortality have changed over time in the U.S. The fundamental cause hypothesis predicts as diseases become more preventable due to innovation in medical knowledge or technology, individuals with greater access to resources will disproportionately benefit, triggering the formation or worsening of health disparities along social cleavages. We examine socioeconomic disparities in mortality due to lung cancer, a disease that became increasingly preventable with the development and dissemination of knowledge of the causal link between smoking cigarettes and lung cancer, and compare it to that of pancreatic cancer, a disease for which there have been no major prevention or treatment innovations. County-level disease-specific mortality rates for those !45 years, adjusted for sex, race, and age during 1968e2009 are derived from death certificate and population data from the National Center for Health Statistics. SES is measured using five county-level variables from four decennial censuses, interpolating values for intercensal years. Negative binomial regression was used to model mortality. Results suggest the impact of SES on lung cancer mortality increases 0.5% per year during this period. Although lung cancer mortality rates are initially higher in higher SES counties, by 1980 persons in lower SES counties are at greater risk and by 2009 the difference in mortality between counties with SES one SD above compared to one SD below average was 33 people per 100,000. In contrast, we find a small but significant reverse SES gradient in pancreatic cancer mortality that does not change over time. These data support the fundamental cause hypothesis: social conditions influencing access to resources more greatly impact mortality when preventative knowledge exists. Public health interventions and policies should facilitate more equitable distribution of new health-enhancing knowledge and faster uptake and utilization among lower SES groups.

Colorectal cancer is the second most deadly form of cancer in the United States. As of 2008, 5.4%... more Colorectal cancer is the second most deadly form of cancer in the United States. As of 2008, 5.4% of all Americans will be diagnosed with colorectal cancer. Developments in prevention and treatment, achieved mostly since 1980, have caused a rapid decline in mortality rates among the general population. However, this decline has been accompanied by a simultaneous increase in racial disparities. Fundamental cause' theory posits that these disparities emerge as new preventive knowledge or treatment regimens for a particular disease are used more quickly by people with more education and economic resources, who are better positioned to benefit from new health-enhancing knowledge (Link and Phelan 2005). The objective of this paper is to analyze the effects of socioeconomic status and race as fundamental causes' of colorectal cancer mortality trends in the United States from 1968 to 2005. Data used come from two sources: the Surveillance, Epidemiology, and End Results Data collect...

Contemporary studies in disparities of cancer mortality have noted an association between persist... more Contemporary studies in disparities of cancer mortality have noted an association between persistent negative health outcomes and social conditions. Fundamental cause theory posits that social and economic inequalities persist because individuals with more social and economic resources are better able to avoid health risks and to attenuate the consequences of disease. The history of Hodgkin's lymphoma, for which a cure was first found in 1968 with large-scale testing completed in 1970, presents a unique opportunity to follow the impact of the fundamental causes of disease over time for a cancer where survival outcomes in the US have recently aligned across race and gender. Internationally, recovery rates vary strongly by socioeconomic status. Currently in the US, 5-year survival rates are: 84.0% for white men; 86.7% for white women; 78.5% for black men; and 87.1% for black women (19962002 rates). It is expected that, historically, these outcomes were more disparate. Using death ...

American Journal of Epidemiology

We aimed to examine the relationship between socioeconomic status (SES) and suicide associated wi... more We aimed to examine the relationship between socioeconomic status (SES) and suicide associated with the introduction and diffusion of selective serotonin reuptake inhibitors (SSRIs). Negative binomial regression was used to estimate county-level suicide rates among persons aged 25 years or older using death certificate data collated by the National Center for Health Statistics from 1968 to 2009; SES was measured using the decennial US Census. The National Health and Nutrition Examination Survey and the Medical Expenditure Panel Survey were used to measure SSRI use. Once SSRIs became available in 1988, a 1% increase in SSRI usage was associated with a 0.5% lower suicide rate. Prior to the introduction of SSRIs, SES was not related to suicide. However, with each 1% increase in SSRI use, a 1–standard deviation (SD) higher SES was associated with a 0.6% lower suicide rate. In 2009, persons living in counties with SES 1 SD above the national average were 13.6% less likely to commit suicide than those living in counties with SES 1 SD below the national average—a difference of 1.9/100,000 adults aged ≥25 years. Higher SSRI use was associated with lower suicide rates among US residents aged ≥25 years; however, SES inequalities modified the association between SSRI use and suicide.

American journal of public health, 2013

Context: Colorectal cancer is a major cause of mortality in the United States, with 52,857 deaths... more Context: Colorectal cancer is a major cause of mortality in the United States, with 52,857 deaths estimated in 2012. To explore further the social inequalities in colorectal cancer mortality, we used fundamental cause theory to consider the role of societal diffusion of information and socioeconomic status.

The journals of gerontology. Series B, Psychological sciences and social sciences, 2013

We describe and compare the expected performance trajectories of older adults on the Mini-Mental ... more We describe and compare the expected performance trajectories of older adults on the Mini-Mental Status Examination (MMSE) across six independent studies from four countries in the context of a collaborative network of longitudinal studies of aging. A coordinated analysis approach is used to compare patterns of change conditional on sample composition differences related to age, sex, and education. Such coordination accelerates evaluation of particular hypotheses. In particular, we focus on the effect of educational attainment on cognitive decline.

Social science & medicine (1982), 2014

This study examines how associations between socioeconomic status (SES) and lung and pancreatic c... more This study examines how associations between socioeconomic status (SES) and lung and pancreatic cancer mortality have changed over time in the U.S. The fundamental cause hypothesis predicts as diseases become more preventable due to innovation in medical knowledge or technology, individuals with greater access to resources will disproportionately benefit, triggering the formation or worsening of health disparities along social cleavages. We examine socioeconomic disparities in mortality due to lung cancer, a disease that became increasingly preventable with the development and dissemination of knowledge of the causal link between smoking cigarettes and lung cancer, and compare it to that of pancreatic cancer, a disease for which there have been no major prevention or treatment innovations. County-level disease-specific mortality rates for those !45 years, adjusted for sex, race, and age during 1968e2009 are derived from death certificate and population data from the National Center for Health Statistics. SES is measured using five county-level variables from four decennial censuses, interpolating values for intercensal years. Negative binomial regression was used to model mortality. Results suggest the impact of SES on lung cancer mortality increases 0.5% per year during this period. Although lung cancer mortality rates are initially higher in higher SES counties, by 1980 persons in lower SES counties are at greater risk and by 2009 the difference in mortality between counties with SES one SD above compared to one SD below average was 33 people per 100,000. In contrast, we find a small but significant reverse SES gradient in pancreatic cancer mortality that does not change over time. These data support the fundamental cause hypothesis: social conditions influencing access to resources more greatly impact mortality when preventative knowledge exists. Public health interventions and policies should facilitate more equitable distribution of new health-enhancing knowledge and faster uptake and utilization among lower SES groups.

Vaccine, 2014

Background: Socioeconomic inequalities in vaccination can reduce the ability and efficiency of gl... more Background: Socioeconomic inequalities in vaccination can reduce the ability and efficiency of global efforts to reduce the burden of disease. Vaccination is particularly critical because the poorest children are often at the greatest risk of contracting preventable infectious diseases, and unvaccinated children may be clustered geographically, jeopardizing herd immunity. Without herd immunity, these children are at even greater risk of contracting disease and social inequalities in associated morbidity and mortality are amplified. Methods: Data on vaccination for children under five came from the most recent Demographic and Health Survey in Madagascar (2008Madagascar ( -2009. Vaccination status was available for diptheria, pertussis, tetanus, hepatitis B, measles, tuberculosis, poliomyelitis, and H. influenza type-B. Multilevel logistic regression was used to analyze childhood vaccination by parental socioeconomic status while accounting for shared district, cluster, and household variation. Maps were created to serve as a roadmap for efforts to increase vaccination. Findings: Geographic variation in vaccination rates was substantial. Districts that were less covered were near other districts with limited coverage. Most districts lacked herd immunity for diphtheria, pertussis, poliomyelitis and measles. Full herd immunity was reached in a small number of districts clustered near the capital. While within-district variation in coverage was substantial; parental education and wealth were independently associated with vaccination. Interpretation: Socioeconomic inequalities in vaccination reduce herd immunity and perpetuate inequalities by allowing infectious diseases to disproportionately affect the most vulnerable populations. Findings indicated that most districts had low immunization coverage rates and unvaccinated children were geographically clustered. The result was inequalities in vaccination and reduced herd immunity. To further improve coverage, interventions must take a multilevel approach that focuses on both supply-and demand-side barriers to delivering vaccination to underserved regions, and to the poorest children in those regions.

Objectives. We used the fundamental cause hypothesis as a framework for understanding the creatio... more Objectives. We used the fundamental cause hypothesis as a framework for understanding the creation of health disparities in colorectal cancer mortality in the United States from 1968 to 2005. Methods. We used negative binomial regression to analyze trends in county-level gender-, race-, and age-adjusted colorectal cancer mortality rates among individuals aged 35 years or older. Results.

Abstract On average, older people remember less and walk more slowly than do younger persons. Som... more Abstract On average, older people remember less and walk more slowly than do younger persons. Some researchers argue that this is due in part to a common biologic process underlying age-related declines in both physical and cognitive functioning. Only recently have longitudinal data become available for analyzing this claim.

Social science & medicine (1982), Jan 1, 2012

International journal of epidemiology, Jan 1, 2012

Conclusions In all three birth cohorts, substantial educational benefit remained after adjustment... more Conclusions In all three birth cohorts, substantial educational benefit remained after adjustment for adolescent cognition and parental social class, offsetting an effect equivalent of 0.5 to 1.5 standard deviations lower adolescent cognition. We also find that the likelihood of earning a university degree depends in part on adolescent cognition, gender and parental social class. We conclude that inequalities in adult cognition derive in part from educational experiences after adolescence.