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Using historical data from 1,763 birth cohorts from 1800 to 1935 in 13 developed countries, we show that what is now seen as normal—a large excess of female life expectancy in adulthood—is a demographic phenomenon that emerged among people born in the late 1800s. We show that excess adult male mortality is clearly rooted in specific age groups, 50–70, and that the sex asymmetry emerged in cohorts born after 1880 when male:female mortality ratios increased by as much as 50% from a baseline of about 1.1. Heart disease is the main condition associated with increased excess male mortality for those born after 1900. We further show that smoking-attributable deaths account for about 30% of excess male mortality at ages 50–70 for cohorts born in 1900–1935. However, after accounting for smoking, substantial excess male mortality at ages 50–70 remained, particularly from cardiovascular disease. The greater male vulnerability to cardiovascular conditions emerged with the reduction in infectious mortality and changes in health-related behaviors. Female life expectancy now exceeds that of males in all countries. Although this gender difference has become accepted as normal, it is a relatively recent demographic phenomenon that emerged with the reduction of infections and the increase in the share of adult mortality attributed to cancer and cardiovascular disease. Heart disease is the main condition associated with increased excess male mortality, making the strongest contributions in birth cohorts of 1900–1935. Smoking behavior accounts for about 30% of male excess mortality at ages 50–70 for those born in 1900–1935. The remaining excess male mortality may be explained by underlying traits of vulnerability to cardiovascular disease that emerged with the reduction of infections and changes in diet and other lifestyle factors.

The Cambodian population has experienced an increase in the proportion of stunted children who have overweight mothers during a period of rapid social and economic growth. We aimed to identify socio-economic factors associated with this household-level double burden over time. We used data from four Cambodia Demographic and Health Surveys from 2000 to 2014 to study the impact of socio-economic status (SES) on the link between child stunting and overweight mothers in two periods 2000-2005 v. 2010-2014. We hypothesised that SES would be a primary factor associated with this phenomenon. We included 14 988 children under the age of 5 years, among non-pregnant mothers aged 15-49 years of age and conducted analysis on a subsample of 1572 children with overweight mothers. Nationally representative household survey across all regions. SES factors, specifically household wealth and maternal employment in service or manual occupations (in 2010-2014), are the main drivers of stunting among children of overweight mothers. Children with overweight mothers in the poorest households are more than twice as likely to be stunted than in the richest in both periods (2000-2005: adjusted OR (aOR) = 2·53, 95 % CI: 1·25, 5·13; 2010-2014: aOR = 2·61, 95 % CI: 1·43, 4·77), adjusting for other SES factors, indicating that despite decreasing income inequality, the poorest continue to bear excess risk of a double burden of malnutrition. Maternal short stature also doubled the likelihood of child stunting in both periods, which suggests intergenerational transmission of adversity and physical underdevelopment. Socio-economic inequalities should be addressed to reduce disparities in the household-level double burden of malnutrition.

Recent work has unearthed many empirical regularities in mortality trends, including the inverse correlation between life expectancy and life span inequality, and the compression of mortality into older age ranges. These regularities have furnished important insights into the dynamics of mortality by describing, in demographic terms, how different attributes of the life table deaths distribution interrelate and change over time. However, though empirical evidence suggests that the demographically-meaningful metrics these regularities involve (e.g., life span disparity and life table entropy) are correlated to the moments of the deaths distribution (e.g., variance), the broader theoretical connections between life span inequality and the moments of the deaths distribution have yet to be elucidated. In this article we establish such connections and leverage them to furnish new insights into mortality dynamics. We prove theoretical results linking life span disparity and life table entropy to the central moments of the deaths distribution, and use these results to empirically link statistical measures of variation of the deaths distribution (e.g., variance, index of dispersion) to life span disparity and life table entropy. We validate these results via empirical analyses using data from the Human Mortality Database and extract from them several new insights into mortality shifting and compression in human populations.

Objective: Our goal was to assess emergency medical services (EMS) provider-perceived Alzheimer’s disease and related dementias (ADRD) by patient sociodemographic characteristics and ZIP code tabulation areas (ZCTA) in the prehospital setting. Methods: We conducted a retrospective descriptive analysis of EMS calls with patient contact for adults ≥ 65 years of age who were provided prehospital care between February 1, 2020 and January 31, 2022, using data from the San Francisco Department of Emergency Management and the 2021 American Community Survey. Logistic regression models assessed the associated between EMS providerperceived ADRD and patient sociodemographic characteristics, including age, race/ethnicity, incident location, and ZCTA-level socioeconomic status. Results: A total of 55,129 patient encounters were recorded, with EMS provider-perceived ADRD recorded in 4,112 (7.5%). Among cases with EMS provider-perceived ADRD, the most common primary impressions were mental disorders (17.1%), weakness (17.0%), injury (15.7%), and pain (13.1%). Increasing age was associated with higher odds of EMS provider-perceived ADRD among both sexes. Among females, EMS provider-perceived ADRD was higher among Hispanics (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.11–1.52), Blacks (OR 1.20, 95% CI 1.03–1.40), Asians (OR 1.18, 95% CI 1.06–1.31), and Native Hawaiian and Pacific Islanders (OR 1.48, 95% CI 1.05–2.08]), while among males, only Asians (OR 87, 95% CI .76–.99) had lower odds, all compared to Whites. Females in lowand medium-income ZCTAs had lower odds of EMS provider-perceived ADRD relative to high-income ZCTAs, with no significant findings in males. Conclusion: Our findings suggest a higher prevalence of EMS provider-perceived Alzheimer’s disease and related dementias among minoritized and socioeconomically disadvantaged populations, including the oldest adults, and racial and ethnic minority communities. Future research and more precise data collection is needed to ensure equity for older adults who access emergency care in the prehospital setting.

Background In the last thirty years, major shifts in immigrant policy at national and state levels has heightened boundaries among citizens, permanent residents, and those with other statuses. While there is mounting evidence that citizenship influences immigrant health care inequities, there has been less focus on how policies that reinforce citizenship stratification may shape the extent of these inequities. We examine the extent to which the relationship between citizenship and health care inequities is moderated by state-level criminalization policies. Methods Taking a comparative approach, we assess how distinct criminalization policy contexts across US states are associated with inequitable access to care by citizenship status. Utilizing a data set with state-level measures of criminalization policy and individual-level measures of having a usual source of care from the National Health Interview Survey, we use mixed-effects logistic regression models to assess the extent to which inequities in health care access between noncitizens and US born citizens vary depending on states’ criminalization policies. Results Each additional criminalization policy was associated with a lower odds that noncitizens in the state had a usual source of care, compared to US born citizens. Conclusion Criminalization policies shape the construction of citizenship stratification across geography, such as exacerbating inequities in health care access by citizenship.

Background Despite research that has shown that the presence of support persons during maternity care is associated with more respectful care, support persons are frequently excluded due to facility practices or negative attitudes of providers. Little quantitative research has examined how integrating support persons in maternity care has implications for the quality of care received by women, a potential pathway for improving maternal and neonatal health outcomes. This study aimed to investigate how integrating support persons in maternity care is associated with multiple dimensions of the quality of maternity care. Methods We used facility-based cross-sectional survey data from women ( n  = 1,138) who gave birth at six high-volume facilities in Nairobi and Kiambu counties in Kenya and their support persons ( n  = 606) present during the immediate postpartum period. Integration was measured by the Person-Centered Integration of Support Persons (PC-ISP) items. We investigated quality of care outcomes including person-centered care outcomes (i.e., Person-Centered Maternity Care (PCMC) and Satisfaction with care ) and clinical outcomes (i.e., Implementation of WHO-recommended clinical practices ). We used fractional regression with robust standard errors to estimate associations between PC-ISP and care outcomes. Results Compared to low integration, high integration (≥four woman-reported PC-ISP experiences vs. <4) was associated with multiple dimensions of quality care: 3.71%-point (95% CI: 2.95%, 4.46%) higher PCMC scores, 2.76%-point higher (95% CI: 1.86%, 3.65%) satisfaction with care scores, and 4.43%-point (95% CI: 3.52%, 5.34%) higher key clinical practices, controlling for covariates. PC-ISP indicators related to communication with providers showed stronger associations with quality of care compared to other PC-ISP sub-constructs. Some support person-reported PC-ISP experiences were positively associated with women’s satisfaction and key practices. Conclusions Integrating support persons, as key advocates for women, is important for respectful maternity care. Practices to better integrate support persons, especially improving communication between support persons with providers, can potentially improve the person-centered and clinical quality of maternity care in Kenya and other low-resource settings.

As of 31 January 2021, 63.9 million cases and 1.4 million deaths had been reported in Europe and North America, which accounted for 62.5% and 62.4% of the global total, respectively. Comparing the level of mortality across countries has proven difficult because of inherent limitations in the most commonly cited measures (e.g., case-fatality rates). We collected the cumulative number of confirmed deaths from COVID-19 by age in 2020 from the L’Institut National d’études Démographiques (INED) database and Statistics Canada for 15 European and North American countries. We calculated age-specific death rates and age-standardized death rates (ASDR) for each country over a 1-year period from 6 February 2020 (date of first COVID-19 death in Europe and North America) to 5 February 2021 using established demographic methods. We estimated that COVID-19 was the second leading cause of death behind cancer in England and Wales and France and the third leading cause of death behind cancer and heart disease in nine countries including the US. Countries with higher all-cause mortality prior to the COVID-19 experienced higher COVID-19 mortality than countries with lower all-cause mortality prior to the pandemic. The COVID-19 ASDR varied substantially within country (e.g., a 5-fold difference among the highest and lowest mortality states in Germany). Consistently strong public health measures may have lessened the level of mortality for some European and North American countries. In contrast, many of the largest countries and economies in these regions may continue to experience a high mortality level because of poor implementation and adherence to such measures.

The naked mole rat defies the Gompertz law and shows no sign of increased mortality risk as it gets older.The naked mole rat defies the Gompertz law and shows no sign of increased mortality risk as it gets older.

Cigarette smoking during pregnancy increases the risk of preterm birth, low birth weight, and infant mortality. To assess the probability of preterm birth among expectant mothers who smoked cigarettes before pregnancy and quit smoking at the start or during pregnancy. This cross-sectional study analyzed information provided on live birth certificates from 2011 through 2017 that were obtained from US states that implemented the 2003 revision of the US live birth certificate. In total, 25 233 503 expectant mothers who delivered live neonates and had known prepregnancy and trimester-specific cigarette smoking frequency were included in the analyses. Cigarette smoking frequency (1-9, 10-19, and ≥20 cigarettes per day) 3 months prior to pregnancy and for each trimester during pregnancy. Cigarette smoking cessation throughout pregnancy, after the first trimester, after the second trimester, and during the third trimester irrespective of first and second trimester smoking. Probability of preterm birth (<37 weeks' gestation). Of 25 233 503 expectant mothers who delivered live neonates between 2011 and 2017, the modal age at delivery was 25 to 29 years; 52.9% were non-Hispanic white, 23.6% were Hispanic, and 14.2% were non-Hispanic black women; 22 600 196 mothers did not smoke during the 3 months prior to pregnancy, and 2 633 307 smoked during the 3 months prior to pregnancy. The proportion of prepregnancy smokers who quit throughout pregnancy was 24.3% in 2011 and 24.6% in 2017. The proportion of prepregnancy smokers who quit during the third trimester was 39.5% in 2011 and 39.7% in 2017. High-frequency cigarette smoking often occurred among expectant mothers who smoked during pregnancy (eg, 46.9% of third-trimester smokers smoked ≥10 cigarettes per day in 2017). The probability of preterm birth decreased more the earlier smoking cessation occurred in pregnancy. For example, the probability of preterm birth was 9.8% (95% CI, 9.7%-10.0%) among 25- to 29-year-old, non-Hispanic white, primigravida and primiparous expectant mothers (ie, pregnant for the first time and not yet delivered) who smoked 1 to 9 cigarettes per day prior to pregnancy and maintained this frequency throughout their pregnancy. The probability of preterm birth was 9.0% (95% CI, 8.8%-9.1%) if smoking cessation occurred at the start of the second trimester (an 8.9% relative decrease), and 7.8% (95% CI, 7.7%-8.0%) if cessation occurred at the start of pregnancy (a 20.3% relative decrease). Quitting smoking-and quitting early in pregnancy-was associated with reduced risk of preterm birth even for high-frequency cigarette smokers.

BACKGROUND There is growing empirical evidence supporting theories of developmental origins of health and disease (DOHaD). However, the implications of DOHaD conjectures for aggregate population patterns of human disease, disability, mortality, and aging are poorly understood. OBJECTIVE We empirically test two predictions derived from a formal model of aggregate population-level impacts of DOHaD. This model predicts that populations potentially influenced by delayed effects should experience singularities in their adult mortality patterns that can be empirically detected from aggregate data. METHODS We test predictions using a large mortality database for populations in the Latin American and Caribbean (LAC) region, spanning nearly one hundred years of mortality history. RESULTS Results are consistent, within explicit bounds of uncertainty, with expected patterns. We find that younger cohorts in countries whose mortality decline starts more recently experience deceleration in survival gains at older ages, attenuation of the rate of aging at older ages, and a decline in the association between early childhood and adult mortality. CONCLUSIONS Results point to the importance of adverse early conditions for human longevity. Future research should shed light on the impact on morbidity, disability, and healthy life expectancy. CONTRIBUTION To our knowledge this is the first time that implications of DOHaD conjectures for populations' mortality patterns are formulated precisely and empirically tested with aggregate population data.