Seminar Series

We investigate whether racial disparities in health outcomes worsen as hospitals reach capacity, when rationing on the basis of provider and system biases may become more salient. Using time-stamped electronic health records from two large hospitals, we find that in-hospital mortality increased substantially for Black patients when hospitals approached capacity, but not for White patients. Strain-related increases in racial mortality gaps largest for high-risk patients. We provide evidence of rationing on the basis of wait times, documenting a startling fact: sicker Black patients waited longer for care than healthier White patients at all capacity levels.

The warnings of potential climate migration first appeared in the scientific literature in the late 1970s when increased recognition that disintegrating ice sheets could drive people to migrate from coastal cities. Since that time, scientists have modelled potential climate migration without integrating other population processes, potentially obscuring the demographic amplification of this migration. Climate migration could amplify demographic change -- enhancing migration to destinations and suppressing migration to origins. Additionally, older populations are the least likely to migrate and climate migration could accelerate population aging in origin areas. Here, we investigate climate migration under sea-level rise (SLR), a single climatic hazard, and examine both the potential demographic amplification effect and population aging by combining matrix population models, flood hazard models, and a migration model built on 40 years of environmental migration in the US to project the US population distribution of US counties.

The REWARD study asks whether and how exposure to neighborhood-level disadvantage shapes health inequities via epigenetic mechanisms. REWARD draws on data from the Survey of the Health of Wisconsin (SHOW), a uniquely rich dataset that combines social and health survey measures with residential histories spanning up to five decades, spatio-temporally linked neighborhood conditions, and epigenetic clocks constructed based on DNA methylation in whole blood.

Schools are expected to equip students with the skills to climb the socioeconomic ladder. This paper examines teachers' contributions to this process. To this end, we explore the determinants of Chile's college admission test for the universe of test takers between 2013 and 2021. The analysis exploits unique and rich matched teacher-student data gathered from multiple administrative information sources, allowing us to account for student, school, and teacher characteristics. We implement different decompositions of the production function of cognitive achievement, including value-added specifications.

Major longitudinal studies of aging, including the Survey of Health and Ageing in Europe (SHARE), have used retrospective life history (RLH) interviews to collect earlier life course exposures. However, reliability of RLH data has not been comprehensively evaluated against prospectively collected information. We present initial results from an adaptation of the SHARE RLH interview, fielded with the long-running American's Changing Lives (ACL) study (ACL-LIFE). Retrospectively and prospectively collected reports about different kinds of life events and statuses reveal varying levels of mismatch in reports of the occurrence of events like health shocks, bereavement, and others, with even more discordance in the reported count of events and their timing. The implications of these mismatches and their nonrandom occurrence is discussed in the context of life course analyses of the social determinants of health.

The first half of the 20th Century saw a dramatic transformation of mortality in the United States, as infectious disease went from ubiquitous and unpredictable and rare and controllable. This revolution in mortality may shape U.S. population health even today. Diverse evidence suggests that infectious exposures in the first year of life can have lasting consequences for individual health and development, as well as altering population composition through intense early mortality selection. The cohorts born in the first half of the twentieth century United States experienced rapidly and unevenly changing infectious exposures. How might that affect health, and inequality in health, today? This talk establishes some basic descriptive facts about how infectious disease exposure was distributed by space, race, and place, and how this changed during the first half of the twentieth century. Results track the evolution of exposures over this period from uniformly high, to extremely mixed and variable, to uniformly low -- albeit only for whites. These patterns suggest new hypotheses about population health today, and may also ultimately be used to investigate what thresholds of exposure, within the range typically experienced by real cohorts, matter for subsequent health.

Much evidence suggests a strong causal association between social relationships and health and mortality risks. Research acknowledges social relationships as a “double-edged” phenomenon—social support favors longevity, while social strain fosters cumulative disadvantages in health. However, little research explores social relationship dynamics over the entire life course. Using four waves of HRS 2006-2018 data, I identify four group-based trajectories of perceived social support and social strain to examine the degree of exposure to social support and social strain and their effects on psychological and physical health among older populations in the U.S. The preliminary results show mixed effects on health selection and social causation. Specifically, people with persistently low or steadily decreasing perceived social support from spouses and children are less likely to have good self-rated health. However, people who perceive increased social support from their children are more likely to be in poor health. In contrast, persistently high and increased social strain from one’s spouse is associated with lower chances of good health; low social strain from children is less likely to be associated with poor health. Interestingly, people who perceive persistently high or increased social strain from family and friends are less likely to have poor health, which indicates a strong health selection effect. These findings suggest a differential effect of social support and social strain from close ties (spouse and children) compared to weaker ties (other relatives and friends).

While evidence suggests a durable relationship between redlining and population health, we currently lack an empirical account of how this historical act of racialized violence produced contemporary inequities. In this paper, we use a mediation framework to evaluate how redlining grades influenced later life expectancy and the degree to which contemporary racial disparities in life expectancy between Black working-class neighborhoods and White professional-class neighborhoods can be explained by past Home Owners’ Loan Corporation (HOLC) mapping. Life expectancy gaps between differently graded tracts are driven by economic isolation and disparate property valuation which developed within these areas in subsequent decades. Still, only a small percent of a total disparity between contemporary Black and White neighborhoods is explained by HOLC grades. We discuss the role of HOLC maps in analyses of structural racism and health, positioning them as only one feature of a larger public–private project conflating race with financial risk. Policy implications include not only targeting resources to formerly redlined neighborhoods but also the larger project of dismantling racist theories of value that are deeply embedded in the political economy of place.

Grit, hardiness, resilience, and mindfulness are attributes associated with performance under, and mitigation of the effects of, high-stress environments over time. Studying these attributes often requires simulating high-stress in a controlled setting. Over the past four years, our multi-institutional research team has studied the contributions of these psychological characteristics (and a limited number of biomarkers) to performance and completion of Basic Underwater Demolition/SEAL training (BUD/S), one of the most high stress environments possible outside of combat. Exposure to cold, sleep deprivation, and intense physical activity are leveraged to understand the ability of students to withstand the high levels of stress that produces an attrition rate of 65-85%. Here, we discuss the overall goals and challenges of the project, and we briefly present results from three published papers investigating: (1) the measurement of grit, hardiness, and resilience among the BUD/S trainee population; (2) the relationship between resilience, mindfulness, and successful completion of BUD/S; and (3) patterns of change in grit, hardiness, and resilience over the course of training.