Detecting the ‘Black Hole’ of age-period excess mortality in 25 countries: Age-period-cohort residual analysis

in Bell, Andrew (Ed.) Age, Period, and Cohort Effects (in press)

In a time of worldwide availability of annual age-specific mortality data, we lack basic tools for detecting and graphing, from a comparative perspective, fine-grained deviations from mortality trends. We ... [more ▼]

In a time of worldwide availability of annual age-specific mortality data, we lack basic tools for detecting and graphing, from a comparative perspective, fine-grained deviations from mortality trends. We provide a new age-period-cohort-based methodology, combining information from age-period (AP) and APC-Detrended (APCD) analyses to detect all-cause mortality increases. Plotting the resulting AP coefficients and APCD residuals in equilateral Lexis diagrams, mortality patterns can easily be distinguished as age, period, or cohort trends and fluctuations. We highlight abnormalities as interactions of age and period (‘Black Holes’). We then investigate the ‘Black Holes’ of mortality of young-adult cohorts in the early 1990s in Spain, other southern European countries, and the U.S., in emphasizing their simultaneously occurring mortality crises. Additional analyses with WHO mortality data and epidemiological evidence from other studies show that these mortality increases likely result from lack of treatment and inadequate public health responses to the beginnings of the HIV/AIDS epidemic. We discuss other possible applications of the new method. [less ▲]

Who is going to pay the price of Covid-19? Reflections about an unequal Brazil

in International Journal for Equity in Health (2020), 19

How to actively protect against dementia. Epidemiological evidence from Luxembourg

Presentation (2020, February)

Gender inequalities across the life course: A societal perspective on gender differences in dementia

Scientific Conference (2019, October)

Introduction. Women are at increased risk of developing dementia, which can only partly be explained with differences in longevity, sex biology, or differences in detection/diagnosis. A promising approach ... [more ▼]

Introduction. Women are at increased risk of developing dementia, which can only partly be explained with differences in longevity, sex biology, or differences in detection/diagnosis. A promising approach at the population level is the systematic investigation of life course conditions for men and women across countries and cohorts in order to detect if schooling or work opportunities differ by gender. In the cognitive reserve framework, education and work reflect opportunities for cognitively stimulating activities, which increase cognitive reserve across the life course, and which could delay cognitive decline and the diagnosis of dementia. Method. We develop a framework for systematizing gender inequalities across different life stages and life domains, with a focus on systematic disadvantages for women that could be relevant barriers to cognitive reserve development. For the empirical analysis, we gather individual information and performance on cognitive tests from several harmonized cross-national aging surveys, i.e. the U.S. Health and Retirement Study and sister studies (SHARE, ELSA, SAGE), separated by cohort. Historical figures on gender inequalities for countries and cohorts, and their relevant timings in the life course of the older respondents, e.g. during schooling, were gathered from different sources, and merged with the individual-level data. Results. The new framework leads to testable hypotheses in both the Western and global context regarding life-course socialization and schooling and work opportunities that have been different for men and women. We will present preliminary evidence of how female (dis)advantages on different cognitive tests – memory, executive functioning – are mirroring societal gender inequalities. Discussion. We need to better understand how different life-course opportunities for men and women can create gender differences in dementia at old ages in order to identify individuals at risk today and improve conditions for future generations. [less ▲]

WYLD Special Symposium: Technological Innovations in Dementia Diagnosis and Care

Scientific Conference (2019, October)

Researchers and entrepreneurs present technological innovations in dementia diagnosis and care, particularly through the use of wearables, apps, and novel data analysis techniques. These innovations ... [more ▼]

Researchers and entrepreneurs present technological innovations in dementia diagnosis and care, particularly through the use of wearables, apps, and novel data analysis techniques. These innovations address complex challenges of differential dementia diagnosis and ensuring high-quality and safe home and formal care. [less ▲]

Epidemiology of and inequalities in ageing

Presentation (2019, June 05)

Social and behavioral factors in cognitive aging: Applying the causal inference framework in observational studies

Scientific Conference (2019, May 25)

Rationale: There is an urgent need to better understand how to maintain cognitive functioning at older ages with lifestyle interventions, given that there is currently no medical cure available to prevent ... [more ▼]

Rationale: There is an urgent need to better understand how to maintain cognitive functioning at older ages with lifestyle interventions, given that there is currently no medical cure available to prevent, halt or reverse the progression of cognitive decline and dementia. However, in current models, it is still not well established which social and behavioral modifiable factors (e.g. education, BMI, physical activity, sleep, depression) matter most at which ages, and which behavioral profiles are most protective against cognitive decline. In the last years, advances in the fields of causal inference have equipped epidemiology and social sciences with methods and models to approach causal questions in observational studies. Method: The presentation will give an overview of the causal inference framework to investigate the value of behavior changes in cognitive aging. Motivated by conflicting recent publications if physical activity should or should not be recommended to reduce individual risk of cognitive decline, we emulate a target trial where sedentary people are followed over the course of the Survey of Health, Ageing and Retirement in Europe (SHARE) and compare their cognitive development depending on initiating or not physical activity at a later measurement. Extended inclusion/exclusion criteria, and concepts of incident versus prevalent users and multiple eligibility are introduced. Discussion: The causal inference framework applied to observational studies is able to guide study design to reconcile conflicting evidence from intervention and observational studies. Investigations under the new framework have fewer ethical considerations compared to intervention research and, considering the need to follow up individuals over several decades, are considerably more cost-effective. Limitations are discussed. [less ▲]

A Bourdieusian approach to class‐related inequalities: the role of capitals and capital structure in the utilisation of healthcare services in later life

in Sociology of Health and Illness (2019)

This paper draws on Bourdieu's theory of economic, social and cultural capital to understand the relative effect of the volume and the composition of these capitals on healthcare service use in later life ... [more ▼]

This paper draws on Bourdieu's theory of economic, social and cultural capital to understand the relative effect of the volume and the composition of these capitals on healthcare service use in later life. Based on data from the fifth wave of the Survey of Health, Aging, and Retirement in Europe (n = 64,840), we first look at the contribution of each capital in the use of three healthcare services (general practitioner, dentist and hospital). Using cluster analysis, we then mobilise Bourdieu's concept of habitus to explain how the unequal distribution of material and non‐material capitals acquired in childhood lead to different levels of health and hospital care utilisation in later life. After controlling for demographic and health insurance variables, our results show that economic capital has the strongest individual association among the three capitals. However, the results of a cluster analysis used to distinguish between capital structures show that those with high non‐material capital and low material capital have higher levels of primary healthcare utilisation, and in turn lower levels of hospital use. Bourdieu's approach sheds light on the importance of capitals in all forms and structures to understand the class‐related mechanisms that contribute to different levels of healthcare use. [less ▲]

The Long-lasting Impact of Inequality of Educational Opportunities on Later-life Cognitive Functioning

Scientific Conference (2019)

Health access and wealth: Does capital structure matter?

Scientific Conference (2018, December)