Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 190, Issue 11, Pages 2242-2255Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwab076
Keywords
cohort analysis; gender disparities; health behaviors; mental health; morbidity and mortality; obesity; physiological status; racial disparities
Categories
Funding
- Eunice Kennedy Shriver National Institute for Child Health and Human Development [P2CHD058484]
- National Institute on Aging [R03AG053463]
- Centers for Disease Control and Prevention [R03SH000046]
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Since the turn of the century, morbidity and mortality rates have been increasing among middle-aged and young-old Americans. Physiological dysregulation has continuously increased across different generations, with White men showing the highest magnitude of increase and Black men experiencing the steepest increase in chronic inflammation. The worsening physiological and mental health profiles among younger generations, particularly in Whites, pose challenging prospects in terms of morbidity and mortality for the United States.
Morbidity and mortality have been increasing among middle-aged and young-old Americans since the turn of the century. We investigated whether these unfavorable trends extend to younger cohorts and their underlying physiological, psychological, and behavioral mechanisms. Applying generalized linear mixed-effects models to data from 62,833 adults from the National Health and Nutrition Examination Surveys (1988-2016) and 625,221 adults from the National Health Interview Surveys (1997-2018), we found that for all sex and racial groups, physiological dysregulation has increased continuously from Baby Boomers through late-Generation X and Generation Y. The magnitude of the increase was higher for White men than for other groups, while Black men had a steepest increase in low urinary albumin (a marker of chronic inflammation). In addition, Whites underwent distinctive increases in anxiety, depression, and heavy drinking, and they had a higher level than Blacks and Hispanics of smoking and drug use in recent cohorts. Smoking is not responsible for the increasing physiological dysregulation across cohorts. The obesity epidemic contributes to the increase in metabolic syndrome but not in low urinary albumin. The worsening physiological and mental health profiles among younger generations imply a challenging morbidity and mortality prospect for the United States, one that might be particularly inauspicious for Whites.
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