Biomedical subjects

Nancy Krieger

Publications and source records attributed to Nancy Krieger.

At least 19 recordsLinked to original sources

PubMed2006

Monitoring socioeconomic disparities in death: comparing individual-level education and area-based socioeconomic measures.

We compared all-cause mortality rates stratified by individual-level education and by census tract area-based socioeconomic measures for Massachusetts (1999-2001). Among persons aged 25 and older, the age-adjusted relative index of inequality was slightly higher for the census tract than for the individual education measures (1.5 vs 1.2, respectively). Only the census tract socioeconomic measures could provide a relative index of inequality (2-3) for deaths before age 25 or detect expected socioeconomic disparities for deaths among persons 65 and older (relative index of inequality= approximately 1.2 vs 0.8 for census tract measures and individual education, respectively).

Adolescent↗

PubMed2006

Race/ethnicity and changing US socioeconomic gradients in breast cancer incidence: California and Massachusetts, 1978-2002 (United States).

OBJECTIVE: We tested the hypothesis that the US socioeconomic gradient in breast cancer incidence is declining, with the decline most pronounced among racial/ethnic groups with the highest incidence rates. METHODS: We geocoded the invasive incident breast cancer cases for three US population-based cancer registries covering: Los Angeles County, CA (1978-1982, 1988-1992, 1998-2002; n = 68,762 cases), the San Francisco Bay Area, CA (1978-1982, 1988-1992, 1998-2002; n = 37,210 cases) and Massachusetts (1988-1992, 1998-2002; n = 48,111 cases), linked the records to census tract area-based socioeconomic measures, and, for each socioeconomic stratum, computed average annual breast cancer incidence rates for the 5-year period straddling the 1980, 1990, and 2000 census, overall and by race/ethnicity and gender. RESULTS: Our findings indicate that the socioeconomic gradient in breast cancer incidence is: (a) relatively small (at most 1.2) and stable among US white non-Hispanic and black women; (b) sharper and generally increasing among Hispanic and Asian and Pacific Islander American women; and (c) cannot be meaningfully analyzed without considering effect modification by race/ethnicity and immigration. CONCLUSION: Our results indicate that secular changes in US socioeconomic gradients in breast cancer incidence exist and vary by race/ethnicity.

Breast Neoplasms↗

PubMed2006

A century of census tracts: health & the body politic (1906-2006).

In 2006, the U.S. celebrates the 100th birthday of the census tract. These geographic units, born out of concerns for urban well-being, were first proposed in 1906 to provide a "convenient and scientific city map system" for the City of New York. They were employed for the first time in the U.S. census in 1910 in eight cities, via a joint effort involving the U.S. Census Bureau and state and local health departments. Initially termed "sanitary areas" because of their relevance to planning for public health and health services, census tracts are now widely used by all sectors of government and by myriad disciplines in the health, social, and geographic sciences for research as well as policy development, implementation, and evaluation. In this article, I describe the census tract's underappreciated origins, give examples of its current use in analyzing and addressing social disparities in health and health care, and discuss its continued significance and implications for population health and the public data required for informed democratic governance.

Censuses↗

PubMed2006

Mapping and measuring social disparities in premature mortality: the impact of census tract poverty within and across Boston neighborhoods, 1999-2001.

The identification and documentation of health disparities are important functions of public health surveillance. These disparities, typically falling along lines defined by gender, race/ethnicity, and social class, are often made visible in urban settings as geographic disparities in health between neighborhoods. Recognizing that premature mortality is a powerful indicator of disparities in both health status and access to health care that can readily be monitored using routinely available public health surveillance data, we undertook a systematic analysis of spatial variation in premature mortality in Boston (1999-2001) across neighborhoods and sub-neighborhoods in relation to census tract (CT) poverty. Using a multilevel model based framework, we estimated that the incidence of premature mortality was 1.39 times higher (95% credible interval 1.09-1.78) among persons living in the most economically deprived CTs (>/=20% below poverty) compared to those in the least impoverished tracts (<5% below poverty). We present maps of model-based standardized mortality ratios that show substantial within-neighborhood variation in premature mortality and a sizeable decrease in spatial variation after adjustment for CT poverty. Additionally, we present maps of model-based direct standardized rates that can more readily be compared to externally published rates and targets, as well as maps of the population attributable fraction that show that in some of Boston's poorest neighborhoods, the proportion of excess deaths associated with CT poverty reaches 25-30%. We recommend that these methods be incorporated into routine analyses of public health surveillance data to highlight continuing social disparities in premature mortality.

Adolescent↗

PubMed2006

Social hazards on the job: workplace abuse, sexual harassment, and racial discrimination--a study of Black, Latino, and White low-income women and men workers in the United States.

This study documents the prevalence of workplace abuse, sexual harassment at work, and lifetime experiences of racial discrimination among the United for Health cohort of 1,202 predominantly black, Latino, and white women and men low-income union workers in the Greater Boston area. Overall, 85 percent of the cohort reported exposure to at least one of these three social hazards; exposure to all three reached 20 to 30 percent among black women and women and men in racial/ethnic groups other than white, black, or Latino. Workplace abuse in the past year, reported by slightly more than half the workers, was most frequently reported by the white men (69%). Sexual harassment at work in the past year was reported by 26 percent of the women and 22 percent of the men, with values of 20 percent or more in all racial/ ethnic-gender groups other than Latinas and white men. High exposure to racial discrimination was reported by 37 percent of the workers of color, compared with 10 percent of the white workers, with black workers reporting the greatest exposure (44%). Together, these findings imply that the lived--and combined-experiences of class, race, and gender inequities and their attendant assaults on human dignity are highly germane to analyses of workers' health.

Adult↗

PubMed2005

Stormy weather: race, gene expression, and the science of health disparities.

In the current US political climate, conservative foundations are seeking to frame debates over determinants of racial/ethnic health disparities as a matter of "politically correct" unscientific ideology (concerning the health impacts of discrimination) vs scientific yet "politically incorrect" expertise rooted in biological facts (concerning genes). I draw on historical and contemporary examples to place conservative polemics in context, and also highlight fundamental flaws in their arguments involving the use of spurious categories (e.g., Caucasian), logical fallacies, temporal fallacies, and an erroneous emphasis on gene frequency over gene expression. The larger goal is to strengthen development of a more critical, reflexive, and rigorous science capable of generating evidence useful for rectifying--rather than perpetuating--social disparities in health.

Gene Expression↗

PubMed2005

Methods and baseline characteristics of two group-randomized trials with multiracial and multiethnic working-class samples.

INTRODUCTION: Few papers address the methodological challenges in recruiting participants for studies of cancer prevention interventions designed for multiracial and multiethnic working-class populations. This paper reports the results of the sample selection and survey methods for two group-randomized intervention studies. METHODS: The two group-randomized intervention studies, Healthy Directions-Small Business (HD-SB) and Healthy Directions-Health Centers (HD-HC), included a worksite-based study in 26 small manufacturing businesses and a study in 10 outpatient health centers. We used selection and recruitment methods to obtain a multiracial and multiethnic working-class study sample. In 2000 and 2001, we assessed baseline measures of sociodemographic characteristics and behavioral outcomes by self-report. We then computed intraclass correlation coefficients (ICCs). RESULTS: Of the 1740 participants in the HD-SB study, 68% were non-Hispanic whites, and 76% had working-class occupations. In the HD-HC study, 59% of 2219 participants were non-Hispanic whites. Among those who worked, 51% had working-class occupations. Large percentages of both samples reported not meeting recommended guidelines for the target behaviors. For example, 86% of members of both samples consumed fewer than the recommended five servings of fruits and vegetables per day. The ICCs for the four target behaviors in HD-SB were between 0.006 and 0.02. In the HD-HC study, the ICCs ranged from 0.0004 to 0.003. CONCLUSION: The two studies were successful in recruiting multiracial and multiethnic working-class participants. Researchers will find the estimates of the primary outcomes and their ICCs useful for planning future studies.

Adolescent↗

PubMed2005

Lifetime socioeconomic position and twins' health: an analysis of 308 pairs of United States women twins.

BACKGROUND: Important controversies exist about the extent to which people's health status as adults is shaped by their living conditions in early life compared to adulthood. These debates have important policy implications, and one obstacle to resolving them is the relative lack of sufficient high-quality data on childhood and adult socioeconomic position and adult health status. We accordingly compared the health status among monozygotic and dizygotic women twin pairs who lived together through childhood (until at least age 14) and subsequently were discordant or concordant on adult socioeconomic position. This comparison permitted us to ascertain the additional impact of adult experiences on adult health in a population matched on early life experiences. METHODS AND FINDINGS: Our study employed data from a cross-sectional survey and physical examinations of twins in a population-based twin registry, the Kaiser Permanente Women Twins Study Examination II, conducted in 1989 to 1990 in Oakland, California, United States. The study population was composed of 308 women twin pairs (58% monozygotic, 42% dizygotic); data were obtained on childhood and adult socioeconomic position and on blood pressure, cholesterol, post-load glucose, body mass index, waist-to-hip ratio, physical activity, and self-rated health. Health outcomes among adult women twin pairs who lived together through childhood varied by their subsequent adult occupational class. Cardiovascular factors overall differed more among monozygotic twin pairs that were discordant compared to concordant on occupational class. Moreover, among the monozygotic twins discordant on adult occupational class, the working class twin fared worse and, compared to her professional twin, on average had significantly higher systolic blood pressure (mean matched difference = 4.54 mm Hg; 95% confidence interval [CI], 0.10-8.97), diastolic blood pressure (mean matched difference = 3.80 mm Hg; 95% CI, 0.44-7.17), and low-density lipoprotein cholesterol (mean matched difference = 7.82 mg/dl; 95% CI, 1.07-14.57). By contrast, no such differences were evident for analyses based on educational attainment, which does not capture post-education socioeconomic position. CONCLUSION: These results provide novel evidence that lifetime socioeconomic position influences adult health and highlight the utility of studying social plus biological aspects of twinship.

Adolescent↗

PubMed2005

Work factors and occupational class disparities in sickness absence: findings from the GAZEL cohort study.

OBJECTIVES: To estimate the contribution of stress-related and physical work factors to occupational class disparities in sickness absence from work. METHODS: Our sample consisted of 8847 men and 2886 women participating in the French GAZEL cohort study. Occupational class and medically certified sickness absence data (1995-2001) were obtained from the participants' employer. Work characteristics (physical and stress-related) were self-reported. We calculated rate ratios with Poisson regression models; fractions of sickness absence attributable to work factors were estimated with the Miettinen formula. RESULTS: Sickness absence was distributed along an occupational gradient. Work characteristics accounted for 19% (women) and 21% (men) of all absences. Physical work conditions accounted for 42% and 13% of absences for musculoskeletal reasons, and work stress accounted for 48% and 40% of psychiatric absences. Overall, about 20% of the occupational class gradient in sickness absence could have been associated with deleterious work conditions. CONCLUSION: Work conditions contribute to sickness absence, particularly among manual workers and clerks. Policies that decrease ergonomic constraints and work stress also could reduce the burden of ill health and sickness absence among the lowest strata of working populations.

Absenteeism↗

PubMed2005

Experiences of discrimination: validity and reliability of a self-report measure for population health research on racism and health.

Population health research on racial discrimination is hampered by a paucity of psychometrically validated instruments that can be feasibly used in large-scale studies. We therefore sought to investigate the validity and reliability of a short self-report instrument, the "Experiences of Discrimination" (EOD) measure, based on a prior instrument used in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Study participants were drawn from a cohort of working class adults, age 25-64, based in the Greater Boston area, Massachusetts (USA). The main study analytic sample included 159 black, 249 Latino, and 208 white participants; the validation study included 98 African American and 110 Latino participants who completed a re-test survey two to four weeks after the initial survey. The main and validation survey instruments included the EOD and several single-item discrimination questions; the validation survey also included the Williams Major and Everyday discrimination measures. Key findings indicated the EOD can be validly and reliably employed. Scale reliability was high, as demonstrated by confirmatory factor analysis, Cronbach's alpha (0.74 or greater), and test-re-test reliability coefficients (0.70). Structural equation modeling demonstrated the EOD had the highest correlation (r=0.79) with an underlying discrimination construct compared to other self-report discrimination measures employed. It was significantly associated with psychological distress and tended to be associated with cigarette smoking among blacks and Latinos, and it was not associated with social desirability in either group. By contrast, single-item measures were notably less reliable and had low correlations with the multi-item measures. These results underscore the need for using validated, multi-item measures of experiences of racial discrimination and suggest the EOD may be one such measure that can be validly employed with working class African Americans and Latino Americans.

Adult↗

PubMed2005

The impact of a police drug crackdown on drug injectors' ability to practice harm reduction: a qualitative study.

This paper employs qualitative methods to explore the ramifications of a police drug crackdown on drug injectors' ability to practice harm reduction. Between August and December 2000, we conducted open-ended interviews with 40 illicit-drug-injecting residents of a New York City police precinct undergoing a crackdown. Interview topics included participants' experiences with police in the precinct and their drug use practices. Grounded theory methods were used to analyze resulting transcripts. Because place emerged as a salient analytic category, we also drew on elements of social geography to interpret results. The analysis suggests that particular crackdown tactics, notably frequent police searches of participants' bodies and elevated surveillance of the precinct's public spaces, reconfigured participants' experiences of their bodies and the public spaces comprising the precinct in ways that adversely affected their capacity to engage in harm reduction. Frequent police searches, for example, discouraged participants from carrying the injection equipment they needed to ensure that they could inject with a sterile syringe. Constant monitoring of local public spaces made it difficult for homeless women and men to inject safely. Simultaneously, participants expressed support for police actions that reduced public drug activity. Given these findings, we recommend the implementation of strategies, designed by partnerships of community groups and governmental and non-governmental organizations, which reduce public drug activity without imperiling injectors' health. Possible strategies include improving access to treatment and establishing safe injection spaces.

Adolescent↗

PubMed2005

Defining and investigating social disparities in cancer: critical issues.

Research and action to address social disparities in cancer requires clarity about what constitutes and causes these persistent and onerous inequities in health. Currently, both scientific literature and government documents exhibit important disagreements, confused terminology, and considerable, if not deliberate, vagueness about the meaning of the phrase 'cancer disparities' and the related term 'social disparities in health.' This article accordingly reviews critical issues relevant to cohering understanding of what is meant by 'cancer disparities;' offers a definition premised on the causal contention that social disparities in health, by definition, arise from social inequity; and considers its implications for developing a multidisciplinary research agenda on social inequalities in cancer. Tackling this issue will require rigorous and critical frameworks, questions, and methods derived from multiple disciplines, and will necessarily involve epidemiologic, clinical, and intervention research, both quantitative and qualitative. At issue is making conscious research choices: about which types of disparities we study, in relation to which aspect of cancer, so as to improve the likelihood our research will help inform a society-wide discourse about the extent, origins of, and remedies for social injustices in cancer, thereby aiding efforts to eliminate social inequalities in health.

Health Services Accessibility↗

PubMed2005

Cancer disparities: developing a multidisciplinary research agenda - preface.

In this Special Issue, we present a series of papers concerned with developing a multidisciplinary research agenda to address social disparities in cancer. Motivating this Special Issue are two concerns: (1) despite major advances in knowledge during the 20th century about the extent, determinants, treatment, and prevention of cancer, social disparities in cancer, including within the United States, remain serious, persistent, and require redress; and (2) huge gaps in knowledge exist regarding the causes of and solutions to social disparities in cancer across the full cancer continuum, from prevention to occurrence to diagnosis to treatment and, all too often, to death. Consequently, critical research is critically needed, both to answer the unanswered questions and to ascertain why existing knowledge is not implemented to reduce and eliminate these disparities. To help advance work in this field, we share papers developed for a January 2004 workshop on cancer disparities held at the Dana Farber/Harvard Cancer Center (DF/HCC), in Boston, MA. Topics addressed include: the definition and magnitude of, and programmatic responses to, social disparities in cancer, plus development of a systematic approach to raising research questions to address cancer disparities, using the case examples of breast, cervix, colon, and prostate cancer.

Diagnosis, Differential↗

PubMed2005

Occupational class, occupational mobility and cancer incidence among middle-aged men and women: a prospective study of the French GAZEL cohort*.

OBJECTIVE: To examine the association between occupational class, occupational mobility and cancer incidence in the 1990s. METHODS: Prospective study of 14,853 men and 5493 women employed by a large French company. Incident cases (any cancer, smoking and alcohol-related, breast) were ascertained through a validated company-based cancer registry (1990-2002). Hazard ratios (HRs) by occupational class and by career-long occupational mobility were calculated adjusting for age, marital status, tobacco and alcohol consumption, weight, diet, asbestos exposure, family history of cancer, and reproductive history. RESULTS: 359 male cancers (107 smoking and alcohol-related) and 208 female cases (120 breast cancers) were observed. Male clerks and manual workers were at high risk, particularly of smoking and alcohol-related cancers (compared to managers, age-adjusted HRs: 2.95 95% CI 1.37-6.38 and 2.18 95% CI 1.15-4.11). Adjusting for specific health behaviors and other cancer risk factors reduced this gradient (fully-adjusted HRs respectively 1.95 95% CI 0.89-4.27 and 1.54 95% CI 0.80-2.97). The risk was also associated with occupational mobility. We found no association between women's occupational class and cancer. CONCLUSION: The incidence of smoking and alcohol-related cancers among French men shows a strong socioeconomic gradient. Policies addressing these social disparities are needed.

Adult↗

PubMed2005

Donation after cardiac death: the University of Wisconsin experience with liver transplantation.

OBJECTIVE: To determine whether the outcomes of liver transplantation (LTx) from donation after cardiac death (DCD) donors are equivalent to those from donation after brain death (DBD) donors. SUMMARY BACKGROUND DATA: Because of the significant donor organ shortage, more transplant centers are using livers recovered from DCD donors. However, long-term, single-center outcomes of liver transplantation from DCD donors are limited. METHODS: From January 1, 1993, to July 31, 2002, 553 liver transplants were performed from DBD donors and 36 were performed from DCD donors. Differences in event rates between the groups were compared with Kaplan-Meier estimates and the log-rank test. Differences in proportion and differences of means between the groups were compared with Fisher exact test and the Wilcoxon rank sum test, respectively. RESULTS: Mean warm ischemic time at recovery in the DCD group was 17.8 +/- 10.6 minutes. The overall rate of biliary strictures was greater in the DCD group at 1 year (33% versus 10%) and 3 years (37% versus 12%; P = 0.0001). The incidence of hepatic artery thrombosis, portal vein stenosis/thrombosis, ischemic-type biliary stricture (ITBS), and primary nonfunction were similar between groups. However, the incidence of both hepatic artery stenosis (16.6% versus 5.4%; P = 0.001) and hepatic abscess and biloma formation (16.7% versus 8.3%; P = 0.04) were greater in the DCD group. Trends toward worse patient and graft survival and increased incidence of ITBS were seen in DCD donors greater than 40 years compared with DCD donors less than 40 years. Overall patient survival at 1 year (DCD, 80%; versus DBD, 91%) and 3 years (DCD, 68%; versus DBD, 84%) was significantly less in the DCD group (P = 0.002). Similarly, graft survival at 1 year (DCD, 67%; versus DBD, 86%) and 3 years (DCD, 56%; versus DBD, 80%) were significantly less in the DCD group (P = 0.0001). CONCLUSIONS: Despite similar rates of primary nonfunction, LTx after controlled DCD resulted in worse patient and graft survival compared with LTx after DBD and increased incidence of biliary complications and hepatic artery stenosis. However, overall results of LTx after controlled DCD are encouraging; and with careful donor and recipient selection, LTx after DCD may successfully increase the donor liver pool.

Adult↗

PubMed2005

Embodiment: a conceptual glossary for epidemiology.

This construct and process are central to ecosocial theory and epidemiological inquiry. Recognising that we, as humans, are simultaneously social beings and biological organisms, the notion of "embodiment" advances three critical claims: (1) bodies tell stories about-and cannot be studied divorced from--the conditions of our existence; (2) bodies tell stories that often--but not always--match people's stated accounts; and (3) bodies tell stories that people cannot or will not tell, either because they are unable, forbidden, or choose not to tell. Just as the proverbial "dead man's bones" do in fact tell tales, via forensic pathology and historical anthropometry, so too do our living bodies tell stories about our lives, whether or not these are ever consciously expressed. This glossary sketches some key concepts, definitions, and hypotheses relevant for using the construct of "embodiment" in epidemiological research, so as to promote not only rigorous science but also social equity in health.

Ecology↗

PubMed2005

Hormone replacement therapy, cancer, controversies, and women's health: historical, epidemiological, biological, clinical, and advocacy perspectives.

Routine acceptance of use of hormone replacement therapy (HRT) was shattered in 2002 when results of the largest HRT randomised clinical trial, the women's health initiative, indicated that long term use of oestrogen plus progestin HRT not only was associated with increased risk of cancer but, contrary to expectations, did not decrease, and may have increased, risk of cardiovascular disease. In June 2004 a group of historians, epidemiologists, biologists, clinicians, and women's health advocates met to discuss the scientific and social context of and response to these findings. It was found that understanding the evolving and contending knowledge on hormones and health requires: (1) considering its societal context, including the impact of the pharmaceutical industry, the biomedical emphasis on individualised risk and preventive medicine, and the gendering of hormones; and (2) asking why, for four decades, since the mid-1960s, were millions of women prescribed powerful pharmacological agents already demonstrated, three decades earlier, to be carcinogenic? Answering this question requires engaging with core issues of accountability, complexity, fear of mortality, and the conduct of socially responsible science.

Cardiovascular Diseases↗

PubMed2005

Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the Public Health Disparities Geocoding Project.

OBJECTIVES: We describe a method to facilitate routine monitoring of socioeconomic health disparities in the United States. METHODS: We analyzed geocoded public health surveillance data including events from birth to death (c. 1990) linked to 1990 census tract (CT) poverty data for Massachusetts and Rhode Island. RESULTS: For virtually all outcomes, risk increased with CT poverty, and when we adjusted for CT poverty racial/ethnic disparities were substantially reduced. For half the outcomes, more than 50% of cases would not have occurred if population rates equaled those of persons in the least impoverished CTs. In the early 1990s, persons in the least impoverished CT were the only group meeting Healthy People 2000 objectives a decade ahead. CONCLUSIONS: Geocoding and use of the CT poverty measure permit routine monitoring of US socioeconomic inequalities in health, using a common and accessible metric.

Censuses↗