Understanding Accumulation of Health-Related Inequities over the Life Course Using the Mean Cumulative Count

Citation

LeMasters, Katherine; Renson, Audrey; Zalla, Lauren C.; Martin, Chantel L.; & Edwards, Jessie K. (2023). Understanding Accumulation of Health-Related Inequities over the Life Course Using the Mean Cumulative Count. American Journal of Epidemiology, 192(9), 1425-1431. PMCID: PMC10666969

Abstract

Understanding how health inequities develop over time is necessary to inform interventions, but methods to do so are underutilized. We provide an example of the accumulation of stressful life events using the mean cumulative count (MCC), which estimates the expected number of events per person as a function of time, allowing for censoring and competing events. Data come from the National Longitudinal Survey on Youth 1997, a nationally representative data set. To compare the MCC with standard practice, we present the proportion experiencing 1, 2, and 3+ stressful events and the cumulative probability of experiencing at least 1 event by end of follow-up. Our sample included 6,522 individuals ages 18-33 followed for a median of 14 years. Using the MCC, by age 20, the expected number of encounters was 56 events/100 for Black non-Hispanic, 47/100 for White non-Hispanic, and 50/100 for Hispanic persons. By age 33, inequities grew to 117, 99, and 108 events/100, respectively. The MCC revealed that inequities in stressful events accumulate over early adulthood, partially driven by repeat events; this information was not evident from conventional approaches. This method can be used to identify intervention points for disrupting the accumulation of repeat events to improve health equity.

URL

http://dx.doi.org/10.1093/aje/kwad123

Reference Type

Journal Article

Year Published

2023

Journal Title

American Journal of Epidemiology

Author(s)

LeMasters, Katherine
Renson, Audrey
Zalla, Lauren C.
Martin, Chantel L.
Edwards, Jessie K.

Article Type

Commentary

PMCID

PMC10666969

Data Set/Study

National Longitudinal Studys (NLS)

Continent/Country

United States

State

Nonspecific

Race/Ethnicity

White
Black
Hispanic

ORCiD

LeMasters - 0000-0002-1754-1730
Renson - 0000-0003-1603-2587
Martin, C. - 0000-0003-1907-0810
Edwards, J -0000-0002-1741-335X