Adrianne Frech

Coverage gaps and periods of uninsurance are associated with decreased health care utilization, treatment nonadherence, and health-related work limitations. Yet little is known about long-term trajectories of insurance coverage. We used sequence analysis and a nationally representative cohort study to identify and describe three trajectories of health insurance coverage from ages 25 to 37: stable private coverage (40%); stabilizing public coverage (16%); and recurrent uninsurance (44%). Estimated time exposed to uninsurance for each group was 0.2, 1.7, and 5.2 years, respectively. Those with recurrent uninsurance were more likely to be male, Black or Hispanic, working part-time, in poorer health, or living in the U.S. South or West. Prolonged and cyclical uninsurance is common in the years following the transition to adulthood, with disadvantaged adults more likely to experience recurrent uninsurance. Furthermore, examining insurance status cross-sectionally underestimates long-term exposure to coverage instability and may impede effective interventions aimed at securing long-term access to coverage.

Drawing on life course and intersectional approaches, this study examines how education shapes the intertwined domains of work and family across race and ethnicity. By applying multichannel sequence analysis and cluster analysis to the National Longitudinal Survey of Youth 1979, we identify a typology of life course trajectories of work and family and test for the interactive associations of race and ethnicity with college education for different trajectory types. While our results show statistically significant and often sizable education effects across racial and ethnic groups for most of the work‒family clusters, they also suggest that the size and direction of the education effect vary widely across groups. Educational attainment plays an outsize role in shaping Black women's work‒family lives, increasing their access to steady work and partnerships, while educational attainment primarily works to increase White women's participation in part-time work. In contrast, Latina women's work‒family trajectories are less responsive to their educational attainment. In combination, the racialized role of education and persistent racial and ethnic gaps across the education distribution yield unequal patterns in work‒family strategies among Black, Latina, and White women.

We use the National Longitudinal Survey of Youth 1979 to identify group-based trajectories of unemployment risk as workers age in the United States. Our novel methodological approach reveals 73% of full-time workers spend much of their 20, 30, and 40 s with a relatively low risk of unemployment. The remaining sizable minority varies in the timing and relative degree of their unemployment risk. Eighteen percent experience early career unemployment risk into their early thirties, well after the transition to adulthood. Chronic unemployment characterizes the labor market experiences of the remaining 9%. When expanding the sample to all workers, we find two key differences: the overall prevalence of unemployment is greater each year for all groups and the distribution of respondents across groups differs, with fewer workers experiencing Lower unemployment and more workers experiencing Early Career or Higher unemployment. Unemployment risk is shaped by experiences of long-term unemployment in young adulthood and early labor market constraints. Moreover, while men and women appear equally at risk of Early career unemployment, men are particularly at risk of Higher unemployment. Black workers were significantly more likely to be at risk of Higher unemployment, but only slightly more likely to be at risk of Early career unemployment. Since Early career unemployment risk gives way to steadier work for most, this suggests that some men and some Black workers face disproportionately high levels of employment precarity. Our findings point to the importance of a life course approach for understanding the relationship between unemployment and labor market precarity.

Over the past several decades, U.S. men’s paid work has transformed from a state of high stability and continuity to a state of increased instability and precarity. Despite this, full-time employment throughout adulthood remains the presumed standard for modern American men. The authors investigated the diversity of men’s workforce experiences using the National Longitudinal Survey of Youth “National Longitudinal Survey of Youth - 1979 cohort” and identified six multitrajectories of men’s time spent employed, unemployed, and out of the labor force from ages 27 to 49. The authors identified one multitrajectory of steady work, three of increasing unemployment or time out of work, one of increasing steady work, and one of intermittent work. Contrary to conventional assumptions, only 41 percent of men followed a trajectory of continuous, high employment over the duration of their prime earning years. This suggests that most men do not achieve the “ideal worker norm,” raising implications for how research and policy conceptualize men’s work experiences.

Social determinants of health (SDH) have emerged as a major area of emphasis in medicine over the last 30 years. While increasing interest in SDH has led to a proliferation of literature on this topic, it is unclear whether the medical evidence base on SDH has assimilated contributions from other disciplines. We analyzed interdisciplinary contributions to the medical evidence base on SDH, using a bibliographic analysis of highly cited literature reviews. Medical review articles from 1990 to 2020 were queried using the Scopus database, with a keyword search in the title and abstract for “social determinants of health.” The top 100 most highly cited articles were sampled for inclusion, and references in each review were screened to identify journal articles published in other disciplines. An initial Scopus search identified 502 eligible reviews. After reviewing the top 100 most highly cited articles, 40 articles published between 2000 and 2017 met our inclusion criteria. and received between 33 and 940 citations. These reviews included references to a median of 41 journal articles (interquartile range [IQR]: 25, 67), of which a median of 11 was from public health journals (IQR: 6, 18) and 4 were from other social science fields (IQR: 1, 11). On multivariable analysis, more recent reviews incorporated more sources from public health but not from other social science fields. Relevant SDH scholarship from sociology and related fields is not being integrated into the evidence base directed at clinician audiences and may be underutilized in shaping policy and practice in these areas.

Chronic pain is associated with reduced work participation, but longitudinal data on the work impact of chronic pain are limited. We used data from the National Longitudinal Survey of Youth-1997 cohort to analyze how pain interference in early adulthood was associated with subsequent exit from the labor force in a longitudinal survey. Pain interference at age 29 and employment status were self-reported at subsequent biennial interviews. Exit from the labor force, return to employment, and development of new health-related work limitations after age 29 were analyzed using survival analysis methods. Among 5819 respondents, 10% and 3% endorsed “a little” or “a lot” of pain interference at age 29, respectively. During follow-up (median of 26 months until censoring or labor force exit), 43% of respondents had exited the labor force at least once and 10% developed a new work-related health limitation. The highest pain interference group (compared with no pain interference) had higher hazard of labor force exit (hazard ratio: 1.26; 95% confidence interval: 1.01-1.57; P = 0.044) and of developing new health-related work limitations (hazard ratio: 2.45; 95% confidence interval: 1.64-3.67; P < 0.001), with similar results for the group experiencing “a little” pain interference at age 29. In this nationally representative cohort, any level of pain interference reported at age 29 was found to predict increased hazards of subsequent labor force exit and health-related work limitation. Early identification and treatment of pain problems among young workers can help reduce burdens of future unemployment and disability.

Objectives: We estimate associations between unemployment trajectories from ages 27-49 and physical and mental health at age 50. Methods: Data are from the U.S. National Longitudinal Survey of Youth, 1979 ( N=6434). Group-based trajectory models are used to identify unemployment trajectories. Generalized linear models with a modified Bolck, Croon, and Hagenaars (BCH) correction are used to regress health on unemployment trajectory groups. Results: We identified “Consistently Low (70%),” “Decreasing Mid-Career (18%),” and “Persistently High (12%)” unemployment trajectories. Experiencing Decreasing Mid-Career or Persistently High trajectories was associated with worse physical and mental health at age 50 than Consistently Low trajectories. Experiencing a Persistently High trajectory was associated with worse physical and mental health than a Decreasing Mid-Career trajectory. Discussion: Timing and likelihood of unemployment are associated with midlife health. Mid-Career unemployment is associated with worse physical and mental health at age 50, but not to the same degree as Persistently High unemployment.

Introduction: Heart transplantation is the definitive treatment for end-stage heart failure. Left ventricular assist devices (LVADs) are a continually improving technology that extends life for some candidates on the heart transplant waiting list. Research Questions: Our objective is to compare Black-White differences in LVAD implantation and heart transplant outcomes during a period of technological innovation when the pulsatile flow LVAD was largely replaced by the continuous flow LVAD between 1999-2014. Design: We used transplant registry data from the United Network for Organ Sharing (N = 5,550) to identify Black and White patients with heart failure who used an LVAD as a bridge-to-transplant (BTT). Using logistic regression, we compared Black-White differences in access to newer LVAD technology and timing of implantation relative to wait listing for heart transplantation. We used competing-risks event history models to predict transplant outcomes across race, LVAD type, and timing of LVAD implantation. Results: Black and White candidates were equally likely to receive newer continuous flow LVADs, but Black candidates received LVADs later in the disease course (i.e. after transplant listing). This later timing of technological intervention contributed to poorer wait list outcomes among black transplant candidates, including lower likelihood of receiving a heart transplant and greater likelihood of being removed from the wait list due to worsening health. Discussion: Delayed LVAD implantation is more common among Black patients and is associated with poorer transplant outcomes.