Ssm-Population Health最新文献

{"title":"Empirical design of population health strategies accounting for the distribution of population health risks","authors":"Ayumi Hashimoto ,&nbsp;Hideki Hashimoto","doi":"10.1016/j.ssmph.2024.101741","DOIUrl":"10.1016/j.ssmph.2024.101741","url":null,"abstract":"<div><div>Recent discussions in epidemiology have emphasised the need to estimate the heterogeneous effects of risk factors across the distribution of health outcomes for better aetiological understanding of the determinants of population health. We propose using quantile regression-based decomposition to expand the empirical discussion on population health intervention strategies for health equity by incorporating population homogeneity/heterogeneity in the risk–outcome association. We theorised that the ‘proportionate universalism’ approach presumes population homogeneity in the risk–outcome association with varying risk intensities, which decomposition analysis shows as the ‘covariates part’ between groups. Conversely, the ‘targeted approach’ assumes population heterogeneity in the risk–outcome association across the outcome range, which the analysis identifies as the ‘coefficients part’. Our demonstration, using a case of education-related disparity in dietary behaviours, exemplified that differences between education groups were mainly explained by the coefficients part. This finding suggests heterogeneity in their risk profiles, necessitating a ‘targeted approach’ across outcome quantiles to close the gap. The ‘proportionate universalism’ strategy could be partially applied to specific quantile segments where the covariates part remained significant as a supplementary intervention. However, simply increasing the magnitude of certain risk factors (e.g., income) showed conflicting directions between covariates and coefficients parts. Structural modifications of risk–outcome associations would therefore be more equitable. We also discuss the potential strengths and limitations of the analysis, suggesting that it may be complemented by data-driven methods using machine learning to identify discriminating risk factors for population health equity.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101741"},"PeriodicalIF":3.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11729676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of digital infrastructure construction on older adults' cognitive health: Evidence from a quasi-natural experiment in China","authors":"Jun-qi Ma ,&nbsp;Li Sheng","doi":"10.1016/j.ssmph.2024.101739","DOIUrl":"10.1016/j.ssmph.2024.101739","url":null,"abstract":"<div><div>The digital infrastructure has profoundly changed people's daily lives and health outcomes. However, the causal effect of digital infrastructure on cognitive health remains unclear. The study employs the “Broadband China” policy as a reliable proxy for digital infrastructure, using the China Health and Retirement Longitudinal Study (CHARLS) five waves panel data from 2011 to 2020 and a staggered difference-in-differences (DID) method to investigate the causal impact of digital infrastructure construction on the cognitive health in Chinese older adults. We find that digital infrastructure construction has a significant positive effect on the cognitive health of older adults, and the dynamic DID results confirm a persistent effect. Mechanism analysis shows that digital infrastructure improves cognitive health by increasing social interaction, health promotion behaviors (including medical insurance participation and physical exercise), and reducing medical costs. Heterogeneity analysis indicates that the cognitive health-improving effect of digital infrastructure construction is stronger among older adults living in urban areas and high-GDP cities, male, low and middle-aged, and highly educated. Our research findings provide empirical evidence for improving cognitive health and healthy aging among older adults through the development of digital infrastructure.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101739"},"PeriodicalIF":3.6,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11714668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The dual impact of education and occupation on cognitive functioning in older Mexican adults: A cross-sectional exploratory study","authors":"José Eduardo Cabrero Castro ,&nbsp;Mariela Gutierrez ,&nbsp;Theresa Andrasfay ,&nbsp;Emma Aguila ,&nbsp;Brian Downer","doi":"10.1016/j.ssmph.2024.101738","DOIUrl":"10.1016/j.ssmph.2024.101738","url":null,"abstract":"<div><div>This research investigated the relationship between cognitive performance and an individual's educational attainment as well as occupational mental demands among Mexican adults aged 50 or older. We hypothesized that cognitively demanding work boosts cognitive performance for older adults regardless of their education level. To test our hypothesis, we analyzed data on 12,939 individuals in the 2012 Mexican Health and Aging Study using a Generalized Linear Model with a Gaussian family and identity link function. We assessed cognitive demands of occupations with the National Information Network's descriptors, focusing on worker-oriented and job-oriented mental demands. We found that greater worker-oriented (β = 0.5; CI = 0.45, 0.55) and job-oriented (β = 0.49; CI = 0.45, 0.53) mental demands predicted better cognitive performance. Educational attainment correlated even more strongly with better cognitive performance (β = 0.9; CI = 0.87, 0.92). Both our models showed a statistically significant negative interaction between medium occupational mental demands and medium education level (job-oriented: β = −0.09; CI = −0.14, −0.05; worker-oriented: β = −0.07; CI = −0.12, −0.02). Other interaction terms were not significant. This study highlighted a significant effect of educational attainment on cognitive function, which is more pronounced than that of occupational mental demands. The association of higher occupational mental demands with higher cognitive function appeared to be largely independent of educational background. The similarity in cognitive scores using worker-oriented or job-oriented metrics suggests that both are useful for assessing occupational mental demands. Education and cognitive engagement at work are crucial for promoting cognitive health in aging populations.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101738"},"PeriodicalIF":3.6,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11721833/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectories and patterns of US counties’ policy responses to the COVID-19 pandemic: A sequence analysis approach","authors":"Yunyu Amy Chiang ,&nbsp;Lucia Pacca ,&nbsp;Anusha Vable ,&nbsp;Thomas Carton ,&nbsp;Mark J. Pletcher ,&nbsp;Rita Hamad","doi":"10.1016/j.ssmph.2024.101734","DOIUrl":"10.1016/j.ssmph.2024.101734","url":null,"abstract":"<div><h3>Background</h3><div>It is increasingly recognized that policies played a role in mitigating or exacerbating health inequities during the COVID-19 pandemic. While US counties were particularly active in policymaking, limited work has characterized geographic and temporal variation in pandemic-era policymaking at the local level, a prerequisite for later studies examining the health effects of these policies. This paper fills this gap by characterizing county-level COVID-19-related policy trajectories over time using a novel national policy database and innovative methods.</div></div><div><h3>Methods</h3><div>Data came from the US COVID-19 County Policy (UCCP) Database, including 309 counties in 50 states plus Washington DC during January 2020 to December 2021. We examined measures of overall policy comprehensiveness, as well as three domains including containment and closure, economic response, and public health. We applied sequence analysis to characterize county-level trajectories overall and within each policy domain, and cluster analysis to group similar trajectories.</div></div><div><h3>Results</h3><div>There was wide variation in policymaking, with nearly half of counties demonstrating consistently comprehensive policymaking, about 15–20% with consistently low comprehensiveness, and the remainder exhibiting intermittent comprehensiveness. Economic policies were less comprehensive than containment/closure and public health policies. There was also substantial variation within and across states, and associations with county characteristics.</div></div><div><h3>Conclusion</h3><div>This study is among the first to document substantial geographic and temporal variation in a variety of US county-level COVID-19-related policies, which likely contributed to health disparities during and after the pandemic. Future work should evaluate how these different policy trajectories differentially affected health and social outcomes.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101734"},"PeriodicalIF":3.6,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11714380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The long-term impact of childhood peer relationships on disability in later life: Causal mediation evidence from older Chinese adults","authors":"Zi Zhou,&nbsp;Feiyu Wang","doi":"10.1016/j.ssmph.2024.101735","DOIUrl":"10.1016/j.ssmph.2024.101735","url":null,"abstract":"<div><div>Despite the recognized importance of social connections in Chinese culture, research on how childhood peer relationship deficits impact health later in life has been limited. This study aimed to investigate the association between childhood peer relationship deficits and the odds of disability among older Chinese adults and to explore the potential mediating roles of social isolation, loneliness, and cognitive function. Using the longitudinal sample of respondents aged 60 years and older in the China Health and Retirement Longitudinal Study 2013–2018 (<em>N</em> = 7133), the link between peer relationship deficits in childhood and disability in late life was assessed using marginal structural models, and the potential mediating effects of social isolation, loneliness, and cognitive function were examined by the inverse odds ratio weighting technique. Participants who experienced greater childhood peer relationship deficits were more prone to disability (odds ratio: 1.19, 95% CI: 1.09, 1.29) than those with more positive childhood peer interactions. The inverse odds ratio weighting analysis indicated that social isolation, loneliness, and cognitive function individually played partial mediating roles in the association between childhood peer relationships and disability by 11.36% (95% CI: 4.04%–18.99%), 11.95 % (95% CI: 4.65%–19.23%), and 24.58% (95% CI: 17.01%–32.43%), respectively. The combined mediation effect of the three mediators was 30.57% (95% CI: 23.52%–39.91%). These findings suggest that interventions to enhance social connections and cognitive health in older adults may help mitigate the long-term impacts of childhood peer relationship deficits on disability among older Chinese adults.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101735"},"PeriodicalIF":3.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying intersectional groups at risk for missing breast cancer screening: Comparing regression- and decision tree-based approaches","authors":"Núria Pedrós Barnils,&nbsp;Benjamin Schüz","doi":"10.1016/j.ssmph.2024.101736","DOIUrl":"10.1016/j.ssmph.2024.101736","url":null,"abstract":"<div><div>Malignant neoplasm of the breast was the fifth leading cause of death among women in Germany in 2020. To improve early detection, nationwide breast cancer screening (BCS) programmes for women 50–69 have been implemented since 2005. However, Germany has not reached the European benchmark of 70% participation, and socio-demographic inequalities persist. At the same time, challenges exist to identify groups of women at high risk for non-participation, since it is likely that this is due to disadvantages on multiple social dimensions. This study, therefore, aimed to identify intersectional groups of women at higher risk of not attending BCS by comparing two analytical strategies: a) evidence-informed regression and b) decision tree-based regression. Participants were drawn from the German 2019 European Health Interview Survey (N = 23,001; 21.6% response rate). Two logistic regressions using cross-classification intersectional groups based on relevant PROGRESS-Plus characteristics adjusted by age were built. The evidence-informed approach selected relevant variables based on the literature and the decision tree approach on the best-performing tree. The first identified low-income women born outside Germany, living in rural areas and not cohabiting with their partner at higher risk of never attending BCS (OR = 9.48, p = 0.002), whereas the second, based on a Classification and Regression Tree (61.91% balanced accuracy), determined widowed women living alone, with children, with a partner and children, or in other arrangements, and residing in specific federal states (i.e. Bavaria, Brandenburg, Bremen, Hamburg, or Saarland) (OR = 3.43, p &lt; 0.001). Compared to the evidence-informed regression, the decision tree-based regression yielded higher discriminatory accuracy (AUC = 0.6726 vs AUC = 0.6618) and added relevant nuances in the identification of at-risk intersectional groups, going beyond known inequality dimensions and, therefore, helping the inclusion of under-studied populations in breast cancer screening.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101736"},"PeriodicalIF":3.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconceptualizing rurality: Exploring community capital to identify distinct rural classes in the United States","authors":"Jennifer L. Cruz ,&nbsp;Douglas A. Luke ,&nbsp;Rachel M. Ceballos ,&nbsp;Shoba Ramanadhan ,&nbsp;Karen M. Emmons","doi":"10.1016/j.ssmph.2024.101729","DOIUrl":"10.1016/j.ssmph.2024.101729","url":null,"abstract":"<div><h3>Background</h3><div>In population health research, rurality is often defined using broad population density measures, which fail to capture the diverse and complex characteristics of rural areas. While researchers have developed more nuanced approaches to study neighborhood and area effects on health in urban settings, similar methods are rarely applied to rural environments. To address this gap, we aimed to explore dimensions of contextual heterogeneity across rural settings in the US.</div></div><div><h3>Methods</h3><div>We conducted an exploratory latent class analysis (LCA) to identify distinct classes of rurality. Using the Community Capitals Framework, we collated and analyzed nationally representative data for each domain of rural community capital across all rural census tracts in the US (n = 15,643). Data for this study were sourced from ten publicly available datasets spanning the years 2018–2021. To provide preliminary validation of our findings, we examined the Social Vulnerability Index (SVI) percentile rankings across the identified rural classes.</div></div><div><h3>Results</h3><div>A four-class model solution provided the best fit for our data. Our LCA results identified four distinct classes of rurality that vary in terms of capital types: Outlying (n = 3,566, 22.7%), Developed (n = 3,210, 20.5%), Well-Resourced (n = 4,896, 31.3%), and Adaptable (n = 3,981, 25.4%). The mean SVI percentile rankings differed significantly across these classes, with Well-Resourced having the lowest and Adaptable the highest mean percentile rankings.</div></div><div><h3>Conclusions</h3><div>We identified different types of rurality at the census tract level that fall along a social gradient as indicated by variation in SVI percentile rankings. These findings highlight that each rural class has a unique combination of community capitals. This nuanced approach to conceptualizing rurality provides the opportunity to identify interventions that meet specific rural communities' unique strengths and needs.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101729"},"PeriodicalIF":3.6,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11700284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unincorporation in counties as a political determinant of health: An exploration of five states","authors":"Cristina Gomez-Vidal ,&nbsp;Ashley N. Palmer ,&nbsp;Katherine Kitchens ,&nbsp;G. Allen Ratliff ,&nbsp;Genevieve Graaf","doi":"10.1016/j.ssmph.2024.101728","DOIUrl":"10.1016/j.ssmph.2024.101728","url":null,"abstract":"<div><div>Local government policies and practices shape the context of the places that can alter a population's life chances through socioeconomic factors, built environments, and healthcare access. County governments, one of the most ubiquitous U.S. political structures, impact health outcomes within their jurisdiction through multiple policy levers and pathways. By identifying which political determinants within counties are associated with variation in life expectancy and premature death, we can better intervene on modifiable factors. One overlooked political determinant from public health studies is the county's responsibility as the primary local government for approximately a third of the U.S. population and 93% of land in unincorporated areas. To conduct an ecological study and assess associations between county population health and county responsibility for unincorporated areas and populations, we created and tested two county indicators of unincorporation. Multilevel multivariable regression results showed that larger proportions of unincorporated land within a county are associated with lower average county life expectancy. More testing of the measurement is needed to understand the relationship between unincorporation, county government, and population health outcomes.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"28 ","pages":"Article 101728"},"PeriodicalIF":3.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142743341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Taiso practice and risk of functional disability and dementia among older adults in Japan: The JAGES cohort study","authors":"Satoru Kanamori ,&nbsp;Kenjiro Kawaguchi ,&nbsp;Taishi Tsuji ,&nbsp;Kazushige Ide ,&nbsp;Hiroyuki Kikuchi ,&nbsp;Kokoro Shirai ,&nbsp;Mitsuya Yamakita ,&nbsp;Yuko Kai ,&nbsp;Ichiro Kawachi ,&nbsp;Katsunori Kondo","doi":"10.1016/j.ssmph.2024.101731","DOIUrl":"10.1016/j.ssmph.2024.101731","url":null,"abstract":"<div><h3>Background</h3><div>Taiso is a Japanese term encompassing meanings akin to calisthenics. Taiso is a widely used exercise program in Japan but whether it prevents functional disability and dementia remains unclear. This study aimed to elucidate the association between practicing Taiso, especially focusing on the well-known Radio-Taiso, and functional disability and dementia in older adults in Japan.</div></div><div><h3>Methods</h3><div>This population-based prospective cohort study used data from the Japan Gerontological Evaluation Study (JAGES). The participants were 18,016 people aged 65 years or older who resided in 19 municipalities in Japan and were not certified as needing long-term care at the start of follow-up. The outcomes were all functional disability, moderate-to-severe functional disability, and dementia, during an average of 5.3 years of follow-up. Four groups were created based on type of Taiso practice (None, Radio-Taiso only, Other Taiso only, or Both). The Cox proportional hazards model adjusted for age, sex, equivalized income, educational attainment, household composition, employment status, diseases requiring treatment, activities of daily living, depression, cognitive impairment, and walking duration.</div></div><div><h3>Results</h3><div>The analysis included data from 11,219 individuals. The mean age of respondents was 74.2 years and 46.3% were men. Compared with the no-practice group, the Other Taiso only group showed a notably decreased risk of all functional disability (hazard ratio [95% CI] 0.87 [0.78–0.96]). The Other Taiso only group was associated with a significant reduction in the hazard ratio for moderate-to-severe functional disability (0.81 [0.70–0.93]). Decreases in the hazard ratio for dementia were also observed in the Radio-Taiso only (0.82 [0.68–0.9998]) and Other Taiso only groups (0.81 [0.70–0.93]).</div></div><div><h3>Conclusions</h3><div>Practicing Taiso, including Radio-Taiso, may reduce the risk of dementia in older adults, while practicing other types of Taiso may reduce the risk of functional disability.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"28 ","pages":"Article 101731"},"PeriodicalIF":3.6,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142756715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term trajectories of depressive symptoms by military affiliation","authors":"Elizabeth C. Coppola ,&nbsp;Shelley MacDermid Wadsworth ,&nbsp;Zoe E. Taylor ,&nbsp;Laura Schwab-Reese ,&nbsp;Sharon L. Christ","doi":"10.1016/j.ssmph.2024.101733","DOIUrl":"10.1016/j.ssmph.2024.101733","url":null,"abstract":"<div><h3>Objectives</h3><div>Using a national sample of Americans, this study estimated and compared patterns of depressive symptom trajectories stratified by military service. This study then examined associations between sociodemographic factors theorized to shape entry into military service and trajectory patterns.</div></div><div><h3>Method</h3><div>Data came from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study that followed participants from adolescence (1994–1995) through midlife (2016–2018). Latent growth mixture modeling was used to estimate depressive symptom trajectories among civilians (<em>n</em> = 17,644) and participants who served in the military (<em>n</em> = 1266). Associations between trajectory membership and sociodemographic factors were tested with multinomial regression.</div></div><div><h3>Results</h3><div>Trajectories were best represented by 4-class linear models. “Low” was the largest class, representing 74.4% of civilians and 70.4% of those who served. The second largest class, “low then increasing,” was comprised of 13.6% of civilians and 19.6% of service members. The third smallest class, “high then decreasing” class, included 8.8% of civilians and 4.5% of service members. An “increasing” class emerged with high depressive symptoms by midlife, comprised of 3.2% of civilians and 5.5% of those who served. Gender and family structure had robust associations with trajectory membership.</div></div><div><h3>Discussion</h3><div>A larger percentage of those who served were in the “increasing” trajectory characterized by concerningly high depressive symptoms by midlife, underscoring the need for continued screening in depressive symptoms throughout the life course. Associations between family structure and gender on depressive symptoms support calls for conceptualizing family structure as a social determinant of health and continued investment in women's health.</div></div>","PeriodicalId":47780,"journal":{"name":"Ssm-Population Health","volume":"29 ","pages":"Article 101733"},"PeriodicalIF":3.6,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11667064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}