Virginia W Chang
Virginia W Chang
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Associate Professor of Social and Behavioral Sciences
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Professional overview
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Virginia W. Chang, MD, PhD is Associate Professor of Social and Behavioral Sciences at NYU School of Global Public Health, Associate Professor of Population Health at NYU School of Medicine, and Affiliated Associate Professor in the Department of Sociology at NYU. Dr. Chang is a graduate of the Inteflex Program at the University of Michigan, where she received her BS and MD degrees. She then completed a residency in internal medicine, fellowship training with the Robert Wood Johnson Foundation Clinical Scholars Program, and a PhD in sociology, all at the University of Chicago. Prior to joining NYU, Dr. Chang was in the Division of General Internal Medicine at the Perelman School of Medicine at the University of Pennsylvania and a staff physician at the Philadelphia Veterans Administration Medical Center.
As a physician and sociologist, Dr. Chang integrates perspectives from medicine, epidemiology, sociology, and demography in her research. Much of her work has focused on obesity and health disparities, engaging topics such as the influence of socially structured context (e.g., racial segregation, income inequality, neighborhood social/physical disorder) on obesity; the relationship of obesity to mortality and disability; the influence of weight status on the quality of medical care; socioeconomic disparities in health and mortality; and the inter-relationships between health, medical technologies, and stratification.
Her research program has been funded by the NICHD, NHLBI, and NIA of the National Institutes of Health, the Veterans Health Administration, the Robert Wood Johnson Foundation, the Measy Foundation, the American Diabetes Association, and the Russell Sage Foundation. She is the recipient of numerous awards, including the Society of General Internal Medicine Award for Outstanding Junior Investigator of the Year and the Marjorie A. Bowman Award from the University of Pennsylvania School of Medicine for achievement in the health evaluation sciences. Dr. Chang is also a Diplomate of the American Board of Internal Medicine.
Dr. Chang’s publications span a variety of disciplines, including journals such as JAMA, Annals of Internal Medicine, JAMA Internal Medicine, Health Affairs, American Journal of Public Health, American Journal of Epidemiology, Journal of Health & Social Behavior, Social Science & Medicine, Demography, and Social Forces. She was recently an Associate Editor of the Journal of Health & Social Behavior.
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Education
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BS, Biomedical Sciences and Philosophy, University of Michigan, Ann Arbor, MIMD, Medicine, University of Michigan Medical School, University of Michigan, Ann Arbor, MIMA, Sociology, University of Chicago, Chicago, ILPhD, Sociology, University of Chicago, Chicago, IL-Fellow, Robert Wood Johnson Clinical Scholars Program, University of Chicago, Chicago, ILResident, Department of Medicine, University of Chicago, Chicago, ILIntern, Department of Medicine, University of Chicago, Chicago, IL-Diplomate, American Board of Internal MedicineLicensed Medical Physician, Commonwealth of Pennsylvania
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Honors and awards
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Majorie A. Bowman Research Award, University of Pennsylvania School of Medicine (2010)Outstanding Junior Investigator of the Year, Society of General Internal Medicine (2008)Robert Austrian Faculty Award for Health Evaluation Reserach, Department of Medicine, University of Pennsylvania School of Medicine (2008)Physician Faculty Scholars Award, Robert Wood Johnson Foundation (2007)Finalist, Hamolsky Junior Facutly Award, Society of General Internal Medicine (2004)Finalist, Richard Saller Prize for Best Dissertation in the Division of the Social Sciences, University of Chicago (2003)Graduate University Fellowship, University of Chicago (2001)Eli G. Rochelson Memorial Award for Excellence in Pulmonary and Critical Care Medicine, University of Michigan Medical School (1994)Biomedical Research Program Scholarship, University of Michigan Medical School (1991)James B. Angell Scholar, University of Michigan (1988)William J. Branstrom Freshman Prize, University of Michigan (1986)
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Areas of research and study
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Global HealthHealth DisparitiesInternal MedicineObesityPopulation HealthSocial Behaviors
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Publications
Publications
Ultra-processed food consumption and excess weight among US adults
AbstractJuul, F., Martinez-Steele, E., Parekh, N., Monteiro, C. A., & Chang, V. W. (n.d.).Publication year
2018Journal title
The British journal of nutritionVolume
120Issue
1Page(s)
90-100AbstractUltra-processed foods provide 58 % of energy intake and 89 % of added sugars in the American diet. Nevertheless, the association between ultra-processed foods and excess weight has not been investigated in a US sample. The present investigation therefore aims to examine the association between ultra-processed foods and excess weight in a nationally representative sample of US adults. We performed a cross-sectional analysis of anthropometric and dietary data from 15 977 adults (20-64 years) participating in the National Health and Nutrition Examination Survey 2005-2014. Dietary data were collected by 24-h recall. Height, weight and waist circumference (WC) were measured. Foods were classified as ultra-processed/non-ultra-processed according to the NOVA classification. Multivariable linear and logistic regression was used to evaluate the association between ultra-processed food consumption (% energy) and BMI, WC and odds of BMI≥25 kg/m2, BMI≥30 kg/m2 and abdominal obesity (men: WC≥102 cm, women: WC≥88 cm). Prevalence of BMI≥25 kg/m2, BMI≥30 kg/m2 and abdominal obesity was 69·2, 36·1 and 53·0 %, respectively. Consuming ≥74·2 v. ≤36·5 % of total energy from ultra-processed foods was associated with 1·61 units higher BMI (95 % CI 1·11, 2·10), 4·07 cm greater WC (95 % CI 2·94, 5·19) and 48, 53 and 62 % higher odds of BMI≥25 kg/m2, BMI≥30 kg/m2 and abdominal obesity, respectively (OR 1·48; 95 % CI 1·25, 1·76; OR 1·53; 95 % CI 1·29, 1·81; OR 1·62; 95 % CI 1·39, 1·89, respectively; P for trend<0·001 for all). A significant interaction between being female and ultra-processed food consumption was found for BMI (F 4,79=4·89, P=0·002), WC (F 4,79=3·71, P=0·008) and BMI≥25 kg/m2 (F 4,79=5·35, P<0·001). As the first study in a US population, our findings support that higher consumption of ultra-processed food is associated with excess weight, and that the association is more pronounced among women.Birth weight, early life weight gain and age at menarche: a systematic review of longitudinal studies
AbstractJuul, F., Chang, V. W., Brar, P., & Parekh, N. (n.d.).Publication year
2017Journal title
Obesity ReviewsVolume
18Issue
11Page(s)
1272-1288AbstractBackground and objective: Adiposity in pre- and postnatal life may influence menarcheal age. Existing evidence is primarily cross-sectional, failing to address temporality, for which the role of adiposity in early life remains unclear. The current study sought to systematically review longitudinal studies evaluating the associations between birth weight and infant/childhood weight status/weight gain in relation to menarcheal age. Methods: PubMed, EMBASE, Web of Science, Global Health (Ovid) and CINAHL were systematically searched. Selected studies were limited to English-language articles presenting multi-variable analyses. Seventeen studies reporting risk estimates for birth weight (n = 3), infant/childhood weight gain/weight status (n = 4) or both (n = 10), in relation to menarcheal age were included. Results: Lower vs. higher birth weight was associated with earlier menarche in nine studies and later menarche in one study, while three studies reported a null association. Greater BMI or weight gain over time and greater childhood weight were significantly associated with earlier menarche in nine of nine and six of seven studies, respectively. Conclusions: Studies suggested that lower birth weight and higher body weight and weight gain in infancy and childhood may increase the risk of early menarche. The pre- and postnatal period may thus be an opportune time for weight control interventions to prevent early menarche, and its subsequent consequences.The obesity paradox and incident cardiovascular disease: A population-based study
AbstractChang, V. W., Langa, K. M., Weir, D., & Iwashyna, T. J. (n.d.).Publication year
2017Journal title
PloS oneVolume
12Issue
12AbstractBackground: Prior work suggests that obesity may confer a survival advantage among persons with cardiovascular disease (CVD). This obesity “paradox” is frequently studied in the context of prevalent disease, a stage in the disease process when confounding from illness-related weight loss and selective survival are especially problematic. Our objective was to examine the association of obesity with mortality among persons with incident CVD, where biases are potentially reduced, and to compare these findings with those based on prevalent disease. Methods: We used data from the Health and Retirement Study, an ongoing, nationally representative longitudinal survey of U.S. adults age 50 years and older initiated in 1992 and linked to Medicare claims. Cox proportional hazard models were used to estimate the association between weight status and mortality among persons with specific CVD diagnoses. CVD diagnoses were established by self-reported survey data as well as Medicare claims. Prevalent disease models used concurrent weight status, and incident disease models used pre-diagnosis weight status. Results: We examined myocardial infarction, congestive heart failure, stroke, and ischemic heart disease. A strong and significant obesity paradox was consistently observed in prevalent disease models (hazard of death 18–36% lower for obese class I relative to normal weight), replicating prior findings. However, in incident disease models of the same conditions in the same dataset, there was no evidence of this survival benefit. Findings from models using survey- vs. claims-based diagnoses were largely consistent. Conclusion: We observed an obesity paradox in prevalent CVD, replicating prior findings in a population-based sample with longer-term follow-up. In incident CVD, however, we did not find evidence of a survival advantage for obesity. Our findings do not offer support for reevaluating clinical and public health guidelines in pursuit of a potential obesity paradox.Trends in the Relationship between Obesity and Disability, 1988-2012
AbstractChang, V. W., Alley, D. E., & Dowd, J. B. (n.d.).Publication year
2017Journal title
American Journal of EpidemiologyVolume
186Issue
6Page(s)
688-695AbstractRising obesity rates, coupled with population aging, have elicited serious concern over the impact of obesity on disability in later life. Prior work showed a significant increase in the association between obesity and disability from 1988 to 2004, calling attention to disability as a cost of longer lifetime exposure to obesity. It is not known whether this trend has continued. We examined functional impairment and impairment in activities of daily living (ADL) (defined as severe or moderate to severe) for adults aged 60 years or older (n = 16,770) over 3 time periods in the National Health and Nutrition Examination Survey. The relative odds of impairment for obese individuals versus normal-weight individuals significantly increased from period 1 (1988-1994) to period 2 (1999-2004) for all outcomes. In period 3 (2005-2012), this association remained stable for functional and severe ADL impairment and decreased for moderate-to-severe ADL impairment. The fraction of population disability attributable to obesity followed a similar trend. The trend of an increasing association between obesity and disability has leveled off in more recent years, and is even improving for some measures. These findings suggest that public health and policy concerns that obesity would continue to become more disabling over time have not been borne out.Mortality attributable to low levels of education in the United States
AbstractKrueger, P. M., Tran, M. K., Hummer, R. A., & Chang, V. W. (n.d.).Publication year
2015Journal title
PloS oneVolume
10Issue
7AbstractBackground: Educational disparities in U.S. adult mortality are large and have widened across birth cohorts. We consider three policy relevant scenarios and estimate the mortality attributable to: (1) individuals having less than a high school degree rather than a high school degree, (2) individuals having some college rather than a baccalaureate degree, and (3) individuals having anything less than a baccalaureate degree rather than a baccalaureate degree, using educational disparities specific to the 1925, 1935, and 1945 cohorts. Methods: We use the National Health Interview Survey data (1986-2004) linked to prospective mortality through 2006 (N=1,008,949), and discrete-time survival models, to estimate educationand cohort-specific mortality rates. We use those mortality rates and data on the 2010 U.S. population from the American Community Survey, to calculate annual attributable mortality estimates. Results: If adults aged 25-85 in the 2010 U.S. population experienced the educational disparities in mortality observed in the 1945 cohort, 145,243 deaths could be attributed to individuals having less than a high school degree rather than a high school degree, 110,068 deaths could be attributed to individuals having some college rather than a baccalaureate degree, and 554,525 deaths could be attributed to individuals having anything less than a baccalaureate degree rather than a baccalaureate degree. Widening educational disparities between the 1925 and 1945 cohorts result in a doubling of attributable mortality. Mortality attributable to having less than a high school degree is proportionally similar among women and men and among non-Hispanic blacks and whites, and is greater for cardiovascular disease than for cancer. Conclusions: Mortality attributable to low education is comparable in magnitude to mortality attributable to individuals being current rather than former smokers. Existing research suggests that a substantial part of the association between education and mortality is causal. Thus, policies that increase education could significantly reduce adult mortality.Obesity and 1-year outcomes in older Americans with severe sepsis
AbstractPrescott, H. C., Chang, V. W., O’Brien, J. M., Langa, K. M., & Iwashyna, T. J. (n.d.).Publication year
2014Journal title
Critical care medicineVolume
42Issue
8Page(s)
1766-1774AbstractObjectives: Although critical care physicians view obesity as an independent poor prognostic marker, growing evidence suggests that obesity is, instead, associated with improved mortality following ICU admission. However, this prior empirical work may be biased by preferential admission of obese patients to ICUs, and little is known about other patient-centered outcomes following critical illness. We sought to determine whether 1-year mortality, healthcare utilization, and functional outcomes following a severe sepsis hospitalization differ by body mass index. Design: Observational cohort study. Setting: U.S. hospitals. Patients: We analyzed 1,404 severe sepsis hospitalizations (1999-2005) among Medicare beneficiaries enrolled in the nationally representative Health and Retirement Study, of which 597 (42.5%) were normal weight, 473 (33.7%) were overweight, and 334 (23.8%) were obese or severely obese, as assessed at their survey prior to acute illness. Underweight patients were excluded a priori. Interventions: None. Measurements and main results: Using Medicare claims, we identified severe sepsis hospitalizations and measured inpatient healthcare facility use and calculated total and itemized Medicare spending in the year following hospital discharge. Using the National Death Index, we determined mortality. We ascertained pre-and postmorbid functional status from survey data. Patients with greater body mass indexes experienced lower 1-year mortality compared with nonobese patients, and there was a dose-response relationship such that obese (odds ratio = 0.59; 95% CI, 0.39-0.88) and severely obese patients (odds ratio = 0.46; 95% CI, 0.26-0.80) had the lowest mortality. Total days in a healthcare facility and Medicare expenditures were greater for obese patients (p < 0.01 for both comparisons), but average daily utilization (p = 0.44) and Medicare spending were similar (p = 0.65) among normal, overweight, and obese survivors. Total function limitations following severe sepsis did not differ by body mass index category (p = 0.64). Conclusions: Obesity is associated with improved mortality among severe sepsis patients. Due to longer survival, obese sepsis survivors use more healthcare and result in higher Medicare spending in the year following hospitalization. Median daily healthcare utilization was similar across body mass index categories.Early life exposure to the 1918 influenza pandemic and old-age mortality by cause of death
AbstractMyrskylä, M., Mehta, N. K., & Chang, V. W. (n.d.).Publication year
2013Journal title
American journal of public healthVolume
103Issue
7Page(s)
e83-e90AbstractObjectives. We sought to analyze how early exposure to the 1918 influenza pandemic is associated with old-age mortality by cause of death. Methods. We analyzed the National Health Interview Survey (n = 81 571; follow-up 1989-2006; 43 808 deaths) and used year and quarter of birth to assess timing of pandemic exposure. We used Cox proportional and Fine-Gray competing hazard models for all-cause and cause-specific mortality, respectively. Results. Cohorts born during pandemic peaks had excess all-cause mortality attributed to increased noncancer mortality. We found evidence for a trade-off between noncancer and cancer causes: cohorts with high noncancer mortality had low cancer mortality, and vice versa. Conclusions. Early disease exposure increases old-age mortality through noncancer causes, which include respiratory and cardiovascular diseases, and may trigger a trade-off in the risk of cancer and noncancer causes. Potential mechanisms include inflammation or apoptosis. The findings contribute to our understanding of the causes of death behind the early disease exposure-latermortality association. The cancer-noncancer trade-off is potentially important for understanding the mechanisms behind these associations.Obesity and Mortality
AbstractMehta, N. K., & Chang, V. W. (n.d.). In The Oxford Handbook of the Social Science of Obesity (1–).Publication year
2012AbstractThis chapter reports that the mortality penalty linked with obesity has been falling in recent decades. It describes how, in current data, the relationship between obesity and mortality is complex; although class II and III obesity are associated with elevated mortality risk, overweight and class I obesity are generally not associated with higher mortality. Studies that measure body mass index (BMI) when respondents are middle aged and model mortality into later life can give a better sense of the BMI and mortality relationship at the older ages. A high BMI is a small source of excess deaths in the United States, although this topic continues to be controversial. Studies that measure BMI in middle age and model subsequent mortality may give a better sense of the effect of BMI on mortality for those over the age of 50.Gender equality, development, and cross-national sex gaps in life expectancy
AbstractMedalia, C., & Chang, V. W. (n.d.).Publication year
2011Journal title
International Journal of Comparative SociologyVolume
52Issue
5Page(s)
371-389AbstractFemale life expectancy exceeds male life expectancy in almost every country throughout the world. Nevertheless, cross-national variation in the sex gap suggests that social factors, such as gender equality, may directly affect or mediate an underlying biological component. In this article, we examine the association between gender equality and the sex gap in mortality. Previous research has not addressed this question from an international perspective with countries at different levels of development. We examine 131 countries using a broad measure of national gender equality that is applicable in both Less Developed Countries (LDCs) and Highly Developed Countries (HDCs). We find that the influence of gender equality is conditional on level of development. While gender equality is associated with divergence between female and male life expectancies in LDCs, it is associated with convergence in HDCs. The relationship between gender equality and the sex gap in mortality in HDCs strongly relates to, but is not explained by, sex differences in lung cancer mortality. Finally, we find that divergence in LDCs is primarily driven by a strong positive association between gender equality and female life expectancy. In HDCs, convergence is potentially related to a weak negative association between gender equality and female life expectancy, though findings are not statistically significant.Race/ethnic differences in adult mortality: The role of perceived stress and health behaviors
AbstractKrueger, P. M., Saint Onge, J. M., & Chang, V. W. (n.d.).Publication year
2011Journal title
Social Science and MedicineVolume
73Issue
9Page(s)
1312-1322AbstractWe examine the role of perceived stress and health behaviors (i.e., cigarette smoking, alcohol consumption, physical inactivity, sleep duration) in shaping differential mortality among whites, blacks, and Hispanics. We use data from the 1990 National Health Interview Survey (N = 38,891), a nationally representative sample of United States adults, to model prospective mortality through 2006. Our first aim examines whether unhealthy behaviors and perceived stress mediate race/ethnic disparities in mortality. The black disadvantage in mortality, relative to whites, closes after adjusting for socioeconomic status (SES), but re-emerges after adjusting for the lower smoking levels among blacks. After adjusting for SES, Hispanics have slightly lower mortality than whites; that advantage increases after adjusting for the greater physical inactivity among Hispanics, but closes after adjusting for their lower smoking levels. Perceived stress, sleep duration, and alcohol consumption do not mediate race/ethnic disparities in mortality. Our second aim tests competing hypotheses about race/ethnic differences in the relationships among unhealthy behaviors, perceived stress, and mortality. The social vulnerability hypothesis predicts that unhealthy behaviors and high stress levels will be more harmful for race/ethnic minorities. In contrast, the Blaxter (1990) hypothesis predicts that unhealthy lifestyles will be less harmful for disadvantaged groups. Consistent with the social vulnerability perspective, smoking is more harmful for blacks than for whites. But consistent with the Blaxter hypothesis, compared to whites, current smoking has a weaker relationship with mortality for Hispanics, and low or high levels of alcohol consumption, high levels of physical inactivity, and short or long sleep hours have weaker relationships with mortality for blacks.Secular declines in the association between obesity and mortality in the United States
AbstractMehta, N. K., & Chang, V. W. (n.d.).Publication year
2011Journal title
Population and Development ReviewVolume
37Issue
3Page(s)
435-451AbstractRecent research suggests that rising obesity will restrain future gains in US life expectancy and that obesity is an important contributor to the current shortfall in us longevity compared to other high-income countries. Estimates of the contribution of obesity to current and future national-level mortality patterns are sensitive to estimates of the magnitude of the association between obesity and mortality at the individual level. We assessed secular trends in the obesity/mortality association among cohorts of middle-aged adults between 1948 and 2006 using three long-running US data sources: the Framingham Heart Study, the National Health and Nutrition Examination Survey, and the National Health Interview Survey. We find substantial declines over time in the magnitude of the association between obesity and overall mortality and, in certain instances, cardiovascular-specific mortality. We conclude that estimates of the contribution of obesity to current national-level mortality patterns should take into account recent reductions in the magnitude of the obesity and mortality association.Metabolic syndrome and weight gain in adulthood
AbstractAlley, D. E., & Chang, V. W. (n.d.).Publication year
2010Journal title
Journals of Gerontology - Series A Biological Sciences and Medical SciencesVolume
65Issue
1Page(s)
111-117AbstractBackgroundThe influence of long-term adult weight history on metabolic risk independent of attained body mass index (BMI) is unknown.MethodsUsing nationally representative data on adults aged 50-64 years from the 1999-2006 National Health and Nutrition Examination Surveys, we examined weight change for two periods of adulthood: prime age (age 25-10 years ago) and midlife (the last 10 years). Weight changes in each period were categorized as stable (gain <10 kg) or gain (gain ≥10 kg) to create weight history comparison groups: stable-stable, gain-stable (prime age gain), stable-gain (midlife gain), and gain-gain (continuous gain). Persons who lost weight were excluded. Logistic regression predicted odds of metabolic syndrome and its subcomponents based on weight history, adjusting for current BMI and covariates.ResultsParticipants in the gain-stable group had 89% elevated odds of metabolic syndrome (odds ratio = 1.89, 95% CI: 1.19-3.01) relative to the stable-stable group, even after adjustment for current BMI. All weight gain groups had increased odds of low HDL and high triglycerides relative to participants with continuously stable weights. No significant associations were found between weight history and hypertension or high glucose.ConclusionsWeight history confers information about metabolic risk factors above and beyond attained weight status. In particular, adult weight gain is related to risk of low HDL and high triglycerides. Weight history may contribute to our understanding of why some obese older persons are metabolically healthy but others are not.Quality of care among obese patients
AbstractChang, V. W., Asch, D. A., & Werner, R. M. (n.d.).Publication year
2010Journal title
JAMAVolume
303Issue
13Page(s)
1274-1281AbstractContext Clinicians often have negative attitudes toward obesity and express dissatisfaction in caring for obese patients. Moreover, obese patients often feel that clinicians are biased or disrespectful because of their weight. These observations raise the concern that obese patients may receive lower quality of care. Objective To determine whether performance on common outpatient quality measures differs by patient weight status. Design, Setting, and Participants Eight different performance measures were examined in 2 national-level patient populations: (1) Medicare beneficiaries (n=36122) using data from the Medicare Beneficiary Survey (1994-2006); and (2) recipients of care from the Veterans Health Administration (VHA) (n=33550) using data from an ongoing performance-evaluation program (2003-2004). Main Outcome Measures Performance measures among eligible patients for diabetes care (eye examination, glycated hemoglobin [HbA 1c] testing, and lipid screening), pneumococcal vaccination, influenza vaccination, screening mammography, colorectal cancer screening, and cervical cancer screening. Measures were based on a combination of administrative claims, survey, and chart review data. Results We found no evidence that obese or overweight patients were less likely to receive recommended care relative to normal-weight patients. Moreover, success rates were marginally higher for obese and/or overweight patients on several measures. The most notable differentials were observed for recommended diabetes care among Medicare beneficiaries: comparing obese vs normal-weight patients with diabetes, obese patients were more likely to receive recommended care on lipid screening (72% vs 65%; odds ratio, 1.37 [95% confidence interval, 1.09-1.73]) and HbA 1c testing (74% vs 62%; odds ratio, 1.73 [95% confidence interval, 1.41-2.11]). All analyses were adjusted for sociodemographic factors, health status, clinical complexity, and visit frequency. Conclusions Amongsamplesofpatients from theMedicareandVHApopulations, there was no evidence across 8 performance measures that obese or overweight patients received inferior care when compared with normal-weight patients. Being obese or overweight was associated with a marginally higher rate of recommended care on several measures.Social capital and glucose control
AbstractLong, J. A., Field, S., Armstrong, K., Chang, V. W., & Metlay, J. P. (n.d.).Publication year
2010Journal title
Journal of Community HealthVolume
35Issue
5Page(s)
519-526AbstractThere is a growing diabetes epidemic in the United States and if we are to halt its progress we need to better understand the social determinants of this disease and its control. Social capital, which has been associated with general health and mortality, may be one important mediator of glucose control. In this study we determine if neighborhood social capital is associated with glucose control, independent of individual factors. We performed a cross-sectional study of Black veterans with diabetes living in Philadelphia. We merged individual-level data from surveys and charts with six area-level social capital descriptors. Holding all other variables constant, patients who lived in neighborhoods that scored near the 5th percentile of working together to improve the neighborhood were estimated to have glycosylated hemoglobin (HbA1c) values that were at least one point above a conservative clinical definition of "diabetes control" (HbA1c B 8%). If these same patients were to live in neighborhoods in the 95th percentile, their expected HbA1c would be over a point below the cut-off value 8%. No other measure of social capital was associated with HbA1c. In this study of black veterans with diabetes we observed that living in neighborhoods where people work together is associated with better glucose control.Fundamental cause theory, technological innovation, and health disparities: The case of cholesterol in the era of statins
AbstractChang, V. W., & Lauderdale, D. S. (n.d.).Publication year
2009Journal title
Journal of health and social behaviorVolume
50Issue
3Page(s)
245-260AbstractAlthough fundamental cause theory has been highly influential in shaping the research literature on health disparities, there have been few empirical demonstrations of the theory, particularly in dynamic perspective. In this study, we examine how income disparities in cholesterol levels have changed with the emergence of statins, an expensive and potent new drug technology. Using nationally representative data from 1976 to 2004, we find that income gradients for cholesterol were initially positive, but then reversed and became negative in the era of statin use. While the advantaged were previously more likely to have high levels of cholesterol, they are now less likely. We consider our case study against a broader theoretical framework outlining the relationship between technology innovation and health disparities. We find that the influence of technologies on socioeconomic disparities is subject to two important modifiers: (1) the nature of the technological change and (2) the extent of its diffusion and adoption.Mortality attributable to obesity among middle-aged adults in the United States
AbstractMehta, N. K., & Chang, V. W. (n.d.).Publication year
2009Journal title
DemographyVolume
46Issue
4Page(s)
851-872AbstractObesity is considered a major cause of premature mortality and a potential threat to the longstanding secular decline in mortality in the United States. We measure relative and attributable risks associated with obesity among middle-aged adults using data from the Health and Retirement Study (1992-2004). Although class II/III obesity (BMI ≥ 35.0 kg/m2) increases mortality by 40% in females and 62% in males compared with normal BMI (BMI = 18.5-24.9), class I obesity (BMI = 30.0-34.9) and being overweight (BMI = 25.0-29.9) are not associated with excess mortality. With respect to attributable mortality, class II/III obesity (BMI ≥ 35.0) is responsible for approximately 4% of deaths among females and 3% of deaths among males. Obesity is often compared with cigarette smoking as a major source of avoidable mortality. Smoking-attributable mortality is much larger in this cohort: about 36% in females and 50% in males. Results are robust to confounding by preexisting diseases, multiple dimensions of socioeconomic status (SES), smoking, and other correlates. These findings challenge the viewpoint that obesity will stem the long-term secular decline in U.S. mortality.Neighborhood racial isolation, disorder and obesity
AbstractChang, V. W., Hillier, A. E., & Mehta, N. K. (n.d.).Publication year
2009Journal title
Social ForcesVolume
87Issue
4Page(s)
2063-2092AbstractRecent research suggests that racial residential segregation may be detrimental to health. This study investigates the influence of neighborhood racial isolation on obesity and considers the role of neighborhood disorder as a mediator in this relationship. For the city of Philadelphia, we find that residence in a neighborhood with high black racial isolation is associated with a higher body mass index and higher odds of obesity among women, but not men, highlighting important sex differences in the influence of neighborhood structure on health. Furthermore, the influence of high racial isolation on women's weight status is mediated, in part, by the physically disordered nature of such neighborhoods. Disorder of a more social nature (as measured by incident crime) is not associated with weight status.Racial differences in the impact of comorbidities on survival among elderly men with prostate cancer
AbstractPutt, M., Long, J. A., Montagnet, C., Silber, J. H., Chang, V. W., Liao, K., Schwartz, J. S., Pollack, C. E., Wong, Y. N., & Armstrong, K. (n.d.).Publication year
2009Journal title
Medical Care Research and ReviewVolume
66Issue
4Page(s)
409-435AbstractThis study investigates differences in the effects of comorbidities on survival in Medicare beneficiaries with prostate cancer. Medicare data were used to assemble a cohort of 65- to 76-year-old Black (n = 6,402) and White (n = 47,458) men with incident localized prostate cancer in 1999 who survived ĝ‰¥1 year postdiagnosis. Comorbidities were more prevalent among Blacks than among Whites. For both races, greater comorbidity was associated with decreasing survival rates; however, the effect among Blacks was smaller than in Whites. After adjusting for age, socioeconomic status, and community characteristics, the association between increasing comorbidities and survival remained weaker for Blacks than for Whites, and racial disparity in survival decreased with increasing number of comorbidities. Differential effects of comorbidities on survival were also evident when examining different classes of comorbid conditions. Adjusting for treatment had little impact on these results, despite variation in the racial difference in receipt of prostatectomy with differing comorbidity levels.Weight change, initial bmi, and mortality among middle- and older-aged adults
AbstractMyrskyla, M., & Chang, V. W. (n.d.).Publication year
2009Journal title
EpidemiologyVolume
20Issue
6Page(s)
840-848AbstractBackground: It is not known how the relationship between weight change and mortality is influenced by initial body mass index (BMI) or the magnitude of weight change. Methods: We use the nationally representative Health and Retirement Study (n = 13,104; follow-up 1992-2006) and Cox regression analysis to estimate relative mortality risks for 2-year weight change by initial BMI among 50- to-70-year-old Americans. We defined small weight loss or gain as a change of 1-2.9 BMI units and large weight loss or gain as a change of 3-5 BMI units. Results: Large and small weight losses were associated with excess mortality for all initial BMI levels below 32 kg/m2 (eg, hazard ratio [HR] for large weight loss from BMI of 30 = 1.61 [95% confidence interval = 1.31-1.98]; HR for small weight loss from BMI of 30 = 1.19 [1.06-1.28]). Large weight gains were associated with excess mortality only at high BMIs (eg, HR for large weight gain from BMI of 35 = 1.33 [1.00-1.77]). Small weight gains were not associated with excess mortality for any initial BMI level. The weight loss-mortality association was robust to adjustments for health status and to sensitivity analyses considering unobserved confounders. Conclusions: Weight loss is associated with excess mortality among normal, overweight, and mildly obese middle- and older-aged adults. The excess risk increases for larger losses and lower initial BMI. These results suggest that the potential benefits of a lower BMI may be offset by the negative effects associated with weight loss. Weight gain may be associated with excess mortality only among obese people with an initial BMI over 35.Affect and heart disease
Chang, V. W. (n.d.).Publication year
2008Journal title
BMJVolume
337Issue
7660Page(s)
3-4Being poor and coping with stress: Health behaviors and the risk of death
AbstractKrueger, P. M., & Chang, V. W. (n.d.).Publication year
2008Journal title
American journal of public healthVolume
98Issue
5Page(s)
889-896AbstractObjectives. Individuals may cope with perceived stress through unhealthy but often pleasurable behaviors. We examined whether smoking, alcohol use, and physical inactivity moderate the relationship between perceived stress and the risk of death in the US population as a whole and across socioeconomic strata. Methods. Data were derived from the 1990 National Health Interview Survey's Health Promotion and Disease Prevention Supplement, which involved a representative sample of the adult US population (n=40335) and was linked to prospective National Death Index mortality data through 1997. Gompertz hazard models were used to estimate the risk of death. Results. High baseline levels of former smoking and physical inactivity increased the impact of stress on mortality in the general population as well as among those of low socioeconomic status (SES), but not middle or high SES. Conclusions. The combination of high stress levels and high levels of former smoking or physical inactivity is especially harmful among low-SES individuals. Stress, unhealthy behaviors, and low SES independently increase risk of death, and they combine to create a truly disadvantaged segment of the population.The relationship between measured performance and satisfaction with care among clinically complex patients
AbstractWerner, R. M., & Chang, V. W. (n.d.).Publication year
2008Journal title
Journal of general internal medicineVolume
23Issue
11Page(s)
1729-1735AbstractBACKGROUND: Recent work has shown that clinically complex patients are more likely to receive recommended care, but it is unknown whether higher achievement on individual performance goals results in improved care for complex patients or detracts from other important but unmeasured aspects of care, resulting in unmet needs and lower satisfaction with care. OBJECTIVE: To examine the relationship between measured performance and satisfaction with care among clinically complex patients DESIGN AND PARTICIPANTS: An observational analysis of a national sample of 35,927 veterans included in the External Peer Review Program in fiscal years 2003 and 2004. MEASUREMENTS: First, compliance with individual performance measures (breast cancer screening with mammography, colorectal cancer screening, influenza vaccination, pneumococcal vaccination, lipid monitoring, use of ACE inhibitor in heart failure, and diabetic eye examination), as well as overall receipt of recommended care, was estimated as a function of each patient's clinical complexity. Second, global satisfaction with care was estimated as a function of clinical complexity and compliance with performance measures. MAIN RESULTS: Higher clinical complexity was predictive of slightly higher overall performance (OR 1.13, 95% CI 1.09 to 1.18) and higher performance on most individual performance measures, an effect that was mediated by increased visit frequency. High measured performance was associated with higher satisfaction with care among patients with high clinical complexity. In fact, as complexity increased, the effect of achieving high performance on the odds of being satisfied with care also increased CONCLUSIONS: Not only was measured performance higher in clinically complex patients, but satisfaction with care was also higher among clinically complex patients with high measured performance, suggesting that compliance with performance measures in clinically complex patients does not crowd out unmeasured care.The shape of things to come: obesity, aging, and disability.
AbstractAlley, D. E., Chang, V. W., & Doshi, J. (n.d.).Publication year
2008Journal title
LDI issue briefVolume
13Issue
3Page(s)
1-4AbstractRising obesity represents one of the most disturbing health trends in the U.S. and elsewhere. Obese people are at greater risk for diabetes, cardiovascular disease, disability, and mortality. However, recent studies also suggest that the obese population has grown "healthier" since the 1960s, probably due to improved medical care for cardiovascular disease. It is unclear whether these improvements have resulted in more or less disability in obese people as they age. This issue Brief summarizes two studies that examine the prevalence of obesity over time in the elderly and disabled, and the changing relationship of obesity and disability.Weight Status and Restaurant Availability. A Multilevel Analysis
AbstractMehta, N. K., & Chang, V. W. (n.d.).Publication year
2008Journal title
American journal of preventive medicineVolume
34Issue
2Page(s)
127-133AbstractBackground: Empiric studies find that contextual factors affect individual weight status over and above individual socioeconomic characteristics. Given increasing levels of obesity, researchers are examining how the food environment contributes to unhealthy weight status. An important change to this environment is the increasing availability of away-from-home eating establishments such as restaurants. Methods: This study analyzed the relationship between the restaurant environment and weight status across counties in the United States. Individual data from the 2002-2006 Behavioral Risk Factor Surveillance System (N=714,054) were linked with restaurant data from the 2002 U.S. Economic Census. Fast-food and full-service restaurant density, along with restaurant mix (the ratio of fast-food to full-service restaurants), were assessed. Results: Fast-food restaurant density and a higher ratio of fast-food to full-service restaurants were associated with higher individual-level weight status (BMI and the risk of being obese). In contrast, a higher density of full-service restaurants was associated with lower weight status. Conclusions: Area-level restaurant mix emerged as an important correlate of weight status, with components of the restaurant environment exhibiting differential associations. Hence, it is the availability of fast-food relative to other away-from-home choices that appears salient for unhealthy weight outcomes. Areas with a high density of full-service restaurants were indicative of a more healthful eating environment, suggesting a need for research into the comparative healthfulness of foods served at different types of restaurants. Future prospective studies are required to delineate causal pathways.The changing relationship of obesity and disability, 1988-2004
AbstractAlley, D. E., & Chang, V. W. (n.d.).Publication year
2007Journal title
Journal of the American Medical AssociationVolume
298Issue
17Page(s)
2020-2027AbstractContext: Recent studies suggest that the obese population may have been growing healthier since the 1960s, as indicated by a decrease in mortality and cardiovascular risk factors. However, whether these improvements have conferred decreased risk for disability is unknown. The obese population may be living longer with better-controlled risk factors but paradoxically experiencing more disability. Objective: To determine whether the association between obesity and disability has changed over time. Design, Setting, and Participants: Adults aged 60 years and older (N=9928) with measured body mass index from 2 waves of the nationally representative National Health and Nutrition Examination Surveys (NHANES III [1988-1994] and NHANES 1999-2004). Main Outcome Measures: Reports of much difficulty or inability to perform tasks in 2 disability domains: functional limitations (walking one-fourth mile, walking up 10 steps, stooping, lifting 10 lb, walking between rooms, and standing from an armless chair) and activities of daily living (ADL) limitations (transferring, eating, and dressing). Results: Among obese individuals, the prevalence of functional impairment increased 5.4% (from 36.8%-42.2%; P=.03) between the 2 surveys, and ADL impairment did not change. At time 1 (1988-1994), the odds of functional impairment for obese individuals were 1.78 times greater than for normal-weight individuals (95% confidence interval [CI], 1.47-2.16). At time 2 (1999-2004), this odds ratio increased to 2.75 (95% CI, 2.39-3.17), because the odds of functional impairment increased by 43% (OR 1.43; 95% CI, 1.18-1.75) among obese individuals during this period, but did not change among nonobese individuals. With respect to ADL impairment, odds for obese individuals were not significantly greater than for individuals with normal weight (OR, 1.31; 95% CI, 0.92-1.88) at time 1, but increased to 2.05 (95% CI, 1.45-2.88) at time 2. This was because the odds of ADL impairment did not change for obese individuals but decreased by 34% among nonobese individuals (OR, 0.66; 95% CI, 0.50-0.88). Conclusions: Recent cardiovascular improvements have not been accompanied by reduced disability within the obese older population. Rather, obese participants surveyed during 1999-2004 were more likely to report functional impairments than obese participants surveyed during 1988-1994, and reductions in ADL impairment observed for nonobese older individuals did not occur in those who were obese. Over time, declines in obesity-related mortality, along with a younger age at onset of obesity, could lead to an increased burden of disability within the obese older population.