Browsing by Subject "Mortality"

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A cohort perspective of U.S. adult mortality
(2011-05) Masters, Ryan Kelly; Hummer, Robert A.; Hayward, Mark D.; Powers, Daniel A.; Umberson, Debra J.; Krueger, Patrick M.
This dissertation advances a cohort perspective to analyze trends in racial and educational disparities in U.S. adult mortality. The project is organized around three themes. First, I emphasize that recent temporal changes in U.S. adult mortality risk are rooted in cohort forces. Unfortunately, much of the mortality literature has failed to account for the fact that the sociohistorical conditions of U.S. cohorts have changed dramatically, and these changes have tremendous implications for population health and mortality trends. My work clearly shows the pitfalls of omitting these cohort effects from analyses of U.S. adult mortality risk. Second, I illustrate that because exposure to social and health conditions have changed over time, resources in adulthood are growing increasingly important in shaping U.S. adult mortality risk. In this regard, my findings also highlight growing disparities in U.S. mortality across race/ethnic gender groups. Third, I advance a cohort theory of U.S. mortality, drawing from both “fundamental cause” theory and a life course perspective of mortality but couching them in a cohort framework to highlight the importance of historical changes in U.S. social and health contexts in both childhood and adulthood. This cohort perspective is then used to analyze three central topics in the U.S. mortality literature: the black-white crossover in older-adult mortality, the growing educational gap in U.S. adult mortality, and the origins and persistence of black-white inequalities in U.S. adult mortality. I estimate hierarchical age-period-cohort cross-classified random effects models using National Health Interview Survey-Linked Mortality Files between 1986 and 2006 to simultaneously analyze age, period, and cohort patterns of U.S. adult mortality rates. I find (1) the black-white crossover is a cohort-specific phenomenon, (2) educational disparities in U.S. adult mortality rates are growing across birth cohorts, not time periods, and (3) racial disparities in U.S. adult mortality rates stem from cumulative racial stratification across both cohorts and the life course. Such findings have direct consequences for both mortality theories and policy recommendations. Only by considering the disparate sociohistorical conditions that U.S. cohorts have endured across their life courses can we fully understand and address current and future health disparities in the United States.
Educational differentials in U.S. adult mortality : trends and causes
(2014-12) Sasson, Isaac; Weinreb, Alexander; Hayward, Mark D; Hummer, Robert A; Powers, Daniel A; Tuljapurkar, Shripad; Umberson, Debra J
As life expectancy at birth in the United States approaches eighty years of age, educational differentials in adult mortality are greater than ever. One of the key sociological insights of our time is that these two processes are fundamentally interrelated. As society gains greater social capacity to control health and disease socioeconomic status (SES) becomes increasingly important for shaping healthy social environments and lifestyles, which reduce the risk of mortality. Of all SES indicators, educational attainment is perhaps the single most important predictor of mortality in the United States. Not only do low-educated Americans have shorter lifespans compared to their college-educated counterparts, on average, but they have recently suffered absolute declines in life expectancy. However, debates surrounding the extent, causes, and even validity of those trends continue. This dissertation makes several unique contributions to our understanding of lifespan inequality by educational attainment in the United States. First, using vital statistics data, it documents trends in life expectancy and lifespan variation—a unique dimension of lifespan inequality—by educational attainment for black and white Americans of both genders from 1990 to 2010. Second, it decomposes those trends by age and cause of death in order to understand the proximate causes of the educational disparity in adult mortality. Third, it evaluates the extent to which changes in the composition of education groups account for the rising education-mortality gradient. The findings reveal that the gap in life expectancy at age 25 between the low educated (having fewer than twelve years of schooling) and the college educated has doubled among men and more than tripled among women over the study period; that life expectancy declined among low-educated white men and women (by 0.6 and 3.1 years, respectively); and that much of these trends is attributed to an increase in premature deaths from smoking-related diseases and external causes. While both sides of the selection-causation debate have merit, changes in group composition do not fully account for the increase in mortality among low-educated Americans, for whom economic circumstances have worsened. Overall, the association between educational attainment and adult mortality is pervasive, enduring, and increasing in magnitude.
An epidemiological analysis of mortality and morbidity in five late prehistoric populations from the upper and central Texas coast
(1989) Powell, Joseph F. (Joseph Frederick), 1964-; Not available
Essays in applied microeconomics
(2021-04-20) Park, Jiwon; Linden, Leigh L., 1975-; Trejo, Stephen J.; Murphy, Richard; Fabregas, Raissa
The first chapter examines whether funding for public schools affects parents' decision to send their children to private schools in the US. In the wake of the Great Recession, funding for public K-12 education fell precipitously and stayed low for several years. Exploiting the fact that states with greater reliance on state appropriations and states with no income tax experienced larger cuts, I instrument for local public school funding. I find that students exposed to a $1,000 (9.0 percent) decrease in per-pupil funding are more likely to enroll in private schools by 0.48 to 0.59 percentage points (4.5 to 5.6 percent). I show further that the effect is strongest among high socioeconomic status students living in disadvantaged areas. These findings suggest that reductions in public school resources lead to greater inequality in education and negatively change student composition in public schools through school choice. In the second chapter, I investigate the effect of Facility-Based Childbirth Policy (FBCP) to promote facility-based child delivery (FBD) and prenatal care in Rwanda. To identify the causal effect on childhood mortality rates, I utilize the geographical variation of FBD in the baseline period and the timing of the policy in a difference-in-difference framework. The reform has a substantial effect on infant (under one year) and child (under five years) mortality, with reductions of 12 and 25 deaths per 1,000 live births, respectively. However, the overall reduction in newborn (seven days) neonatal (30 days) mortality is not statistically significant despite a large increase in FBD. I also show that other policy interventions like performance-based financing schemes can strengthen the treatment effect on newborn and neonatal mortality, implying the importance of multiple approaches to reduce mortality rates. The third chapter explores whether the increase in service outsourcing to India has reduced the employment of the occupations with greater exposure to Indian service imports. To account for endogeneity, I instrument for the growth of the US's service import from India, exploiting the change in Indian import in European countries. The occupation-level analysis produces a mixed result. An increase in service imports reduces the total employment from 2000 to 2006; however, the effect attenuates in the later period of 2006 to 2016. The change is skill-biased: the reduction in employment is smaller for college-educated workers in the first period, and the sign reverses later.
Essays in health economics
(2022-05) Stripling, Sam; Geruso, Michael; Cabral, Marika; Oettinger, Gerald
The three chapters of this dissertation explore the effects of two of the largest policy levers in the United States, Medicare and Medicaid, on health and hospitals. My first chapter examines the effects of Medicare on short-run mortality. Despite being at the forefront of policy debates, credibly estimating whether health insurance reduces mortality remains empirically elusive. The key challenge is creating research designs that have the statistical power to reliably detect the effects of health insurance on mortality. This chapter presents new, population-level estimates of the impact of Medicare on short-run mortality. I use restricted-access Census data to link complete, administrative death records to individual survey responses for nearly 30% of the US population. To understand the effects of Medicare on mortality, I use a regression discontinuity design, comparing the mortality of individuals just above and below the age-65 eligibility threshold. I also consider whether the impact of Medicare on mortality differs by demographics, previous health insurance status, and income-level. I find no statistically significant effects of Medicare on mortality for the full population, previously uninsured, or low-income individuals. The second chapter of my dissertation looks at the effects of the Affordable Care Act Medicaid Expansion on mortality. Given that Medicaid and Medicare are two of the largest policy levers for improving health in the United States, it is important to compare the mortality effects of Medicare to those of Medicaid. This chapter examines whether Medicaid eligibility reduces mortality for near-elderly individuals. I begin by using CDC data and a differences-in-differences design to analyze whether the ACA Medicaid Expansion reduced the mortality rate for individuals aged 55-64. I note several potentially important limitations in using CDC data for studying the effects of Medicaid on mortality. I discuss the merits of circumventing these limitations by using the restricted Census infrastructure to link survey data to administrative death records. I conclude with a cross-study comparison of the effects of Medicare and Medicaid on mortality, and discuss the policy relevance of my findings. The third chapter of my dissertation studies how hospitals respond to the Affordable Care Act Medicaid Expansions. While the first two chapters of the dissertation focus on the benefits of public health insurance for insurance recipients, public health insurance can also significantly benefit health care providers. Hospitals frequently provide health care to uninsured patients without receiving compensation. ACA Medicaid expansions reduced hospitals’ uncompensated care burdens by providing the uninsured with a means of payment in the form of insurance. Anecdotal evidence from hospital administrators suggests hospitals in expansion states respond to their improved financial positions by increasing capacity, purchasing equipment, and hiring more workers. I investigate such claims using hospital financial report data from CMS. Using a differences-in-differences regression framework, I find no evidence that hospitals in expansion states increased bed capacity, capital expenditures, or FTEs relative to hospitals in non-expansion states.
Essays on public and labor economics
(2024-05) Son, Jinyeong; Cabral, Marika; Tuttle, Cody; Magdalena, Bennett; Murphy, Richard
This dissertation comprises three chapters in the fields of public and labor economics. Specifically, they address questions in two areas: (i) the determinants of children’s human capital accumulation, particularly from the perspective of health status, and (ii) the consequences of public policy interventions in health insurance markets. Chapter 1 examines the effects of pregnancy timing among teenagers aged 15–18 on their short- and long-run educational and labor market outcomes. Specifically, I estimate the marginal impact of a one-year difference in pregnancy timing for each age interval—15–16, 16–17, and 17–18—leveraging linked administrative data from Texas. To identify the effect of pregnancy timing, I examine both within-individual changes in outcomes surrounding pregnancy and across-individual comparisons in outcomes after pregnancy, among matched individuals who are balanced on a wide range of characteristics but differ in the timing of pregnancy. The results indicate that experiencing pregnancy one year earlier increases absences and the likelihood of leaving school, particularly during the postpartum year. Further, the results indicate that becoming pregnant one year earlier has adverse long-term consequences: it reduces high school graduation by age 20, decreases college enrollment and completion in the early 20s, and leads to lower employment and earnings in the mid-20s, with these detrimental effects being most pronounced for the youngest group. Finally, I present suggestive evidence that providing parental support to teenage mothers during the postpartum year could mitigate the short-term disruptions they face, such as increased absences and higher dropout rates. Chapter 2, previously published in the Journal of Public Economics, explores whether and to what extent state-mandated health insurance benefits improve health outcomes in the context of diabetes mandates. Specifically, in Chapter 2, I use data from the restricted-use Multiple Cause of Death Mortality database and the Behavioral Risk Factor Surveillance System to investigate the effects of diabetes mandates on diabetes-related mortality rates, along with the underlying mechanisms behind the estimated effects. Using a difference-in-differences framework that leverages variation in the enactment of mandates both across states and over time, I find that approximately 3.1 fewer diabetes-related deaths per 100,000 occur annually in mandate states than in non-mandate states. The mechanism analysis suggests higher utilization of the mandated medical benefits caused these mortality improvements. These findings can inform the ongoing policy debate on strengthening or weakening coverage mandates, including Essential Health Benefits under the Affordable Care Act. Chapter 3, co-authored with Marika Cabral and Colleen Carey, investigates the determinants of health insurance choice in Medicare—a setting with vast geographic variation in the share of individuals selecting the public option versus private alternative. We analyze insurance decisions among individuals who move to quantify the relative importance of individual-specific factors (such as preferences or income) and place-specific factors (such as local health insurance options) on insurance decisions. We find roughly 40% of the geographic variation in the share selecting private coverage is due to place-based factors, while the remainder is explained by individuals. Our findings highlight the importance of individual factors in these decisions and may inform discussions about the use of policy to address geographic disparities.
Gender differences in the life course origins of adult functioning and mortality
(2011-08) Montez, Jennifer Karas; Hayward, Mark D.; Hummer, Robert A.; Umberson, Debra J.; Pudrovska, Tetyana; Osborne, Cynthia
A high degree of physical functioning is necessary for independently performing the numerous routine and valued tasks of daily life. Poor functioning not only hinders independent living, it can lower the quality of life, impede full social participation, and elevate the risk of death. However, not all adults are at equal risk of poor functioning: women experience worse functioning and live a greater number of years functionally impaired compared with men. Studies of this gap have focused on inequities in adult circumstances, such as socioeconomic status, but have generally fallen short of fully accounting for it. Recasting this research within a life-course, epidemiological framework points to the potential role of early-life circumstances. Early-life circumstances may impart a biological imprint, and they may also launch long-term trajectories of social circumstances, that could differentially shape functioning for men and women. Thus, this dissertation examines the life course origins of the gender gap in functioning and active life expectancy among older U.S. adults using two nationally-representative datasets: the National Survey of Midlife Development in the United States and the Health and Retirement Study. In sum, the findings reveal that: (a) a host of early-life circumstances, such as parents’ education levels, leave an indelible stamp on functional ability and active life expectancy for women and men, irrespective of adult circumstances, (b) while some early-life adversities, such as extreme poverty, were marginally more consequential for women’s than men’s functioning, they appear to be primarily more consequential for precipitating metabolic conditions such as diabetes and obesity rather than directly impacting functioning, (c) explanations of the gap must incorporate endogenous biological differences between men and women; explanations that focus exclusively on socially-structured inequities are insufficient, and (d) exposures to socioeconomic resources accumulate across the life course to shape functioning differently for men than women; particularly between white men, who enjoy better functioning with higher educational attainment irrespective of early-life socioeconomic exposures, and white women whose functioning gains plateau if they experienced early-life socioeconomic adversities. Overall, the results underscore the importance of a life course perspective in explicating gender disparities in functioning, longevity, and active life expectancy.
Global change : projecting expansion of invasive species and climate change impacts at the tree-tundra ecotone in the Himalaya
(2014-08) Mainali, Kumar Prasad; Parmesan, Camille, 1961-; Singer, Micheal; White, Joseph; Young, Kenneth; Simpson, Beryl
Modeling the distribution of species, especially of invasive species in non-native ranges, has multiple challenges. We develop some novel approaches to species distribution modeling aimed at reducing the influences of these challenges and improve realism of projections. We estimated species-environment relationship with four modeling methods, viz., random forest (RF), boosted regression trees (BRT), generalized linear models (GLM), and generalized additive models (GAM), running each of them with multiple scenarios of (1) sources of occurrences and geographically isolated background ranges, (2) approaches of drawing background points, (3) alternate sets of predictor variables. When a species' distribution is in a non-equilibrium state, as is the case for most invasive species, model projections are very sensitive to the choice of training dataset. Contrary to previous studies, we found that model accuracy is much improved by using a global dataset for model training (both presences and background points from the world), rather than restricting data input to the species' native range. Projections outside the training region, especially in invaded regions, can be very different depending on the modeling method used. Globally projecting, we show that vast stretches of currently uninvaded geographic spaces in multiple continents harbor highly suitable habitats for Parthenium. Projections away from the sampled space (i.e. into areas of potential future invasion), can be very different with different modeling methods, raising questions about the reliability of ensemble projection. Data-driven models that efficiently fit the dominant pattern but exclude highly local features in dataset and model interactions as they appear in data (e.g., boosted regression trees) improve generalization of the species distribution modeling. Alpine treelines are responding to current climate change worldwide. To understand tree line dynamics and its potential drivers, we studied the primary two dominant tree species, Abies spectabilis (AS) and Rhododendron campanulatum (RC), on the north facing slope of two mountains in central Nepal. We determined spatial pattern of regeneration potential, mortality and abundance for various size/age classes, and we identified the most important drivers of such patterns. We also conducted a reciprocal transplant experiment on saplings of RC, moving them between species limit and treeline that were spaced apart by 150m. Young plants (<2m tall) of RC have higher density above treeline than below treeline. Mature plants (>2m tall) of RC, on the contrary, show insignificant trend towards higher density below treeline than above. Mortality of RC was always lower above treeline than below, independent of size class. AS saplings have extremely lower density above treeline than below, with mature plants being virtually absent above treeline. Elevation was identified as the only significant predictor of the decrease in density of both species above treeline. The saplings are progressively younger and shorter with distance above treeline. Both species are regenerating faster above treeline than below. These results are consistent with upward shift of the tree line of RC as a result of recent amelioration of temperature. Climatic extremes during spring affect mortality and leaf size whereas growth is affected by summer climate. Individuals from the species limit, if they survive, perform better when moved downhill than they do at home, and also out-perform the locals. Although the upper elevational boundary of RC is shifting upward, these results indicate that strong differences still exist between individuals across a short elevational gradient, with individuals at the extreme limit of the species range being more tolerant to extreme climate conditions but less tolerant of competition compared to individuals only 150m lower in elevation.
The household production of men's and women's health in the United States
(2013-08) Brown, Dustin Chad; Hayward, Mark D.; Hummer, Robert A.
The inverse association between individuals' own education and adverse health outcomes is well established, but the influence of other people's education -- particularly those with close social ties or who are family members -- and adult health outcomes is not. The material and non-material resources available to individuals via their own education likely are shared within a marriage to become resources at the household or family-level. Research on spousal education and adult health outcomes is sparse -- especially in the United States. Therefore, this dissertation examines how husbands and wives' education combine within marriage to influence each other's self-rated health and annual risk of death in the United States. The analyses utilize two nationally representative data sources: the National Health Interview Survey (NHIS) and the National Health Interview Survey Linked Mortality File (NHIS-LMF). Chapter Two establishes an inverse association between spousal education and poor/fair self-rated health among married adults in the United States. The results also showed that spousal education attenuated the association between one's own education and fair/poor self-rated health more for married women than married men and age-specific analyses revealed that these differences were largest among married persons ages 45-64. Chapter Three reveals that individuals' own education and their spouse's education each share an inverse association with the annual risk of death among married adults. Although this association generally does not vary by gender, spousal education apparently is a more important determinant of all-cause mortality risk among married non-Hispanic whites in comparison to married non-Hispanic blacks. Age-specific analyses also suggest that the influence of own and spousal education on adult mortality risk weakened with increasing age. Chapter Four assesses life expectancy differentials between men and women in different marital status groups at different points in the educational distribution. The results imply that spousal education substantially contributes to life expectancy disparities between married and unmarried persons. The results also imply that focusing only on the relationship between married persons' own education and life expectancy masks substantial heterogeneity within educational groups attributable to spousal education. Overall, the findings strongly suggest that education is a shared or household health resource among husbands and wives.
The impact of Medicare Part D coverage on medication adherence and health outcomes in end-stage renal disease (ESRD) patients
(2013-05) Park, Haesuk; Rascati, Karen L.
The purpose of this study was to investigate the impact of Medicare Part D coverage on medication adherence and health outcomes in dialysis patients. A retrospective analysis (2006-2010) using the United States Renal Data System was conducted for Medicare-eligible dialysis patients. Cardiovascular disease morbidity, healthcare utilization and expenditures, medication adherence, and mortality rates were compared, categorized based on patients’ Part D coverage in 2007 for those who: 1) did not reach the coverage gap (cohort 1); 2) reached the coverage gap but not catastrophic coverage (cohort 2); 3) reached catastrophic coverage (cohort 3); and 4) did not reach the coverage gap but received a low-income subsidy (cohort 4). Cox proportional hazards models, Kaplan-Meier methods, logistic regressions, generalized linear models, and generalized estimating equations were used. A total of 11,732 patients were included as meeting inclusion criteria: 1) cohort 1: 3,678 patients had out-of-pocket drug costs <$799; 2) cohort 2: 4,349 patients had out-of-pocket drug costs between $799 and $3,850; 3) cohort 3: 1,310 patients had out-of-pocket drug costs > $3,850; and 4) cohort 4: the remaining 2,395 patients had out-of-pocket drug costs <$799 but received a low-income subsidy. After adjusting for demographic and clinical factors, patients in cohort 2 and cohort 3 had 42 percent and 36 percent increased risk of cardiovascular disease (odds ratio (OR)=1.42, 95% confidence interval (CI):1.20-1.67; OR=1.38, 95% CI:1.10-1.72); and had 36 percent and 37 percent higher death rates compared to those in cohort 4, respectively (hazard ratio (HR)=1.36, 95% CI:1.27-1.44; HR=1.37, 95% CI:1.27-1.48). Patients in cohort 2 were more likely to be nonadherent to medications for diabetes (OR=1.72, 95% CI:1.48-1.99), hypertension (OR=1.69, 95% CI:1.54-1.85), hyperlipidemia (OR=2.01, 95% CI:1.76-2.29), hyperphosphatemia (OR=1.74, 95% CI:1.55-1.95), and hyperparathyroidism (OR=2.08, 95% CI:1.66-2.60) after reaching the coverage gap. These patients had total health care costs that were $2,644 higher due to increased rates of hospitalization and outpatient visits, despite $2,419 lower pharmacy costs compared to patients in cohort 4 after controlling for covariates (p<0.0001). Reaching the Part D coverage gap was associated with decreased medication adherence and unfavorable clinical and economic outcomes in dialysis patients.
Racial and ethnic inequality in adult survival in the United States
(2013-08) Lariscy, Joseph Tyler, 1984-; Hummer, Robert A.
While all racial/ethnic groups in the U.S. exhibited an increase in longevity during the twentieth century, inequalities in survival remain. Hispanics have the highest life expectancy at birth in the United States, non-Hispanic blacks have the lowest, and non-Hispanic whites exhibit life expectancy between the two minority groups. An overarching objective of Healthy People 2020 is to "achieve health equity, eliminate disparities, and improve the health of all groups." Yet, a similar objective based on the Healthy People 2010 campaign regarding reduction of health inequalities was clearly not met. As the population of the United States becomes increasingly diverse as a result of immigration, intermarriage, and evolving notions regarding race and ethnicity, health demographers must monitor adult survival outcomes and inequalities across racial and ethnic subpopulations. This dissertation examines current inequalities in survival among Hispanic, non-Hispanic black, and non-Hispanic white adults in the United States. Using the 1989-2006 National Health Interview Survey Linked Mortality Files and 2010 U.S. National Vital Statistics System, I contribute to the understanding of racial/ethnic survival disparities through three empirical studies: The first chapter affirms that Hispanic mortality rate and life expectancy estimates are favorable relative to blacks and whites, particularly for foreign-born Hispanics and from smoking-related causes. The second chapter shows that, in addition to their higher mean age at death, Hispanics exhibit less variability around that mean relative to non-Hispanic whites. Non-Hispanic blacks, on the other hand, have greater variability and lower life expectancy than the other two racial/ethnic groups. The lower variability among Hispanics relative to whites is largely attributable to lower incidence in cancer, suicide, and other external cause mortality, whereas the greater variability among blacks relative to whites is mainly due to greater dispersion in age at death from heart disease and the residual cause grouping. The third chapter finds that smoking initiation in childhood or adolescence contributes additional mortality risk for current heavy and light smokers relative to never smokers. Lower smoking prevalence and later initiation among foreign-born and U.S-born Hispanics account for much of their lower mortality risk relative to whites.
The relationship between adult mortality and educational attainment in Argentina
(2014-08) Manzelli, Hernan Martin; Hummer, Robert A.
The study of the relationship between socioeconomic characteristics and mortality patterns has been a traditional research focus in demography, representing one of the core areas of the discipline. In Latin America, there is an important set of studies that show a significant inverse relationship between socioeconomic status and mortality rates. However, mainly due to limitations in the available data, we know very little about the specific relation between educational attainment and adult mortality. This inverse relationship between educational attainment and mortality rates provides just the tip of the iceberg for a large set of questions: How wide are educational differences in overall adult mortality in Argentina? Does the association between educational attainment and adult mortality vary by age group, gender and region? Are there unique adult mortality patterns by education among specific causes of death? Has the adult mortality differential by education attainment widened or narrowed as education attainment increased between 1991 and 2010? The main objective of this research was to describe and analyze the relationship between educational attainment and adult mortality patterns during the 1991-2010 period in Argentina. The data used in this study come from the Argentinian Mortality Files for the period 1991-2010 and from the 1991, 2001 and 2010 Argentinian Censuses. Results show a clear gradient in the specific mortality rates according to educational groups, for both sexes and for all age groups. The existence and direction of this relationship was as expected; however, the magnitude of educational differences was much higher than what has been found in other countries. The data also exhibited a clear declining trend in mortality inequalities by education as age increased. Educational differences in overall adult mortality did not display an increasing pattern over time. The year 2001, which was characterized by serious economic and social crisis in the country, displayed the highest educational inequalities in mortality in comparison to either 1991 or 2010. The findings of this dissertation are relevant to policy questions about health care and social inequalities in death.
The social consequences of the fall of Communism : a sociological analysis of the health crisis in Eastern Europe
(2013-05) Minagawa, Yuka; Hummer, Robert A.
Sociological interest in the relationship between the social structure and health began with the classic work of Durkheim, who first identified socially constructed patterns of suicide rates in Western European countries. Drawing on this structural tradition, a large literature has investigated how health is influenced and shaped by societal factors. Despite a great deal of research on the social causation of health, however, the potentially adverse effects of social structures have been rarely studied. If people's health is linked to broader social conditions, then it follows that health is also subject to societal disruption, especially in the wake of the breakdown or failure of the existing social structure. This dissertation advances our understanding of the relationship between the social structure and health at the population level, focusing on post-communist Eastern Europe as a case study. There are three interrelated goals in this dissertation: first, to elucidate differences in health and mortality outcomes between East Central Europe and the former Soviet Union; second, to numerically substantiate the association between drastic social change and the risk of death due to suicide; and third, to reveal the structural factors related to overall population health status in Eastern Europe. Using aggregate-level data for Eastern European countries for the post-communist period, I find that (1) there are growing inequalities in life expectancy and infant mortality between East Central Europe and the former Soviet Union, and mechanisms associated with disparities vary by gender and age; (2) consistent with Durkheim's theory of suicide, drastic structural change is related to increased suicide death rates for the period immediately after the collapse of communism; and (3) the malfunctioning of the social structure is inversely associated with the health status of populations. Taken together, fully understanding the health consequences of communism's fall in Eastern Europe requires research that looks beyond individual-level risk factors to incorporate the broader characteristics of the social structure in which populations are embedded.