Neel Patel, Hamza Mirza, Payal Bai, Vedant Shah, Harsh Patel, Milan Khealani, Geetika Kukreja, Sri J Obulareddy
Aplastic Anemia Mimicking Myelofibrosis: A Diagnostic Dilemma
Cureus
life expectancy decreasing us without national efforts address factors support policies programs directed children living areas concentrated poverty life expectancy likely continue decline costs suffering associated unnatural deaths increase identify childhood factors associated death unnatural causes midadulthood cohort study longitudinal data childhood characteristics came grouprandomized intervention trial implemented baltimore city public schools baltimore maryland baseline 19851986 students entering first grade selected participate age 6 years participants followed midadulthood national death index search december 31 2020 data analysis performed february may 2023 exposures included individual factors ie sociodemographic characteristics teacherreported aggressive behavior selfreported depression anxiety early alcohol cannabis use assaultive violence exposure family peer factors ie household structure education level deviant peer affiliation parental monitoring neighborhood factors ie rates neighborhood assault public assistance main outcome unnatural death defined death due unintentional injury suicide homicide national death index search ascertained participants died age 41 42 years cause death multivariable cox proportional hazards models used identify whether exposures independently associated future mortality unnatural causes initial trial included 2311 children longitudinal data available 2180 participants median iqr age first grade 63 6065 years 1090 female 500 1461 black 670 1168 received free reduced lunch first grade 536 total 111 male participants 102 29 female participants 27 died among died 96 male participants 865 14 female participants 483 died unnatural causes two factors remained significantly associated mortality unnatural causes female sex associated reduced risk hazard ratio 013 95 ci 008022 neighborhood public assistance associated increased risk hazard ratio 189 95 ci 109330 urban populationbased cohort study modifiable risk factors mortality level individual eg depression anxiety substance use family eg household education level identified however degree neighborhood poverty early childhood significantly associated death unnatural causes early adulthood suggesting economic policies needed advance health equity relation premature mortality