Importance: Increasing mortality from suicide, drug overdose, and alcohol-related liver disease (collectively referred to as deaths of despair) is a critical public health crisis. Income inequality and social mobility have been separately associated with all-cause mortality; however, no studies have examined their interaction with these preventable deaths.Objective: To assess the interaction between income inequality and social mobility with deaths of despair among working-age Hispanic, non-Hispanic Black, and non-Hispanic White populations.Design, Setting, and Participants: This cross-sectional study analyzed data from the Centers for Disease Control and Prevention WONDER (Wide-Ranging Online Data for Epidemiologic Research) database on county-level deaths of despair from 2000 to 2019 across racial and ethnic groups. Statistical analysis was performed from January 8 to May 20, 2023.Exposures: The primary exposure of interest was county-level income inequality, measured by the Gini coefficient. Another exposure was race- and ethnicity-specific absolute social mobility. Tertiles for the Gini coefficient and social mobility were created to evaluate the dose-response association.Main Outcomes and Measures: The main outcomes were adjusted risk ratios (RRs) of deaths from suicide, drug overdose, and alcoholic liver disease. The interaction between income inequality and social mobility was formally tested on both the additive and multiplicative scales.Results: The sample included 788 counties for Hispanic populations, 1050 counties for non-Hispanic Black populations, and 2942 counties for non-Hispanic White populations. Over the study period, 152 350, 149 589, and 1 250 156 deaths of despair were recorded for working-age Hispanic, non-Hispanic Black, and non-Hispanic White populations, respectively. Compared with the reference group (counties with low income inequality and high social mobility), counties with greater income inequality (high inequality: RR, 1.26 [95% CI, 1.24-1.29] for Hispanic populations; RR, 1.18 [95% CI, 1.15-1.20] for non-Hispanic Black populations; and RR, 1.22 [95% CI, 1.21-1.23] for non-Hispanic White populations) or less social mobility (low mobility: RR, 1.79 [95% CI, 1.76-1.82] for Hispanic populations; RR, 1.64 [95% CI, 1.61-1.67] for non-Hispanic Black populations; and RR, 1.38 [95% CI, 1.38-1.39] for non-Hispanic White populations) had higher RRs for deaths of despair. In counties with high income inequality and low social mobility, positive interactions were observed on the additive scale for Hispanic populations (relative excess risk due to interaction [RERI], 0.27 [95% CI, 0.17-0.37]), non-Hispanic Black populations (RERI, 0.36 [95% CI, 0.30-0.42]), and non-Hispanic White populations (RERI, 0.10 [95% CI, 0.09-0.12]). In contrast, positive interactions on the multiplicative scale were found only for non-Hispanic Black populations (ratio of RRs, 1.24 [95% CI, 1.18-1.31]) and non-Hispanic White populations (ratio of RRs, 1.03 [95% CI, 1.02-1.05]), but not for Hispanic populations (ratio of RRs, 0.98 [95% CI, 0.93-1.04]). In the sensitivity analyses using continuous Gini coefficient and social mobility, a positive interaction was observed between higher income inequality and lower social mobility with deaths of despair on both the additive and multiplicative scales for all 3 racial and ethnic groups.Conclusions and Relevance: This cross-sectional study found that the joint exposure of unequal income distribution and lack of social mobility was associated with additional risks for deaths of despair, suggesting that addressing the underlying social and economic conditions is crucial in responding to the epidemic of deaths of despair.

Fraud jeopardizes older people’s physical, mental, and economic well-being, and financial literacy and risk preference have been linked to the risk of fraud experience. Given the inconsistent evidence, we investigated whether financial literacy and risk preferences were associated with fraud exposure and victimization among middle-aged and older adults. We analyzed data from the 2015 China Household Finance Survey, including 22,121 participants aged 50 and older. Poisson regression models were conducted to determine the association of financial literacy and risk preference with fraud experience. We found that financial literacy and risk preference were positively associated with fraud exposure and victimization. The prevalence of fraud victimization among middle-aged and older adults with the highest financial literacy and risk preference levels was 46.5% and 45.8% higher than among those with the lowest levels, respectively. These findings suggested that basic financial knowledge is insufficient to protect older people from fraud exposure and victimization.

Background Relative deprivation induced by social comparisons is hypothesised to deleteriously affect health. Previous work has proposed the index as a measure of relative deprivation; however, the performance of this novel index still needs further testing in the working-age population. This study examined the association of three relative deprivation measures (the Yitzhaki Index, income rank and the index) with human flourishing outcomes. Methods This cross-sectional study analysed data from 2177 working-age adults in Taiwan. We conducted least-squares linear models to investigate the association between relative deprivation measures and health, happiness, life satisfaction, meaning in life, social relationships, and subjective well-being. Results When using sex and age as the reference group, for each increased SD in the Yitzhaki Index, the six human flourishing outcomes decreased by 0.10–0.20 SD. The results were consistent across various definitions of the reference group. Based on the Akaike information criterion, the Yitzhaki Index generally showed better model fits for health, happiness, life satisfaction and meaning in life, and had comparable model fits with the income rank for social relationships and subjective well-being. In comparing the relative performance of the index, positive α parameters (0<α<1) generally showed better model fits, suggesting that individuals were more sensitive to comparisons with those more distant from their own income level. Conclusion Policies to reduce relative deprivation by lowering income inequality could contribute to a higher level of health, happiness, life satisfaction, meaning in life, social relationships and subjective well-being.

Objective: Sugar-sweetened beverages (SSB) are linked to increased metabolic risk. However, the sex differences in the relationship between SSB intake and adverse health effects remain unclear. Therefore, the present study examined the association between SSB consumption and metabolic risks among working-age males and females from Taiwanese communities.Design: A community-based study utilised data from a comprehensive health screening project conducted by the Public Health Bureau in Changhua County, Taiwan. Metabolic risks included waist circumference, systolic blood pressure, diastolic blood pressure, total cholesterol, TAG, LDL cholesterol and fasting glucose level using serum tests.Setting: Participants were recruited in Changhua County, Taiwan.Participants: Between 2005 and 2014, 92 724 citizens participated in the health screening; our data analysis included 75 278 respondents between 30 and 64.Results: The results showed that the frequency of SSB consumption was associated with abnormal waist circumference and elevated total cholesterol, TAG, LDL and glucose in both men and women. Increased SSB consumption frequency was associated with elevated glucose and hypertension in women. Even a slight increase in SSB intake frequency was related to raising the metabolic risks. Similar patterns were evident when models included BMI; however, the associations were attenuated. In the BMI-stratified subgroup analysis, the relationship between SSB consumption and metabolic risks was more pronounced in participants without obesity.Conclusion: The present study suggests that SSB consumption carries metabolic risk among working-age Taiwanese, particularly women and those without obesity. Health promotion programmes should raise awareness of the health hazards associated with SSB.