Anusha Vable, ScD, MPH

Associate Professor,
Family Community Medicine

I am a Social Epidemiologist and the director of VabLab, a large research team at UCSF that focuses on identifying and advocating for structural solutions to health inequities. We employ methods from basic linear regression with interaction terms; to sophisticated approaches for identifying causal effects from epidemiology and econometrics; to sequence analysis, an approach that originated in genetics but has extensions in social science to identify common patterns in variables that unfold over time. Our research focuses on socioeconomic exposures (particularly education, but also occupation and income) and diseases associated with aging (particularly cognitive aging, but also heart disease and diabetes); I have received several R01 and R01-equivalent grants as PI or mPI to support these goals.

Methodologically, VabLab has two areas of expertise that may be especially important for equity researchers:
[1] Quantile regression: a method to evaluate how exposures impact the entire outcome distribution (vs. the mean, which is typically evaluated). This is important for equity research because the most structurally minoritized individuals are typically in the tails of the outcome distribution.
[2] Sequence analysis is a powerful and underutilized method to characterize variables that occur over time or over the lifecourse. Our team has been using sequence analysis to understand educational trajectories from age 14 – 48; employment trajectories from ages 18 – 65; air pollution trajectories from 2000 – 2010; state-level abortion access trajectories from 1970 – 2014, Earned Income Tax Credit trajectories from ages 22 - 48, etc., and how these exposures predict subsequent health outcomes. Sequence analysis is descriptive, not causal, but I argue that for most exposures that cumulate over the lifecourse, we are in the descriptive phase, not the causal phase.

Substantively, our team evaluates if socioeconomic exposures and policies are racist / discriminatory (widen inequities) or anti-racist / anti-discriminatory (narrow inequities). We have found that the Korean War GI Bill, which subsidized college education for qualifying veterans, predicted smaller socioeconomic disparities in markers of mental, physical and cognitive health among veterans compared to non-veterans. Similarly, in work led by postdoc Dr. Aayush Khadka, we found that Vietnam War GI Bill eligibility shifted and reshaped the blood pressure distribution to one of lower CVD risk and reduced childhood socioeconomic disparities in blood pressure. We have also found that structurally marginalized groups (women, racial minoritized people, and those from lower socioeconomic backgrounds) seem to benefit more from each year of education than structurally advantaged groups (e.g. high socioeconomic status White men). Our work to date suggests programs and policies to increase educational attainment could be powerful mechanism to reduce racial and socioeconomic health inequities; these consistent findings inform our social change work.

Our social change work, informed by our substantive work, focuses on building the evidence base for the state of California to invest in the public education system at 3 levels:
[1] Early childhood (0 - 5 years): we know this period is critical and we know it’s a market failure; if it’s a market failure, it’s the government’s responsibility to fix this; they are the only ones who can.
[2] K-12 education in California has been underfunded for decades: uneven distribution of buses, nurses, and guidance counselors; they have to fundraise for basic programming like physical education, music, and arts. Especially important for equity is decoupling the funding for public education from property taxes; that is, we need to create a system where the size of your house doesn’t determine the quality of your public education options.
[3] Higher education: tuition at UCs and CSU systems used to be free; similarly, the reason 48,000 UC employees went on strike in 2022 has the same root cause: underfunding by the state. To make up for the budgetary shortfall caused by underinvestment by the state, our public universities are squeezing students with ballooning tuition payments and squeezing low-wage workers with barely livable wages in order to stay solvent. Higher education at public universities can become accessible to the public again if the state decides to prioritize it.

The State of California is under-investing in our kids. We know that education is the primary mechanism for opportunity and social mobility in this country, therefore it is vital that we convince the state to adequately fund the education system. I am not talking about a one-time investment, but a massive and systemic course-correction.


Associations of Food Insecurity and Memory Function Among Middle to Older-Aged Adults in the Health and Retirement Study.

JAMA network open

Lu P, Kezios K, Jawadekar N, Swift S, Vable A, Zeki Al Hazzouri A

Childhood Residential Mobility and Mental and Physical Health in Later Life: Findings From the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.

Journal of applied gerontology : the official journal of the Southern Gerontological Society

Yen IH, Bennett A, Allen S, Vable A, Long DL, Brooks M, Ream RK, Crowe M, Howard VJ

Lifecourse Educational Trajectories and Hypertension in Midlife: An Application of Sequence Analysis.

The journals of gerontology. Series A, Biological sciences and medical sciences

Duarte CDP, Wannier SR, Cohen AK, Glymour MM, Ream RK, Yen IH, Vable AM

Understanding the benefits of different types and timing of education for mental health: A sequence analysis approach.

The journals of gerontology. Series B, Psychological sciences and social sciences

Vable AM, Duarte CDP, Wannier SR, Chan-Golston AM, Cohen AK, Glymour MM, Ream RK, Yen IH

Does the Type and Timing of Educational Attainment Influence Physical Health? A Novel Application of Sequence Analysis.

American journal of epidemiology

Vable AM, Duarte CD, Cohen AK, Glymour MM, Ream RK, Yen IH

Short-term effects of the earned income tax credit on mental health and health behaviors.

Preventive medicine

Collin DF, Shields-Zeeman LS, Batra A, Vable AM, Rehkopf DH, Machen L, Hamad R

Homelessness, housing instability, and abortion outcomes at an urban US abortion clinic.

American journal of obstetrics and gynecology

Orlando MS, Vable AM, Holt K, Wingo E, Newmann S, Shapiro BJ, Borne D, Drey EA, Seidman D

Performance of Matching Methods as Compared With Unmatched Ordinary Least Squares Regression Under Constant Effects.

American journal of epidemiology

Vable AM, Kiang MV, Glymour MM, Rigdon J, Drabo EF, Basu S

Quality and quantity: The association of state-level educational policies with later life cardiovascular disease.

Preventive medicine

Hamad R, Nguyen TT, Glymour MM, Vable A, Manly JJ, Rehkopf DH

Mother's education and late-life disparities in memory and dementia risk among US military veterans and non-veterans.

Journal of epidemiology and community health

Vable AM, Eng CW, Mayeda ER, Basu S, Marden JR, Hamad R, Glymour MM

Trends for Reported Discrimination in Health Care in a National Sample of Older Adults with Chronic Conditions.

Journal of general internal medicine

Nguyen TT, Vable AM, Glymour MM, Nuru-Jeter A

Discrimination in health care and biomarkers of cardiometabolic risk in U.S. adults

Social Science and Medicine Population Health

Nguyen TT, Vable AM, Glymour MM, Nuru-Jeter A

Are There Spillover Effects from the GI Bill? The Mental Health of Wives of Korean War Veterans.

PloS one

Vable AM, Kawachi I, Canning D, Glymour MM, Jimenez MP, Subramanian SV

Can social policy influence socioeconomic disparities? Korean War GI Bill eligibility and markers of depression.

Annals of epidemiology

Vable AM, Canning D, Glymour MM, Kawachi I, Jimenez MP, Subramanian SV

Does the "widowhood effect" precede spousal bereavement? Results from a nationally representative sample of older adults.

The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry

Vable AM, Subramanian SV, Rist PM, Glymour MM

Outcomes of the Botswana national HIV/AIDS treatment programme from 2002 to 2010: a longitudinal analysis.

The Lancet. Global health

Farahani M, Vable A, Lebelonyane R, Seipone K, Anderson M, Avalos A, Chadborn T, Tilahun H, Roumis D, Moeti T, Musuka G, Busang L, Gaolathe T, Malefho KC, Marlink R

Short- and long-term associations between widowhood and mortality in the United States: longitudinal analyses.

Journal of public health (Oxford, England)

Moon JR, Glymour MM, Vable AM, Liu SY, Subramanian SV

Combating Obesity at Community Health Centers (COACH): a quality improvement collaborative for weight management programs.

Journal of health care for the poor and underserved

Wilkes AE, John PM, Vable AM, Campbell A, Heuer L, Schaefer C, Vinci L, Drum ML, Chin MH, Quinn MT, Burnet DL

Undergoing transformation to the patient centered medical home in safety net health centers: perspectives from the front lines.

Ethnicity & disease

Quinn MT, Gunter KE, Nocon RS, Lewis SE, Vable AM, Tang H, Park SY, Casalino LP, Huang ES, Birnberg J, Burnet DL, Summerfelt WT, Chin MH

Patient-centered medical home characteristics and staff morale in safety net clinics.

Archives of internal medicine

Lewis SE, Nocon RS, Tang H, Park SY, Vable AM, Casalino LP, Huang ES, Quinn MT, Burnet DL, Summerfelt WT, Birnberg JM, Chin MH

Development of a safety net medical home scale for clinics.

Journal of general internal medicine

Birnberg JM, Drum ML, Huang ES, Casalino LP, Lewis SE, Vable AM, Tang H, Quinn MT, Burnet DL, Summerfelt T, Chin MH

Implications of the new definition of diabetes for health disparities.

Journal of the National Medical Association

Vable AM, Drum ML, Tang H, Chin MH, Lindau ST, Huang ES

Sexuality among middle-aged and older adults with diagnosed and undiagnosed diabetes: a national, population-based study.

Diabetes care

Lindau ST, Tang H, Gomero A, Vable A, Huang ES, Drum ML, Qato DM, Chin MH