Recruitment and retention of minority participants in the health and retirement study

Differential association of ultraprocessed food categories with risk of developing cognitive impairment in middle-aged and older adults in a longitudinal panel study

BACKGROUND

The majority (∼65%) of food products purchased by United States households are considered ultraprocessed foods (UPFs). Consumption of UPF is associated with a variety of adverse health outcomes including dementia. Most research on UPF consumption and cognition measure UPF as a single entity despite extensive variability in the types of foods that are considered UPF.

OBJECTIVES

The objective of this study was to investigate the extent to which consumption of individual categories of UPF are related to risk of developing cognitive impairment over 7 y.

METHODS

Data from the Health and Retirement Study (HRS), a panel study, were used to examine UPF consumption and risk of developing cognitive impairment in 4750 middle-aged and older United States adults. Diet was assessed using the Harvard Food Frequency Questionnaire at baseline and cognitive status was assessed biennially from 2014 to 2020 using measures of recall and executive function. Foods were categorized using the NOVA system. The UPF foods were divided into categories based on previously reported criteria. The relationship between total UPF consumption and 9 UPF categories and cognitive status were assessed using adjusted Cox proportional hazard analyses.

RESULTS

In total, 1363 participants developed cognitive impairment. Consumption of an additional average daily serving of ultraprocessed animal products and beverages were associated with 17% (95% Confidence interval [CI]: 1.032, 1.326) and 6.3% (95% CI: 1.010, 1.118) heightened risk of developing cognitive impairment throughout the study period, respectively. Total UPF consumption and consumption of other UPF categories (other, sweets, spreads, savory snacks, ready-to-eat meals, grains, and dairy-based) were not associated with risk of developing cognitive impairment.

CONCLUSIONS

These results reinforce the value of separating UPF into categories. The link between UPF animal products and beverages with cognitive functions may be, in part, explained by their ingredients, such as additives, or by the poor nutritional composition of products rich in simple sugars and low in dietary fibers.

Depression, Subjective Health, Obesity, and Multimorbidity are Associated with Epigenetic Age Acceleration

Background

Epigenetic aging, measured through various DNA methylation-based clocks, may have implications for predicting disease risk. However, the sensitivity of different epigenetic clocks that have emerged as biomarkers for biological aging and in predicting physical and mental health outcomes remains uncertain. This study examines the age and sex-adjusted associations between multiple epigenetic age acceleration measures and three key health indicators, including self-rated health, depressive symptoms, and body mass index (BMI), in a nationally representative sample of U.S. middle-aged and older adults.

Methods

We analyzed data from 4,018 adults in the 2016 wave of the Health and Retirement Study (HRS), which included several epigenetic age acceleration measures: HORVATH, HANNUM, LEVINE, HORVATHSKIN, LIN, WEIDNER, VIDALBRALO, YANG, ZHANG, BOCKLANDT, GARAGNANI, and GRIMAGE. Linear regression models were used to assess the associations between epigenetic age acceleration and self-rated health (poor health), depressive symptoms, and BMI, adjusting for age and sex.

Results

We found significant positive associations between epigenetic age acceleration and worse self-rated health, higher depressive symptoms, and increased BMI. However, these associations varied across different epigenetic clocks, with some measures potentially having more consistent utility for specific health outcomes than others.

Conclusion

Epigenetic age acceleration is linked to poorer self-rated health, greater depressive symptoms, and higher BMI, but choosing which epigenetic clock(s) to use is also important. These findings underscore the need to consider multiple epigenetic aging markers when assessing health risks and highlight the potential for particular clocks to serve as more sensitive indicators of physical and mental health outcomes.

Stakeholder perspectives on an adult cerebral palsy community registry: A qualitative study

BACKGROUND

The Cerebral Palsy Research Network (CPRN) community registry has yielded valuable information about changes in function and pain in adults with cerebral palsy (CP) through a patient-reported outcomes registry. However, it requires increased enrollment and diversity of participants to produce more generalizable conclusions.

OBJECTIVE

To identify stakeholder perspectives about the barriers and facilitators to enrollment in the CPRN Community Registry, strategies to enhance recruitment efforts, and important questions for the registry.

METHODS

Qualitative descriptive study using iterative focus groups, followed by inductive thematic analysis. Participants included adults with CP and caregivers, clinical investigators, and community leaders in the CP and disability spaces. Focus groups explored perspectives about motivations for registry participation, barriers and facilitators to participation, and strategies for increasing and enhancing diversity of enrollment.

RESULTS

Four focus groups were conducted (20 participants with lived experience; 10 clinical investigators; 9 community leaders). All participants valued the information provided by the registry and felt that ongoing data collection was important. Barriers and related facilitators to participation include benefits of participation, awareness, accessibility, and collaboration with community and clinical partners. Adults with lived experience seek more precisely defined health and function outcomes for adults with CP.

CONCLUSIONS

Adults with lived experience, clinical investigators, and community leaders identified barriers and facilitators to participation in a patient-reported registry and important questions. This study revealed that communicating a direct benefit to the participant, improved visibility and accessibility, leveraging collaboration with clinical and community partners, and answering more precise research questions could promote enrollment.

Associations between discriminatory experiences and dementia in the Health and Retirement Study

Dramatic racial and ethnic disparities in dementia necessitate research into potential risk factors and points of intervention. Using data from a large sample (n = 13,733) of older US residents participating in the Health and Retirement Study between 2006 and 2016, we investigated relationships between everyday and major discrimination and development of dementia. Data on self-reported everyday and major discrimination were collected via questionnaires. Algorithmic classification of probable dementia status was determined via a battery of cognitive tests. We used logistic regression models, and analyses were stratified by race and ethnicity and sex. We found that overall, more frequent experiences of everyday discrimination were associated with higher odds of developing dementia (odds ratio (OR) = 1.18; 95% confidence interval (CI): 1.10, 1.27; p < 0.001). Estimates stratified by race similarly suggested the positive association between everyday discrimination and odds of dementia onset was highest in non-Hispanic Black participants (OR: 1.30; 95% CI: 1.13, 1.51; p < 0.001). Our results reveal a link between frequency of everyday experiences of discrimination and dementia onset and highlight the role of psychosocial exposures in health and disease. This study underlines the impact that psychosocial stressors can have on cognitive health. Interventions addressing psychosocial risk factors experienced disproportionately by historically marginalized groups may be crucial in the goal to mitigate dementia disparities and achieve dementia equity.

Mapping the Landscape of Those Left Behind When a Person With Dementia Dies: Roles of Race and Ethnicity

INTRODUCTION

People with dementia can have many family and friends who might be affected by their deaths. Pursuing the long-term aim of understanding how dementia deaths affect close family and friends, this project lays groundwork through estimates of who those close family and friends are, with special attention to race and ethnicity.

METHOD

Regression models estimated associations between dementia, race/ethnicity, and close family and friend network size, controlling for age, sex, education, marital status, and household wealth for 1386 deceased people with dementia from the Health and Retirement Study (2004 to 2018).

RESULTS

Persons with dementia had an average of 9.4 close family and friends at death. But patterns of close family and friends were different among non-Latino Black (10.8), Latino (9.9), and non-Latino White (9.2) people with dementia at death. Notably, non-Latino White persons with dementia had the fewest close family (3.7), followed by non-Latino Black (5.1), and Latino (7.7) persons with dementia.

DISCUSSION

Knowing who might be affected by dementia deaths is the first step to explore how dementia-related deaths impact close family and friends. Future work can now sample bereaved family and friends of people with dementia to explore their experiences and develop culturally appropriate supports.

Reasons for undergoing amyloid imaging among diverse enrollees in the A4 study

INTRODUCTION

Understanding attitudes toward participation among diverse preclinical Alzheimer's disease (AD) trial participants could yield insights to instruct future recruitment.

METHODS

Using data from the Anti-Amyloid Treatment in Asymptomatic AD (A4) Study, we examined differences among mutually exclusive racial and ethnic groups in views and perceptions of amyloid imaging (VPAI), a measure of motivations to undergo amyloid biomarker testing in the setting of preclinical AD. We used linear regression to quantify differences at baseline.

RESULTS

Compared to non-Hispanic or Latino (NH) White participants, Hispanic or Latino (3.52 points, 95% confidence interval [CI]: [2.61, 4.42]); NH Asian (2.97 points, 95% CI: [1.71, 4.22]); and NH Black participants (2.79 points, 95% CI: [1.96, 3.63]) participants demonstrated higher levels of endorsement of the VPAI items at baseline.

DISCUSSION

Differences may exist among participants from differing ethnic and racial groups in motivations to undergo biomarker testing in the setting of a preclinical AD trial.

HIGHLIGHTS

Representative samples in AD clinical trials are vital to result in generalizability. We assessed motivations to undergo amyloid imaging in a preclinical AD trial. Racial and ethnic minority groups showed higher endorsement of VPAI items. Differences were driven by perceived risk, plan/prepare, and curiosity domains. Few observations among racial and ethnic groups changed after biomarker disclosure.

Diversity in the study of aging and lifespan development

In psychology, authors have shined a light on a lack of ethnic/racial and cultural diversity in sampling and scholarship. These issues pertain also to the study of aging and lifespan development. This article presents examples of how diverse sampling, across ethnic/racial groups and cultures, enriches theories of aging and adult development. There remain, however, numerous theoretical insights that are yet to be uncovered by future research that seeks to further diversify this sub-discipline. Good practices and avenues to diversification are considered, including targeted sampling of minority groups in the community, online sampling with use of data screening tools, lifespan-orientated surveys initiated in non-Western countries, and a redress of the balance in the perceived value of research from different regions of the world.

Trust and subjective knowledge influence perceived risk of lead exposure

Lead exposure is a persistent environmental hazard that poses risks to human health. But motivating protective action is challenging with this low visibility hazard whose health effects are often subtle and chronic. Higher risk perception is generally associated with taking protective measures, so public health efforts prioritize risk messaging. Yet, little is known about perceptions of lead exposure risk among the U.S. public. Using cross-sectional data from a national survey of 1035 U.S. residents, we measured the role of trust in government management of lead and subjective knowledge about lead as predictors of perceived risk of lead exposure, controlling for demographic and environmental factors. We also assessed if subjective knowledge moderated the relationship between trust and perceived risk. Our results reveal positive relationships between trust in government management of lead, subjective knowledge about lead, and risk perception, which we attribute in part to the important role government agencies play in secondary prevention, or communicating the risks of environmental lead exposure. We also found that younger people and people living in a house built before lead paint regulations passed in 1978 perceived higher lead risks. Our findings suggest that general communication about lead risks should aim to increase people's subjective knowledge in a consistent and balanced way that improves trust in government messengers.

Incarceration's lingering health effects on Black men: impacts persist into retirement

Background

The unique challenges Black men face within the criminal justice system underscore structural and systemic factors driving widespread inequalities. The long-term effects of these challenges on economic, health, and social outcomes as individuals transition to retirement remain poorly understood, highlighting a critical gap in our knowledge of life trajectories long after justice system involvement.

Objectives

This study investigated the enduring health impacts of incarceration on Black men, particularly focusing on the transition into retirement. It aimed to explore the influence of race and gender on experiences of incarceration before age 50, and how such experiences affected self-rated health during the retirement transition.

Methods

Utilizing data from the Health and Retirement Study, which followed individuals aged 50-59 for up to thirty years, this research examined the interplay of race, gender, incarceration history, and self-rated health during the retirement transition. Logistic regression and path modeling were employed for data analysis.

Results

Logistic regression results indicated that being Black, male, and having lower educational attainment significantly increased the likelihood of experiencing incarceration before the age of 50 (p < 0.05). This suggests that Black men with lower levels of education are at the greatest risk of incarceration. The path model revealed a correlation between incarceration experiences before age 50 and poorer self-rated health at the time of retirement.

Conclusion

The findings highlighted the disproportionately high risk of incarceration among Black men, especially those with lower educational attainment, and its persistent negative impacts on health decades later, including during the transition into retirement. Addressing structural racism and the mass incarceration of Black men is crucial for achieving racial health equity as individuals retire.

Time Path of Weight Status Before and After Incident Dementia

Objectives: Identifying whether obesity is a risk factor for dementia is complicated by the possibility of weight change as dementia evolves. This article investigates an extended time path of body mass index (BMI) before and after incident dementia in a nationally representative sample. Methods: Using the Health and Retirement Study (2000-2016), we examine (1) the longitudinal relationship between BMI and incident dementia and (2) heterogeneity in the BMI trajectory by initial BMI level. Results: Weight loss begins at least one decade before incident dementia, then accelerates in the years immediately preceding dementia onset and continues after incident dementia. Those with higher levels of BMI at baseline experienced a much greater decline relative to those with a normal weight. Discussion: Our results help explain the contradicting findings in the literature regarding the relationship between obesity and dementia and highlight the need for using extended longitudinal data to understand dementia risk.

Acceptability and Feasibility of a Socially Enhanced, Self-Guided, Positive Emotion Regulation Intervention for Caregivers of Individuals With Dementia: Pilot Intervention Study

BACKGROUND

The responsibilities of being a primary caregiver for a loved one with dementia can produce significant stress for the caregiver, leading to deleterious outcomes for the caregiver's physical and psychological health. Hence, researchers are developing eHealth interventions to provide support for caregivers. Members of our research team previously developed and tested a positive emotion regulation intervention that we delivered through videoconferencing, in which caregiver participants would meet one-on-one with a trained facilitator. Although proven effective, such delivery methods have limited scalability because they require significant resources in terms of cost and direct contact hours.

OBJECTIVE

This study aimed to conduct a pilot test of a socially enhanced, self-guided version of the positive emotion regulation intervention, Social Augmentation of Self-Guided Electronic Delivery of the Life Enhancing Activities for Family Caregivers (SAGE LEAF). Studies have shown that social presence or the perception of others in a virtual space is associated with enhanced learning and user satisfaction. Hence, the intervention leverages various social features (eg, discussion boards, podcasts, videos, user profiles, and social notifications) to foster a sense of social presence among participants and study team members.

METHODS

Usability, usefulness, feasibility, and acceptability data were collected from a pilot test in which participants (N=15) were given full access to the SAGE LEAF intervention over 6 weeks and completed preintervention and postintervention assessments (10/15, 67%). Preliminary outcome measures were also collected, with an understanding that no conclusions about efficacy could be made, because our pilot study did not have a control group and was not sufficiently powered.

RESULTS

The results suggest that SAGE LEAF is feasible, with participants viewing an average of 72% (SD 42%) of the total available intervention web pages. In addition, acceptability was found to be good, as demonstrated by participants' willingness to recommend the SAGE LEAF program to a friend or other caregiver. Applying Pearson correlational analyses, we found moderate, positive correlation between social presence scores and participants' willingness to recommend the program to others (r9=0.672; P=.03). We also found positive correlation between social presence scores and participants' perceptions about the overall usefulness of the intervention (r9=0.773; P=.009). This suggests that participants' sense of social presence may be important for the feasibility and acceptability of the program.

CONCLUSIONS

In this pilot study, the SAGE LEAF intervention demonstrates potential for broad dissemination for dementia caregivers. We aim to incorporate participant feedback about how the social features may be improved in future iterations to enhance usability and to further bolster a sense of social connection among participants and study staff members. Next steps include partnering with dementia clinics and other caregiver-serving organizations across the United States to conduct a randomized controlled trial to evaluate the effectiveness of the intervention.

Hospitalization's association with depression in adults over 50 years old: does living arrangement matter? Findings from the Health and Retirement Study

OBJECTIVES

To examine how living arrangements are associated with depressive symptoms in late middle-life and older adults following hospitalization within the last two years.

DESIGN

We used the 2016 wave of the Health and Retirement Study (HRS), a nationally representative survey of adults over 50 years old living in the United States.

METHODS

The dependent variable was whether HRS participants screened positive for having depressive symptoms. The primary independent variable was self-reported hospitalization in the prior two years. We stratified bivariate analyses and multivariate logistic regressions by living arrangement to examine hospitalizations' association with depressive symptoms.

RESULTS

Depressive symptoms were less prevalent among participants who were married or partnered and living with a partner (14.0%) compared to those who were not married or partnered and were living with others (31.7%) and were not married or partnered and were living alone (27.8%). In multivariate analyses stratified by living arrangement, however, hospitalization was associated with depressive symptoms for those married or partnered and living with a partner (OR = 1.39, 95% CI: 1.14-1.69) but not for those who were not married and living with other(s) (OR = 0.88, 95% CI: 0.65-1.18) and not married or partnered and living alone (OR = 1.06, 95% CI: 0.82-1.36).

CONCLUSIONS

Late middle-life and older adults residing with spouses or cohabitating appear at risk for having depressive symptoms following a hospitalization. A better understanding of how relationships and living arrangements may affect depression risk in the context of an acute medical illness is needed to identify points of intervention.

Exploring patient medication adherence and data mining methods in clinical big data: A contemporary review

BACKGROUND

Increasingly, patient medication adherence data are being consolidated from claims databases and electronic health records (EHRs). Such databases offer an indirect avenue to gauge medication adherence in our data-rich healthcare milieu. The surge in data accessibility, coupled with the pressing need for its conversion to actionable insights, has spotlighted data mining, with machine learning (ML) emerging as a pivotal technique. Nonadherence poses heightened health risks and escalates medical costs. This paper elucidates the synergistic interaction between medical database mining for medication adherence and the role of ML in fostering knowledge discovery.

METHODS

We conducted a comprehensive review of EHR applications in the realm of medication adherence, leveraging ML techniques. We expounded on the evolution and structure of medical databases pertinent to medication adherence and harnessed both supervised and unsupervised ML paradigms to delve into adherence and its ramifications.

RESULTS

Our study underscores the applications of medical databases and ML, encompassing both supervised and unsupervised learning, for medication adherence in clinical big data. Databases like SEER and NHANES, often underutilized due to their intricacies, have gained prominence. Employing ML to excavate patient medication logs from these databases facilitates adherence analysis. Such findings are pivotal for clinical decision-making, risk stratification, and scholarly pursuits, aiming to elevate healthcare quality.

CONCLUSION

Advanced data mining in the era of big data has revolutionized medication adherence research, thereby enhancing patient care. Emphasizing bespoke interventions and research could herald transformative shifts in therapeutic modalities.

Attributions for Everyday Discrimination and All-Cause Mortality Risk Among Older Black Women: A Latent Class Analysis Approach

BACKGROUND AND OBJECTIVES

This study examined the relationship between number of attributed reasons for everyday discrimination and all-cause mortality risk, developed latent classes of discrimination attribution, and assessed whether these latent classes were related to all-cause mortality risk among U.S. older Black women.

RESEARCH DESIGN AND METHOD

Participants were from the 2006 and 2008 waves of the Health and Retirement Study (N = 1,133; 335 deaths). Vital status was collected through the National Death Index through 2013 and key informant reports through 2019. Latent class analyses were conducted on discrimination attributions. Weighted Cox proportional hazards model was used to predict all-cause mortality. Analyses controlled for demographic characteristics, socioeconomic status, and health.

RESULTS

Reporting greater attributions for everyday discrimination was associated with higher mortality risk (hazard ratio [HR] = 1.117; 95% confidence interval [CI]: 1.038-1.202; p < .01), controlling for demographic characteristics, socioeconomic status, and health as well as health behaviors. A 4-class solution of the latent class analysis specified the following attribution classes: No/Low Attribution; Ancestry/Gender/Race/Age; Age/Physical Disability; High on All Attributions. When compared to the No/Low Attribution class, membership in the High on All Attributions class was associated with greater mortality risk (HR = 2.809; CI: 1.458-5.412; p < .01).

DISCUSSION AND IMPLICATIONS

Findings underscore the importance of everyday discrimination experiences from multiple sources in shaping all-cause mortality risk among older Black women. Accordingly, this study problematizes the homogenization of Black women in aging research and suggests the need for health interventions that consider Black women's multiplicity of social statuses.

Migration, work, and retirement: the case of Mexican-origin populations

Mexico and the United States both face rapid population aging as well as older populations with high poverty rates. Among the most vulnerable populations of retirement age in either nation are Mexican immigrants to the United States. This work uses data from the U.S. Health and Retirement Study and the Mexican Health and Aging Study to assess retirement decisions among persons born in Mexico and working in either nation as well as such decisions by non-Hispanic Whites in the United States. Social security system incentives matter for the retirement of Mexican immigrants in the U.S. but not for return-migrants in Mexico.

Exploring potential for selection bias in using survey data to estimate the association between institutional trust and depression

PURPOSE

We tested the hypothesis that low institutional trust would be associated with depressive symptom elevation, with attention to potential selection bias.

METHODS

The District of Columbia Area Survey (DCAS) was conducted by mail in 2018. Invitations sent to 8800 households resulted in a sample of 1061 adults. Institutional trust questions referenced nonprofit organizations, businesses, and government. Depressive symptom elevation was assessed using PHQ-9. Logistic regression model estimates were compared with and without adjustment for sociodemographic characteristics and neighborhood satisfaction; among complete cases and following multiple imputation of missing covariate data; and with and without survey weights or correction for collider selection bias.

RESULTS

Of 968 participants without missing depressive symptom or trust data, 24% reported low institutional trust. Low institutional trust was associated with elevated depressive symptoms (adjusted OR following multiple imputation: 2.0; 95% CI: 1.1, 3.4), although the association was attenuated with use of survey weights (adjusted OR incorporating multiple imputation and survey weights: 1.6; 95% CI: 0.7, 3.2).

CONCLUSIONS

Under contrasting scenarios where low institutional trust and depressive symptoms jointly increase nonresponse, selection bias could lead to under- or overestimation of this association. Future research could explore posited selection bias scenarios that differ in direction of bias.

Assessing targeted invitation and response modes to improve survey participation in a diverse New York City panel: Healthy NYC

BACKGROUND

Healthy NYC is an innovative survey panel created by the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) that offers a cost-effective mechanism for collecting priority and timely health information. Between November 2020 and June 2021, invitations for six different surveys were sent to Healthy NYC panelists by postal mail, email, and text messages. Panelists had the option to complete surveys online or via paper survey.

METHODS

We analyzed whether panelists varied by sociodemographic characteristics based on the contact mode they provided and the type of invitation that led to their response using logistic regression models. Poisson regression models were used to determine whether the number of invitations received before participating in a survey was associated with sociodemographic characteristics.

RESULTS

Younger age and higher education were positively associated with providing an email or text contact. Furthermore, age, race, and income were significant predictors for invitation modes that led to a survey response. Black panelists had 72% greater odds (OR 1.72 95% CI: 1.11-2.68) of responding to a mail invite and 33% lesser odds (OR 0.67, 95% CI: 0.54-0.83) of responding to an email invite compared with White panelists. Additionally, in five of the six surveys, more than half of the respondents completed surveys after two invites. Email invitations garnered the highest participation rates.

CONCLUSIONS

We recommend using targeted invitation modes as an additional strategy to improve participation in panels. For lower-income panelists who do not provide an email address, it may be reasonable to offer additional response options that do not require internet access. Our study's findings provide insight into how panels can tailor outreach to panelists, especially among underrepresented groups, in the most economical and efficient ways.

Demographic and Health Characteristics of Older Latino Birth Cohorts in the Health and Retirement Study

OBJECTIVES

Latinos are the fastest aging racial/ethnic minority group in the United States. One limitation to understanding the diverse experiences of older Latinos is the lack of nationally representative data necessary to examine factors contributing to changes in population-level health over time. This is needed to provide a more comprehensive picture of the demographic characteristics that influence the health and well-being of older Latinos.

METHODS

We utilized the steady-state design of the Health and Retirement Study (HRS) from 1992 to 2016 to examine the demographic and health characteristics of five entry birth cohorts of older Latinos aged 51-56 years (n = 2,882). Adjusted Wald tests were used to assess statistically significant differences in demographic and health characteristics across the HRS birth cohorts.

RESULTS

Cross-cohort comparisons of demographic and health characteristics of older Latinos indicate significant change over time, with later-born HRS birth cohorts less likely to identify as Mexican-origin, more likely to identify as a racial "other," and more likely to be foreign-born. In addition, we find that later-born cohorts are more educated and exhibit a higher prevalence of hypertension, diabetes, and obesity.

DISCUSSION

Increasing growth and diversity among the older U.S. Latino population make it imperative that researchers document changes in the demographic composition and health characteristics of this population as it will have implications for researchers, policymakers, health care professionals, and others seeking to anticipate the needs of this rapidly aging population.

Greater Inclusion of Asian Americans in Aging Research on Family Caregiving for Better Understanding of Racial Health Inequities

With the substantial demographic changes in racial composition in the United States since 1965, research on racial health inequities must build upon the Black-White binary to assess the complex ways "race" affects health and aging. Considering variation in the prevalence and meanings of aging across racialized groups requires concerted efforts to expand and disaggregate samples. Aligned with the goals of the intersectionality framework, we argue that greater inclusion of Asian Americans is critical to advance both theoretical and methodological considerations that enable us to investigate the lived experiences of Asian Americans. Using caregiving as an example, we discuss how systemic, cultural, and interpersonal marginalization from racism and other oppressive systems intertwine with "race" to produce the race effects. Greater inclusion of Asian Americans helps further provide the opportunity to conceptualize culture as dynamic and interacting with structure to produce different racial patterns. Meaningful inclusion of Asian Americans in research requires more systemic effort to collect accurate, reliable, and quality data for Asian Americans that can be disaggregated by other important axes of stratification.

Biopsychosocial pathways in dementia inequalities: Introduction to the Michigan Cognitive Aging Project

Racial/ethnic inequalities in dementia risk are a major public health and health justice concern. Group differences that persist despite adjustment for socioeconomic and vascular indicators suggest that known dementia risk factors exhibit differential impact across race/ethnicity and/or there are unrecognized dementia risk factors that are racially patterned. This article provides targeted examples of both of these possibilities. First, depressive symptoms and white matter hyperintensities represent two known dementia risk factors that more strongly relate to negative cognitive outcomes among Black older adults than Whites, pointing to the need to consider contextual factors. Second, racial discrimination and external perceived control predict worse brain and cognitive aging above and beyond known risk factors. These psychosocial factors warrant explicit consideration in dementia cohort studies. Several challenges appear to be particularly relevant to the study of dementia inequalities, including selective survival and recruitment. These challenges complicate not only cross-study comparisons, but also within-study causal inferences. This article provides recommendations for addressing these challenges in order to accelerate high-quality research on dementia inequalities. Stemming from these recommendations, the article introduces the design and methods of the Michigan Cognitive Aging Project, a new, racially-balanced cohort study of Black and White adults transitioning to late life. In sum, careful research with community partners is needed to more fully explore the factors and contexts that create and sustain racial/ethnic disparities, as well as those that buffer against them. The ultimate goal of this research is to facilitate the dismantling of structural barriers to health justice for diverse older people. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Contribution of socioeconomic, lifestyle, and medical risk factors to disparities in dementia and mortality

Extensive literature in the United States documents racial/ethnic and gender disparities in the incidence and prevalence of dementia yet few studies have examined how race/ethnicity and gender intersect to shape inequalities in the risk of dementia. Moreover, few studies have examined heterogeneity in the contribution of known risk factors to dementia across these demographic strata while properly accounting for the semi-competing risk of death. I calculated the proportion of dementia cases attributable to socioeconomic, lifestyle, and medical risk factors across demographic subgroups using nationally representative data from the US-based Health and Retirement Study for the years 2000-2016 and a multistate framework that accounts for the semi-competing risk of death. Socioeconomic resources contributed to the largest number of dementia cases but the magnitude of this contribution varied across strata defined by race/ethnicity and gender. The greatest potential for dementia prevention was observed among non-Hispanic black and Hispanic men and women, supporting an intersectionality approach, and underscoring the need for culturally sensitive intervention and public health initiatives to address the growing burden of dementia. Taken together, work demonstrates the potential benefit of taking an intersectional approach to understanding disparities in dementia.

Trajectories of Depressive Symptoms Experienced by Older People: Effects of Time, Hurricane Sandy, and the Great Recession

OBJECTIVES

To examine depressive symptom trajectories as a function of time and exposure to Hurricane Sandy, accounting for the effects of the Great Recession.

METHODS

We analyzed 6 waves of data from a 12-year panel using latent class growth models and multinomial logistic regression.

RESULTS

We identified 4 groups of people experiencing different trajectories of depressive symptoms. The groups differed on baseline characteristics (gender, age, education, income, race), history of diagnosed depression, and initial level of depressive symptoms. The group with the highest levels of depressive symptoms reported greater levels of peri-traumatic stress exposure to Hurricane Sandy.

DISCUSSION

Depressive symptoms increased as a function of the Great Recession, but exposure to Hurricane Sandy was not associated with subsequent increases in depressive symptoms for any of the 4 groups. People who consistently experienced high levels of depressive symptoms over time reported the highest levels of peri-traumatic stress during Hurricane Sandy. Findings highlight the importance of accounting for historical trends when studying the effects of disaster, identify people likely to be at risk during a disaster, and provide novel information about the causal relationship between exposure to disaster and depressive symptoms.

Methods and Early Recruitment of a Community-Based Study of Cognitive Impairment Among Mexican Americans and Non-Hispanic Whites: The BASIC-Cognitive Study

BACKGROUND

As the Mexican American (MA) population grows and ages, there is an urgent need to estimate the prevalence of cognitive impairment or dementia (CID), cognitive trajectories, and identify community resource needs. The Brain Attack Surveillance in Corpus Christi (BASIC)-Cognitive project is a population-based study to address these issues among older MAs and non-Hispanic whites (NHW) and their informal care providers.

OBJECTIVE

Present the methodology and initial recruitment findings for the BASIC-Cognitive project.

METHOD

Random, door-to-door case ascertainment is used in Nueces County, Texas, to recruit community-dwelling and nursing home residents ≥65 and informal care providers. Households are identified from a two-stage area probability sample, using Census data to aim for equal balance of MAs and NHWs. Individuals with cognitive screens indicative of possible CID complete neuropsychological assessment (Harmonized Cognitive Assessment Protocol from the Health and Retirement Study). Informal care providers complete comprehensive interview and needs assessment. Study pairs repeat procedures at 2-year follow-up. Asset and concept mapping are performed to identify community resources and study care providers' perceptions of needs for individuals with CID.

RESULTS

1,030 age-eligible households were identified, or 27% of households for whom age could be determined. 1,320 individuals were age-eligible, corresponding to 1.3 adults per eligible household. Initial recruitment yielded robust participation in the MA eligible population (60% of 689 individuals that completed cognitive screening).

CONCLUSION

The BASIC-Cognitive study will provide critical information regarding the prevalence of CID in MAs, the impact of caregiving, and allocation of community resources to meet the needs of this population.

Understanding Attrition and Bolstering Retention in a Longitudinal Panel of Older Adults: ORANJ BOWL

Background and Objectives

Attrition from longitudinal studies can affect the generalizability of findings especially when studying developmental constructs such as successful aging.

Research Design and Methods

Using data from a 12-year (6-wave) panel of 5,688 older people (aged 50-74 at baseline), we compared people retained in the panel with people lost to follow-up on demographic characteristics and measures of successful aging. After instituting expanded retention strategies at Wave 6 (i.e., a team-based approach, social media, and paid web search engines), we compared different groups of people lost to follow-up (i.e., deceased and withdrawn due to lack of interest) and different types of completers (i.e., full completers vs. lost and reengaged completers).

Results

At baseline, Wave 6 completers were significantly younger, less likely to be African American, more likely to be married, reported higher levels of income and education, were more likely to be working full-time, had less pain and fewer chronic illnesses, and reported higher levels of subjective successful aging and functional ability than those lost to follow-up. Analyses demonstrated differences across groups based on the reason for loss (i.e., deceased, impaired, and not interested). Participants who missed an interview but returned to the panel were significantly different from those who participated in all waves of data collection. Expanded retention efforts improved generalizability, as people returning to the panel reported lower levels of education, lower levels of income, and were more likely to be African American.

Discussion and Implications

Biased attrition within longitudinal research affects the interpretation of study findings, especially when studying developmental outcomes. However, expanded retention strategies can reduce bias and loss and should be used to enhance retention efforts in longitudinal work.

Patterns and risk factors of opioid-suspected EMS overdose in Houston metropolitan area, 2015-2019: A Bayesian spatiotemporal analysis

BACKGROUND

Opioid-related overdose deaths are the top accidental cause of death in the United States, and development of regional strategies to address this epidemic should begin with a better understanding of where and when overdoses are occurring.

METHODS AND FINDINGS

In this study, we relied on emergency medical services data to investigate the geographical and temporal patterns in opioid-suspected overdose incidents in one of the largest and most ethnically diverse metropolitan areas (Houston Texas). Using a cross sectional design and Bayesian spatiotemporal models, we identified zip code areas with excessive opioid-suspected incidents, and assessed how the incidence risks were associated with zip code level socioeconomic characteristics. Our analysis suggested that opioid-suspected overdose incidents were particularly high in multiple zip codes, primarily south and central within the city. Zip codes with high percentage of renters had higher overdose relative risk (RR = 1.03; 95% CI: [1.01, 1.04]), while crowded housing and larger proportion of white citizens had lower relative risks (RR = 0.9; 95% CI: [0.84, 0.96], RR = 0.97, 95% CI: [0.95, 0.99], respectively).

CONCLUSIONS

Our analysis illustrated the utility of Bayesian spatiotemporal models in assisting the development of targeted community strategies for local prevention and harm reduction efforts.

Perspective on the "African American participation in Alzheimer disease research: Effective strategies" workshop, 2018

The Washington University School of Medicine Knight Alzheimer Disease Research Center's "African American Participation in Alzheimer Disease Research: Effective Strategies" Workshop convened to address a major limitation of the ongoing scientific progress regarding Alzheimer's disease and related dementias (ADRD): participants in most ADRD research programs overwhelmingly have been limited to non-Hispanic white persons, thus precluding knowledge as to how ADRD may be represented in non-white individuals. Factors that may contribute to successful recruitment and retention of African Americans into ADRD research were discussed and organized into actionable next steps as described within this report.

Dementia Caregiving Research: Expanding and Reframing the Lens of Diversity, Inclusivity, and Intersectionality

This forum expands and reframes the lens of dementia caregiving research among diverse racial and ethnic groups to better understand the unique needs, stressors, and strengths of multicultural and racial-ethnic family caregivers in the United States. By providing more diverse and inclusive knowledge on caregiving to older adults in the United States, we can create a new path forward with regards to caregiving research. Throughout the article, major questions and answers are supported by critiquing some of the caregiving literature. Discussions are provided to help create inclusive ways of conceptualizing caregiving research and using methodological approaches to reflect the diversity of caregivers and care recipients in the United States. Expanding and reframing the conceptual and methodological lens of diversity, inclusivity and intersectionality can provide evidence to support effective policy, practice, and care in addressing the needs of diverse groups of caregivers and older adults living with dementia.

Identifying Cohabiting Couples in Administrative Data: Evidence from Medicare Address Data

Marital status is recognized as an important social determinant of health, income, and social support, but is rarely available in administrative data. We assessed the feasibility of using exact address data and zip code history to identify cohabiting couples using the 2018 Medicare Vital Status file and ZIP codes in the 2011-2014 Master Beneficiary Summary Files. Medicare beneficiaries meeting our algorithm displayed characteristics consistent with assortative mating and resembled known married couples in the Health and Retirement Study linked to Medicare claims. Address information represents a promising strategy for identifying cohabiting couples in administrative data including healthcare claims and other data types.

Disparities in patient-centered communication for Black and Latino men in the U.S.: Cross-sectional results from the 2010 health and retirement study

BACKGROUND

A lack of patient-centered communication (PCC) with health providers plays an important role in perpetuating disparities in health care outcomes and experiences for minority men. This study aimed to identify factors associated with any racial differences in the experience of PCC among Black and Latino men in a nationally representative sample.

METHODS

We employed a cross-sectional analysis of four indicators of PCC representative of interactions with doctors and nurses from (N = 3082) non-Latino White, Latino, and Black males from the 2010 Health and Retirement Study (HRS) Core and the linked HRS Health Care Mail in Survey (HCMS). Men's mean age was 66.76 years. The primary independent variable was Race/Ethnicity (i.e. Black and Hispanic/Latino compared to white males) and covariates included age, education, marital status, insurance status, place of care, and self-rated health.

RESULTS

Bivariate manova analyses revealed racial differences across each of the four facets of PCC experience such that non-Hispanic white men reported PC experiences most frequently followed by black then Hispanic/Latino men. Multivariate linear regressions predictive of PCC by race/ethnicity revealed that for Black men, fewer PCC experiences were predicted by discriminatory experiences, reporting fewer chronic conditions and a lack of insurance coverage. For Hispanic/Latino men, access to a provider proved key where not having a place of usual care solely predicted lower PCC frequency.

IMPLICATIONS

Researchers and health practitioners should continue to explore the impact of inadequate health care coverage, time-limited medical visits and implicit racial bias on medical encounters for underrepresented patients, and to advocate for accessible, inclusive and responsive communication between minority male patients and their health providers.

Perceived Discrimination Trajectories and Depressive Symptoms Among Middle-Aged and Older Black Adults

BACKGROUND AND OBJECTIVES

Perceived discrimination is a risk factor for poor mental health. However, most studies measure discrimination at one time point, which does not account for heterogeneity in the cumulative patterning of exposure to discrimination. To address this gap, we examine the association between discrimination trajectories and depressive symptoms among black middle-aged and older adults.

RESEARCH DESIGN AND METHODS

Data were analyzed from a subsample of black Health and Retirement Study respondents (2006-2018, N = 2926, older than 50 years). General discrimination and racial discrimination trajectories were constructed based on the Everyday Discrimination Scale using repeated measures latent profile analyses. We examined the extent to which the association between discrimination trajectories are differentially associated with depressive symptoms (8-item Center for Epidemiological Studies-Depression scale) using negative binomial regression models adjusted for potential confounders. Effect modification by age and gender was tested.

RESULTS

Individuals in the persistently high (incident rate ratio [IRR]: 1.70; 95% confidence interval [CI]: 1.49-1.95) and moderate general discrimination trajectories (IRR: 1.19; 95% CI: 1.06-1.33) were more likely to have elevated depressive symptoms in comparison to those in the persistently low trajectory. This relationship was strongest among older adults aged older than 65 years. Respondents in the persistently high racial discrimination trajectory (IRR: 1.50; 95% CI: 1.29-1.73) had a higher risk of elevated depressive symptoms in comparison to respondents in the persistently low trajectory. Sensitivity analyses indicated that there was an independent association between persistently high racial discrimination trajectory class and elevated depressive symptoms, after adjusting for racial discrimination measured at a single time point.

DISCUSSION AND IMPLICATIONS

Characterizing longitudinal patterns of perceived discrimination may facilitate the stratification of mental health risk and vulnerability among black middle-aged and older adults. Trajectories of racial discrimination may inform risk of worse depressive symptoms more accurately than a single assessment of discrimination.

Gender Differences in Cognitive Function among Older Mexican Immigrants

This paper uses data from the Health and Retirement Study (HRS) and the Mexican Health and Aging Study (MHAS) to study the cognitive function of Mexican-born older adults residing in the United States (Mexican immigrants). We find that, once differences in socioeconomic factors are accounted for, the cognitive function of male Mexican immigrants is statistically indistinguishable from that of male non-Hispanic (NH) whites, but the cognitive scores of female Mexican immigrants remain significantly below those of their NH white counterparts. We explore four potential hypotheses that may explain the cognition gap for female Mexican immigrants. Namely, we investigate whether the relative incidence of risk factors for dementia, when compared to NH whites, is higher for female than for male Mexican immigrants (the "risk factor hypothesis"); whether the mortality rate of male Mexican immigrants with low cognition is higher, relative to their white counterparts, than that of female Mexican immigrants (the "survival bias hypothesis"); whether female Mexican immigrants are less positively selected than their male counterparts in terms of predisposition to cognitive decline when compared with either the non-migrant Mexican population or the population of return migrants (the "differential selection hypothesis"); and whether male immigrants are better acculturated to life in the United States than female immigrants (the "acculturation hypothesis). We find no support for the risk-factor, survival, or acculturation hypotheses but we find evidence suggesting that the differential selection hypothesis may explain part of the female cognitive gap. Our results imply that older Mexican females currently residing in the U.S. may be at elevated risk for dementia and should be targeted by campaigns aimed at preventing or diagnosing the condition.

Retaining Hispanics: Lessons From the Hispanic Community Health Study/Study of Latinos

We aimed to examine the retention of Hispanics/Latinos participating in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a prospective cohort study of 16,415 adults in 4 US cities who were enrolled between 2008 and 2011. We summarized retention strategies and examined contact, response, and participation rates over 5 years of annual follow-up interviews. We then evaluated motivations for participation and satisfaction with retention efforts among participants who completed a second in-person interview approximately 6 years after their baseline interview. Finally, we conducted logistic regression analyses estimating associations of demographic, health, and interview characteristics at study visit 1 (baseline) with participation, high motivation, and high satisfaction at visit 2. Across 5 years, the HCHS/SOL maintained contact, response, and participation rates over 80%. The most difficult Hispanic/Latino populations to retain included young, single, US-born males with less than a high school education. At visit 2, we found high rates of motivation and satisfaction. HCHS/SOL participants primarily sought to help their community and learn more about their health. High rates of retention of Hispanics/Latinos can be facilitated through the employment of bilingual/bicultural staff and the development of culturally tailored retention materials.

Racial Disparities in Stroke Recovery Persistence in the Post-Acute Stroke Recovery Phase: Evidence from the Health and Retirement Study

Background and Purpose

Blacks have a higher burden of post-stroke disability. Factors associated with racial differences in long-term post-stroke disability are not well-understood. Our aim was to assess the long-term racial differences in risk factors associated with stroke recovery.

Methods

We examined Health and Retirement Study (HRS) longitudinal interview data collected from adults living with stroke who were aged >50 years during 2000-2014. Analysis of 1,002 first-time, non-Hispanic, Black (210) or White (792) stroke survivors with data on activities of daily living (ADL), fine motor skills (FMS) and gross motor skills (GMS) was conducted. Ordinal regression analysis was used to assess the impact of sex, race, household residents, household income, comorbidities, and the time since having a stroke on functional outcomes.

Results

Black stroke survivors were younger compared with Whites (69 ± 10.4 vs 75 ± 11.9). The majority (~65%) of Black stroke survivors were female compared with about 54% White female stroke survivors (P=.007). Black stroke survivors had more household residents (P<.001) and comorbidities (P<.001). Aging, being female, being Black and a longer time since stroke were associated with a higher odds of having increased difficulty in ADL, FMS and/or GMS. Comorbidities were associated with increased difficulty with GMS. Black race increased the impact of comorbidities on ADL and FMS in comparison with Whites.

Conclusion

Our data suggest that the effects of aging, sex and unique factors associated with race should be taken into consideration for future studies of post-stroke recovery and therapy.

General Health Care Utilization Among Nonelderly Cancer Survivors Before and After Affordable Care Act Implementation: Early Results

PURPOSE

The number of nonelderly cancer survivors is expected to grow and so are their health care costs. Many cancer survivors worry about medical bills. This study examined the impact of the Affordable Care Act (ACA) on the rate of insurance, average annual health care expenditure, and patient care experience among cancer survivors and investigated the patient characteristics that were associated with highly rated care experiences before and after ACA implementation.

METHODS

The study is a cross-sectional analysis of adult, nonelderly cancer survivors in the 2011 and 2016 Medical Expenditure Panel Survey who completed health care experience questionnaires. Percent covered by insurance both before and after the ACA was calculated, including total out-of-pocket (OOP) expenses as a percentage of overall health care expenditure per patient. Regression was performed to determine characteristics associated with patient experience ratings.

RESULTS

Health insurance coverage for cancer survivors was higher in 2016 than in 2011 (98.4% v 94.4%; P = .006). OOP spending as a percentage of health care expenditure among those with expenses decreased and was most striking in those with no insurance. Privately insured individuals were 3 times as likely to rate their care experience high compared with those with no insurance (odds ratio, 3.31; P < .0001). Those with above-average ratings of self-health and with few comorbidities rated their care experiences highly.

CONCLUSION

After the ACA, OOP costs have decreased for all types of insurance coverage. The association between patient experience and health status warrants additional study to better manage and coordinate the care of such patients.

Do Race and Everyday Discrimination Predict Mortality Risk? Evidence From the Health and Retirement Study

Everyday discrimination is a potent source of stress for racial minorities, and is associated with a wide range of negative health outcomes, spanning both mental and physical health. Few studies have examined the relationships linking race and discrimination to mortality in later life. We examined the longitudinal association among race, everyday discrimination, and all-cause mortality in 12,081 respondents participating in the Health and Retirement Study. Cox proportional hazards models showed that everyday discrimination, but not race, was positively associated with mortality; depressive symptoms and lifestyle factors partially accounted for the relationship between everyday discrimination and mortality; and race did not moderate the association between everyday discrimination and mortality. These findings contribute to a growing body of evidence on the role that discrimination plays in shaping the life chances, resources, and health of people, and, in particular, minority members, who are continuously exposed to unfair treatment in their everyday lives.

Association of Parenthood With Incident Heart Disease in United States' Older Men and Women: A Longitudinal Analysis of Health and Retirement Study Data

Objective: To examine the association of number of children birthed/fathered with incident heart disease, accounting for socioeconomic and lifestyle characteristics. Methods: We analyzed data from 24,923 adults 50 and older (55% women) in the Health and Retirement Study. Participants self-reported number of children and doctor-diagnosed incident heart disease. Cox proportional hazards models estimated heart disease risk. Results: Compared to women with one to two children, those with five or more had increased risk of heart disease (hazard ratio [HR] = 1.13, 95% confidence interval [CI] = [1.03, 1.25]). Compared to men with one to two children, those with five or more had a marginally increased risk of heart disease (HR = 1.11, 95% CI = [0.99, 1.25]), but this association attenuated in models adjusting for socioeconomic and lifestyle variables. Compared to men with no children, those with five or more retained a borderline significant association in the fully adjusted model (HR = 1.15, 95% CI = [0.99, 1.35]). Discussion: Social and lifestyle pathways appear to link parenthood to cardiovascular health.

Depressive Symptoms Among Aging Hispanic Americans: Longitudinal Effects of Positive Spousal Support and Previous Depressive Symptoms

Objective: We aimed to investigate the longitudinal effects of spousal support on aging Hispanic Americans' depressive symptoms using population-based data from the Health and Retirement Study (HRS). Method: Using hierarchical multiple regressions, we investigated whether baseline positive spousal support and previous depressive symptoms were significant predictors of depressive symptoms 8 years later in a sample of 264 aging Hispanic Americans. Results: We discovered that previous depressive symptoms, baseline chronic conditions, and positive spousal support were all significant predictors of long-term depressive symptoms. Discussion: Our findings underline the need to address persistent depression and chronic diseases in the aging Hispanic population. We also highlight the potential benefits of empowering spouses as a resource for promoting mental health in this group. These findings are also encouraging for future studies in depression, aging, and comorbidity, especially in the vastly increasing population of aging Hispanic Americans.

Racial and ethnic differences in trends in dementia prevalence and risk factors in the United States

INTRODUCTION

Disparities in dementia prevalence across racial/ethnic groups in the United States may not be narrowing over time.

METHODS

Data from Health and Retirement Study (2000 to 2012) were analyzed. Dementia was ascertained based on cognitive, functional measures. Logistic regression was used to quantify association between dementia and risk factors, including chronic conditions, use of drug treatment for them, separately for whites, blacks, and Hispanics.

RESULTS

Disparities in dementia prevalence declined between blacks and whites and increased between Hispanics and whites. Adjusting for risk factors reduced but did not eliminate disparities. Compared to no hypertension, untreated hypertension was associated with increased risk of dementia for all racial/ethnic groups while treated hypertension was associated with reduced risk for whites. Diabetes treated with oral drugs was not associated with increased dementia risk.

DISCUSSION

Racial disparities in dementia may be reduced by prevention and management of disease and promoting educational attainment among blacks and Hispanics.

Understanding the Racial/Ethnic Gap in Bank Account Ownership among Older Adults

The observed racial/ethnic gap in bank account ownership among older adults is substantial. We investigate socioeconomic, cognitive, and cultural barriers underling it. As additional potential barriers are accounted for, the residual gaps in financial inclusion with respect to Whites are reduced by 19% for blacks and 46% for Hispanics. We find that citizenship and "taste for privacy" play a limited role for both minority groups, while real asset ownership, health, cognitive ability, and cultural hurdles contribute substantially to the gap. For Hispanics, language barriers explain most of the gap, while neighborhood-level socioeconomic characteristics are more salient for blacks. We also examine how the racial/ethnic composition of couples influences financial decisions. We estimate a significantly smaller residual gap between "mixed" and white couples than between minority and white couples. We provide empirical evidence suggesting that, other things equal, mixed couples are less concerned with the cultural/psychological barriers facing minority couples.

Overweight or obese BMI is associated with earlier, but not later survival after common acute illnesses

Background

Obesity has been associated with improved short-term mortality following common acute illness, but its relationship with longer-term mortality is unknown.

Methods

Observational study of U.S. Health and Retirement Study (HRS) participants with federal health insurance (fee-for-service Medicare) coverage, hospitalized with congestive heart failure (N = 4287), pneumonia (N = 4182), or acute myocardial infarction (N = 2001), 1996–2012. Using cox proportional hazards models, we examined the association between overweight or obese BMI (BMI ≥ 25.0 kg/m²) and mortality to 5 years after hospital admission, adjusted for potential confounders measured at the same time as BMI, including age, race, sex, education, partnership status, income, wealth, and smoking status. Body mass index (BMI) was calculated from self-reported height and weight collected at the HRS survey prior to hospitalization (a median 1.1 year prior to hospitalization). The referent group was patients with a normal BMI (18.5 to < 25.0 kg/m²).

Results

Patients were a median of 79 years old (IQR 71–85 years). The majority of patients were overweight or obese: 60.3% hospitalized for heart failure, 51.5% for pneumonia, and 61.6% for acute myocardial infarction. Overweight or obese BMI was associated with lower mortality at 1 year after hospitalization for congestive heart failure, pneumonia, and acute myocardial infarction—with adjusted hazard ratios of 0.68 (95% CI 0.59–0.79), 0.74 (95% CI: 0.64–0.84), and 0.65 (95%CI: 0.53–0.80), respectively. Among participants who lived to one year, however, subsequent survival was similar between patients with normal versus overweight/obese BMI.

Conclusions

In older Americans, overweight or obese BMI was associated with improved survival following hospitalization for congestive heart failure, pneumonia, and acute myocardial infarction. This association, however, is limited to the shorter-term. Conditional on surviving to one year, we did not observe a survival advantage associated with excess weight.

Electronic supplementary material

The online version of this article (10.1186/s12877-018-0726-2) contains supplementary material, which is available to authorized users.

Engaging African Americans in Research: The Recruiter's Perspective

Purpose

To examine barriers recruiters encounter when enrolling African American study participants, identify motivating factors to increase research participation, and provide recommendations to facilitate successful minority recruitment.

Background

Recruiters are often the first point of contact between the research study and potential African American participants. While challenges in enrolling African Americans into clinical and epidemiologic research has been reported in numerous studies the non-physician recruiter's role as a determinant of overall participation rates has received minimal attention.

Methods

We conducted four 90-minute teleconference focus groups with 18 recruiters experienced in enrolling African Americans for clinical and epidemiologic studies at five academic/medical institutions. Participants represented diverse racial and ethnic backgrounds and were asked to reflect on barriers preventing African Americans from participating in research studies, factors that motivated participation, and recommendations to increase participation of African Americans in research. Multi-coder and thematic data analysis was implemented using the Braun and Clarke method.

Results

Prominent concerns in recruitment of African Americans in research include fear and mistrust and inflexible research protocols. The participants suggest that improved recruitment could be achieved through cross-cultural and skillset building training opportunities for recruiters, greater community engagement among researchers, and better engagement with clinic staff and research teams.

Late mortality after acute hypoxic respiratory failure

BACKGROUND

Acute hypoxic respiratory failure (AHRF) is associated with significant acute mortality. It is unclear whether later mortality is predominantly driven by pre-existing comorbid disease, the acute inciting event or is the result of AHRF itself.

METHODS

Observational cohort study of elderly US Health and Retirement Study (HRS) participants in fee-for-service Medicare (1998-2012). Patients hospitalised with AHRF were matched 1:1 to otherwise similar adults who were not currently hospitalised and separately to patients hospitalised with acute inciting events (pneumonia, non-pulmonary infection, aspiration, trauma, pancreatitis) that may result in AHRF, here termed at-risk hospitalisations. The primary outcome was late mortality-death in the 31 days to 2 years following hospital admission.

RESULTS

Among 15 075 HRS participants, we identified 1268 AHRF and 13 117 at-risk hospitalisations. AHRF hospitalisations were matched to 1157 non-hospitalised adults and 1017 at-risk hospitalisations. Among patients who survived at least 30 days, AHRF was associated with a 24.4% (95%CI 19.9% to 28.9%, p<0.001) absolute increase in late mortality relative to adults not currently hospitalised and a 6.7% (95%CI 1.7% to 11.7%, p=0.01) increase relative to adults hospitalised with acute inciting event(s) alone. At-risk hospitalisation explained 71.2% of the increased odds of late mortality, whereas the development of AHRF itself explained 28.8%. Risk for death was equivalent to at-risk hospitalisation beyond 90 days, but remained elevated for more than 1 year compared with non-hospitalised controls.

CONCLUSIONS

In this national sample of older Americans, approximately one in four survivors with AHRF had a late death not explained by pre-AHRF health status. More than 70% of this increased risk was associated with hospitalisation for acute inciting events, while 30% was associated with hypoxemic respiratory failure.

Sociodemographic disparities in chronic pain, based on 12-year longitudinal data

Existing estimates of sociodemographic disparities in chronic pain in the United States are based on cross-sectional data, often treat pain as a binary construct, and rarely test for nonresponse or other types of bias. This study uses 7 biennial waves of national data from the Health and Retirement Study (1998-2010; n = 19,776) to describe long-term pain disparities among older (age 51+) American adults. It also investigates whether pain severity, reporting heterogeneity, survey nonresponse, and/or mortality selection might bias estimates of social disparities in pain. In the process, the article clarifies whether 2 unexpected patterns observed cross-sectionally-plateauing of pain above age 60, and lower pain among racial/ethnic minorities-are genuine or artefactual. Findings show high prevalence of chronic pain: 27.3% at baseline, increasing to 36.6% thereafter. Multivariate latent growth curve models reveal extremely large disparities in pain by sex, education, and wealth, which manifest primarily as differences in intercept. Net of these variables, there is no racial/ethnic minority disadvantage in pain scores, and indeed a black advantage vis-à-vis whites. Pain levels are predictive of subsequent death, even a decade in the future. No evidence of pain-related survey attrition is found, but surveys not accounting for pain severity and reporting heterogeneity are likely to underestimate socioeconomic disparities in pain. The lack of minority disadvantage (net of socioeconomic status) appears genuine. However, the age-related plateauing of pain observed cross-sectionally is not replicated longitudinally, and seems partially attributable to mortality selection, as well as to rising pain levels by birth cohort.

Are distinctive risk indicators associated with different stages of caries in children? A cross-sectional study

Background

Actual caries figures emphasize the need to identify the risk indicators involved in the disease’s development. The hypothesis that certain risk indicators might affect the dynamic evolution of the caries process was assessed; to clarify this premise, a cross-sectional survey was performed in school children.

Methods

A total of 390 subjects aged 6–8 years old were randomly selected. Caries was assessed, and the subjects were stratified as follows: i) highest caries score; ii) most prevalent caries score; and iii) number of affected teeth. Parents/guardians completed a questionnaire regarding vital statistics, socio-economic indicators, dietary habits, oral hygiene habits and oral health behaviours.

Results

Caries was detected in 42.31% of the subjects. Maternal nationality, parental education level, use of a sweetened pacifier at night, intake of lactose-free milk and toothbrushing frequency were statistically significant associated (p < 0.05) with subjects stratified according to the highest caries score. Parental educational level, maternal occupational status and use of a sweetened pacifier at night were associated (p < 0.05) with affected children stratified according to the most prevalent caries score. Maternal educational level and intake of lactose-free milk were associated with subjects with moderate caries stages compared to being caries-free (p = 0.01 and p = 0.02, respectively). Maternal nationality (p < 0.01) and toothbrushing frequency (p = 0.01) were associated with subjects affected by extensive lesions compared to caries-free children. In subjects affected by initial lesions as the most prevalent figure, gender (male) and paternal occupation status (unemployed) were statistically significant associated (p = 0.03 and p = 0.04, respectively) compared to those affected by highest prevalence of extensive caries lesions. In children with the highest prevalence of moderate caries lesions, maternal education level (p < 0.01), paternal occupational status (p = 0.03) and use of a sweetened pacifier at night (p < 0.01) were statistically significantly associated.

Conclusions

Maternal nationality, maternal low level of education, intake of lactose-free milk and low toothbrushing frequency were involved in the change from caries-free status to different caries stages. Gender, paternal unemployment, maternal low educational level and use of a sweetened pacifier were correlated with caries progression, showing how distinctive risk indicators were associated with different caries stages.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3865-4) contains supplementary material, which is available to authorized users.

Cranial Magnetic Resonance Imaging in Elderly American Indians: Design, Methods, and Implementation of the Cerebrovascular Disease and Its Consequences in American Indians Study

The Cerebrovascular Disease and its Consequences in American Indians (CDCAI) Study recruited surviving members of a 20-year, longitudinal, population-based cohort of American Indians focused on cardiovascular disease, its risk factors, and its consequences. The goal of the CDCAI Study is to characterize the burden, risk factors, and manifestations of vascular brain injury identified on cranial MRI. The CDCAI Study investigators enrolled 1,033 participants aged 60 and older from 11 American Indian communities and tribes in the Northern Plains, Southern Plains, and Southwestern United States. In addition to cranial MRI performed according to standardized protocols, participants underwent extensive medical interview, clinical examination, neurocognitive testing, physical function evaluation, electrocardiogram, and provided blood and urine specimens. Participants also self-administered questionnaires covering demographics, quality of life, and medical history. This report describes the design, implementation, and some of the unique challenges of this study and data collection.

Racial and ethnic differences in cognitive function among older adults in the USA

OBJECTIVE

Examine differences in cognition between Hispanic, non-Hispanic black (NHB), and non-Hispanic white (NHW) older adults in the United States.

DATA/METHODS

The final sample includes 18 982 participants aged 51 or older who received a modified version of the Telephone Interview for Cognitive Status during the 2010 Health and Retirement Study follow-up. Ordinary least squares will be used to examine differences in overall cognition according to race/ethnicity.

RESULTS

Hispanics and NHB had lower cognition than NHW for all age groups (51-59, 60-69, 70-79, 80+). Hispanics had higher cognition than NHB for all age groups but these differences were all within one point. The lower cognition among NHB compared to NHW remained significant after controlling for age, gender, and education, whereas the differences in cognition between Hispanics and NHW were no longer significant after controlling for these covariates. Cognitive scores increased with greater educational attainment for all race/ethnic groups, but Hispanics exhibited the least benefit.

DISCUSSION

Our results highlight the role of education in race/ethnic differences in cognitive function during old age. Education seems beneficial for cognition in old age for all race/ethnic groups, but Hispanics appear to receive a lower benefit compared to other race/ethnic groups. Further research is needed on the racial and ethnic differences in the pathways of the benefits of educational attainment for late-life cognitive function. Copyright © 2016 John Wiley & Sons, Ltd.

Childhood cancer survivorship research in minority populations: A position paper from the Childhood Cancer Survivor Study

By the middle of this century, racial/ethnic minority populations will collectively constitute 50% of the US population. This temporal shift in the racial/ethnic composition of the US population demands a close look at the race/ethnicity-specific burden of morbidity and premature mortality among survivors of childhood cancer. To optimize targeted long-term follow-up care, it is essential to understand whether the burden of morbidity borne by survivors of childhood cancer differs by race/ethnicity. This is challenging because the number of minority participants is often limited in current childhood cancer survivorship research, resulting in a paucity of race/ethnicity-specific recommendations and/or interventions. Although the overall childhood cancer incidence increased between 1973 and 2003, the mortality rate declined; however, these changes did not differ appreciably by race/ethnicity. The authors speculated that any racial/ethnic differences in outcome are likely to be multifactorial, and drew on data from the Childhood Cancer Survivor Study to illustrate the various contributors (socioeconomic characteristics, health behaviors, and comorbidities) that could explain any observed differences in key treatment-related complications. Finally, the authors outlined challenges in conducting race/ethnicity-specific childhood cancer survivorship research, demonstrating that there are limited absolute numbers of children who are diagnosed and survive cancer in any one racial/ethnic minority population, thereby precluding a rigorous evaluation of adverse events among specific primary cancer diagnoses and treatment exposure groups. Cancer 2016;122:2426-2439. © 2016 American Cancer Society.

Predictors of New Onset Sleep Medication and Treatment Utilization Among Older Adults in the United States

BACKGROUND

Sleep disturbances are common among older adults resulting in frequent sleep medication utilization, though these drugs are associated with a number of risks. We examine rates and predictors of new prescription sleep medications and sleep treatments, as well as sleep treatments without a doctor's recommendation.

METHODS

Participants were 8,417 adults aged 50 and older from two waves of the nationally representative Health and Retirement Study (HRS) who were not using a sleep medication or treatment at baseline (2006). Logistic regression analyses are run with sociodemographic, health, and mental health factors as predictors of three outcomes: new prescription medication use, sleep treatment use, and sleep treatment out of a doctor's recommendation in 2010.

RESULTS

New sleep medication prescriptions were started by 7.68%, 12.62% started using a new sleep treatment, and 31.93% were using the treatment outside of their doctor's recommendation. Common predictors included greater severity of insomnia, worsening insomnia, older age, and use of psychiatric medications. New prescription medication use was also associated with poorer mental and physical health, whereas new sleep treatment was associated with being White, higher educated, and drinking less alcohol.

CONCLUSIONS

Starting a new prescription sleep medication may reflect poorer health and higher health care utilization, whereas beginning a sleep treatment may reflect an individual's awareness of treatments and determination to treat their problem. Clinicians should be aware of predictors of new sleep medication and treatment users and discuss various forms of treatment or behavioral changes to help patients best manage sleep disturbance.