Mortality risk in older inner-city African Americans

Self-rated health trajectories in the African American health cohort

BACKGROUND

Self-rated health taps health holistically and dynamically blends prior health histories with current illness burdens and expectations for future health. While consistently found as an independent predictor of functional decline, sentinel health events, physician visits, hospital episodes, and mortality, much less is known about intra-individual changes in self-rated health across the life course, especially for African Americans.

MATERIALS/METHODS

Data on 998 African American men and women aged 50-64 years old were taken from a probability-based community sample that was first assessed in 2000-2001 and re-assessed 1, 2, 3, 4, 7, and 9 years later. Using an innovative approach for including decedents in the analysis, semi-parametric group-based mixture models were used to identify person-centered group trajectories of self-rated health over time. Multivariable multinomial logistic regression analysis was then used to differentiate the characteristics of AAH participants classified into the different group trajectories.

RESULTS

Four self-rated health group trajectories were identified: persistently good health, good but declining health, persistently fair health, and fair but declining health. The main characteristics that differentiated the self-rated health trajectory groups from each other were age, education, smoking, morbidity (angina, congestive heart failure, diabetes, and kidney disease), having been hospitalized in the year prior to baseline, depressive symptoms, mobility limitations, and initial self-rated health.

CONCLUSIONS

This is the first study to examine self-rated health trajectories separately among African Americans. Four qualitatively distinct self-rated health group trajectories were identified that call into question the accuracy of prior reports that a single, average self-rated health trajectory for African Americans adequately captures their within-group heterogeneity.

Testosterone is not associated with mortality in older African-American males

INTRODUCTION. Although testosterone and its association with disease progression and mortality is a widely studied topic, no studies have evaluated mortality risks related to testosterone levels in an older African-American population. The mechanisms for known racial differences in mortality risk for certain cancers and cardiovascular risk factors are largely unknown. Elucidating a mortality risk associated with testosterone levels may give insight into the elevated risk for certain diseases in African-Americans. METHODS AND RESULTS. Study data were derived from a cohort 622 African-Americans (age 80.05  ±  6.4, range 68-102) from Saint Louis, Missouri that includes 190 males (age 79.38  ±  6.2, range 70-102). The eligible sample for this report includes 56 of the 190 males (age 78.89  ±  6.9, range 70-102) who donated blood at baseline in 1992-1994 and subsequently tested for total testosterone and bioavailable testosterone. Covariates for adjusted analyses were lower body functional limitations, physician visits and comorbidities, also collected at baseline. Males' mean bioavailable testosterone levels (ng/dl) were 33.33  ±  24.4 (n above 70 ng/dl = 5) and mean total testosterone levels (ng/dl) were 246.63  ±  118.7 (n above 300 ng/dl = 20). Vital status was determined through 2002; 41 males (73%) were deceased and 15 were alive. Mortality did not differ among males with testosterone levels <300 versus 300+ (p = 0.42) or with bioavailable testosterone levels <70 versus > 70 (p  =  0.34). Total testosterone levels did not predict mortality when adjusted for age (Adjusted Hazard Ratio [AHR] = 0.998; 95% confidence interval [CI] 0.995-1.001; p = 0.28) or adjusted for age and other covariates (AHR  =  0.099; 95% CI 0.996, 1.002; p  =  0.35). Bioavailable testosterone levels did not predict mortality when adjusted for age (AHR  =  0.992; 95% CI .977-1.007; p  =  0.30) or when adjusted for age and other covariates (AHR 0.991; 95% CI .976-1.006; p  =  0.261). CONCLUSION. In older African-American males, total and bioavailable testosterone levels, with and without adjustment for covariates, are not independently associated with mortality risk.

The influence of chronic disease, physical function, and lifestyle on health transition among the middle-aged and older persons in Taiwan

The purpose of this study was to examine the influence of chronic disease, physical function, and lifestyle on health transitions among the middle-aged and older persons in Taiwan. A longitudinal design was applied to investigate whether chronic disease, physical function, and lifestyle were associated significantly with health transition in this population. Data on participants were obtained from the Survey of Health and Living Status of the Middle Aged and Elderly in Taiwan, a study initially conducted in 1999 that encompassed observations on 2,130 individuals 53 years and older. Data were collected again in 2003 to capture the health transition. A binary probit model was used to determine relationships between health transition and sociodemographic factors, chronic disease, physical functional ability, and lifestyle conditions by gender. Principal empirical results confirmed that, after controlling for potentially confounding variables, those participants who were relatively younger and had higher education levels were more likely to maintain good health during the study period (1999-2003) for both men and women. In addition, when other factors were excluded, this article identified stroke as the ailment most strongly associated with continuing good health. Similarly, activities of daily living and instrumental activities of daily living demonstrated significant and negative effects on continuing good health regardless of gender. However, lifestyle rendered interesting and plausible findings. Smoking showed a significant influence on health transition for women but an insignificant influence on such for men. Regular exercise showed significance for both men and women. Findings suggest that chronic disease, physical functional ability, and lifestyle variables have strong and significant influences on health transition for the middle-aged and older persons. Research results should be useful in developing strategies that target disease care services and lifestyles for the target group.

Health through the urban lens

Cities are now the major sites of human habitation worldwide, a trend that will continue for the foreseeable future, not only in the developed world but in developing countries. Urban residence impacts health and health prospects both positively and negatively through a complex mix of exposures and mechanisms. In addition, cities concentrate population subsets of various demographic, economic, and social characteristics, some with particular health risks and vulnerabilities. Looking at health through the urban lens allows increased understanding of disparate risks and emphasizes the essentiality of collaborative efforts in protecting and enhancing the health of populations, especially those living in cities.