Measuring Cognitive Function and Cognitive Decline with Response Time Data in NSHAP

OBJECTIVES

Scholarly, clinical, and policy interest in cognitive function has grown over the last several decades in part due to large increases in Alzheimer's Disease and related dementias as populations age. However, adequate measures of cognitive function have not been available in many research data sets. We argue that a wealth of previously unexploited survey data exists to model cognition and cognitive decline.

METHODS

We use metadata of the time it takes older respondents in the National Social Life, Health and Aging Survey, which we label response times (RT), to answer questions in a standard cognitive assessment. We compare several measures of RT to a survey-adapted form of the Montreal Cognitive Assessment (MoCA).

RESULTS

We show that RT predict both concurrent and future MoCA scores. Our results show that longer and more varied RT at baseline predict lower MoCA scores five year later, net of baseline scores and controls. We also show that the effect of RT measures on predicting current MoCA differ for individuals of different races and ages, but are not different by gender.

DISCUSSION

Our paper demonstrates that RT constitute a separate powerful measure of cognitive functioning. RT may be remarkably useful both to clinicians and social scientists because they can increase accuracy of cognitive assessment without increasing the time it takes to administer the assessment.

Moderation of associations between weight discrimination and diabetes status by psychosocial factors

Weight discrimination has adverse effects on health that include increasing the risk factors for developing type 2 diabetes. Preliminary evidence suggests a positive association between weight discrimination and diagnosed diabetes; however, it is unknown whether psychosocial resources may buffer this association. In logistic regressions stratified by gender, we examined links between weight discrimination and diabetes among a nationally representative sample of U.S. adults (the National Social Life, Health, and Aging Project; N = 2,794 adults age 50 and older in 2015-16). We also tested the extent to which trait-resilience and social support from a spouse/partner, family, and friends buffered any observed association. We adjusted for known predictors of diabetes (age, race/ethnicity, Body Mass Index) and conducted sensitivity analyses restricted to men and women with obesity. Net of covariates, in the overall sample, weight discrimination was associated with significantly greater odds of having ever had diabetes among women (OR = 2.00, 95% CI [1.15, 3.47]), but not men. Among women with obesity, weight discrimination was only significantly associated with greater odds of diabetes for those with low resilience (OR = 1.84, 95% CI [1.01, 3.35]). Among men overall, weight discrimination was associated with lower odds of diabetes for those with high family support (OR = 0.03, 95% CI [0.003, 0.25]) as well as those with high friend support (OR = 0.34, 95% CI [0.13, 0.91]); similar effects were observed in men with obesity. These novel findings evince a role for psychosocial resources in buffering associations between weight discrimination and diabetes.

Racial and ethnic disparities in short interval pregnancy following delivery in Catholic vs non-Catholic hospitals among California Medicaid enrollees

OBJECTIVES

We examined the impact of Catholic hospital delivery on short interval pregnancy in the California 2010-2014 Medicaid population.

STUDY DESIGN

We used Cox regression to estimate the association between hospital affiliation and short interval pregnancy, adjusting for patient factors.

RESULTS

Catholic hospital delivery had increased the risk of pregnancy within 6 months for Black (hazard ratio [HR] 1.11, 95% CI 1.06, 1.17) and Hispanic (HR 1.07, 95% CI 1.05, 1.09) but not for White women (HR 1.02, 95% CI 0.98, 1.05).

CONCLUSIONS

Among California women with Medicaid, Catholic hospital delivery was associated with short interval pregnancy only among women of color.

Relating depression, anxiety, stress and loneliness to 5-year decline in physical function and frailty

OBJECTIVES

While depression has been associated with physical function decline and worsening frailty in older adults, the impact of other mental health symptoms on physical function and frailty is unknown. The study objective was to determine whether depression, perceived stress, loneliness, and anxiety symptoms affect 5-year physical function and frailty trajectories of older adults.

METHODS

The National Social Life, Health, and Aging Project (NSHAP) is a nationally-representative study of adults born between 1920 and 1947. The analysis included data collected in 2010-11 and 2015-16. Mental health symptoms were quantified using NSHAP's measures of anxiety (range:0-21), perceived stress (0-8), depression (0-22), and loneliness (0-6); higher scores indicated worse symptoms. We regressed 2015-16 3 m usual walk time, five-repeated chair stand time or an adapted frailty phenotype scale (0-4) separately on each 2010-11 mental health scale, adjusting for baseline physical function or frailty, demographics, and comorbidities.

RESULTS

In separate models, every one-point increase on the depression or perceived stress scales was associated with, respectively, a 0.06 s slower (95 % CI: 0.03, 0.10) or 0.09 s slower (95 % CI: 0.01, 0.16) 5-year walk time. Every one-point increase on the depression or perceived stress scales was associated with a 0.15 s slower (95 % CI: 0.06, 0.23) or 0.16 s slower (95 % CI: 0.02, 0.29) 5-year chair stand time. Every one-point increase on the depression scale predicted 0.06 higher log odds of having a worse frailty score 5 years later. Only depression's association with 3 m walk time and chair stands remained significant in models including all four mental health scales.

DISCUSSION

Older adults with more depression and to a lesser extent stress symptoms may experience faster physical function decline and worsening frailty. Future work exploring and addressing the mechanisms underlying these relationships are warranted.

Preconception care utilization: Self-report versus claims-based measures among women with Medicaid

The objective of this study is to compare self-reported preconception care utilization (PCU) among Medicaid-covered births to Medicaid claims. We identified all Medicaid-covered births to women ages 15-45 in 26 states in the year 2012 among the Pregnancy Risk Assessment and Monitoring System (PRAMS) survey and Medicaid Analytic eXtract (MAX) claims data, and identified preconception services in the latter using diagnosis codes published by Health and Human Services' Office of Population Affairs. We fit mixed-effects logistic regression models for the probability of PCU on sociodemographic factors (age, race, and ethnicity) and clinical diagnoses (depression, diabetes, or hypertension), separately for each dataset. Among 652,929 women delivering in MAX, 28.1% received at least one claims-based preconception service while an estimated 23.6% (95% CI 22.1-25.3) of PRAMS respondents reported receiving preconception care. Adjusting for age, chronic diseases, and state, PCU rates in both MAX and PRAMS were higher for non-Hispanic Black versus non-Hispanic White women (OR 1.51, 95% CI 1.49-1.54 and OR 2.05, 95% CI 1.60-2.62, respectively). Adjusting for differences in age, race and ethnicity, and state, PCU rates were higher for patients with diabetes (OR 1.34, 95% CI 1.29-1.40 and OR 1.82, 95% CI 1.16-2.85) or hypertension (OR 1.22, 95% CI 1.18-1.27 and OR 1.85, 95% CI 1.41-2.44). While Hispanic and Asian women were also more likely to report PCU than their non-Hispanic White counterparts (OR 2.07, 95% CI 1.53-2.80 and OR 3.37, 95% CI 2.28-4.98), they were less likely to have received it (OR 0.74, 95% CI 0.73-0.75 and OR 0.65, 95% CI 0.63-0.67). In conclusion, comparing self-report to claims measures of PCU, we found similar trends in the differences between non-Hispanic Black and White women, and between those with vs. without diabetes and hypertension. However, the two data sources differed in trends in other racial/ethnic groups (differences between Hispanic vs. non-Hispanic White women, and between Asian vs. non-Hispanic White women), and in those with vs. without depression. This suggests that while Medicaid claims can be a useful tool for studying preconception care, they may miss certain types of care among some sub-groups of the population or be subject to reporting differences that are hard to surmise. Both data sets have potential benefits and drawbacks as research tools.

Genetic coding variant in complement factor B (CFB) is associated with increased risk for perianal Crohn's disease and leads to impaired CFB cleavage and phagocytosis

OBJECTIVE

Perianal Crohn's disease (pCD) occurs in up to 40% of patients with CD and is associated with poor quality of life, limited treatment responses and poorly understood aetiology. We performed a genetic association study comparing CD subjects with and without perianal disease and subsequently performed functional follow-up studies for a pCD associated SNP in Complement Factor B (CFB).

DESIGN

Immunochip-based meta-analysis on 4056 pCD and 11 088 patients with CD from three independent cohorts was performed. Serological and clinical variables were analysed by regression analyses. Risk allele of rs4151651 was introduced into human CFB plasmid by site-directed mutagenesis. Binding of recombinant G252 or S252 CFB to C3b and its cleavage was determined in cell-free assays. Macrophage phagocytosis in presence of recombinant CFB or serum from CFB risk, or protective CD or healthy subjects was assessed by flow cytometry.

RESULTS

Perianal complications were associated with colonic involvement, OmpC and ASCA serology, and serology quartile sum score. We identified a genetic association for pCD (rs4151651), a non-synonymous SNP (G252S) in CFB, in all three cohorts. Recombinant S252 CFB had reduced binding to C3b, its cleavage was impaired, and complement-driven phagocytosis and cytokine secretion were reduced compared with G252 CFB. Serine 252 generates a de novo glycosylation site in CFB. Serum from homozygous risk patients displayed significantly decreased macrophage phagocytosis compared with non-risk serum.

CONCLUSION

pCD-associated rs4151651 in CFB is a loss-of-function mutation that impairs its cleavage, activation of alternative complement pathway, and pathogen phagocytosis thus implicating the alternative complement pathway and CFB in pCD aetiology.

Association of APOE ε4 Status With Long-term Declines in Odor Sensitivity, Odor Identification, and Cognition in Older US Adults

BACKGROUND AND OBJECTIVES

The APOE ε4 allele confers susceptibility to faster decline in odor identification and subsequently to Alzheimer disease (AD). Odor identification requires recognizing and naming odors and detecting them (odor sensitivity). Whether APOE ε4 is associated with decline of odor sensitivity and whether such decline serves as a harbinger of cognitive decline and AD remains unclear. We determined whether and when APOE ε4 affects decline in odor sensitivity, odor identification, and cognition in the National Social Life Health and Aging Project (NSHAP).

METHODS

We used data from NSHAP, a nationally representative survey study of home-dwelling US older adults. Olfaction was measured over time (odor identification in 2005, 2010, and 2015; odor sensitivity in 2010 and 2015; both using validated tests). Cognition was measured with a modified version of the Montreal Cognitive Assessment in 2010 and 2015. Genotyping was performed using DNA samples collected in 2010. Odor sensitivity and identification were compared among APOE ε4 carriers and noncarriers stratified by age. Relationships between APOE ε4, odor sensitivity, odor identification, and cognition were analyzed in cross-section using ordinal logistic regression and longitudinally using mixed-effects models adjusted for confounders.

RESULTS

Odor sensitivity was measured in 865 respondents, odor identification in 1,156 respondents, and cognition in 864 respondents; all these respondents had genetic data available. Odor sensitivity deficits in APOE ε4 carriers were apparent at ages 65-69 years, whereas odor identification deficits did not appear until ages 75-79 years. Subsequently, odor sensitivity did not decline more rapidly with aging in APOE ε4 carriers compared with that in noncarriers (carrier status and aging interaction: odds ratio [OR] 1.44, 95% CI 0.94-2.19, p = 0.092), whereas odor identification declined more rapidly in carriers (aging 10 years interaction: OR 0.26, 95% CI 0.13-0.52, p < 0.001). As expected, and in parallel to odor identification, cognition declined more rapidly in APOE ε4 carriers (interaction: OR 0.55, 95% CI 0.34-0.89, p = 0.015).

DISCUSSION

APOE ε4 affects decline of odor sensitivity earlier than odor identification or cognition. Thus, testing odor sensitivity may be useful to predict future impaired cognitive function. Identifying the mechanism underlying these relationships will elucidate the key role of olfaction in neurodegeneration during aging.

Reply to: Comment on: Data-driven classification of health status of older adults with diabetes: The diabetes and aging study

This letter comments on the letter by Christiaens

Data-driven classification of health status of older adults with diabetes: The diabetes and aging study

BACKGROUND

We set out to identify empirically-derived health status classes of older adults with diabetes based on clusters of comorbid conditions which are associated with future complications.

METHODS

We conducted a cohort study among 105,786 older (≥65 years of age) adults with type 2 diabetes enrolled in an integrated healthcare delivery system. We used latent class analysis of 19 baseline comorbidities to derive health status classes and then compared incident complication rates (events per 100 person-years) by health status class during 5 years of follow-up. Complications included infections, hyperglycemic events, hypoglycemic events, microvascular events, cardiovascular events, and all-cause mortality.

RESULTS

Three health status classes were identified: Class 1 (58% of the cohort) had the lowest prevalence of most baseline comorbidities, Class 2 (22%) had the highest prevalence of obesity, arthritis, and depression, and Class 3 (20%) had the highest prevalence of cardiovascular conditions. The risk for incident complications was highest for Class 3, intermediate for Class 2 and lowest for Class 1. For example, the age, sex and race-adjusted rates for cardiovascular events (per 100 person-years) for Class 3, Class 2 and Class 1 were 6.5, 2.3, and 1.6, respectively; 2.1, 1.2, 0.7 for hypoglycemia; and 8.0, 3.8, and 2.3 for mortality.

CONCLUSIONS

Three health status classes of older adults with diabetes were identified based on prevalent comorbidities and were associated with marked differences in risk of complications. These health status classes can inform population health management and guide the individualization of diabetes care.

Identifying high-impact variants and genes in exomes of Ashkenazi Jewish inflammatory bowel disease patients

Inflammatory bowel disease (IBD) is a group of chronic digestive tract inflammatory conditions whose genetic etiology is still poorly understood. The incidence of IBD is particularly high among Ashkenazi Jews. Here, we identify 8 novel and plausible IBD-causing genes from the exomes of 4453 genetically identified Ashkenazi Jewish IBD cases (1734) and controls (2719). Various biological pathway analyses are performed, along with bulk and single-cell RNA sequencing, to demonstrate the likely physiological relatedness of the novel genes to IBD. Importantly, we demonstrate that the rare and high impact genetic architecture of Ashkenazi Jewish adult IBD displays significant overlap with very early onset-IBD genetics. Moreover, by performing biobank phenome-wide analyses, we find that IBD genes have pleiotropic effects that involve other immune responses. Finally, we show that polygenic risk score analyses based on genome-wide high impact variants have high power to predict IBD susceptibility.

Androstadienone sensitivity is associated with attention to emotions, social interactions, and sexual behavior in older U.S. adults

Δ 4,16-androstadien-3-one (androstadienone) is a putative human pheromone often linked to sexual attraction in young adults, although specific associations with sexual behavior are not yet established. Androstadienone also serves a broader social-emotional function beyond the sexual domain, specifically tuning the brain to efficiently process emotional information. Whether these effects persist throughout the lifespan into post-reproductive life is unknown. In a laboratory study of older adults, those with greater androstadienone odor sensitivity paid greater attention to subliminal emotional information, specifically, angry faces (p = 0.05), with a similar relationship to happy faces. In contrast, the physical odor n-butanol (a control) did not affect emotional attention (p = 0.49). We then extended this laboratory research and determined whether sensitivity to androstadienone affects the everyday lives of older adults by measuring their social and sexual behavior. In this second study, we surveyed in a nationally representative sample of US older adults living in their homes (National Social Life and Aging Project, 62-90 years; n = 2,086), along with their sensitivity to androstadienone, general olfactory function, health and demographics. Greater sensitivity to androstadienone was associated with richer social lives: having more friends, increased communication with close friends and family, and more participation in organized social events and volunteer activities (all p's ≤ 0.05, generalized linear models, adjusted for age and gender). It was also associated with more recent sexual activity, more frequent sexual thoughts, and viewing sex as an important part of life (all p's ≤ 0.05). General olfactory function did not explain these associations, supporting a specialized function for this pheromone during everyday life, and expanding its role to social life as well as sexual behavior, likely mediated by enhanced attention to emotional information.

IMPLICATIONS FOR MORTALITY RISK: CONSEQUENCES OF SURVEY NONRESPONSE IN HOME-DWELLING OLDER ADULTS

Nonrespondents generally suffer from worse health outcomes than respondents. Are they unwilling or unable to respond? Our aim was to address this issue. Data (N=3,130) from 2010-2015 waves of National Social Life Health and Aging Project (NSHAP, W2, W3) was used. Four groups of participants were considered based on their response status at W3: alive, incapacitated, deceased, and nonrespondents. Nonrespondents represented cases with no information at W3, beyond their disability and death information. General linear models were used to compare group means at baseline (W2) in terms of mortality risk (Lee index) or cognitive impairment (MOCA), adjusted for demographic variables. Like the deceased or incapacitated groups, the nonrespondent group displayed significantly worse outcomes (Least Squares Means) than the alive group: Lee index alive=5.82, deceased=9.66, incapacitated=8.29 and nonrespondents=7.80; MOCA alive=21.57, deceased=19.79, incapacitated=19.19 and nonrespondents=19.84. Being a nonrespondent likely indicates incapacity, not reluctance to responding. Earlier follow-up surveys could optimize response rates.

Large-scale sequencing identifies multiple genes and rare variants associated with Crohn's disease susceptibility

Genome-wide association studies (GWASs) have identified hundreds of loci associated with Crohn's disease (CD). However, as with all complex diseases, robust identification of the genes dysregulated by noncoding variants typically driving GWAS discoveries has been challenging. Here, to complement GWASs and better define actionable biological targets, we analyzed sequence data from more than 30,000 patients with CD and 80,000 population controls. We directly implicate ten genes in general onset CD for the first time to our knowledge via association to coding variation, four of which lie within established CD GWAS loci. In nine instances, a single coding variant is significantly associated, and in the tenth, ATG4C, we see additionally a significantly increased burden of very rare coding variants in CD cases. In addition to reiterating the central role of innate and adaptive immune cells as well as autophagy in CD pathogenesis, these newly associated genes highlight the emerging role of mesenchymal cells in the development and maintenance of intestinal inflammation.

Racial and Ethnic Disparities in the Observed COVID-19 Case Fatality Rate Among the U.S. Population

Purpose

During the initial 12 months of the pandemic, racial and ethnic disparities in COVID-19 death rates received considerable attention but it has been unclear whether disparities in death rates were due to disparities in case fatality rates (CFRs), incidence rates or both. We examined differences in observed COVID-19 CFRs between U.S. White, Black/African American, and Latinx individuals during this period.

Methods

Using data from the COVID Tracking Project and the Centers for Disease Control and Prevention COVID-19 Case Surveillance Public Use dataset, we calculated CFR ratios comparing Black and Latinx to White individuals, both overall and separately by age group. We also used a model of monthly COVID-19 deaths to estimate CFR ratios, adjusting for age, gender, and differences across states and time.

Results

Overall Black and Latinx individuals had lower CFRs than their White counterparts. However, when adjusting for age, Black and Latinx had higher CFRs than White individuals among those younger than 65. CFRs varied substantially across states and time.

Conclusions

Disparities in COVID-19 case fatality among U.S. Black and Latinx individuals under age 65 were evident during the first year of the pandemic. Understanding racial and ethnic differences in COVID-19 CFRs is challenging due to limitations in available data.

Preconception care and severe maternal morbidity in the United States

BACKGROUND

In the United States, approximately 52,000 women per year (accounting for 1.46% of births) experience severe maternal morbidity, which is defined as a complication that causes significant maternal harm or risk of death. It disproportionately affects women from racial or ethnic minorities, people with chronic diseases, and those with Medicaid or no insurance. Preconception care has been hailed as a strategy to improve pregnancy outcomes and reduce disparities, but its broad benefits for maternal outcomes have not been demonstrated.

OBJECTIVE

Our objective was to measure the association between preconception care and the odds of severe maternal morbidity among women with Medicaid.

STUDY DESIGN

This is a secondary analysis of Medicaid claims using the Medicaid Analytic Extract files (2010-2012). We used the International Classification of Diseases, Ninth Revision codes, published by the US Office of Population Affairs' Quality Family Planning program to define 7 domains of preconception care. The primary outcome was maternal death within 12 weeks of delivery or severe maternal morbidity during birth hospitalization, defined by the presence of any diagnosis or procedure on the severe maternal morbidity International Classification of Diseases, Ninth Revision code list from the Centers for Disease Control and Prevention. Because this list may overestimate severe maternal morbidity by counting any blood transfusion, our secondary outcome used the same code list but without transfusion. We reviewed care in the year before conception and used logistic regression to estimate the association between each domain and severe maternal morbidity for all births to women enrolled in Medicaid and aged 15 to 45 years with births during 2012. We performed a subgroup analysis for women with chronic disease (kidney disease, hypertension, or diabetes).

RESULTS

Severe maternal morbidity or death occurred in 26,285 births (1.74%) when including blood transfusions and 9,481 births (0.63%) when excluding transfusions. Receiving contraceptive services in the year before conception was associated with decreased odds of severe maternal morbidity (adjusted odds ratio, 0.92; 95% confidence interval, 0.88-0.95) and pregnancy test services were associated with increased odds (adjusted odds ratio, 1.08; 95% confidence interval, 1.01-1.14). In the primary analysis, no significant associations were observed for other preconception care domains. Among those women with at least 1 chronic disease, contraceptive care (adjusted odds ratio, 0.84; 95% confidence interval, 0.75-0.95) and routine physical or gynecologic exams (adjusted odds ratio, 0.79; 95% confidence interval, 0.71-0.88) were associated with decreased odds of severe maternal morbidity. Similar associations were found for severe maternal morbidity when excluding blood transfusion.

CONCLUSIONS

Contraceptive services in the year before conception and routine exams for women with chronic disease are associated with decreased odds of severe maternal morbidity or death for Medicaid enrollees.

Analyzing Birth Cohorts With the National Social Life, Health, and Aging Project

OBJECTIVES

In this article, we seek to provide assistance to those who might want to use data from the National Social Life, Health, and Aging Project (NSHAP) Rounds 1-3 to compare those born in different cohorts. We outline 2 theoretical models that underlie the design of NSHAP-the life course model and the birth cohorts model-and review examples of social and political changes that may have differentially affected cohorts of older adults. Then we present 2 ways that NSHAP data might be used to compare cohorts, show examples of analyses of cohort differences in measures in NSHAP, and discuss features of the data that might affect their use for this purpose.

METHODS

Round 3 of the NSHAP added a group of respondents born between 1948 and 1965, the Baby Boom. Together with data from an earlier cohort, interviewed in Rounds 1-3, these data allow analysis of birth cohorts of older adults in the United States. We show examples of some approaches.

RESULTS

Our age-matched cohort differences approach included all observations where the respondent was aged 57-67 at the time of interview in different time periods (3,816 observations overall; 2,316 for the Silent Generation cohort and 1,500 for the Baby Boom cohort). Our second approach, age, period, and cohort effects, models the effects of age and birth year using restricted cubic splines, with one model excluding the linear effect of birth year, and the other excluding the linear effect of period. We present examples of analyses using each of these methods.

DISCUSSION

We describe features of the NSHAP data of which researchers should be aware when conducting cohort analyses with these data.

Tracking Egocentric Social Network Change Across Three Rounds of National Survey Data

BACKGROUND

The National Social Life, Health, and Aging Project (NSHAP) has collected 3 rounds of data on older adults' egocentric social networks. We describe the structure of network data collection for different components of the sample and the data that are available for those groups. We also describe survey techniques that were used to track specific personnel changes that occurred within respondents' networks during the 10-year study period.

METHOD

Descriptive statistics are presented for measures of network size, composition, and internal structure at all 3 rounds, respondent-level summary measures of change in these characteristics between and across rounds, and measures of change associated with the loss and addition of network members across Rounds 1, 2, and 3. Procedures that were used to clean the network change data are also explained.

RESULTS

The NSHAP network change module provides reliable information about specific changes that occurred within respondents' confidant networks. For returning baseline respondents, there is considerable overlap with respect to which confidants are named in successive rosters, but the norm is for Round 3 networks to be composed primarily of new confidants.

DISCUSSION

These data provide new insights into the dynamic nature of networks in later life. Data limitations, and directions for future research, are discussed.

Sample Design and Estimation in the National Social Life, Health, and Aging Project: Round 3 (2015-2016)

OBJECTIVES

This article, and corresponding articles for the earlier rounds of the National Social Life, Health, and Aging Project (NSHAP), provide the scientific underpinning for the statistical analysis of NSHAP data. The 2015-2016 round of data collection for NSHAP comprised the third wave of data collection for the original cohort born 1920-1947 (C1) and the first wave of data collection for a second cohort born 1948-1965 (C2). Here we describe (a) our protocol for reinterviewing C1; (b) our approach to the sample design for C2, including the frame construction, stratification, clustering, and within-household selection; and (c) the construction of cross-sectional weights for the entire 2015-2016 sample when analyzed at the individual level or when analyzed as a sample of cohabiting couples. We also provide guidance on computing design-based standard errors.

METHODS

The sample for C2 was drawn independently of the C1 sample using the NORC U.S. National Sampling Frame. A probability sample of households containing at least one individual born 1948-1965 was drawn, and from these, each age-eligible individual was included together with their cohabiting spouse or partner (even if not age-eligible). This C2 sample was combined with the C1 sample to yield a sample representative of the U.S. population of adults born 1920-1965.

RESULTS

Among C1, we conducted 2,409 interviews corresponding to a 91% conditional response rate (i.e., among previous respondents); the unconditional three-wave response rate for the original C1 sample was 71%. Among C2, we conducted 2,368 interviews corresponding to a response rate of 76%.

DISCUSSION

Together C1 and C2 permit inference about the U.S. population of home-dwelling adults born from 1920 to 1965. In addition, three waves of data from C1 are now available, permitting longitudinal analyses of health outcomes and their determinants among older adults.

2015-2016 Normative Data for the 3-m Usual Walk, Five Repeated Chair Stands, and Static Balance Components of the SPPB Among U.S. Older Adults Across Two Nationally Representative Data Sets: NSHAP and NHATS

OBJECTIVES

Our primary objective was to examine the distribution of 3-m usual walk, five repeated chair stands, and three static balance stance performances among age and gender subgroups of adults at least 65 years in two national data sets. We secondarily determined whether demographic-function associations varied across data sets, birth cohorts, or models incorporating data from those "unable to do" tasks.

METHODS

Two nationally representative data sets were used to generate survey weight-adjusted performance distributions: the 2015-2016 National Social Life Health and Aging Project and the 2016 National Health and Aging Trends Study. We then regressed walk and chair stand performance on age, gender, and race/ethnicity, examining differences across data sets, birth cohorts (1920-1947, 1948-1965), and before/after incorporating the "unable to do" performers.

RESULTS

Findings confirmed the gradual decline in function with age and allowed estimation of "relative" performance within age/gender subgroups. Data set distribution differences were noted, possibly due to recruitment, eligibility, and protocol variations. Demographic associations were similar across data sets but generally weaker among the 1948-1965 cohort and in models including the sizable "unable to do" group.

DISCUSSION

We present the largest, most current Short Physical Performance Battery reference data in U.S. adults aged 65 or older. Findings support standardization of administration protocols in research and clinical care and differentiating absolute from relative performance.

Variability in Hourly Activity Levels: Statistical Noise or Insight Into Older Adult Frailty?

BACKGROUND

Frailty is associated with lower mean activity; however, hourly activity is highly variable among older individuals. We aimed to relate frailty to hourly activity variance beyond frailty's association with mean activity.

METHOD

Using the 2010-2011 National Social Life, Health and Aging Project wrist accelerometry data (n = 647), we employed a mixed-effects location scale model to simultaneously determine whether an adapted phenotypic frailty scale (0-4) was associated with the log10-mean hourly counts per minute (cpm) and between-and within-subject hourly activity variability, adjusting for demographics, health characteristics, season, day-of-week, and time-of-day. We tested the significance of a Frailty × Time-of-day interaction and whether adjusting for sleep time altered relationships.

RESULTS

Each additional frailty point was associated with a 7.6% (10-0.0343, β = -0.0343; 95% CI: -0.05, -0.02) lower mean hourly cpm in the morning, mid-day, and late afternoon but not evening. Each frailty point was also associated with a 24.5% (e0.219, β = 0.219; 95% CI: 0.09, 0.34) greater between-subject hourly activity variance across the day; a 7% (e0.07, β = 0.07; 95% CI: 0.01¸ 0.13), 6% (e0.06, β = 0.06; 95% CI: 0, 0.12), and 10% (e0.091, β = 0.091; 95% CI: 0.03, 0.15) greater within-subject hourly activity variance in the morning, mid-day, and late afternoon, respectively; and a 6% (e-0.06, β = -0.06; 95% CI: -0.12, -0.003) lower within-subject hourly activity variance in the evening. Adjusting for sleep time did not alter results.

CONCLUSIONS

Frail adults have more variable hourly activity levels than robust adults, a potential novel marker of vulnerability. These findings suggest a need for more precise activity assessment in older adults.

Serum Analyte Profiles Associated With Crohn's Disease and Disease Location

BACKGROUND

Crohn's disease (CD) can affect any segment of the digestive tract but is most often localized in the ileal, ileocolonic, and colorectal regions of the intestines. It is believed that the chronic inflammation in CD is a result of an imbalance between the epithelial barrier, the immune system, and the intestinal microbiota. The aim of the study was to identify circulating markers associated with CD and/or disease location in CD patients.

METHODS

We tested 49 cytokines, chemokines, and growth factors in serum samples from 300 patients with CD and 300 controls. After quality control, analyte levels were tested for association with CD and disease location.

RESULTS

We identified 13 analytes that were higher in CD patients relative to healthy controls and that remained significant after conservative Bonferroni correction (P < 0.0015). In particular, CXCL9, CXCL1, and interleukin IL-6 had the greatest effect and were highly significant (P < 5 × 10-7). We also identified 9 analytes that were associated with disease location, with VEGF, IL-12p70, and IL-6 being elevated in patients with colorectal disease (P < 3 × 10-4).

CONCLUSIONS

Multiple serum analytes are elevated in CD. These implicate the involvement of multiple cell types from the immune, epithelial, and endothelial systems, suggesting that circulating analytes reflect the inflammatory processes that are ongoing within the gut. Moreover, the identification of distinct profiles according to disease location supports the existence of a biological difference between ileal and colonic CD, consistent with previous genetic and clinical observations.

Re-examining the Classification of Older Adults with Diabetes by Comorbidities and Relationship with Frailty, Disability, and 5-year Mortality

BACKGROUND

Limited research has been conducted to risk stratify older adults with diabetes. Our objective was to re-examine the 2005-06 classification systems in participants who are now five years older.

METHODS

We examined a subsample of 884 community-residing older adults with the diagnosis of diabetes from the National Social Life, Health, and Aging Project (NSHAP). The primary objective was to utilize a latent class analysis (LCA) to fit a model to 11 comorbidities, comparing the 2010-11 LCA model to that of 2005-6. The secondary objective was to evaluate the association of the identified classes with frailty, disability, and five-year mortality.

RESULTS

Both 2005-6 LCA and the 2010-11 LCA model fit three similar comorbidity profiles: Class 1 with the lowest rates of nearly all comorbidities, Class 2 had highest rates of obesity, hypertension, arthritis, and incontinence, and Class 3 had the higher rates of myocardial infarctions, congestive heart failure, and stroke. When compared to the healthier Class 1 (class probability=0.67), participants with a comorbidity profile with more prevalent cardiovascular conditions (Class 3; 0.09) were at higher risk of frailty and mortality, but not disability; whereas participants with a comorbidity profile with more prevalent geriatric syndrome conditions (Class 2; 0.24) were at higher risk of frailty and disability, but not mortality.

CONCLUSIONS

We reconfirmed three latent-classes with distinct comorbidity profiles among older adults with diabetes. However, the complex relationships between comorbidity classes with frailty, disability, and mortality will likely require revision of the current rationale for stratified goal setting and treatment selection.

Inflamed Ulcerative Colitis Regions Associated With MRGPRX2-Mediated Mast Cell Degranulation and Cell Activation Modules, Defining a New Therapeutic Target

BACKGROUND & AIMS

Recent literature has implicated a key role for mast cells in murine models of colonic inflammation, but their role in human ulcerative colitis (UC) is not well established. A major advance has been the identification of mrgprb2 (human orthologue, MRGPX2) as mediating IgE-independent mast cell activation. We sought to define mechanisms of mast cell activation and MRGPRX2 in human UC.

METHODS

Colon tissues were collected from patients with UC for bulk RNA sequencing and lamina propria cells were isolated for MRGPRX2 activation studies and single-cell RNA sequencing. Genetic association of all protein-altering G-protein coupled receptor single-nucleotide polymorphism was performed in an Ashkenazi Jewish UC case-control cohort. Variants of MRGPRX2 were transfected into Chinese hamster ovary (CHO) and human mast cell (HMC) 1.1 cells to detect genotype-dependent effects on β-arrestin recruitment, IP-1 accumulation, and phosphorylated extracellular signal-regulated kinase.

RESULTS

Mast cell-specific mediators and adrenomedullin (proteolytic precursor of PAMP-12, an MRGPRX2 agonist) are up-regulated in inflamed compared to uninflamed UC. MRGPRX2 stimulation induces carboxypeptidase secretion from inflamed UC. Of all protein-altering GPCR alleles, a unique variant of MRGPRX2, Asn62Ser, was most associated with and was bioinformatically predicted to alter arrestin recruitment. We validated that the UC protective serine allele enhances β-arrestin recruitment, decreases IP-1, and increases phosphorylated extracellular signal-regulated kinase with MRGPRX2 agonists. Single-cell RNA sequencing defines that adrenomedullin is expressed by activated fibroblasts and epithelial cells and that interferon gamma is a key upstream regulator of mast cell gene expression.

CONCLUSION

Inflamed UC regions are distinguished by MRGPRX2-mediated activation of mast cells, with decreased activation observed with a UC-protective genetic variant. These results define cell modules of UC activation and a new therapeutic target.

Comparing loneliness in England and the United States, 2014-2016: Differential item functioning and risk factor prevalence and impact

The purpose of this study is to compare mean levels of loneliness, and correlates of loneliness, among older adults in the U.S. and England. Comparisons are conducted after attending to comparability of the loneliness measure between countries based on tests for discriminatory capacity and differential item functioning of the 3-item UCLA Loneliness Scale. Cross-sectional data from the 2015–16 wave of the National Social Life, Health and Aging Project (NSHAP) and the 2014–2015 wave of the English Longitudinal Study on Ageing (ELSA) were analyzed using graded item response models and multiple indicators and multiple causes (MIMIC) models. Risk factors included demographic variables, health characteristics, and social characteristics that were harmonized across surveys. Because of differences in the racial-ethnic composition of the U.S. and England, analyses were limited to white respondents (N = 2624 in NSHAP; N = 6639 in ELSA). Only respondents born 1925–1965 were included in analyses. Discriminatory capacity was evident in each item being able to distinguish a lonely from a nonlonely individual. Differential item functioning (DIF) was evident in country differences in the likelihood of endorsing the “lack companionship” item at a given level of trait loneliness, and in DIF among marital status, education, and gender subgroups that were comparable across countries. Overall loneliness levels are equivalent in England and the U.S. Risk factor impact did not differ between countries, but differences in risk factor prevalence between countries combined to produce a net result of slightly lower mean levels of loneliness in older adults in England than in the U.S. after risk factor adjustment. The fact that the impact of risk factors were similar across countries suggests that evidence of successful interventions in one country could be leveraged to accelerate development of effective interventions in the other.

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Scale items differed in ability to distinguish between loneliness levels.

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Items functioned differentially by country and by individual characteristics.

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Overall loneliness among white older adults does not differ between countries.

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Risk factor impact on loneliness did not differ between countries.

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Loneliness levels are lower in England despite greater risk factor prevalence.

Are U.S. older adults getting lonelier? Age, period, and cohort differences

Media portrayals of a loneliness "epidemic" are premised on an increase in the proportion of people living alone and decreases in rates of civic engagement and religious affiliation over recent decades. However, loneliness is a subjective perception that does not correspond perfectly with objective social circumstances. In this study, we examined whether perceived loneliness is greater among the Baby Boomers-individuals born 1948-1965-relative to those born 1920-1947 and whether older adults have become lonelier over the past decade (2005-2016). We used data from the National Social Life, Health and Aging Project and from the Health and Retirement Study collected during 2005-2016 to estimate differences in loneliness associated with age, birth year, and survey time point. Overall, loneliness decreased with age through the early 70s, after which it increased. We found no evidence that loneliness is substantially higher among the Baby Boomers or that it has increased over the past decade. Loneliness is, however, associated with poor health, living alone or without a spouse-partner, and having fewer close family and friends, which together accounted for the overall increase in loneliness after age 75. Although these data do not support the idea that older adults are becoming lonelier, the actual number of lonely individuals may increase as the Baby Boomers age into their 80s and beyond. Our results suggest that attention to social factors and improving health may help to mitigate this. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

NEW ACCELEROMETRY PATTERNS IN FRAILTY: HOURLY ACTIVITY AND VARIANCE

Wearable sensors may improve our ability to identify frailty in the community. Frailty has been historically defined, in part, by reduced average activity; however, new analytic methods of aggregate, free-living accelerometry data suggest that frailty may be more fully characterized above and beyond reduced average activity. Using mixed-effect regression models of awake hourly activity from the National Social Life, Health and Aging Project dataset, we have shown that frail adult activity is most reduced in the morning relative to pre- and non-frail adults rather than the afternoon or evening. High residual between- and within-subject activity variance in this model prompted further study of activity variance. A follow-up analysis using a mixed-effect location-scale model of hourly activity data revealed that increasing frailty in older adults is associated with greater between-subject as well as within-subject hourly activity variability, particularly in the morning and afternoon. Study implications and future directions will be discussed.

DISTRIBUTION, PREDICTORS, AND CLINICAL RELEVANCE OF 5-YEAR CHANGE IN FRAILTY MEASURES

Implementing frailty assessment into routine clinical practice is a priority. Gait speed and performance on 5 repeated chair stands are two measures of frailty. We face a number of clinical implementation challenges: (1) We lack normative data for U.S. older adults and (2) The clinical relevance of change in frailty measures is unclear. The National Social Life, Health and Aging Project dataset allows an examination of the distribution of 3-meter gait and 5-repeated chair stands times as well as 5-year change in these measures in a nationally-representative, community-dwelling older adult sample. Dr. Huisingh-Scheetz will describe demographic predictors of change in these measures as well as determine whether baseline plus 5-year change in these measures predicts loss of independence in activities of daily living (ADLs).

The Relationship Between Physical Activity and Frailty Among U.S. Older Adults Based on Hourly Accelerometry Data

Background/Objectives

Accelerometry measures older adult (in)activity with high resolution. Most studies summarize activity over the entire wear time. We extend prior work by analyzing hourly activity data to determine how frailty and other characteristics relate to activity among older adults.

Methods

Using wrist accelerometry data collected from the National Social Life, Health and Aging Project (n = 651), a nationally-representative probability sample of older adults, we used mixed effects linear regression to model the logarithm of hourly counts per minute as a function of an adapted phenotypic frailty score, adjusting for demographic and health characteristics, season, day of week and time of day.

Results

Higher frailty scores were associated with modestly lower activity; each frailty point (0-4) corresponded to a 7% lower mean hourly counts per minute. Older age, more comorbidities, male gender, and higher BMI were also associated with lower activity, though the latter was not evident among frail respondents. After adjusting for differences associated with frailty and other covariates, a substantial amount of between-individual variability in activity remained, as well as within-individual variability across days.

Conclusion

Our findings indicate that frail elders, men, those who are older, overweight or have multiple comorbidities are most likely to have low activity. However, residual differences between individuals remain larger than the differences associated with frailty and other covariates. We suggest defining individual-specific activity goals and further research to identify the sources of between-individual variability to better understand how activity reflects health status and to permit the development of more effective interventions.

CommunityRx: A Real-World Controlled Clinical Trial of a Scalable, Low-Intensity Community Resource Referral Intervention

OBJECTIVES

To test the effect of CommunityRx, a scalable, low-intensity intervention that matches patients to community resources, on mental health-related quality of life (HRQOL) (primary outcome), physical HRQOL, and confidence in finding resources.

METHODS

A real-world trial assigned publicly insured residents of Chicago, Illinois, aged 45 to 74 years to an intervention (n = 209) or control (n = 202) group by alternating calendar week, December 2015 to August 2016. Intervention group participants received usual care and an electronic medical record-generated, personalized list of community resources. Surveys (baseline, 1-week, 1- and 3-months) measured HRQOL and confidence in finding community resources to manage health.

RESULTS

At 3 months, there was no difference between groups in mental (-1.03; 95% confidence interval [CI] = -3.02, 0.96) or physical HRQOL (0.59; 95% CI = -0.98, 2.16). Confidence in finding resources was higher in the intervention group (odds ratio = 2.08; 95% CI = 1.18, 3.63); the effect increased at each successive time point. Among intervention group participants, 65% recalled receiving the intervention; 48% shared community resource information with others.

CONCLUSIONS

CommunityRx did not increase HRQOL, but its positive effect on confidence in finding resources for self-care suggests that this low-intensity intervention may have a role in population health promotion.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02435511.

Late-Onset Crohn's Disease Is A Subgroup Distinct in Genetic and Behavioral Risk Factors With UC-Like Characteristics

BACKGROUND

Age of onset is linked to variations in clinical phenotypes and natural history in Crohn's disease (CD). We aim to define etiologically more homogenous subgroups in CD based on ages of onset.

METHODS

We examined the distribution of CD polygenetic risk score (PRS) across ages of diagnosis in a Caucasian cohort of 2344 independent CD patients. We identified subgroups with a distinct distribution of PRS and compared those groups in genetics, demographic characteristics, clinical subphenotypes, and serological markers. The results were replicated in an independent cohort of 13,065 CD patients from the International Inflammatory Bowel Diseases Genetic Consortium (IIBDGC).

RESULTS

We identified a late-onset (LO) subgroup in CD (age at diagnosis ≥ 55 years) with significantly lower PRS compared with the intermediate group (age at diagnosis between 5 and 55 years) in both cohorts. Smoking cessation, a risk factor for ulcerative colitis (UC) and protective factor for CD, had a higher rate in this LO subgroup in comparison with the intermediate group. We also compared the LO group with the intermediate group, and, consistent with previous reports, the LO group more often had colonic CD, had less penetrating disease behavior, and had less need for surgery. Serological analysis showed that LO CD patients were more antineutrophil cytoplasmic antibody positive and less antisaccharomyces cerevisiae antibody positive compared with the intermediate group. Variance component analysis indicated that overall genetic contribution to LO CD was lower relative to the middle group, and genetic heterogeneity testing indicated that LO CD was different from the middle group in underlying genetic architecture.

CONCLUSIONS

Late-onset CD is subgroup distinct in genetic and behavioral risk factors with UC-like characteristics. 10.1093/ibd/izy148_video1izy148.video15791413461001.

Sleep Characteristics and Daytime Cortisol Levels in Older Adults

Objective

Older adults frequently report sleep problems and are at increased risk of cardiometabolic disruption. Experimental sleep restriction of younger adults has suggested that cortisol may be on the pathway between sleep restriction and cardiometabolic disease. We investigated whether the natural variation in sleep among older adults is associated with daytime cortisol level.

Methods

Salivary cortisol samples and actigraphy sleep data were collected from a random subsample of participants in the National Social Life, Health and Aging Project, a nationally representative probability sample of adults aged 62-90 (N = 672). Salivary cortisol was measured with 3 timed samples at the beginning, middle, and end of a 2-hr in-home interview. Sleep characteristics were derived from wrist actigraphy (fragmentation, wake after sleep onset [WASO], and duration) and from survey responses about usual sleep duration and sleep problems. For each individual, a single summary daytime cortisol level was estimated by fitting a marginal longitudinal model for the 3 time-stamped cortisol samples. The resulting estimates were then regressed on each sleep measure, adjusting for sociodemographics, health behaviors, and comorbidities.

Results

From actigraphy, both higher fragmentation score (β = 0.02; 95% confidence interval [CI] = 0.00 to 0.03) and longer WASO (β = 0.27; 95% CI = 0.04 to 0.51) were significantly associated with higher daytime cortisol; sleep duration was not. Self-reported sleep duration and sleep problems were also not associated with cortisol.

Conclusion

Actigraph measures of sleep disturbance are associated with higher daytime cortisol among older adults. However, cross-sectional data cannot distinguish causal direction or whether cortisol and sleep disruption have a common cause.

Genetic Factors Interact With Tobacco Smoke to Modify Risk for Inflammatory Bowel Disease in Humans and Mice

BACKGROUND & AIMS

The role of tobacco smoke in the etiology of inflammatory bowel disease (IBD) is unclear. We investigated interactions between genes and smoking (gene-smoking interactions) that affect risk for Crohn's disease (CD) and ulcerative colitis (UC) in a case-only study of patients and in mouse models of IBD.

METHODS

We used 55 Immunochip-wide datasets that included 19,735 IBD cases (10,856 CD cases and 8879 UC cases) of known smoking status. We performed 3 meta-analyses each for CD, UC, and IBD (CD and UC combined), comparing data for never vs ever smokers, never vs current smokers, and never vs former smokers. We studied the effects of exposure to cigarette smoke in Il10^-/- and Nod2^-/- mice, as well as in Balb/c mice without disruption of these genes (wild-type mice). Mice were exposed to the smoke of 5 cigarettes per day, 5 days a week, for 8 weeks, in a ventilated smoking chamber, or ambient air (controls). Intestines were collected and analyzed histologically and by reverse transcription polymerase chain reaction.

RESULTS

We identified 64 single nucleotide polymorphisms (SNPs) for which the association between the SNP and IBD were modified by smoking behavior (meta-analysis Wald test P < 5.0 × 10^-5; heterogeneity Cochrane Q test P > .05). Twenty of these variants were located within the HLA region at 6p21. Analysis of classical HLA alleles (imputed from SNP genotypes) revealed an interaction with smoking. We replicated the interaction of a variant in NOD2 with current smoking in relation to the risk for CD (frameshift variant fs1007insC; rs5743293). We identified 2 variants in the same genomic region (rs2270368 and rs17221417) that interact with smoking in relation to CD risk. Approximately 45% of the SNPs that interact with smoking were in close vicinity (≤1 Mb) to SNPs previously associated with IBD; many were located near or within genes that regulate mucosal barrier function and immune tolerance. Smoking modified the disease risk of some variants in opposite directions for CD vs UC. Exposure of Interleukin 10 (il10)-deficient mice to cigarette smoke accelerated development of colitis and increased expression of interferon gamma in the small intestine compared to wild-type mice exposed to smoke. NOD2-deficient mice exposed to cigarette smoke developed ileitis, characterized by increased expression of interferon gamma, compared to wild-type mice exposed to smoke.

CONCLUSIONS

In an analysis of 55 Immunochip-wide datasets, we identified 64 SNPs whose association with risk for IBD is modified by tobacco smoking. Gene-smoking interactions were confirmed in mice with disruption of Il10 and Nod2-variants of these genes have been associated with risk for IBD. Our findings from mice and humans revealed that the effects of smoking on risk for IBD depend on genetic variants.

Sleep and Olfaction among Older Adults

BACKGROUND

Sleep and olfaction are both critical physiological processes that tend to worsen with age. Decline in olfaction can be an early indicator of neurodegenerative diseases, whereas poor sleep quality is associated with reduced physical and mental health. Given associations with aging-related health declines, we explored whether variations in sleep were associated with olfactory function among older adults.

METHODS

We assessed the relationship between sleep characteristics and olfaction among 354 community-dwelling older adults. Olfaction was measured using a validated field and survey research tool. Sleep characteristics were measured using wrist actigraphy and with self-report of sleep problems. We fit structural equation models of latent constructs of olfaction based on olfactory task items and let this be a function of each sleep characteristic.

RESULTS

Actigraph sleep quality measures were associated with odor identification, but not with odor sensitivity. Longer duration sleepers had worse odor sensitivity compared to medium (58 h) sleepers, but sleep duration was not associated with odor identification. Reported sleep problems and reported usual duration were not associated with olfaction.

CONCLUSIONS

Diminished sleep quality was associated with reduced capacity to identify odors. Determining whether this is a causal association will require further study and longitudinal data.

Fine particulate matter exposure and olfactory dysfunction among urban-dwelling older US adults

OBJECTIVES

The olfactory nerve is anatomically susceptible to injury from pollution in inspired air, but there are no large-scale epidemiologic studies investigating this relationship.

METHODS

Cross-sectional study using data from the National Social Life, Health, and Aging Project, a representative sample of home-dwelling US adults age 57-85 years. Olfactory function was tested using a validated 5-item odor identification test (Sniffin' Sticks). Exposure to fine particulate matter (PM_2.5) at each respondent's home was estimated as 1-12 month moving averages prior to olfactory assessment using validated spatio-temporal models.

RESULTS

Olfactory dysfunction was significantly associated with PM_2.5 exposures averaged over 3-12 months in urban-dwelling respondents. The strongest effect was for 6 month average exposure (per 1-IQR increase in PM_2.5: OR 1.28, 95% CI 1.05, 1.55) adjusting for age, gender, race/ethnicity, education, cognition, comorbidity, smoking, and the season. Interestingly, the most deleterious effects were observed among the youngest respondents, 57-64 years old, and those living in the northeast and south.

CONCLUSIONS

We show for the first time that air pollution exposure is associated with poor olfaction among urban-living, older US adults.

A Pleiotropic Missense Variant in SLC39A8 Is Associated With Crohn's Disease and Human Gut Microbiome Composition

BACKGROUND & AIMS

Genome-wide association studies have identified 200 inflammatory bowel disease (IBD) loci, but the genetic architecture of Crohn's disease (CD) and ulcerative colitis remain incompletely defined. Here, we aimed to identify novel associations between IBD and functional genetic variants using the Illumina ExomeChip (San Diego, CA).

METHODS

Genotyping was performed in 10,523 IBD cases and 5726 non-IBD controls. There were 91,713 functional single-nucleotide polymorphism loci in coding regions analyzed. A novel identified association was replicated further in 2 independent cohorts. We further examined the association of the identified single-nucleotide polymorphism with microbiota from 338 mucosal lavage samples in the Mucosal Luminal Interface cohort measured using 16S sequencing.

RESULTS

We identified an association between CD and a missense variant encoding alanine or threonine at position 391 in the zinc transporter solute carrier family 39, member 8 protein (SLC39A8 alanine 391 threonine, rs13107325) and replicated the association with CD in 2 replication cohorts (combined meta-analysis P = 5.55 × 10(-13)). This variant has been associated previously with distinct phenotypes including obesity, lipid levels, blood pressure, and schizophrenia. We subsequently determined that the CD risk allele was associated with altered colonic mucosal microbiome composition in both healthy controls (P = .009) and CD cases (P = .0009). Moreover, microbes depleted in healthy carriers strongly overlap with those reduced in CD patients (P = 9.24 × 10(-16)) and overweight individuals (P = 6.73 × 10(-16)).

CONCLUSIONS

Our results suggest that an SLC39A8-dependent shift in the gut microbiome could explain its pleiotropic effects on multiple complex diseases including CD.

Nitrogen dioxide pollution exposure is associated with olfactory dysfunction in older U.S. adults

BACKGROUND

Olfactory dysfunction has profound effects on quality of life, physical and social function, and mortality itself. Nitrogen dioxide (NO₂ ) is a pervasive air pollutant that is associated with respiratory diseases. Given the olfactory nerve's anatomic exposure to airborne pollutants, we investigated the relationship between NO₂ exposure and olfactory dysfunction.

METHODS

The ability to identify odors was evaluated using a validated test in respondents from the National Social Life, Health, and Aging Project (NSHAP), a representative probability sample of home-dwelling, older U.S. adults age 57 to 85 years. Exposure to NO₂ pollution was assessed using measurements obtained from the U.S. Environmental Protection Agency (EPA) Aerometric Information Retrieval System (AIRS) ambient monitoring site closest to each respondent's home. We tested the association between NO₂ exposure and olfactory dysfunction using multivariate logistic regression.

RESULTS

Among older adults in the United States, 22.6% had impaired olfactory function, defined as ≤3 correct (out of 5) on the odor identification test. Median NO₂ exposure during the 365 days prior to the interview date was 14.7 ppb (interquartile range [IQR], 10.8 to 19.7 ppb). An IQR increase in NO₂ exposure was associated with increased odds of olfactory dysfunction (OR, 1.35; 95% CI, 1.07 to 1.72), adjusting for age, gender, race/ethnicity, education, cognition, comorbidity, smoking, and season of the home interview (n = 1823).

CONCLUSION

We show for the first time that NO₂ exposure is associated with olfactory dysfunction in older U.S. adults. These results suggest an important role for NO₂ exposure on olfactory dysfunction, and, potentially, nasal disease more broadly.

Global Sensory Impairment in Older Adults in the United States

OBJECTIVES

To determine whether there may be a common mechanism resulting in global sensory impairment of the five classical senses (vision, smell, hearing, touch, and taste) in older adults.

DESIGN

Representative, population-based study.

SETTING

National Social Life, Health, and Aging Project.

PARTICIPANTS

Community-dwelling U.S. adults aged 57 to 85.

MEASUREMENTS

The frequency with which impairment co-occurred across the five senses was estimated as an integrated measure of sensory aging. It was hypothesized that multisensory deficits would be common and reflect global sensory impairment that would largely explain the effects of age, sex, and race on sensory dysfunction.

RESULTS

Two-thirds of subjects had two or more sensory deficits, 27% had just one, and 6% had none. Seventy-four percent had impairment in taste, 70% in touch, 22% in smell, 20% in corrected vision, and 18% in corrected hearing. Older adults, men, African Americans, and Hispanics had greater multisensory impairment (all P < .01). Global sensory impairment largely accounted for the effects of age, sex, and race on the likelihood of impairment in each of the five senses.

CONCLUSION

Multisensory impairment is prevalent in older U.S. adults. These data support the concept of a common process that underlies sensory aging across the five senses. Clinicians assessing individuals with a sensory deficit should consider further evaluation for additional co-occurring sensory deficits.

Changes in Prescription and Over-the-Counter Medication and Dietary Supplement Use Among Older Adults in the United States, 2005 vs 2011

IMPORTANCE

Prescription and over-the-counter medicines and dietary supplements are commonly used, alone and together, among older adults. However, the effect of recent regulatory and market forces on these patterns is not known.

OBJECTIVES

To characterize changes in the prevalence of medication use, including concurrent use of prescription and over-the-counter medications and dietary supplements, and to quantify the frequency and types of potential major drug-drug interactions.

DESIGN, SETTING, AND PARTICIPANTS

Descriptive analyses of a longitudinal, nationally representative sample of community-dwelling older adults 62 to 85 years old. In-home interviews with direct medication inspection were conducted in 2005-2006 and again in 2010-2011. The dates of the analysis were March to November 2015. We defined medication use as the use of at least 1 prescription or over-the-counter medication or dietary supplement at least daily or weekly and defined concurrent use as the regular use of at least 2 medications. We used Micromedex to identify potential major drug-drug interactions.

MAIN OUTCOMES AND MEASURES

Population estimates of the prevalence of medication use (in aggregate and by therapeutic class), concurrent use, and major drug-drug interactions.

RESULTS

The study cohort comprised 2351 participants in 2005-2006 and 2206 in 2010-2011. Their mean age was 70.9 years in 2005-2006 and 71.4 years in 2010-2011. Fifty-three percent of participants were female in 2005-2006, and 51.6% were female in 2010-2011. The use of at least 1 prescription medication slightly increased from 84.1% in 2005-2006 to 87.7% in 2010-2011 (P = .003). Concurrent use of at least 5 prescription medications increased from 30.6% to 35.8% (P = .02). While the use of over-the-counter medications declined from 44.4% to 37.9%, the use of dietary supplements increased from 51.8% to 63.7% (P < .001 for both). There were clinically significant increases in the use of statins (33.8% to 46.2%), antiplatelets (32.8% to 43.0%), and omega-3 fish oils (4.7% to 18.6%) (P < .05 for all). In 2010-2011, approximately 15.1% of older adults were at risk for a potential major drug-drug interaction compared with an estimated 8.4% in 2005-2006 (P < .001). Most of these interacting regimens involved medications and dietary supplements increasingly used in 2010-2011.

CONCLUSIONS AND RELEVANCE

In this study, the use of prescription medications and dietary supplements, and concurrent use of interacting medications, has increased since 2005, with 15% of older adults potentially at risk for a major drug-drug interaction. Improving safety with the use of multiple medications has the potential to reduce preventable adverse drug events associated with medications commonly used among older adults.

Inherited determinants of Crohn's disease and ulcerative colitis phenotypes: a genetic association study

BACKGROUND

Crohn's disease and ulcerative colitis are the two major forms of inflammatory bowel disease; treatment strategies have historically been determined by this binary categorisation. Genetic studies have identified 163 susceptibility loci for inflammatory bowel disease, mostly shared between Crohn's disease and ulcerative colitis. We undertook the largest genotype association study, to date, in widely used clinical subphenotypes of inflammatory bowel disease with the goal of further understanding the biological relations between diseases.

METHODS

This study included patients from 49 centres in 16 countries in Europe, North America, and Australasia. We applied the Montreal classification system of inflammatory bowel disease subphenotypes to 34,819 patients (19,713 with Crohn's disease, 14,683 with ulcerative colitis) genotyped on the Immunochip array. We tested for genotype-phenotype associations across 156,154 genetic variants. We generated genetic risk scores by combining information from all known inflammatory bowel disease associations to summarise the total load of genetic risk for a particular phenotype. We used these risk scores to test the hypothesis that colonic Crohn's disease, ileal Crohn's disease, and ulcerative colitis are all genetically distinct from each other, and to attempt to identify patients with a mismatch between clinical diagnosis and genetic risk profile.

FINDINGS

After quality control, the primary analysis included 29,838 patients (16,902 with Crohn's disease, 12,597 with ulcerative colitis). Three loci (NOD2, MHC, and MST1 3p21) were associated with subphenotypes of inflammatory bowel disease, mainly disease location (essentially fixed over time; median follow-up of 10·5 years). Little or no genetic association with disease behaviour (which changed dramatically over time) remained after conditioning on disease location and age at onset. The genetic risk score representing all known risk alleles for inflammatory bowel disease showed strong association with disease subphenotype (p=1·65 × 10(-78)), even after exclusion of NOD2, MHC, and 3p21 (p=9·23 × 10(-18)). Predictive models based on the genetic risk score strongly distinguished colonic from ileal Crohn's disease. Our genetic risk score could also identify a small number of patients with discrepant genetic risk profiles who were significantly more likely to have a revised diagnosis after follow-up (p=6·8 × 10(-4)).

INTERPRETATION

Our data support a continuum of disorders within inflammatory bowel disease, much better explained by three groups (ileal Crohn's disease, colonic Crohn's disease, and ulcerative colitis) than by Crohn's disease and ulcerative colitis as currently defined. Disease location is an intrinsic aspect of a patient's disease, in part genetically determined, and the major driver to changes in disease behaviour over time.

FUNDING

International Inflammatory Bowel Disease Genetics Consortium members funding sources (see Acknowledgments for full list).

The Rate of Age-Related Olfactory Decline Among the General Population of Older U.S. Adults

BACKGROUND

Age-related olfactory loss (presbyosmia) is a prevalent sensory impairment with a large public health impact. In cross-sectional analyses, we found striking health disparities in olfactory function among older U.S. adults. Here, we report a 5-year follow-up to determine the magnitude of within-person olfactory decline.

METHODS

The National Social Life, Health, and Aging Project (NSHAP) interviewed a probability sample of home-dwelling older U.S. adults (57-85 years) in 2005-2006 (Wave 1) and reinterviewed them in 2010-2011 (Wave 2), assessing demographics, social life, and health, including olfaction. Odor identification was measured with a 5-item version of the Sniffin' Sticks (0-5 correct). Fourteen hundred and thirty-six respondents provided olfaction data in both waves. Multivariate linear and logistic regression were used to model the association between change in olfactory performance and demographic, health, and psychosocial factors.

RESULTS

Odor identification declined most rapidly among older individuals (0.25 additional errors per 5 years for each decade of age, p < .001) and in men (0.17 additional errors per 5 years compared to women, p = .005). Among those with perfect scores in Wave 1, African Americans declined more rapidly than Whites (p = .04). Neither socioeconomic status, health conditions, cognition, mental health, alcohol use nor smoking was associated with change in olfaction (p > .05, all).

CONCLUSIONS

The rate of olfactory decline increases with age and is greater among men than women despite adjusting for differences in psychosocial and health conditions, indicating physiologic factors as drivers. African Americans are more likely to experience initial olfactory decline, consistent with an earlier onset of aging among this subgroup.

A randomized, controlled trial of chlorhexidine-soaked cloths to reduce methicillin-resistant and methicillin-susceptible Staphylococcus aureus carriage prevalence in an urban jail

OBJECTIVE

To assess an intervention to limit community-associated methicillin-resistant Staphylococcus aureus (MRSA) dissemination.

DESIGN

Randomized, controlled trial.

SETTING

County Jail, Dallas, Texas.

PARTICIPANTS

A total of 4,196 detainees in 68 detention tanks.

METHODS

Tanks were randomly assigned to 1 of 3 groups: in group 1, detainees received cloths that contained chlorhexidine gluconate (CHG) to clean their entire skin surface 3 times per week for 6 months; group 2 received identical cloths containing only water; and group 3 received no skin treatment. During the study, all newly arrived detainees were invited to enroll. Nares and hand cultures were obtained at baseline and from all current enrollees at 2 and 6 months.

RESULTS

At baseline, S. aureus was isolated from 41.2% and MRSA from 8.0% (nares and/or hand) of 947 enrollees. The average participation rate was 47%. At 6 months, MRSA carriage was 10.0% in group 3 and 8.7% in group 1 tanks (estimated absolute risk reduction [95% confidence interval (CI)], 1.4% [-4.8% to 7.1%]; P = .655). At 6 months, carriage of any S. aureus was 51.1% in group 3, 40.7% in group 1 (absolute risk reduction [95% CI], 10.4% [0.01%-20.1%]; P = .047), and 42.8% (absolute risk reduction [95% CI], 8.3% [-1.4% to 18.0%]; P = .099) in group 2.

CONCLUSIONS

Skin cleaning with CHG for 6 months in detainees, compared with no intervention, significantly decreased carriage of S. aureus, and use of water cloths produced a nonsignificant but similar decrease. A nonsignificant decrease in MRSA carriage was found with CHG cloth use.

TRIAL REGISTRATION

ClinicalTrials.gov identifier NCT00785200.

Olfactory thresholds of the U.S. Population of home-dwelling older adults: development and validation of a short, reliable measure

Current methods of olfactory sensitivity testing are logistically challenging and therefore infeasible for use in in-home surveys and other field settings. We developed a fast, easy and reliable method of assessing olfactory thresholds, and used it in the first study of olfactory sensitivity in a nationally representative sample of U.S. home-dwelling older adults. We validated our method via computer simulation together with a model estimated from 590 normosmics. Simulated subjects were assigned n-butanol thresholds drawn from the estimated normosmic distribution and based on these and the model, we simulated administration of both the staircase and constant stimuli methods. Our results replicate both the correlation between the two methods and their reliability as previously reported by studies using human subjects. Further simulations evaluated the reliability of different constant stimuli protocols, varying both the range of dilutions and number of stimuli (6–16). Six appropriately chosen dilutions were sufficient for good reliability (0.67) in normosmic subjects. Finally, we applied our method to design a 5-minute, in-home assessment of older adults (National Social Life, Health and Aging Project, or NSHAP), which had comparable reliability (0.56), despite many subjects having estimated thresholds above the strongest dilution. Thus, testing with a fast, 6-item constant stimuli protocol is informative, and permits olfactory testing in previously inaccessible research settings.

Olfactory function in Wave 2 of the National Social Life, Health, and Aging Project

OBJECTIVE

To investigate the sense of smell, including sensitivity and odor identification, and characterize the U.S. national prevalence of olfactory dysfunction in older adults, thereby facilitating further investigation of the substantial risks for older adults associated with this basic sensory ability.

METHOD

The sense of smell was evaluated using the Olfactory Function Field Exam (OFFE), a measure designed specifically for field research, which assesses 3 components of olfaction: sensitivity to n-butanol (a standard testing odorant) and androstadienone (AND, a key social odor produced by humans), as well as the ability to identify odors. Respondents were randomly selected from the National Social Life, Health, and Aging Project Wave 2 sample to receive the OFFE (n = 2,304), and 2,212 consented to participate.

RESULTS

In the U.S. population aged 62-90, n-butanol detection ability was significantly worse at older ages (ordinal logistic regression, p < .001); however, there was no difference in detection ability between genders (p = .60). AND detection ability was also significantly worse at older ages (p = .003), but in contrast to n-butanol, women outperformed men (p = .001). As expected, odor identification ability was worse in older people than in younger (p < .001), and women were more accurate than men (p = .001).

DISCUSSION

We report for the first time 3 facets of olfactory function and its association with age and gender in a representative sample of U.S. older adults. Future analyses of these data are needed to elucidate the sense of smell's role in physical, social, and mental health with aging.

Glycosylated hemoglobin testing in the National Social Life, Health, and Aging Project

OBJECTIVES

Longitudinal biomeasures of health are still new in nationally representative social science survey research. Data measuring blood sugar control provide opportunities for understanding the development of diabetes and its complications in older adults, but researchers must be aware that some of the differences across time can be due to variations in measurement procedures. This is a well-recognized issue whenever all samples cannot be assayed at the same time and we sought to present the analytic methods to quantify and adjust for the variation.

METHOD

We collected and analyzed HbA1C, glycated hemoglobin, a biomeasure of average blood sugar concentrations within the past few months. Improvements were made in the collection protocol for Wave 2, and assays were performed by a different lab.

RESULTS

The HbA1C data obtained during Wave 1 and Wave 2 are consistent with the expected population distributions for differences by gender, age, race/ethnicity, and diabetes status. Age-adjusted mean HbA1C declined slightly from Wave 1 to Wave 2 by -0.19 (95% confidence interval [CI]: -0.27, -0.10), and the average longitudinal change was -0.12 (95% CI: -0.18, -0.06).

DISCUSSION

Collection of HbA1C in Wave 2 permits researchers to examine the relationship between HbA1C and new health and social measures added in Wave 2, and to identify factors related to the change in HbA1C. Changes in collection protocol and labs between waves may have yielded small systematic differences that require analysts to carefully interpret absolute HbA1C values. We recommend analytic methods for cross wave differences in HbA1C and steps to ensure cross wave comparability in future studies.

Assessment of sleep in the National Social Life, Health, and Aging Project

OBJECTIVES

The relationship of sleep to health has been an active area of research in recent years, and the National Social Life, Health, and Aging Project (NSHAP) expanded sleep data collection in Wave 2 with enhanced core questions and a novel sleep module that included an objective measure of sleep duration and quality.

METHOD

A randomly selected one-third of Wave 2 participants and their spouses or coresident partners were invited to participate in the sleep module. Objective sleep data were collected using wrist actigraphy, an accelerometer that records an integrated measure of motion over short epochs (15 s each). This information is stored and subsequently analyzed to determine sleep and wake periods by epoch. Individuals were instructed to wear the actiwatches for 72 hr. Several sleep parameters were derived from the accelerometer. Individuals concurrently kept a sleep diary.

RESULTS

Sleep actigraphy data were successfully collected from 780 individuals. Many of the survey-based and the actigraph-estimated sleep parameters varied by age and gender. However, age and gender patterns often differed for sleep characteristics that were both asked and measured, such as sleep duration.

DISCUSSION

The survey and actigraphy data provide different information about sleep characteristics. The opportunity to examine actigraph-estimated sleep characteristics in a nationally representative sample of older adults allows novel analyses of the associations of sleep parameters with social and health data.

Assessment of social network change in a national longitudinal survey

OBJECTIVES

This article describes new longitudinal data on older adults' egocentric social networks collected by the National Social Life, Health, and Aging Project (NSHAP). We describe a novel survey technique that was used to record specific personnel changes that occurred within respondents' networks during the 5-year study period, and we make recommendations regarding usage of the resulting data.

METHOD

Descriptive statistics are presented for measures of network size, composition, and structure at both waves, respondent-level summary measures of change in these characteristics between waves, as well as measures that distinguish between changes associated with losses of Wave 1 network members, additions of new ones, and changes in relationships with network members who were present at both waves.

RESULTS

The NSHAP network change module was successful in providing reliable information about specific changes that occurred within respondents' confidant networks. Most respondents lost at least one confidant from W1 and added at least one new confidant between waves as well. Network growth was more common than network shrinkage. Both lost and new ties were weaker than ties that persisted throughout the study period.

DISCUSSION

These data provide new insight into the dynamic nature of networks in later life, revealing norms of network turnover, expansion, and weakening. Data limitations are discussed.

Sensory function: insights from Wave 2 of the National Social Life, Health, and Aging Project

OBJECTIVES

Sensory function, a critical component of quality of life, generally declines with age and influences health, physical activity, and social function. Sensory measures collected in Wave 2 of the National Social Life, Health, and Aging Project (NSHAP) survey focused on the personal impact of sensory function in the home environment and included: subjective assessment of vision, hearing, and touch, information on relevant home conditions and social sequelae as well as an improved objective assessment of odor detection.

METHOD

Summary data were generated for each sensory category, stratified by age (62-90 years of age) and gender, with a focus on function in the home setting and the social consequences of sensory decrements in each modality.

RESULTS

Among both men and women, older age was associated with self-reported impairment of vision, hearing, and pleasantness of light touch. Compared with women, men reported significantly worse hearing and found light touch less appealing. There were no gender differences for vision. Overall, hearing loss seemed to have a greater impact on social function than did visual impairment.

DISCUSSION

Sensory function declines across age groups, with notable gender differences for hearing and light touch. Further analysis of sensory measures from NSHAP Wave 2 may provide important information on how sensory declines are related to health, social function, quality of life, morbidity, and mortality in this nationally representative sample of older adults.