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Spector AL, Quinn KG, Cruz-Almeida Y, Fillingim RB. Chronic Pain Among Middle-Aged and Older Adults in the United States: The Role of Everyday Discrimination and Racial/Ethnic Identity. J Pain 2024; 25:104439. [PMID: 38065467 PMCID: PMC11058034 DOI: 10.1016/j.jpain.2023.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 04/14/2024]
Abstract
Chronic pain disproportionately affects middle-aged and older adults in the United States. Everyday discrimination is associated with worse pain outcomes and is more prevalent among adults from racial/ethnic minoritized groups. Yet, there is limited evidence on relationships between everyday discrimination and chronic pain among middle-aged and older adults, as well as how discrimination and racial/ethnic identity may interact to influence this relationship. We used the 2018 Health and Retirement study to evaluate associations between exposure to everyday discrimination and odds to experience any, severe, and high-impact chronic pain among 5,314 Hispanic, non-Hispanic Black, and non-Hispanic White adults over the age of 50. Logistic regression was used to evaluate the main and interaction effects of everyday discrimination on the odds of chronic pain (any, severe, and high-impact) across racial/ethnic groups. Results showed that Hispanic and non-Hispanic Black middle-aged and older adults had a higher, unadjusted prevalence of severe and high-impact chronic pain and reported more exposure to everyday discrimination compared to non-Hispanic White middle-aged and older adults. In fully adjusted models, exposure to everyday discrimination predicted higher odds to experience each type of chronic pain. In addition, study findings showed that exposure to everyday discrimination significantly raised pain risk among Hispanic and non-Hispanic White, but not non-Hispanic Black, middle-aged, and older adults. Findings underscore the influential role of everyday discrimination on the chronic pain experiences of middle-aged and older adults, as well as differential effects across racial/ethnic groups. PERSPECTIVE: Using national data, we examined associations between discrimination and chronic pain among middle-aged and older adults, including interactions between discrimination and race/ethnicity. Exposure to discrimination predicted a higher chronic pain burden, overall. Differential effects within racial/ethnic groups underscored a need for more nuanced investigations into pain disparities among this population.
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Affiliation(s)
- Antoinette L. Spector
- Department of Rehabilitation Sciences and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Katherine G. Quinn
- Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research (CAIR), Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida, USA
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Mudrazija S, Butrica BA. How does debt shape health outcomes for older Americans? Soc Sci Med 2023; 329:116010. [PMID: 37331283 DOI: 10.1016/j.socscimed.2023.116010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/20/2023]
Abstract
The deleterious effects that debt can have on health outcomes are well documented, yet comprehensive studies of the debt-health link for older adults remain limited even as their indebtedness has increased dramatically in recent decades. Additionally, the literature cannot explain the causal pathway linking poor health with debt. Using data from the Health and Retirement Study (1998-2016), we examine a range of physical and mental health measures and assess how they may be shaped by the amount and type of debt held by older adults. To address the likely endogeneity of debt and health, we employ marginal structural models, developed specifically as an identification strategy in the presence of possible endogeneity, alongside population-averaged models that allow us to compare outcomes for populations with and without debt without relying on unverifiable assumptions regarding the underlying population distribution as is the case with random- and fixed-effects models. Findings indicate that carrying any debt has a negative effect on a range of health outcomes for older adults, including objective and subjective physical and mental health. In addition, the more debt older adults carry, the more detrimental it is for their health. Finally, the type of debt matters: while secured debt has a limited, if any, negative impact on health outcomes, unsecured debt has a substantial negative impact on health. Policymakers should design policies that promote the prudent use of debt and discourage carrying large debt burdens, especially unsecured debt, into retirement as this would promote better health outcomes for older Americans.
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Affiliation(s)
- Stipica Mudrazija
- Department of Health Systems and Population Health, School of Public Health, University of Washington, 3980 15th Ave NE, Seattle, WA, USA.
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Pai M, Lu W, Chen M, Xue B. The association between subjective cognitive decline and trajectories of objective cognitive decline: Do social relationships matter? Arch Gerontol Geriatr 2023; 111:104992. [PMID: 36934694 DOI: 10.1016/j.archger.2023.104992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/05/2023] [Accepted: 03/05/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVES We examine the association between subjective cognitive decline (SCD) and the trajectories of objective cognitive decline (OCD); and the extent to which this association is moderated by social relationships. METHODS Data come from waves 10 (2010) through 14 (2018) of the Health and Retirement Study, a nationally representative panel survey of individuals aged 50 and above in the United States. OCD is measured using episodic memory, and overall cognition. SCD is assessed using a baseline measure of self-rated memory. Social relationships are measured by social network size and perceived positive and negative social support. Growth curve models estimate the longitudinal link between SCD and subsequent OCD trajectories and the interactions between SCD and social relationship variables on OCD. RESULTS SCD is associated with subsequent OCD. A wider social network and lower perceived negative support are linked to slower decline in memory, and overall cognition. None of the social relationship variables, however, moderate the link between SCD and future OCD. CONCLUSION Knowing that SCD is linked to subsequent OCD is useful because at SCD stage, deficits are more manageable relative to those at subsequent stages of OCD. Future work on SCD and OCD should consider additional dimensions of social relationships.
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Affiliation(s)
- Manacy Pai
- Department of Sociology, Kent State University, Kent, OH, United States of America
| | - Wentian Lu
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Miaoqi Chen
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Baowen Xue
- Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
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Sheehan C, Cantu P, Powell D, Tran S. Childhood health conditions and insomnia among adults in mid-life. Aging Health Res 2023; 3:100124. [PMID: 37008305 PMCID: PMC10065450 DOI: 10.1016/j.ahr.2023.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Little is known regarding the influence of childhood health broadly and childhood health conditions specifically on insomnia throughout adulthood. Methods Health and Retirement Study (HRS) Baby Boomers born 1954-1965 were investigated. We fitted regression models predicting self-reported insomnia based on twenty-three retrospectively reported specific childhood health conditions (e.g., measles) and general childhood health measures and adjusted for demographics, childhood socioeconomic status, and adult socioeconomic status. Results Nearly all the measures of childhood health significantly increased insomnia symptoms in adulthood. In a model where all measures were included, we found that respiratory disorders, headaches, stomach problems, and concussions were particularly strong predictors of insomnia. Conclusions Our findings extend past work illustrating the "long arm" of childhood conditions for health, showing that specific health conditions in childhood may indelibly imprint insomnia risk.
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Affiliation(s)
- Connor Sheehan
- School of Social and Family Dynamics, Arizona State University, T. Denny Sanford School of Social and Family Dynamics, Arizona State University, P.O. Box 873701, Tempe, AZ 85287-3701, United States
| | - Phillip Cantu
- Department of Internal Medicine – Geriatrics, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States
| | - Danielle Powell
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615N Wolfe St, Baltimore, MD 21205, United States
| | - Sydney Tran
- School of Social and Family Dynamics, Arizona State University, T. Denny Sanford School of Social and Family Dynamics, Arizona State University, P.O. Box 873701, Tempe, AZ 85287-3701, United States
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Wang K, Gu D. Reciprocal associations between social media use and self-perception of aging among older adults: Do men and women differ? Soc Sci Med 2023; 321:115786. [PMID: 36822012 DOI: 10.1016/j.socscimed.2023.115786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 02/07/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE Despite the positive impact of social media use in late adulthood, social media use is still low among older adults. Research in technology adoption and utilization indicates the importance of age-specific factors, such as self-perception of aging (SPA). As it is unclear whether SPA facilitates social media use or social media use promotes SPA, reverse causality has emerged as a major point of contention within this literature, with several studies reporting conflicting results. Thus, in this study, we aim to contribute unique insight by examining (1) whether positive and negative SPAs demonstrate unique associations with social media use and (2) whether these reciprocal associations differ by gender. METHODS Using two waves (2014 and 2018) from the Health and Retirement Study, 4101 older Americans (age ≥65 years) with normal baseline cognition were included in this study. Autoregressive cross-lagged analyses were conducted to assess reciprocal associations between SPA and social media use among the total sample and by gender subgroups. RESULTS Controlling for covariates, we found that more frequent social media use marginally predicted higher positive SPA four years later (B = 0.02, p = .07), and higher negative SPA marginally predicted less frequent social media use four years later (B = -0.07, p = .08). However, the by-gender analysis showed that the positive effect of social media use on positive SPA was only significant among older men (B = 0.04, p < .05), whereas the negative impact of negative SPA on social media use only existed among older women (B = -0.13, p < .01). CONCLUSIONS The reciprocal associations between SPA and social media use differ by the valence of SPA (positive/negative) and gender. Future interventions for SPA and digital technology use among older adults should be gender-tailored.
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Affiliation(s)
- Kun Wang
- Department of Social Work, College of Community and Public Affairs, Binghamton University, Binghamton, NY, 13902, USA.
| | - Danan Gu
- Independent Researcher, New York, NY, 10017, USA.
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Wolfova K, Wu D, Weiss J, Cermakova P, Kohler HP, Skirbekk VF, Stern Y, Gemmill A, Tom SE. Sons and parental cognition in mid-life and older adulthood. J Psychiatr Res 2022; 156:284-290. [PMID: 36279678 PMCID: PMC10103684 DOI: 10.1016/j.jpsychires.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
Prior research suggests a relationship between number of sons and maternal long-term health outcomes, including dementia. We assessed the relationship between having sons and parental cognitive aging. Specifically, we investigated the relationship between having at least 1 son and parental baseline cognition level and rate of cognitive decline, accounting for life course sociodemographic characteristics in a cohort of 13 222 adults aged ≥50 years from the US Health and Retirement Study. We included only participants with at least one child. We further explored whether this relationship varies by parental sex and whether the magnitude of the relationship increases with each additional son. Cognition was assessed biennially for a maximum of nine times as a sum of scores from immediate and delayed 10-noun free recall tests, a serial 7s subtraction test, and a backwards counting test. Associations were evaluated using linear mixed-effects models, stepwise adjusting for sociodemographic and health-related factors. In our analytic sample of parents, a total of 82.3% of respondents had at least 1 son and 61.6% of respondents were female. Parents of at least 1 son had a faster rate of cognitive decline in comparison to parents without any son. Our results also suggest that cognitive decline was faster among parents of multiple sons, compared to parents with only daughters. Thus, the results support the theory that having sons might have a long-term negative effect on parental cognition.
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Affiliation(s)
- Katrin Wolfova
- Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Prague, 100 00, Czech Republic; National Institute of Mental Health, Klecany, 250 67, Czech Republic; Department of Neurology, Columbia University, 10032, New York, USA
| | - Di Wu
- Department of Biostatistics, Columbia University, 10032, New York, USA
| | - Jordan Weiss
- Department of Demography, UC Berkeley, Berkeley, CA, 94720, USA
| | - Pavla Cermakova
- National Institute of Mental Health, Klecany, 250 67, Czech Republic; Department of Epidemiology, Second Faculty of Medicine, Charles University, Prague, 150 06, Czech Republic
| | - Hans-Peter Kohler
- Department of Sociology, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Vegard Fykse Skirbekk
- Centre for Fertility and Health, The Norwegian Institute of Public Health, Oslo, 0473, Norway
| | - Yaakov Stern
- Department of Neurology, Columbia University, 10032, New York, USA
| | - Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, 21205, Maryland, USA
| | - Sarah E Tom
- Department of Neurology, Columbia University, 10032, New York, USA; Department of Epidemiology, Columbia University, 10032, New York, USA.
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Shiba K, Kubzansky LD, Williams DR, VanderWeele TJ, Kim ES. Purpose in life and 8-year mortality by gender and race/ethnicity among older adults in the U.S. Prev Med 2022; 164:107310. [PMID: 36283485 DOI: 10.1016/j.ypmed.2022.107310] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 10/31/2022]
Abstract
We examined the associations between a sense of purpose and all-cause mortality by gender and race/ethnicity groups. Data were from the Health and Retirement Study, a nationally representative cohort study of U.S. adults aged >50 (n = 13,159). Sense of purpose was self-reported at baseline (2006/2008), and risk of all-cause mortality was assessed over an 8-year follow-up period. We also formally tested for potential effect modification by gender and race/ethnicity. We observed the associations between higher purpose and lower all-cause mortality risk across all gender and race/ethnicity groups. There was modest evidence that the highest level of purpose (versus lowest quartile) was associated with even lower risk of all-cause mortality among women (risk ratio = 0.66, 95% confidence interval: 0.56, 0.77) compared to men (risk ratio = 0.80, 95% confidence interval: 0.69, 0.93; p-value for multiplicative effect modification =0.07). However, we observed no evidence of effect modification by race/ethnicity. Having a higher sense of purpose appears protective against all-cause mortality regardless of gender and race/ethnicity. Purpose, a potentially modifiable factor, might be a health asset across diverse populations.
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Affiliation(s)
- Koichiro Shiba
- Department of Epidemiology, Boston University School of Public Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Human Flourishing Program, University of British Columbia, Vancouver, Canada.
| | - Laura D Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Lee Kum Sheung Center for Health and Happiness, University of British Columbia, Vancouver, Canada
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Sociology, University of British Columbia, Vancouver, Canada
| | - Tyler J VanderWeele
- Harvard University, Cambridge, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Biostatistics, Human Flourishing Program, University of British Columbia, Vancouver, Canada
| | - Eric S Kim
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Lee Kum Sheung Center for Health and Happiness, Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA; Department of Psychology, University of British Columbia, Vancouver, Canada
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Bardenheier BH, Resnik L, Jutkowitz E, Gravenstein S. Self-reported measures of limitation in physical function in late midlife are associated with incident Alzheimer's disease and related dementias. Aging Clin Exp Res 2022. [PMID: 35441254 DOI: 10.1007/s40520-022-02132-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 03/25/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Even small improvements in modifiable Alzheimer's disease and related dementias (ADRD) risk factors could lead to a substantial reduction of dementia cases. AIMS To determine if self-reported functional limitation associates with ADRD symptoms 4-18 years later. METHODS We conducted a prospective longitudinal study using the Health and Retirement Study of adults aged 51-59 years in 1998 without symptoms of ADRD by 2002 and followed them to 2016. Main exposure variables were difficulty with activities of daily living, mobility, large muscle strength, gross motor and upper limb activities. The outcome was incident ADRD identified by the Lange-Weir algorithm, death, or alive without ADRD. We fit two GEE multinomial models for each measure: (1) baseline measure of function and (2) change in function over time. RESULTS In the model with baseline only and outcome, only difficulty with mobility associated with future ADRD across levels of difficulty with near dose-response effect (risk ratios (RR) difficulty with 1-5 functions respectively, compared with no difficulty: 1.82; 2.70; 1.73 2.81; 4.03). Mobility also significantly associated with ADRD when allowing for change over time among those with 3, 4 or 5 versus no mobility limitations (RR 1.76; 2.36; 2.37). DISCUSSION The results infer that an adult in midlife reporting difficulty with mobility as well as those with no mobility limitations in midlife but who later report severe limitations may be at increased risk of incident ADRD. CONCLUSIONS Self-reported measures of mobility limitation may be early indicators of ADRD and may be useful for public health planning.
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Kang SW, Xiang X. Cognitive impairment as a barrier to utilizing preventive health services among older adults. Arch Gerontol Geriatr 2021; 99:104613. [PMID: 34974235 DOI: 10.1016/j.archger.2021.104613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/09/2021] [Accepted: 12/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study aimed to examine the influence of cognitive impairment on preventive health services utilization among older adults. METHODS The study sample came from 1995 to 2014 waves of the Health and Retirement Study (HRS), consisting of 19,644 adults aged 51 years or older. Mixed-effects logistic regression was used to analyze the influence of cognitive impairment, measured using the Telephone Interview for Cognitive Status, on the utilization of four types of preventive health care services, including flu shots, cholesterol tests, mammography for women, and prostate cancer screening for men. RESULTS Persons with cognitive impairment with no dementia were less likely to receive cholesterol tests (OR=0.68, 95% CI=0.64-0.73, p<.001), flu shots (OR=0.86, CI=0.80-0.92, p<.001), mammograms (OR=0.88, CI=0.78-0.99, p<.05), and prostate cancer screenings (OR=0.71, CI=0.71-0.98, p<.05) compared with those without cognitive impairment. Having dementia was associated with a lower odds of receiving cholesterol tests (OR=0.42, CI=0.38-0.47, p<.001), flu shots (OR=0.65, CI=0.57-0.74, p<.001), mammograms (OR=0.70, CI=0.55-0.89, p<.01), and prostate cancer screening (OR=0.68, CI=0.47-0.99, p<.05). CONCLUSIONS Cognitive impairment with or without dementia is a significant barrier to utilizing preventive health services among older adults. Targeted health promotion prevention and intervention strategies and caregiver education are warranted to improve preventive services among older adults with cognitive impairment.
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Affiliation(s)
- Sung-Wan Kang
- Department of Social Welfare, Pusan National University, 2, Busandaehak-ro 63beon-gil, Geumjeong-gu, Busan, 46241, Republic of Korea.
| | - Xiaoling Xiang
- School of Social Work, University of Michigan, 1080 S. University Ave, #3735, Ann Arbor, MI, 48109, USA.
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Bishop NJ, Ullevig SL, Wang K, Zuniga KE. Dietary quality modifies the association between multimorbidity and change in mobility limitations among older Americans. Prev Med 2021; 153:106721. [PMID: 34293383 DOI: 10.1016/j.ypmed.2021.106721] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 06/25/2021] [Accepted: 07/11/2021] [Indexed: 11/21/2022]
Abstract
To identify potentially modifiable risk-factors in the age-related disablement process, we examined the association between change in mobility limitations and multimorbidity and how dietary quality moderates this association. Information from 3320 adults aged 65 and older in 2012 was drawn from the Health and Retirement Study and the Health Care and Nutrition Study. Mobility limitations reported in 2012 and change in mobility limitations from 2012 to 2014 were regressed on multimorbidity measured as number of chronic conditions in 2012, dietary quality measured in 2013 using the Alternative Healthy Eating Index-2010 (AHEI-2010), and their interaction term using Poisson regression. Respondents reported an average of 2.9 (SD, 2.9) mobility limitations in 2012 and 3.1 (SD, 3.0) mobility limitations in 2014, an average of 2.64 (SD, 1.4) chronic conditions in 2012, and mean AHEI-2010 score in 2013 of 57.1 (SD, 10.9). Greater AHEI-2010 scores were associated with fewer mobility limitations at baseline (p < .001) and slower progression of mobility limitations over the two-year observational window (p < .001). For those with AHEI-2010 scores ≥48.4, dietary quality appeared to moderate the association between multimorbidity and change in mobility limitations. These results suggest that improving dietary quality may be an effective means of reducing the progression of mobility limitations among older adults and that dietary quality may modify the effect of multimorbidity on progressive disablement. Our work adds to research supporting dietary quality as a potentially intervenable factor in the reduction of disablement in aging populations.
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Andrea SB, Eisenberg-Guyot J, Peckham T, Oddo VM, Hajat A. Intersectional trends in employment quality in older adults in the United States. SSM Popul Health 2021; 15:100868. [PMID: 34553014 PMCID: PMC8441841 DOI: 10.1016/j.ssmph.2021.100868] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/02/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022] Open
Abstract
Americans' working lives have become more precarious over the past several decades. Worsening employment quality has been linked to poorer physical and mental health and may disproportionately impact marginalized working populations. We examined differences in the quality and character of worker-employer relationships among older workers in the United States (US) across intersecting gender-racial/ethnic-educational subgroups. Using longitudinal data on employment stability, material rewards, workers' rights, working-time arrangements, unionization, and interpersonal power relations from the Health and Retirement Study (1992-2016), we used principal components analysis to construct an employment quality (EQ) score. We estimated intersectional differences in EQ, overall and over time, using generalized estimating equations. Overall, EQ was greatest for white men with college degrees and poorest for Latinx women with < high school degrees. Over time, EQ tended to remain unchanged or slightly worsen across intersectional strata; the greatest EQ reduction was for Latinx women with college degrees, while the greatest improvement was for white women with high school degrees. There are enduring and growing inequities in EQ for older marginalized adults in the US, which may contribute to growing health inequities.
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Affiliation(s)
- Sarah B. Andrea
- OHSU-PSU School of Public Health, Portland, OR, USA
- Lifespan Biostatistics Epidemiology and Research Design Core, Rhode Island Hospital, Providence, RI, USA
| | | | - Trevor Peckham
- University of Washington School of Public Health, Department of Environmental and Occupational Health Sciences, Seattle, WA, USA
| | - Vanessa M. Oddo
- University of Illinois Chicago, Department of Kinesiology and Nutrition, Chicago, IL, USA
| | - Anjum Hajat
- University of Washington School of Public Health, Department of Epidemiology, Seattle, WA, USA
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Davidson T, Vinneau-Palarino J, Goode JA, Boardman JD. Utilizing genome wide data to highlight the social behavioral pathways to health: The case of obesity and cardiovascular health among older adults. Soc Sci Med 2021; 273:113766. [PMID: 33621753 DOI: 10.1016/j.socscimed.2021.113766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/04/2021] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
We use genome-wide data from the 1992-2016 Health and Retirement Study (n = 12,090) to characterize obesity among older adults as genetically or socially oriented. To illustrate the significance of this approach for social epidemiological research, we deem those with the lowest genetic risk for obesity to be socially-behaviorally obese and obesity among those with the highest polygenic risk is characterized as genetically oriented. We then examine the association between obesity and four indicators of cardiovascular health (type-2 diabetes, hypertension, heart problems, and stroke) among those with low, average, and high genetic risk. Our results show that the association between obesity and cardiovascular health is significantly higher for those with the lowest genetic risk (e.g., social-behavioral obesity). We also demonstrate important sex differences such that this association is particularly strong for heart problems among men and hypertension and stroke among women. Our results further demonstrate the centrality of the social and behavioral determinants of health by utilizing detailed information across the human genome and add to both social and genetic epidemiology literatures.
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Affiliation(s)
- Trent Davidson
- Department of Sociology, University of Colorado Boulder, Boulder, CO, USA; Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA; Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA.
| | - Justin Vinneau-Palarino
- Department of Sociology, University of Colorado Boulder, Boulder, CO, USA; Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA; Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - Joshua A Goode
- Department of Sociology, University of Colorado Boulder, Boulder, CO, USA; Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA; Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
| | - Jason D Boardman
- Department of Sociology, University of Colorado Boulder, Boulder, CO, USA; Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA; Institute for Behavioral Genetics, University of Colorado Boulder, Boulder, CO, USA
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Smith J, Larkina M. Early-life Health as a Lifelong Precursor of Self-Related Views of Aging in Later Life. J Gerontol B Psychol Sci Soc Sci 2020; 76:894-899. [PMID: 32861218 PMCID: PMC8063672 DOI: 10.1093/geronb/gbaa141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives Age stereotypes and expectations about one’s own aging commence in childhood but most research focuses on predictive associations with midlife health behaviors, later-life chronic conditions, biomarkers, and longevity. Surprisingly little is known about the role of poor childhood health in these associations. This study aims to fill this gap. Methods Using data from the Health and Retirement Study (HRS: N = 5,773, aged 50–98), we investigated whether diagnosed chronic illness before age 16 and self-rated childhood health predict late-life self-perceptions of aging (SPA) and proportional subjective age discrepancy (PSAD). We conducted multivariate multiple regression analysis (MMRA) to determine the joint and partial effects of the two indicators of childhood health. Models included controls for childhood family financial status as well as late-life self-rated health, chronic illnesses, memory status, and demographic covariates (age, gender, race/ethnicity, marital status, socioeconomic status) in 2016. Results Over and above all covariates and the covariation of the two views of one’s own aging, the MMRA models revealed that the number of childhood chronic illnesses predicted SPA but not for PSAD. Self-rated childhood health predicted both SPA and PSAD in the unadjusted models, but not in the adjusted models. Discussion This study provides new insight into potential early-life precursors of self-evaluations of aging. In particular, childhood diagnoses of chronic illness enhance negative SPA up to 50 years later. Non-normative experiences related to poor health in childhood are lifelong foundations for socioeconomic status, health, and for self-related beliefs about age and aging.
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Affiliation(s)
- Jacqui Smith
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Marina Larkina
- Institute for Social Research, University of Michigan, Ann Arbor
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Gianattasio KZ, Prather C, Glymour MM, Ciarleglio A, Power MC. Racial disparities and temporal trends in dementia misdiagnosis risk in the United States. Alzheimers Dement (N Y) 2019; 5:891-8. [PMID: 31890853 DOI: 10.1016/j.trci.2019.11.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Systematic disparities in misdiagnosis of dementia across racial/ethnic groups have implications for health disparities. We compared the risk of dementia under- and overdiagnosis in clinical settings across racial/ethnic groups from 2000 to 2010. Methods We linked fee-for-service Medicare claims to participants aged ≥70 from the nationally representative Health and Retirement Study. We classified dementia status using an algorithm with similar sensitivity and specificity across racial/ethnic groups and assigned clinical dementia diagnosis status using ICD-9-CM codes from Medicare claims. Multinomial logit models were used to estimate relative risks of clinical under- and overdiagnosis between groups and over time. Results Non-Hispanic blacks had roughly double the risk of underdiagnosis as non-Hispanic whites. While primary analyses suggested a shrinking disparity over time, this was not robust to sensitivity analyses or adjustment for covariates. Risk of overdiagnosis increased over time in both groups. Discussion Our results suggest that efforts to reduce racial disparities in underdiagnosis are warranted.
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Abstract
Homelessness in the United States is often examined using cross-sectional, point-in-time samples. Any experience of homelessness is a risk factor for adverse outcomes, so it is also useful to understand the incidence of homelessness over longer periods. We estimate the lifetime prevalence of homelessness among members of the Baby Boom cohort (n = 6,545) using the 2012 and 2014 waves of the Health and Retirement Study (HRS), a nationally representative survey of older Americans. Our analysis indicates that 6.2 % of respondents had a period of homelessness at some point in their lives. We also identify dramatic disparities in lifetime incidence of homelessness by racial and ethnic subgroups. Rates of homelessness were higher for non-Hispanic blacks (16.8 %) or Hispanics of any race (8.1 %) than for non-Hispanic whites (4.8 %; all differences significant with p < .05). The black-white gap, but not the Hispanic-white gap, remained significant after adjustment for covariates such as education, veteran status, and geographic region.
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Affiliation(s)
- Vincent A Fusaro
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | - Helen G Levy
- Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA
| | - H Luke Shaefer
- School of Social Work & Gerald R. Ford School of Public Policy, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109, USA
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Lutz MW, Casanova R, Saldana S, Kuchibhatla M, Plassman BL, Hayden KM. Analysis of pleiotropic genetic effects on cognitive impairment, systemic inflammation, and plasma lipids in the Health and Retirement Study. Neurobiol Aging 2019; 80:173-186. [PMID: 31201950 DOI: 10.1016/j.neurobiolaging.2018.10.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 08/11/2018] [Accepted: 10/29/2018] [Indexed: 01/31/2023]
Abstract
Variants associated with modulation of c-reactive protein (CRP) and plasma lipids have been investigated for polygenic overlap with Alzheimer's disease risk variants. We examined pleiotropic genetic effects on cognitive impairment conditioned on genetic variants (SNPs) associated with systemic inflammation as measured by CRP and with plasma lipids using data from the Health and Retirement Study. SNP enrichment was observed for cognitive impairment conditioned on the secondary phenotypes of plasma CRP and lipids. Fold enrichment of 100%-800% was observed for increasingly stringent p-value thresholds for SNPs associated with cognitive impairment conditional on plasma CRP, 80%-800% for low-density lipoprotein, and 80%-600% for total cholesterol. Significant associations (false discovery rate Q ≤ 0.05) between cognitive impairment, conditional with either CRP, low-density lipoprotein, or total cholesterol, were found for the locus on chromosome 19 that contains the APOE, TOMM40, APOC1, and PVRL2 genes. Relative numbers of significant SNPs in each of the genes differed by the conditional associations with the secondary phenotypes. Biological interpretation of both the genetic pleiotropy results and the individual genome-wide association results showed that the variants and proximal genes identified are involved in multiple pathological processes including cholesterol metabolism, inflammation, and mitochondrial transport. These findings are potentially important for Alzheimer's disease risk prediction and development of novel therapeutic approaches.
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Affiliation(s)
- Michael W Lutz
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA.
| | - Ramon Casanova
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Santiago Saldana
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Maragatha Kuchibhatla
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Winston-Salem, NC, USA
| | - Brenda L Plassman
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Kathleen M Hayden
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Gilligan AM, Alberts DS, Roe DJ, Skrepnek GH. Death or Debt? National Estimates of Financial Toxicity in Persons with Newly-Diagnosed Cancer. Am J Med 2018; 131:1187-1199.e5. [PMID: 29906429 DOI: 10.1016/j.amjmed.2018.05.020] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/05/2018] [Accepted: 05/23/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of cancer upon a patient's net worth and debt in the US. METHODS This longitudinal study used the Health and Retirement Study from 1998-2014. Persons ≥50years with newly-diagnosed malignancies were included, excluding minor skin cancers. Multivariable generalized linear models assessed changes in net worth and debt (consumer, mortgage, home equity) at 2 and 4 years after diagnosis (year+2, year+4), controlling for demographic and clinically-related variables, cancer-specific attributes, economic factors, and mortality. A 2-year period before cancer diagnosis served as a historical control. RESULTS Across 9.5 million estimated new diagnoses of cancer from 2000-2012, individuals averaged 68.6±9.4 years with slight majorities being married (54.7%), not retired (51.1%), and Medicare beneficiaries (56.6%). At year+2, 42.4% depleted their entire life's assets, with higher adjusted odds associated with worsening cancer, requirement of continued treatment, demographic and socioeconomic factors (ie, female, Medicaid, uninsured, retired, increasing age, income, and household size), and clinical characteristics (ie, current smoker, worse self-reported health, hypertension, diabetes, lung disease) (P<.05); average losses were $92,098. At year+4, financial insolvency extended to 38.2%, with several consistent socioeconomic, cancer-related, and clinical characteristics remaining significant predictors of complete asset depletion. CONCLUSIONS This nationally-representative investigation of an initially-estimated 9.5 million newly-diagnosed persons with cancer who were ≥50 years of age found a substantial proportion incurring financial toxicity. As large financial burdens have been found to adversely affect access to care and outcomes among cancer patients, the active development of approaches to mitigate these effects among already vulnerable groups remains of key importance.
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Affiliation(s)
- Adrienne M Gilligan
- The University of North Texas Health Sciences Center, College of Pharmacy, Fort Worth; Truven Health Analytics, an IBM Company, Houston, Texas
| | - David S Alberts
- The University of Arizona, The University of Arizona Cancer Center, Tucson
| | - Denise J Roe
- The University of Arizona, Mel and Enid Zuckerman College of Public Health, Tucson
| | - Grant H Skrepnek
- The University of Oklahoma Health Sciences Center, College of Pharmacy, Oklahoma City; The University of Oklahoma Health Sciences Center, Peggy and Charles Stephenson Cancer Center, Oklahoma City.
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Seligman B, Tuljapurkar S, Rehkopf D. Machine learning approaches to the social determinants of health in the health and retirement study. SSM Popul Health 2018; 4:95-99. [PMID: 29349278 PMCID: PMC5769116 DOI: 10.1016/j.ssmph.2017.11.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Social and economic factors are important predictors of health and of recognized importance for health systems. However, machine learning, used elsewhere in the biomedical literature, has not been extensively applied to study relationships between society and health. We investigate how machine learning may add to our understanding of social determinants of health using data from the Health and Retirement Study. METHODS A linear regression of age and gender, and a parsimonious theory-based regression additionally incorporating income, wealth, and education, were used to predict systolic blood pressure, body mass index, waist circumference, and telomere length. Prediction, fit, and interpretability were compared across four machine learning methods: linear regression, penalized regressions, random forests, and neural networks. RESULTS All models had poor out-of-sample prediction. Most machine learning models performed similarly to the simpler models. However, neural networks greatly outperformed the three other methods. Neural networks also had good fit to the data (R2 between 0.4-0.6, versus <0.3 for all others). Across machine learning models, nine variables were frequently selected or highly weighted as predictors: dental visits, current smoking, self-rated health, serial-seven subtractions, probability of receiving an inheritance, probability of leaving an inheritance of at least $10,000, number of children ever born, African-American race, and gender. DISCUSSION Some of the machine learning methods do not improve prediction or fit beyond simpler models, however, neural networks performed well. The predictors identified across models suggest underlying social factors that are important predictors of biological indicators of chronic disease, and that the non-linear and interactive relationships between variables fundamental to the neural network approach may be important to consider.
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Affiliation(s)
- Benjamin Seligman
- Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA 90095, USA
| | | | - David Rehkopf
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA 94305, USA
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Smith DK, Castellanos EH, Murphy BA. Financial and socio-economic factors influencing pre- and post-cancer therapy oral care. Support Care Cancer 2018; 26:2143-2148. [PMID: 29372394 DOI: 10.1007/s00520-017-4033-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/25/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE The primary objective of this study is to evaluate how attendance at dental visits may change as cancer patients move through pre-diagnosis, diagnosis, and into survivorship. METHODS The Health and Retirement Study consists of longitudinal survey data collected biannually detailing financial and health information in subjects over 51 years old. We assessed a subset of 4195 patients who received a new cancer diagnosis during the study period. The odds of reporting a dental visit were examined using a mixed effects logistic regression model. A propensity score weighted analysis of the association between dental attendance and survival was also undertaken. RESULTS The odds of attending a dental visit were substantially lower in the peri-diagnosis period OR = 0.784 (0.700, 0.876) and the post-diagnosis period OR = 0.734 (0.655, 0.823) compared to pre-diagnosis. This effect persisted in patients who survived for at least 2 years indicating that the decline in oral health visits was not due to low expected survival. After propensity score weighting, patients who attended a dental visit in the peri-diagnosis period demonstrated a reduced hazard of all-cause mortality HR = 0.825 (0.681, 0.979) compared with those with no attendance. CONCLUSIONS Dental attendance decreases by a statistically and clinically significant amount both during and after cancer therapy despite guideline recommendations encouraging dental referral and monitoring for many types of cancer therapy. Attendance at dental appointments during cancer therapy is associated with improved survival, which is likely due to a combination of direct and indirect effects.
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Affiliation(s)
- Derek K Smith
- Departments of Biostatistics and Oral Maxillofacial Surgery, Vanderbilt University Medical Center, 2525 West End Ave, Ste 11000, Nashville, TN, 37203, USA.
| | - Emily H Castellanos
- Department of Oncology, Vanderbilt University Medical Center, Nashville, TN, 37221, USA
| | - Barbara A Murphy
- Department of Oncology, Vanderbilt University Medical Center, Nashville, TN, 37221, USA
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Abstract
OBJECTIVES Substantive past research suggests that moderate alcohol use confers beneficial health outcomes. The study of moderate alcohol use and cognition has produced variable findings. The primary goal was to examine the relationship between alcohol use and cognitive aging over time (Experiment 1), in a demographically representative, longitudinal survey of older adults. Experiment 2 examined the hypothesis that apolipoprotein E-4 (ApoE-4) would moderate the relationship between moderate drinking and performance on cognitive domains. METHOD The sample was drawn from the Aging, Demographics, and Memory Study (ADAMS) supplement of the Health and Retirement Study (HRS) and included 856 participants over age 65 in 2001. Follow-up data were from 2002, 2006, and 2008. Alcohol use was measured via self-report. Control variables included gender, age, race, number of years of education, medical burden (total number of medical diseases), and marital status. RESULTS Results of Experiment 1 indicated that moderate alcohol use was significantly associated with better baseline functioning across cognitive measures (p ≤ .05), but had no significant effect on rate of change over time across cognitive domains. Results of Experiment 2 indicated that while ApoE-4 carriage did not moderate the relationship between alcohol use and cognitive performance, generally, both ApoE-4 and moderate alcohol use were significant predictors of cognitive performance. CONCLUSIONS Overall, findings from this study support past findings that moderate alcohol use is associated with better cognitive functioning among community-dwelling older adults, and these relative benefits appear to persist throughout later life. However, the role of individual differences on manifestation of benefit remain very poorly understood. Future research should further examine the respective roles of demographic differences associated with cognitive aging, genetic moderators, and the influence of social interaction.
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Affiliation(s)
- Danielle Herring
- a Department of Psychology , University of Central Florida , Orlando , FL , USA
| | - Daniel Paulson
- a Department of Psychology , University of Central Florida , Orlando , FL , USA
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McCluney CL, Schmitz LL, Hicken MT, Sonnega A. Structural racism in the workplace: Does perception matter for health inequalities? Soc Sci Med 2018; 199:106-14. [PMID: 28552294 DOI: 10.1016/j.socscimed.2017.05.039] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 05/12/2017] [Accepted: 05/17/2017] [Indexed: 01/13/2023]
Abstract
Structural racism has been linked to racial health inequalities and may operate through an unequal labor market that results in inequalities in psychosocial workplace environments (PWE). Experiences of the PWE may be a critical but understudied source of racial health disparities as most adults spend a large portion of their lives in the workplace, and work-related stress affects health outcomes. Further, it is not clear if the objective characteristics of the workplace are important for health inequalities or if these inequalities are driven by the perception of the workplace. Using data from the 2008 to 2012 waves of the Health and Retirement Study (HRS), a probability-based sample of US adults 50 years of age and older and the Department of Labor's Occupational Information Network (O*NET), we examine the role of both standardized, objective (O*NET) and survey-based, subjective (as in HRS) measures of PWEs on health and Black-White health inequalities. We find that Blacks experience more stressful PWEs and have poorer health as measured by self-rated health, episodic memory function, and mean arterial pressure. Mediation analyses suggest that these objective O*NET ratings, but not the subjective perceptions, partially explain the relationship between race and health. We discuss these results within the extant literature on workplace and health and health inequalities. Furthermore, we discuss the use of standardized objective measures of the PWE to capture racial inequalities in workplace environment.
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Friedman EM, Shih RA, Slaughter ME, Weden MM, Cagney KA. Neighborhood age structure and cognitive function in a nationally-representative sample of older adults in the U.S. Soc Sci Med 2017; 174:149-58. [PMID: 28033564 DOI: 10.1016/j.socscimed.2016.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/05/2016] [Accepted: 12/02/2016] [Indexed: 02/01/2023]
Abstract
Recent evidence suggests that living in a neighborhood with a greater percentage of older adults is associated with better individual health, including lower depression, better self-rated health, and a decreased risk of overall mortality. However, much of the work to date suffers from four limitations. First, none of the U.S.-based studies examine the association at the national level. Second, no studies have examined three important hypothesized mechanisms - neighborhood socioeconomic status and neighborhood social and physical characteristics - which are significantly correlated with both neighborhood age structure and health. Third, no U.S. study has longitudinally examined cognitive health trajectories. We build on this literature by examining nine years of nationally-representative data from the Health and Retirement Study (2002-2010) on men and women aged 51 and over linked with Census data to examine the relationship between the percentage of adults 65 and older in a neighborhood and individual cognitive health trajectories. Our results indicate that living in a neighborhood with a greater percentage of older adults is related to better individual cognition at baseline but we did not find any significant association with cognitive decline. We also explored potential mediators including neighborhood socioeconomic status, perceived neighborhood cohesion and perceived neighborhood physical disorder. We did not find evidence that neighborhood socioeconomic status explains this relationship; however, there is suggestive evidence that perceived cohesion and disorder may explain some of the association between age structure and cognition. Although more work is needed to identify the precise mechanisms, this work may suggest a potential contextual target for public health interventions to prevent cognitive impairment.
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Xiang X. History of major depression as a barrier to health behavior changes after a chronic disease diagnosis. J Psychosom Res 2016; 85:12-8. [PMID: 27212664 DOI: 10.1016/j.jpsychores.2016.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 04/02/2016] [Accepted: 04/04/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine whether changes in smoking, drinking, and physical activity after a chronic disease diagnosis differ between middle-aged and older adults with and without a history of major depression. METHODS Individual-level data came from 1996 to 2010 waves of the U.S. Health and Retirement Study. Chronic disease diagnosis was ascertained from self-reports of physician diagnosed diseases. Major depression was assessed by the short-form Composite International Diagnostic Interview. Mixed-effects logistic regressions were performed to estimate the potential moderating effect of a history of major depression. RESULTS Baseline major depression was associated with a more than 3-fold increase (OR=4.48, 95% CI=2.27-8.86) in the odds of smoking and 37% decrease (OR=0.63, 95% CI=0.52-0.75) in the odds of staying physically active, but not with odds of excessive drinking. After a chronic disease diagnosis, the odds of smoking was reduced by 75% (OR=0.25, 95% CI=0.20-0.32), the odds of excessive drinking was reduced by 47% (OR=0.53, 95% CI=0.47-0.61), and the odds of staying physically active was reduced by 30% (OR=0.70, 95% CI=0.63-0.78). There was a significant interaction effect for smoking such that the decline in the odds of smoking was smaller among adults with a history of major depression. CONCLUSION Chronic disease diagnosis may be an important teachable moment for health behavior change, but the behavior changing effect may be smaller for those with a history of major depression especially when it comes to smoking.
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Affiliation(s)
- Xiaoling Xiang
- Center for Education in Health Sciences, Feinberg School of Medicine, Northwestern University, 633 North St. Clair, 20th floor, Chicago, IL 60611, United States.
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Abstract
OBJECTIVE The upsurge in prevalence and long-term use of antidepressants among older adults might have profound health implications beyond depressive symptom management. This study examined the relationship between antidepressant use and functional limitation onset in U.S. older adults. METHODS Study sample came from 2006 and 2008 waves of the Health and Retirement Study, in combination with data from 2005 and 2007 Prescription Drug Study. Self-reported antidepressant use was identified based on the therapeutic classification of Cerner Multum's Lexicon. Functional limitations were classified into those pertaining to physical mobility, large muscle function, activities of daily living, gross motor function, fine motor function, and instrumental activities of daily living. Cox proportional hazard models were performed to assess the effects of antidepressant use on future functional limitation onset by limitation category, antidepressant type, and length of use, adjusted by depression status and other individual characteristics. RESULTS Antidepressant use for one year and longer was associated with an increase in the risk of functional limitation by 8% (95% confidence interval=4%-12%), whereas the relationship between antidepressant use less than a year and function limitation was statistically nonsignificant. Antidepressant use was associated with an increase in the risk of functional limitation by 8% (3%-13%) among currently nondepressed participants but not currently depressed participants. CONCLUSION Long-term antidepressant use in older adults should be prudently evaluated and regularly monitored to reduce the risk of functional limitation. Future research is warranted to examine the health consequences of extended and/or off-label antidepressant use in absence of depressive symptoms.
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Affiliation(s)
- Ruopeng An
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, USA.
| | - Lingyun Lu
- College of Pharmacy, California Northstate University, USA
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