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Meza E, Hebert J, Garcia ME, Torres JM, Glymour MM, Vable AM. First-generation college graduates have similar depressive symptoms in midlife as multi-generational college graduates. SSM Popul Health 2024; 25:101633. [PMID: 38434443 PMCID: PMC10905036 DOI: 10.1016/j.ssmph.2024.101633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose Higher education may protect an individual against depressive symptoms, yet, disadvantaged socioeconomic status (SES) during childhood, often measured by lower parental education, may put them at higher risk for depressive symptoms later in life. This study evaluates if midlife depression is similar for first-generation and multi-generation college graduates. Methods For US Health and Retirement Study (HRS) participants ages 55-63 (N = 16,752), we defined a 4-category exposure from parents' (highest of mother or father's) and participant's own years of education, with 16 years indicating college completion: multi-gen (both ≥ 16 years: reference); first-gen (parents <16; own ≥ 16); only parent(s) (parents ≥ 16; own <16); and neither (both <16) college graduates across three birth cohorts. We used linear regressions to evaluate relationships between college completion and depressive symptoms measured by an 8-item Center for Epidemiologic Studies - Depression (CES-D) scale. Models pooled over time evaluated differences by sex, race/ethnicity, and birthplace. Results First-gen and multi-gen college graduates averaged similar depressive symptoms in midlife (β : 0.01; 95% CI: 0.15, 0.13). Results were similar by sex and race/ethnicity. Conclusion Consistent with resource substitution theory, college completion may offset the deleterious effects of lower parental education on midlife depressive symptoms for first-generation graduates.
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Affiliation(s)
- Erika Meza
- Department of Epidemiology and Biostatistics University of California, San Francisco, 550 16th St 2nd Floor, San Francisco, CA, 94158, USA
- Center for Population and Development Studies Harvard University, 9 Bow St. Cambridge, MA 02138, USA
| | - Jillian Hebert
- Department of Family and Community Medicine University of California, San Francisco, 995 Potrero Ave, San Francisco, CA, 94110, USA
| | - Maria E. Garcia
- Department of Epidemiology and Biostatistics University of California, San Francisco, 550 16th St 2nd Floor, San Francisco, CA, 94158, USA
- Division of General Internal Medicine, University of California, San Francisco, 1701 Divisadero St, San Francisco, CA, 94115, USA
| | - Jacqueline M. Torres
- Department of Epidemiology and Biostatistics University of California, San Francisco, 550 16th St 2nd Floor, San Francisco, CA, 94158, USA
| | - M. Maria Glymour
- Department of Epidemiology, Boston University School of Public Health, 715 Albany St, Boston, MA, USA
| | - Anusha M. Vable
- Department of Family and Community Medicine University of California, San Francisco, 995 Potrero Ave, San Francisco, CA, 94110, USA
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Vu C, Arcaya MC, Kawachi I, Williams DR. In Search of the Promised Land: County-Level Disadvantage and Low Birth Weight among Black Mothers of the Great Migration. J Urban Health 2023; 100:1093-1101. [PMID: 37580548 PMCID: PMC10728401 DOI: 10.1007/s11524-023-00778-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/16/2023]
Abstract
The Great Migration was a movement of roughly eight million Black Southerners relocating to the North and West from 1910 to 1980. Despite being one of the most significant mass internal migrations during the twentieth century, little is known about the health outcomes resulting from migration and whether migrators' destination choices were potential mechanisms. This study measured the association between destination county disadvantage and odds of low birth weight during the last decade of the Great Migration. We used the US Census from 1970 as well as the birth records of first-time Black mothers who migrated from the South collected through the National Center of Health Statistics from 1973 to 1980 (n = 154,145). We examined three measures of area-based opportunity: Black male high school graduation rate, Black poverty rate, and racialized economic residential segregation. We used multilevel logistic regression, where mothers were nested within US counties, to quantify the relationship between county disadvantage and low birth weight. After adjusting for individual risk and protective factors for infant health, there was no relationship between county opportunity measures and low birth weight among migrators. Although high socioeconomic opportunity is typically associated with protection of low birth weight, we did not see these outcomes in this study. These results may support that persistent racial discrimination encountered in the North inhibited infant health even as migrators experienced higher economic opportunity relative to the South.
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Affiliation(s)
- Cecilia Vu
- Center for Antiracist Research, Boston University, Boston, MA, USA.
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Mariana C Arcaya
- Department of Urban Studies, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA, USA
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3
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Qian H, Khadka A, Martinez SM, Singh S, Brenowitz WD, Zeki Al Hazzouri A, Hill-Jarrett TG, Glymour MM, Vable AM. Food Insecurity, Memory, and Dementia Among US Adults Aged 50 Years and Older. JAMA Netw Open 2023; 6:e2344186. [PMID: 37988079 PMCID: PMC10663972 DOI: 10.1001/jamanetworkopen.2023.44186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/10/2023] [Indexed: 11/22/2023] Open
Abstract
Importance Despite existing federal programs to increase access to food, food insecurity is common among US older adults. Food insecurity may affect Alzheimer disease and Alzheimer disease-related dementias via multiple mechanisms, yet there is almost no quantitative research evaluating this association. Objective To examine whether food insecurity in older adults is associated with later-life cognitive outcomes. Design, Setting, and Participants This cohort study of US residents aged 50 years and older from the US Health and Retirement Study was restricted to respondents with food insecurity data in 2013 and cognitive outcome data between calendar years 2014 and 2018. Analyses were conducted from June 1 to September 22, 2023. Exposure Food insecurity status in 2013 was assessed using the validated US Department of Agriculture 6-item Household Food Security Module. Respondents were classified as being food secure, low food secure, and very low food secure. Main Outcomes and Measures Outcomes were dementia probability and memory score (standardized to 1998 units), estimated biennially between 2014 and 2018 using a previously validated algorithm. Generalized estimation equations were fit for dementia risk and linear mixed-effects models for memory score, taking selective attrition into account through inverse probability of censoring weights. Results The sample consisted of 7012 participants (18 356 person-waves); mean (SD) age was 67.7 (10.0) years, 4131 (58.9%) were women, 1136 (16.2%) were non-Hispanic Black, 4849 (69.2%) were non-Hispanic White, and mean (SD) duration of schooling was 13.0 (3.0) years. Compared with food-secure older adults, experiencing low food security was associated with higher odds of dementia (odds ratio, 1.38; 95% CI, 1.15-1.67) as was experiencing very low food security (odds ratio, 1.37; 95% CI, 1.11-1.59). Low and very low food security was also associated with lower memory levels and faster age-related memory decline. Conclusions and Relevance In this cohort study of older US residents, food insecurity was associated with increased dementia risk, poorer memory function, and faster memory decline. Future studies are needed to examine whether addressing food insecurity may benefit brain health.
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Affiliation(s)
- Haobing Qian
- Department of Family and Community Medicine, University of California, San Francisco
| | - Aayush Khadka
- Department of Family and Community Medicine, University of California, San Francisco
| | - Suzanna M. Martinez
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Sonali Singh
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | | | - Adina Zeki Al Hazzouri
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | | | - M. Maria Glymour
- Department of Epidemiology, Boston University, Boston, Massachusetts
| | - Anusha M. Vable
- Department of Family and Community Medicine, University of California, San Francisco
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Elman C, Cunningham SA, Howard VJ, Judd SE, Bennett AM, Dupre ME. Birth in the U.S. Plantation South and Racial Differences in all-cause mortality in later life. Soc Sci Med 2023; 335:116213. [PMID: 37717468 DOI: 10.1016/j.socscimed.2023.116213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 07/26/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
The American South has been characterized as a Stroke Belt due to high cardiovascular mortality. We examine whether mortality rates and race differences in rates reflect birthplace exposure to Jim Crow-era inequalities associated with the Plantation South. The plantation mode of agricultural production was widespread through the 1950s when older adults of today, if exposed, were children. We use proportional hazards models to estimate all-cause mortality in Non-Hispanic Black and White birth cohorts (1920-1954) in a sample (N = 21,941) drawn from REasons for Geographic and Racial Differences in Stroke (REGARDS), a national study designed to investigate Stroke Belt risk. We link REGARDS data to two U.S. Plantation Censuses (1916, 1948) to develop county-level measures that capture the geographic overlap between the Stroke Belt, two subregions of the Plantation South, and a non-Plantation South subregion. Additionally, we examine the life course timing of geographic exposure: at birth, adulthood (survey enrollment baseline), neither, or both portions of life. We find mortality hazard rates higher for Black compared to White participants, regardless of birthplace, and for the southern-born compared to those not southern-born, regardless of race. Race-specific models adjusting for adult Stroke Belt residence find birthplace-mortality associations fully attenuated among White-except in one of two Plantation South subregions-but not among Black participants. Mortality hazard rates are highest among Black and White participants born in this one Plantation South subregion. The Black-White mortality differential is largest in this birthplace subregion as well. In this subregion, the legacy of pre-Civil War plantation production under enslavement was followed by high-productivity plantation farming under the southern Sharecropping System.
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Affiliation(s)
- Cheryl Elman
- Social Science Research Institute, Duke University, Durham, NC, 27708, USA.
| | | | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama-Birmingham, USA.
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama-Birmingham, USA.
| | - Aleena M Bennett
- Department of Biostatistics, School of Public Health, University of Alabama-Birmingham, USA.
| | - Matthew E Dupre
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, 27701, USA; Department of Sociology, Duke University, Durham, NC 27710, USA.
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Arias F, Chen F, Shiff H, Marcantonio ER, Jones RN, Schmitt EM, Metzger E, Fong TG, Travison TG, Inouye SK. Parental Education and Delirium Risk after Surgery in Older Adults. Clin Gerontol 2023; 46:253-266. [PMID: 36001869 PMCID: PMC9928599 DOI: 10.1080/07317115.2022.2111289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Efforts to conceptualize risk factors for postoperative delirium in older adults have focused on the time proximate to the episode, but how early-life exposures influence delirium risk is poorly understood. METHODS An observational cohort of 547 patients aged 70+undergoing major non-cardiac surgery at two academic medical centers in Boston. Demographic characteristics, cognition, parental education, health, and participation in cognitively stimulating activities were assessed prior to surgery. Delirium incidence and severity were measured daily during hospitalization. RESULTS Higher paternal education was associated with significantly lower incidence of delirium (X2(1, N =547)=8.35, p <.001; odds ratio OR=.93, 95% CI, .87 to .98) and inversely associated with delirium severity (r(545)=-.13, p <.001). Higher maternal education was associated with lower delirium incidence but did not reach statistical significance. The effect of paternal education on delirium incidence was independent of the patient's education, estimated premorbid intelligence, medical comorbidities, neighborhood disadvantage, and participation in cognitively stimulating activities (X2(2, N =547)=31.22, p <.001). CONCLUSIONS Examining early-life exposures may yield unique insights into the risks and pathogenesis of delirium. CLINICAL IMPLICATIONS Evaluating long-term factors that increase vulnerability to delirium may improve our ability to calculate risk. It may guide clinical decision-making and inform pre- and post-operative recommendations.
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Affiliation(s)
- Franchesca Arias
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, USA
- Harvard Medical School, Boston, USA
| | - Fan Chen
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, USA
| | - Haley Shiff
- Harvard T. H. Chan School of Public Health, Boston, USA
| | - Edward R. Marcantonio
- Harvard Medical School, Boston, USA
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Richard N. Jones
- Department of Psychiatry and Human Behavior, Brown University, Warren Alpert Medical School, Providence, USA
| | - Eva M. Schmitt
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
| | - Eran Metzger
- Department of Medicine, Hebrew SeniorLife, Boston, USA
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, USA
| | - Tamara G. Fong
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, USA
- Harvard Medical School, Boston, USA
| | - Thomas G. Travison
- Harvard Medical School, Boston, USA
- Biostatistics and Data Sciences, Hinda and Arthur Marcus Institute for Aging Research at the Hebrew SeniorLife, Boston, USA
- Department of Medicine and Psychiatry, Harvard Medical School, Boston, USA
| | - Sharon K. Inouye
- Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, USA
- Harvard Medical School, Boston, USA
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
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Eysenbach G, Tan X, Padman R. A Machine Learning Approach to Support Urgent Stroke Triage Using Administrative Data and Social Determinants of Health at Hospital Presentation: Retrospective Study. J Med Internet Res 2023; 25:e36477. [PMID: 36716097 PMCID: PMC9926350 DOI: 10.2196/36477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/17/2022] [Accepted: 12/18/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The key to effective stroke management is timely diagnosis and triage. Machine learning (ML) methods developed to assist in detecting stroke have focused on interpreting detailed clinical data such as clinical notes and diagnostic imaging results. However, such information may not be readily available when patients are initially triaged, particularly in rural and underserved communities. OBJECTIVE This study aimed to develop an ML stroke prediction algorithm based on data widely available at the time of patients' hospital presentations and assess the added value of social determinants of health (SDoH) in stroke prediction. METHODS We conducted a retrospective study of the emergency department and hospitalization records from 2012 to 2014 from all the acute care hospitals in the state of Florida, merged with the SDoH data from the American Community Survey. A case-control design was adopted to construct stroke and stroke mimic cohorts. We compared the algorithm performance and feature importance measures of the ML models (ie, gradient boosting machine and random forest) with those of the logistic regression model based on 3 sets of predictors. To provide insights into the prediction and ultimately assist care providers in decision-making, we used TreeSHAP for tree-based ML models to explain the stroke prediction. RESULTS Our analysis included 143,203 hospital visits of unique patients, and it was confirmed based on the principal diagnosis at discharge that 73% (n=104,662) of these patients had a stroke. The approach proposed in this study has high sensitivity and is particularly effective at reducing the misdiagnosis of dangerous stroke chameleons (false-negative rate <4%). ML classifiers consistently outperformed the benchmark logistic regression in all 3 input combinations. We found significant consistency across the models in the features that explain their performance. The most important features are age, the number of chronic conditions on admission, and primary payer (eg, Medicare or private insurance). Although both the individual- and community-level SDoH features helped improve the predictive performance of the models, the inclusion of the individual-level SDoH features led to a much larger improvement (area under the receiver operating characteristic curve increased from 0.694 to 0.823) than the inclusion of the community-level SDoH features (area under the receiver operating characteristic curve increased from 0.823 to 0.829). CONCLUSIONS Using data widely available at the time of patients' hospital presentations, we developed a stroke prediction model with high sensitivity and reasonable specificity. The prediction algorithm uses variables that are routinely collected by providers and payers and might be useful in underresourced hospitals with limited availability of sensitive diagnostic tools or incomplete data-gathering capabilities.
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Affiliation(s)
| | - Xuan Tan
- Department of Information Systems and Analytics, Leavey School of Business, Santa Clara University, Santa Clara, CA, United States
| | - Rema Padman
- The H John Heinz III College of Information Systems and Public Policy, Carnegie Mellon University, Pittsburgh, PA, United States
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Zhang Z, Liu H, Zhang Y. Marital Loss and Cognitive Function: Does Timing Matter? J Gerontol B Psychol Sci Soc Sci 2022; 77:1916-1927. [PMID: 35512289 PMCID: PMC9535775 DOI: 10.1093/geronb/gbac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study examines the association between age at marital loss (i.e., divorce or widowhood) and cognitive function in later life and whether the association differs by gender. METHODS We used mixed-effects models, drawing on longitudinal data from the Health and Retirement Study (1998-2016). The analytical samples included older adults aged 51 and older who had ever been widowed (N=5,639 with 25,537 person-waves) or divorced (N=10,685 with 50,689 person-waves). RESULTS We find that those who were widowed at younger ages had lower cognitive function than their counterparts who were widowed at older ages, for both men and women, after controlling for covariates. Household income and health-related factors partially accounted for the positive association between age at widowhood and cognitive function. Those who divorced at younger ages also had lower cognitive function than their counterparts who divorced at older ages, but this association was only present among men, not women. Health-related factors partially accounted for the associations between age at divorce and cognitive function among men. DISCUSSION Findings highlight the importance of considering the role of timing of marital loss in cognitive health among older adults.
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Affiliation(s)
- Zhenmei Zhang
- Address correspondence to: Zhenmei Zhang, PhD, Department of Sociology, Michigan State University, 509 East Circle Drive, 316 Berkey Hall, East Lansing, MI 48824-1111, USA. E-mail:
| | - Hui Liu
- Department of Sociology, Michigan State University, East Lansing, Michigan, USA
| | - Yan Zhang
- Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, Wisconsin, USA
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8
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Xiang R, Zhai X, Zhang Q, Wang Z. Relationship Between Dietary Knowledge, Socioeconomic Status, and Stroke Among Adults Involved in the 2015 China Health and Nutrition Survey. Front Nutr 2021; 8:728641. [PMID: 34646851 PMCID: PMC8502799 DOI: 10.3389/fnut.2021.728641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/31/2021] [Indexed: 11/19/2022] Open
Abstract
Stroke is a public health threat that requires urgent attention in China. Nutrients have individual significant impacts on the prevalence of stroke. However, little research has been conducted on the impact of dietary knowledge on stroke and whether the impact is potentially heterogeneous under the effect of socioeconomic status. This study used the 2015 Chinese Health and Nutrition Survey to explore the impact of dietary knowledge and socioeconomic factors on populations suffering from stroke. Results indicated that risk of stroke decreased significantly with increasing dietary knowledge score. Additionally, the impact of dietary knowledge scores on the prevalence of stroke has obvious heterogeneity. First, dietary knowledge scores significantly influenced low-income groups and individuals with low educational levels. Second, the risk of stroke in females is more affected by dietary knowledge. Third, for people living in different areas, dietary knowledge determines whether rural populations suffer from stroke.
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Affiliation(s)
- Ruojun Xiang
- School of Public Health, Guilin Medical University, Guilin, China
| | - Xiaoya Zhai
- Guangxi Key Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin, China
| | - Qiujin Zhang
- Department of Immunology, School of Basic Medicine, Guilin Medical University, Guilin, China
| | - Zhihua Wang
- Department of Immunology, School of Basic Medicine, Guilin Medical University, Guilin, China
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9
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Ehrlich ME, Han B, Lutz M, Ghorveh MG, Okeefe YA, Shah S, Kolls BJ, Graffagnino C. Socioeconomic Influence on Emergency Medical Services Utilization for Acute Stroke: Think Nationally, Act Locally. Neurohospitalist 2021; 11:317-325. [PMID: 34567392 DOI: 10.1177/19418744211010049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background and Purpose Rates of emergency medical services (EMS) utilization for acute stroke remain low nationwide, despite the time-sensitive nature of the disease. Prior research suggests several demographic and social factors are associated with EMS use. We sought to evaluate which demographic or socioeconomic factors are associated with EMS utilization in our region, thereby informing future education efforts. Methods We performed a retrospective analysis of patients for whom the stroke code system was activated at 2 hospitals in our region. Univariate and logistic regression analysis was performed to identify factors associated with use of EMS versus private vehicle. Results EMS use was lower in patients who were younger, had higher income, were married, more educated and in those who identified as Hispanic. Those arriving by EMS had significantly faster arrival to code, arrival to imaging, and arrival to thrombolytic treatment times. Conclusion Analysis of regional data can identify specific populations underutilizing EMS services for acute stroke symptoms. Factors effecting EMS utilization varies by region and this information may be useful for targeted education programs promoting EMS use for acute stroke symptoms. EMS use results in more rapid evaluation and treatment of stroke patients.
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Affiliation(s)
- Matthew E Ehrlich
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Bin Han
- Department of Statistical Science, Duke University, Durham, NC, USA
| | - Michael Lutz
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | | | - Yasmin Ali Okeefe
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Shreyansh Shah
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Brad J Kolls
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Carmelo Graffagnino
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
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10
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Zhang Z, Liu H, Choi SWE. Marital loss and risk of dementia: Do race and gender matter? Soc Sci Med 2021; 275:113808. [PMID: 33713925 PMCID: PMC8015783 DOI: 10.1016/j.socscimed.2021.113808] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/02/2021] [Accepted: 02/26/2021] [Indexed: 12/22/2022]
Abstract
Recent studies have found that marital loss through divorce or widowhood is associated with a higher risk of dementia for older adults. However, whether these associations vary by race and gender is less clear. To address this gap, we drew upon longitudinal data from the Health and Retirement Study (2000-2016) to investigate the association between marital loss and dementia risk, separately for non-Hispanic Whites and non-Hispanic Blacks. We further examined gender variations in the link between marital loss and dementia risk within each racial group. Results from discrete-time event history models suggested that widowhood is significantly associated with a higher risk of dementia for both Whites and Blacks, controlling for basic demographic characteristics. However, while divorce is significantly associated with a higher risk of dementia for Blacks, the association is marginally significant (p < 0.1) for Whites. There are few significant gender variations in these associations except for the effect of divorce among Whites. Even after controlling for economic and health-related factors, we found that divorce is associated with a higher risk of dementia among White men but not among White women. Economic resources explain a significant portion of the association between widowhood and dementia risk, more so for Whites than for Blacks. Our findings call for more research into the pathways through which marital loss shapes the risk of dementia across racial and ethnic groups.
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Affiliation(s)
- Zhenmei Zhang
- Department of Sociology, Michigan State University, USA.
| | - Hui Liu
- Department of Sociology, Michigan State University, USA
| | - Seung-Won Emily Choi
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, USA
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11
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Pedron S, Schmaderer K, Murawski M, Schwettmann L. The association between childhood socioeconomic status and adult health behavior: The role of locus of control. SOCIAL SCIENCE RESEARCH 2021; 95:102521. [PMID: 33653585 DOI: 10.1016/j.ssresearch.2020.102521] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 11/20/2020] [Accepted: 12/20/2020] [Indexed: 06/12/2023]
Abstract
The socioeconomic environment in childhood is a powerful determinant for health behavior in adulthood, subsequently influencing health outcomes. However, the underlying mechanisms are insufficiently understood. This study assesses locus of control (LOC) as a mediator linking childhood socioeconomic status (SES) with health behavior (smoking, regular alcohol consumption, unhealthy diet and low physical activity). Drawing on a representative sample from Germany (SOEP), we investigated these relations using structural equations modelling. Results show that externally oriented LOC explains up to 6% of the relationship between childhood SES and health behavior in adulthood, independently from adult SES. Stratification indicates that these results hold in women but not in men, in younger and middle-aged individuals but not in older ones. Hence, control beliefs play a modest yet significant role in shaping the socioeconomic gradient in health behavior and might have far-reaching consequences on how morbidity and mortality arise and persist across generations.
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Affiliation(s)
- Sara Pedron
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany; German Center for Diabetes Research, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany; Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Marchioninistr. 15, 81377, Munich, Germany; Pettenkofer School of Public Health, Munich, Germany.
| | - Katharina Schmaderer
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Monika Murawski
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany; IFT Institut für Therapieforschung, Leopoldstr. 175, 80804, Munich, Germany
| | - Lars Schwettmann
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany; Department of Economics, Martin Luther University Halle-Wittenberg, Große Steinstraße 73, 06108, Halle (Saale), Germany
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12
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Zaborenko CJ, Ferraro KF, Williams-Farrelly MM. Childhood Misfortune and Late-Life Stroke Incidence, 2004-2014. THE GERONTOLOGIST 2020; 60:1060-1070. [PMID: 32267501 DOI: 10.1093/geront/gnaa007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although most strokes occur in later life, recent studies reveal that negative exposures decades earlier are associated with stroke risk. The purpose of this study was to examine whether accumulated and/or specific domains of early misfortune are related to stroke incidence in later life. RESEARCH DESIGN AND METHODS A decade of longitudinal data from stroke-free participants 50 years or older in the Health and Retirement Study were analyzed (N = 12,473). Incident stroke was defined as either self-reported first incident stroke or death due to stroke between 2004 and 2014. RESULTS Analyses revealed that accumulated misfortune was associated with increased stroke risk, but the relationship was moderated by wealth. Examining specific domains of childhood misfortune revealed that stroke incidence was greater for persons with behavioral/psychological risks, but that this relationship also was moderated by higher wealth for those with only one behavioral/psychological risk. DISCUSSION AND IMPLICATIONS Accumulated childhood misfortune and adolescent depression heighten the risk of stroke in later life, but the influence is remediable through adult wealth. Reducing poverty in later life may decrease stroke incidence for persons exposed to negative childhood exposures.
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Affiliation(s)
- Callie J Zaborenko
- Department of Sociology, Purdue University, West Lafayette, Indiana.,Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana
| | - Kenneth F Ferraro
- Department of Sociology, Purdue University, West Lafayette, Indiana.,Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana
| | - Monica M Williams-Farrelly
- Department of Sociology, Purdue University, West Lafayette, Indiana.,Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana
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13
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Reshetnyak E, Ntamatungiro M, Pinheiro LC, Howard VJ, Carson AP, Martin KD, Safford MM. Impact of Multiple Social Determinants of Health on Incident Stroke. Stroke 2020; 51:2445-2453. [PMID: 32673521 PMCID: PMC9264323 DOI: 10.1161/strokeaha.120.028530] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Social determinants of health (SDOH) have been previously associated with incident stroke. Although SDOH often cluster within individuals, few studies have examined associations between incident stroke and multiple SDOH within the same individual. The objective was to determine the individual and cumulative effects of SDOH on incident stroke. METHODS This study included 27 813 participants from the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study, a national, representative, prospective cohort of black and white adults aged ≥45 years. SDOH was the primary exposure. The main outcome was expert adjudicated incident stroke. Cox proportional hazards models examined associations between incident stroke and SDOH, individually and as a count of SDOH, adjusting for potential confounders. RESULTS The mean age was 64.7 years (SD 9.4) at baseline; 55.4% were women and 40.4% were blacks. Over a median follow-up of 9.5 years (IQR, 6.0-11.5), we observed 1470 incident stroke events. Of 10 candidate SDOH, 7 were associated with stroke (P<0.10): race, education, income, zip code poverty, health insurance, social isolation, and residence in one of the 10 lowest ranked states for public health infrastructure. A significant age interaction resulted in stratification at 75 years. In fully adjusted models, among individuals <75 years, risk of stroke rose as the number of SDOH increased (hazard ratio for one SDOH, 1.26 [95% CI, 1.02-1.55]; 2 SDOH hazard ratio, 1.38 [95% CI, 1.12-1.71]; and ≥3 SDOH hazard ratio, 1.51 [95% CI, 1.21-1.89]) compared with those without any SDOH. Among those ≥75 years, none of the observed effects reached statistical significance. CONCLUSIONS Incremental increases in the number of SDOH were independently associated with higher incident stroke risk in adults aged <75 years, with no statistically significant effects observed in individuals ≥75 years. Targeting individuals with multiple SDOH may help reduce risk of stroke among vulnerable populations.
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Affiliation(s)
- Evgeniya Reshetnyak
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY (E.R., L.C.P., M.M.S.)
| | - Mariella Ntamatungiro
- Department of Internal Medicine, Columbia University College of Physicians and Surgeons, New York, NY (M.N.)
| | - Laura C Pinheiro
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY (E.R., L.C.P., M.M.S.)
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H., A.P.C., K.D.M.)
| | - April P Carson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H., A.P.C., K.D.M.)
| | - Kimberly D Martin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham (V.J.H., A.P.C., K.D.M.)
| | - Monika M Safford
- Department of Medicine, Weill Cornell Medical College, Cornell University, New York, NY (E.R., L.C.P., M.M.S.)
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14
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Duchowny KA, Hicken MT, Cawthon PM, Glymour MM, Clarke P. Life course trauma and muscle weakness in older adults by gender and race/ethnicity: Results from the U.S. health and Retirement Study. SSM Popul Health 2020; 11:100587. [PMID: 32490135 PMCID: PMC7260581 DOI: 10.1016/j.ssmph.2020.100587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 11/03/2022] Open
Abstract
Muscle weakness, as measured by handgrip strength, is a primary determinant of physical functioning and disability. There is a high burden of muscle weakness in the United States with close to 50 percent of older Americans meeting criteria for clinical muscle weakness. While previous racial/ethnic disparities have been documented among older adults, the extent to which lifecourse trauma shapes muscle strength trajectories is unknown. Using U.S. Health and Retirement Study (N = 20,472, Mean Age = 63.8 years) data on grip strength (2006-2014, up to 3 assessments) and retrospectively reported traumatic events, we fit gender-stratified growth curve models to investigate whether traumatic events experienced across the lifecourse or at distinct sensitive periods (childhood, early/emerging adulthood or mid-life) predicted later-life trajectories of grip strength. There was no association between cumulative trauma and trajectories of grip strength and the main effects for the life stage models were largely null. However, among White women, our results suggest that traumatic events experienced during childhood (β = -0.012; 95% CI = -0.024, 0.0004) compared to middle adulthood are associated with faster declines in grip strength in later life. Traumatic events reported during childhood was related to a slower decline in grip strength over time among Hispanic women compared to that for White women (β = 0.086, 95% CI = 0.044, 0.128). Among Black men, the association between traumatic events during early/emerging adulthood and age-related declines in grip strength was stronger for Black men than for White men (interaction β = -0.070; 95% CI = -0.138, 0.001). Traumatic events experienced during distinct life stages may influence later life declines in grip strength and exacerbate racial inequalities in later life. This study addresses an important gap by investigating the life course social determinants of later life muscle strength, which is a key driver of physical functioning and mobility.
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Affiliation(s)
- Kate A Duchowny
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Margaret T Hicken
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Peggy M Cawthon
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Philippa Clarke
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.,Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
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15
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Zusevics KL, Kaemmerer NN, Lang J, Link J, Bluma DD. A Unique Approach to Quality Improvement Within the Stroke System of Care Utilizing Developmental Evaluation. Health Promot Pract 2020; 22:224-235. [PMID: 32285693 DOI: 10.1177/1524839919894305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke is a significant cause of death that requires multiple systems of care to work together to prevent incidence and improve patient outcomes. The Wisconsin Coverdell Stroke Program partnered with a Model Hospital to understand and improve the stroke system of care in one community. Developmental evaluation (DE) is an approach in which evaluators collaborate closely with project stakeholders to examine complex processes and systems within changeable contexts to develop interventions to improve outcomes. DE was used to assess this community's stroke systems across the care continuum through process mapping with Model Hospital staff and through key stakeholder interviews with Model Hospital and emergency medical services staff, patients, and caregivers. Process mapping identified how patients and health care data flow through the system of care and highlighted areas where streamlining could improve the movement of patients and data across the care continuum. Interviews with stakeholders unveiled challenges and successes about how patient data are accessed and shared across the care continuum, and ideas for improving systems to be more efficient and supportive of stroke prevention and patient outcomes. Overall, DE was valuable in gaining an in-depth understanding of this complex environment to develop strategies to enhance stroke systems of care.
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Affiliation(s)
| | | | - Joshua Lang
- University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Jessica Link
- Wisconsin Division of Public Health, Madison, WI, USA
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16
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Zhang Z, Liu H, Choi SW. Early-life socioeconomic status, adolescent cognitive ability, and cognition in late midlife: Evidence from the Wisconsin Longitudinal Study. Soc Sci Med 2020; 244:112575. [PMID: 31606188 PMCID: PMC6926157 DOI: 10.1016/j.socscimed.2019.112575] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 09/17/2019] [Accepted: 09/24/2019] [Indexed: 01/09/2023]
Abstract
Although the association between childhood socioeconomic status (SES) and late-life cognition is well-established, the mechanisms underlying this association are less clear. One important potential mediator seldom examined is adolescent cognitive ability. To address this gap, we examined 5,880 respondents from the Wisconsin Longitudinal Study, which follows a random sample of high school students who graduated from Wisconsin high schools in 1957. Structural equation models were used to examine the direct and indirect effects of childhood SES on cognition in late midlife through adolescent cognitive ability, educational attainment, midlife economic condition, and midlife health. Cognitive function was measured as a latent variable composed of scores from 6 cognitive assessments including immediate and delayed recall, digit ordering, letter and category fluency, and a subset of the Wechsler Adult Intelligence Scale similarities test. We found that childhood SES predicts cognition in late midlife, and this association is largely mediated by adolescent cognitive ability and educational attainment and to a lesser extent by midlife economic condition and health. The findings underscore the long-arm of childhood SES in cognitive function in later life and highlight the complex life-course pathways underlying the association between childhood SES and cognition.
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Affiliation(s)
- Zhenmei Zhang
- Department of Sociology, Michigan State University, United States.
| | - Hui Liu
- Department of Sociology, Michigan State University, United States
| | - Seung-Won Choi
- Department of Sociology, Anthropology, and Social Work, Texas Tech University, United States
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17
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Forrester SN, Gallo JJ, Whitfield KE, Thorpe RJ. A Framework of Minority Stress: From Physiological Manifestations to Cognitive Outcomes. THE GERONTOLOGIST 2019; 59:1017-1023. [PMID: 30169640 PMCID: PMC6858824 DOI: 10.1093/geront/gny104] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Indexed: 12/31/2022] Open
Abstract
Cognitive impairment and dementia continue to threaten the aging population. Although no one is immune, certain groups, namely black older persons, are more likely to have a diagnosis of certain dementias. Because researchers have not found a purely biological reason for this disparity, they have turned to a biopsychosocial model. Specifically, black persons in the United States are more likely to live with social conditions that affect their stress levels which in turn affect physiological regulation leading to conditions that result in higher levels of cognitive impairment or dementia. Here we discuss some of these social conditions such as discrimination, education, and socioeconomic status, and how physiological dysregulation, namely allostatic load that can lead to cognitive impairment and dementia in black persons especially.
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Affiliation(s)
- Sarah N Forrester
- Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
| | - Joseph J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Roland J Thorpe
- Departmnet of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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18
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Vable AM, Gilsanz P, Kawachi I. Is it possible to overcome the 'long arm' of childhood socioeconomic disadvantage through upward socioeconomic mobility? J Public Health (Oxf) 2019; 41:566-574. [PMID: 30811528 PMCID: PMC7967879 DOI: 10.1093/pubmed/fdz018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/21/2019] [Accepted: 01/30/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Socioeconomically disadvantaged children have worse adult health; we test if this 'long arm' of childhood disadvantage can be overcome through upward socioeconomic mobility in adulthood. METHODS Four SES trajectories (stable low, upwardly mobile, downwardly mobile and stable high) were created from median dichotomized childhood socioeconomic status (SES; childhood human and financial capital) and adult SES (wealth at age 67) from Health and Retirement Study respondents (N = 6669). Healthy ageing markers, in tertiles, were walking speed, peak expiratory flow (PEF), and grip strength measured in 2008 and 2010. Multinomial logistic regression models, weighted to be nationally representative, controlled for age, gender, race, birthplace, outcome year and childhood health and social capital. RESULTS Upwardly mobile individuals were as likely as the stable high SES group to be in the best health tertile for walking speed (OR = 0.81; 95% CI: 0.63, 1.05; P = 0.114), PEF (OR = 0.97; 95% CI: 0.78, 1.21; P = 0.810) and grip strength (OR = 0.97; 95%CI: 0.74, 1.27; P = 0.980). DISCUSSION Findings suggest the 'long arm' of childhood socioeconomic disadvantage can be overcome for these markers of healthy ageing through upward socioeconomic mobility.
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Affiliation(s)
- Anusha M Vable
- Department of Family and Community Medicine, University of California, San Francisco, 550 16th Street, San Francisco CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco CA, USA
| | - Paola Gilsanz
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland CA, USA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston MA, USA
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19
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Chang E, Choi S, Kwon I, Araiza D, Moore M, Trejo L, Sarkisian C. Characterizing Beliefs about Stroke and Walking for Exercise among Seniors from Four Racial/Ethnic Minority Communities. J Cross Cult Gerontol 2018; 33:387-410. [PMID: 30141095 PMCID: PMC7672710 DOI: 10.1007/s10823-018-9356-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We described and compared seniors' stroke-related health beliefs among four racial/ethnic communities to inform a culturally-tailored stroke prevention walking intervention. Specific attention was paid to how seniors combined pathophysiology-based biomedical beliefs with non-biomedical beliefs. We conducted twelve language-concordant, structured focus groups with African American, Chinese American, Korean American, and Latino seniors aged 60 years and older with a history of hypertension (n = 132) to assess stroke-related health beliefs. Participants were asked their beliefs about stroke mechanism and prevention strategies in addition to questions corresponding to four constructs from the Health Belief Model: perceived susceptibility, perceived severity, and benefits and barriers to walking for exercise. Using thematic analysis, we iteratively reviewed and coded focus group transcripts to identify recurrent themes within and between racial/ethnic groups. Participants across all four racial/ethnic groups believed that blockages in brain arteries caused strokes. Factors believed to increase susceptibility to stroke were often similar to biomedical risk factors across racial/ethnic groups, but participants also endorsed non-biomedical factors such as strong emotions. The majority of participants perceived stroke as a serious condition requiring urgent medical attention, fearing paralysis or death, but few mentioned severe disability as a stroke consequence. Participants largely believed stroke to be preventable through physical activity, dietary changes, and medication adherence. Perceived benefits of walking for exercise included improved physical health, decreased bodily pain, and ease of participation. Perceived barriers to walking included limited mobility due to chronic medical conditions, increased bodily pain, and low motivation. While seniors' stroke-related health beliefs were often similar to biomedical beliefs across racial/ethnic groups, we also identified several non-biomedical beliefs that were shared across groups. These non-biomedical beliefs regarding perceived stroke susceptibility and severity may warrant further discussion in stroke education interventions. Patterns in non-biomedical beliefs that vary between groups may reflect cultural differences. Stroke education could potentially increase cultural relevancy and impact by addressing such differences in health beliefs as well as perceived benefits and barriers to walking for exercise that vary between different racial/ethnic groups.
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Affiliation(s)
- Emiley Chang
- Department of Medicine, General Internal Medicine, Harbor-UCLA Medical Center, 1000 W. Carson Street, Torrance, CA, 90502, USA.
- David Geffen School of Medicine, University of California, Los Angeles, 885 Tiverton Drive, Los Angeles, CA, 90095, USA.
| | - Sarah Choi
- School of Nursing, University of California, Los Angeles, 700 Tiverton Avenue, Los Angeles, CA, 90095, USA
| | - Ivy Kwon
- Clinical Solutions Associate, Science 37, 12121 Bluff Creek Drive, Suite 100, Los Angeles, CA, 90094, USA
| | - Daniel Araiza
- Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Mignon Moore
- Department of Sociology, Barnard College, Columbia University, 3009 Broadway, New York, NY, 10027, USA
| | - Laura Trejo
- City of Los Angeles Department of Aging, 221 N. Figueroa Street, Suite 500, Los Angeles, CA, 90012, USA
| | - Catherine Sarkisian
- Department of Medicine, Division of Geriatrics, University of California, Los Angeles, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA, 90095, USA
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20
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Abstract
There has been considerable interest in using decomposition methods in epidemiology (mediation analysis) and economics (Oaxaca-Blinder decomposition) to understand how health disparities arise and how they might change upon intervention. It has not been clear when estimates from the Oaxaca-Blinder decomposition can be interpreted causally because its implementation does not explicitly address potential confounding of target variables. While mediation analysis does explicitly adjust for confounders of target variables, it typically does so in a way that effectively entails equalizing confounders across racial groups, which may not reflect the intended intervention. Revisiting prior analyses in the National Longitudinal Survey of Youth on disparities in wages, unemployment, incarceration, and overall health with test scores, taken as a proxy for educational attainment, as a target intervention, we propose and demonstrate a novel decomposition that controls for confounders of test scores (e.g., measures of childhood socioeconomic status [SES]) while leaving their association with race intact. We compare this decomposition with others that use standardization (to equalize childhood SES [the confounders] alone), mediation analysis (to equalize test scores within levels of childhood SES), and one that equalizes both childhood SES and test scores. We also show how these decompositions, including our novel proposals, are equivalent to implementations of the Oaxaca-Blinder decomposition but provide a more formal causal interpretation for these decompositions.
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Affiliation(s)
- John W Jackson
- From the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Tyler J VanderWeele
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
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21
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Vable AM, Kiang MV, Basu S, Rudolph KE, Kawachi I, Subramanian SV, Glymour MM. Military Service, Childhood Socio-Economic Status, and Late-Life Lung Function: Korean War Era Military Service Associated with Smaller Disparities. Mil Med 2018; 183:e576-e582. [PMID: 29509934 DOI: 10.1093/milmed/usx196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/29/2017] [Accepted: 12/05/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Military service is associated with smoking initiation, but U.S. veterans are also eligible for special social, financial, and healthcare benefits, which are associated with smoking cessation. A key public health question is how these offsetting pathways affect health disparities; we assessed the net effects of military service on later life pulmonary function among Korean War era veterans by childhood socio-economic status (cSES). METHODS Data came from U.S.-born male Korean War era veteran (service: 1950-1954) and non-veteran participants in the observational U.S. Health and Retirement Study who were alive in 2010 (average age = 78). Veterans (N = 203) and non-veterans (N = 195) were exactly matched using coarsened exact matching on birth year, race, coarsened height, birthplace, childhood health, and parental and childhood smoking. Results were evaluated by cSES (defined as maternal education <8 yr/unknown or ≥8 yr), in predicting lung function, as assessed by peak expiratory flow (PEF), measured in 2008 or 2010. FINDINGS While there was little overall association between veterans and PEF [β = 12.8 L/min; 95% confidence interval (CI): (-12.1, 37.7); p = 0.314; average non-veteran PEF = 379 L/min], low-cSES veterans had higher PEF than similar non-veterans [β = 81.9 L/min; 95% CI: (25.2, 138.5); p = 0.005], resulting in smaller socio-economic disparities among veterans compared to non-veterans [difference in disparities: β = -85.0 L/min; 95% CI: (-147.9, -22.2); p = 0.008]. DISCUSSION Korean War era military service appears to disproportionately benefit low-cSES veteran lung functioning, resulting in smaller socio-economic disparities among veterans compared with non-veterans.
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Affiliation(s)
- Anusha M Vable
- Center for Population Health Sciences, Department of Medicine, Stanford University, Palo Alto, CA.,Center for Primary Care and Outcomes Research, Department of Health Research and Policy, Stanford University, Stanford, CA
| | - Mathew V Kiang
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sanjay Basu
- Center for Population Health Sciences, Department of Medicine, Stanford University, Palo Alto, CA.,Center for Primary Care and Outcomes Research, Department of Health Research and Policy, Stanford University, Stanford, CA.,Center for Primary Care, Harvard Medical School, Boston, MA
| | - Kara E Rudolph
- Department of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
| | - M Maria Glymour
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
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22
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de Melo Lucena DM, Dos Santos Figueiredo FW, de Alcantara Sousa LV, da Silva Paiva L, do Carmo Almeida TC, Galego SJ, Correa JA, da Silva Maciel E, Adami F. Correlation between municipal human development index and stroke mortality: a study of Brazilian capitals. BMC Res Notes 2018; 11:540. [PMID: 30068387 PMCID: PMC6071391 DOI: 10.1186/s13104-018-3626-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/20/2018] [Indexed: 12/18/2022] Open
Abstract
Objective To analyze the correlation between municipal human development indices (MHDIs) and stroke mortality in residents of Brazilian state capitals in 2010. A secondary data analysis was conducted in 2015 using data for the MHDI and the following dimensions: income, longevity and education which were obtained from the United Nations Development Program. Additionally, we analyzed age-standardized stroke mortality data from the Department of System Information Unified Health of Brazil. Results We observed a correlation between stroke mortality and MHDIs overall (Pearson r = − 0.563; p = 0.002) and within the following dimensions: income (Spearman’s ρ = − 0.479; p = 0.011), longevity (Pearson r = − 0.510; p = 0.006) and education (Pearson r = − 0.592; p = 0.001). We identified moderate but significant negative correlations between MHDI overall and in its individual dimensions (income, longevity, and age) and stroke mortality in Brazilian capitals. Stroke is the second leading cause of death in industrialized countries and the leading cause of death in Brazil. Therefore, the discovery of factors that may influence the epidemiology of stroke is important for the construction of adequate policies considering to the socioeconomic status in these places and with an emphasis in lower socioeconomic status places.
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Affiliation(s)
| | | | | | - Laércio da Silva Paiva
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | | | - Sidnei José Galego
- Disciplina de Angiologia e Cirurgia Vascular, Faculdade de Medicina do ABC, Santo André, Brazil
| | - João Antônio Correa
- Disciplina de Angiologia e Cirurgia Vascular, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | - Fernando Adami
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
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23
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da Silva Paiva L, Schoueri JHM, de Alcantara Sousa LV, Raimundo RD, da Silva Maciel E, Correa JA, Adami F. Regional differences in the temporal evolution of stroke: a population-based study of Brazil according to sex in individuals aged 15-49 years between 1997 and 2012. BMC Res Notes 2018; 11:326. [PMID: 29784031 PMCID: PMC5963170 DOI: 10.1186/s13104-018-3439-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/11/2018] [Indexed: 12/11/2022] Open
Abstract
Objective The present study analyzed the temporal trend of stroke mortality according to sex in individuals aged 15–49 years in the different regions of Brazil between 1997 and 2012. Results There was progressive reduction in mortality rate due to stroke in Brazil. The reduction trend was the same for both sexes, although mortality remained slightly higher among men. There was a difference in mortality rates according to the administrative region of the country. Electronic supplementary material The online version of this article (10.1186/s13104-018-3439-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laércio da Silva Paiva
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de dados, Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, CEP: 09060-870, Brazil.
| | - Jean Henri Maselli Schoueri
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de dados, Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, CEP: 09060-870, Brazil
| | - Luiz Vinicius de Alcantara Sousa
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de dados, Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, CEP: 09060-870, Brazil
| | - Rodrigo Daminello Raimundo
- Departamento de Saúde da Coletividade, Laboratório de Delineamento de Estudos e Escrita Científica, Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, CEP: 09060-870, Brazil
| | - Erika da Silva Maciel
- Universidade Federal do Tocantis, Avenida Lourdes Solino s/n°-Setor Universitário, Miracema, TO, Brazil
| | - João Antonio Correa
- Disciplina de Angiologia e Cirurgia Vascular, Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, CEP: 09060-870, Brazil
| | - Fernando Adami
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de dados, Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, CEP: 09060-870, Brazil
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Hackman DA, Kuan DCH, Manuck SB, Gianaros PJ. Socioeconomic Position and Age-Related Disparities in Regional Cerebral Blood Flow Within the Prefrontal Cortex. Psychosom Med 2018; 80:336-344. [PMID: 29406324 PMCID: PMC7104768 DOI: 10.1097/psy.0000000000000566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Socioeconomic position (SEP) is associated with cerebrovascular health and brain function, particularly in prefrontal cortex and medial temporal lobe regions that exhibit plasticity across the life course. However, it is unknown whether SEP associates with resting cerebral blood flow (CBF), an indicator of baseline brain function, in these regions in midlife, and whether the association is (a) period specific, with independent associations for childhood and adulthood SEP, or driven by life course SEP, and (b) explained by a persistent disparity, widening disparity, or the leveling of disparities with age. METHODS To address these questions, we analyzed cerebral perfusion derived by magnetic resonance imaging in a cross-sectional study of healthy adults (N = 443) who reported on childhood and adult SEP. Main effects were examined as an index of persistent disparity and age by SEP interactions as reflecting widening or leveling disparities. RESULTS Stable high SEP across the lifespan was associated with higher global CBF and regional CBF (rCBF) in inferior frontal gyrus. However, childhood SEP was associated with rCBF in middle frontal gyrus, as moderated by age (β = 0.04, p = .035): rCBF was inversely associated with age only for those whose parents had a high school education or below. No associations were observed for the hippocampus or amygdala. CONCLUSIONS Life course SEP associations with rCBF in prefrontal cortex are suggestive of persistent disparities, whereas the age by childhood SEP interaction suggests that childhood disadvantage relates to a widening disparity, independent of global differences. These differential patterns in midlife may relate to disparities in later-life cerebrovascular and neurocognitive outcomes.
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Affiliation(s)
- Daniel A Hackman
- From the USC Suzanne Dworak-Peck School of Social Work (Hackman), University of Southern California, Los Angeles, California; and Department of Psychology (Kuan, Manuck, Gianaros), Center for the Neural Basis of Cognition (Gianaros), University of Pittsburgh, Pittsburgh, Pennsylvania
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Education, Socioeconomic Status, and Intelligence in Childhood and Stroke Risk in Later Life: A Meta-analysis. Epidemiology 2018; 28:608-618. [PMID: 28410350 DOI: 10.1097/ede.0000000000000675] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Stroke is the second most common cause of death, and a common cause of dependency and dementia. Adult vascular risk factors and socioeconomic status (SES) are associated with increased risk, but less is known about early life risk factors, such as education, childhood SES, or intelligence (IQ). METHODS We comprehensively searched Medline, PsycINFO, and EMBASE from inception to November 2015. We included all studies reporting data on >50 strokes examining childhood/premorbid IQ, SES, and education. Two reviewers independently screened full texts and extracted and cross-checked data, including available risk factor adjustments. We meta-analyzed stroke risk using hazard ratios (HR), odds ratios (OR), and mean differences (MD). We tested effects of study and participant characteristics in sensitivity analyses and meta-regression, and assessed heterogeneity and publication bias. RESULTS We identified 90 studies examining stroke risk and education (79), SES (10), or IQ (nine) including approximately 164,683 stroke and over 5 million stroke-free participants. Stroke risk increased with lower education (OR = 1.35, 95% CI = 1.24, 1.48), SES (OR = 1.28, 95% CI = 1.12, 1.46), and IQ (HR = 1.17, 95% CI = 1.00, 1.37) in studies reporting point estimates, with similar associations for MD. We found minimal publication bias. Between-study heterogeneity was partly explained by participant age and case ascertainment method. CONCLUSIONS Education, childhood SES, and intelligence have modest but important associations with lifetime stroke, and hence dementia, risks. Future studies distinguishing between the individual and combined effects of education, childhood SES and intelligence are needed to determine the independent contribution of each factor to stroke risk. See video abstract at, http://links.lww.com/EDE/B210.
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Gjærde LK, Truelsen TC, Baker JL. Childhood Stature and Growth in Relation to First Ischemic Stroke or Intracerebral Hemorrhage. Stroke 2018; 49:579-585. [DOI: 10.1161/strokeaha.117.019880] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/14/2017] [Accepted: 01/09/2018] [Indexed: 01/20/2023]
Affiliation(s)
- Line Klingen Gjærde
- From the Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.K.G., J.L.B.); Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark (L.K.G., J.L.B.); and Department of Neurology, Rigshospitalet, The Capital Region, Copenhagen, Denmark (T.C.T.)
| | - Thomas Clement Truelsen
- From the Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.K.G., J.L.B.); Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark (L.K.G., J.L.B.); and Department of Neurology, Rigshospitalet, The Capital Region, Copenhagen, Denmark (T.C.T.)
| | - Jennifer Lyn Baker
- From the Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark (L.K.G., J.L.B.); Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Frederiksberg, Denmark (L.K.G., J.L.B.); and Department of Neurology, Rigshospitalet, The Capital Region, Copenhagen, Denmark (T.C.T.)
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Jofre-Bonet M, Serra-Sastre V, Vandoros S. The impact of the Great Recession on health-related risk factors, behaviour and outcomes in England. Soc Sci Med 2018; 197:213-225. [DOI: 10.1016/j.socscimed.2017.12.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 11/29/2017] [Accepted: 12/11/2017] [Indexed: 12/26/2022]
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Vable AM, Gilsanz P, Nguyen TT, Kawachi I, Glymour MM. Validation of a theoretically motivated approach to measuring childhood socioeconomic circumstances in the Health and Retirement Study. PLoS One 2017; 12:e0185898. [PMID: 29028834 PMCID: PMC5640422 DOI: 10.1371/journal.pone.0185898] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 09/21/2017] [Indexed: 11/23/2022] Open
Abstract
Childhood socioeconomic status (cSES) is a powerful predictor of adult health, but its operationalization and measurement varies across studies. Using Health and Retirement Study data (HRS, which is nationally representative of community-residing United States adults aged 50+ years), we specified theoretically-motivated cSES measures, evaluated their reliability and validity, and compared their performance to other cSES indices. HRS respondent data (N = 31,169, interviewed 1992–2010) were used to construct a cSES index reflecting childhood social capital (cSC), childhood financial capital (cFC), and childhood human capital (cHC), using retrospective reports from when the respondent was <16 years (at least 34 years prior). We assessed internal consistency reliability (Cronbach’s alpha) for the scales (cSC and cFC), and construct validity, and predictive validity for all measures. Validity was assessed with hypothesized correlates of cSES (educational attainment, measured adult height, self-reported childhood health, childhood learning problems, childhood drug and alcohol problems). We then compared the performance of our validated measures with other indices used in HRS in predicting self-rated health and number of depressive symptoms, measured in 2010. Internal consistency reliability was acceptable (cSC = 0.63, cFC = 0.61). Most measures were associated with hypothesized correlates (for example, the association between educational attainment and cSC was 0.01, p < 0.0001), with the exception that measured height was not associated with cFC (p = 0.19) and childhood drug and alcohol problems (p = 0.41), and childhood learning problems (p = 0.12) were not associated with cHC. Our measures explained slightly more variability in self-rated health (adjusted R2 = 0.07 vs. <0.06) and number of depressive symptoms (adjusted R2 > 0.05 vs. < 0.04) than alternative indices. Our cSES measures use latent variable models to handle item-missingness, thereby increasing the sample size available for analysis compared to complete case approaches (N = 15,345 vs. 8,248). Adopting this type of theoretically motivated operationalization of cSES may strengthen the quality of research on the effects of cSES on health outcomes.
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Affiliation(s)
- Anusha M. Vable
- Center for Population Health Sciences, Department of Medicine, Stanford University, Palo Alto, California, United States of America
- Center for Primary Care and Outcomes Research, Department of Health Research and Policy, Stanford University, Palo Alto, California, United States of America
- * E-mail:
| | - Paola Gilsanz
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
- Division of Research, Kaiser Permanente, Oakland, California, United States of America
| | - Thu T. Nguyen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - M. Maria Glymour
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, United States of America
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Lee M, Khan MM, Wright B. Is Childhood Socioeconomic Status Related to Coronary Heart Disease? Evidence From the Health and Retirement Study (1992-2012). Gerontol Geriatr Med 2017; 3:2333721417696673. [PMID: 28540340 PMCID: PMC5433678 DOI: 10.1177/2333721417696673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 11/14/2016] [Accepted: 01/23/2017] [Indexed: 11/16/2022] Open
Abstract
Objective: We investigated the association between childhood socioeconomic status (SES) and coronary heart disease (CHD) in older Americans. Method: We used Health and Retirement Study data from 1992 to 2012 to examine a nationally representative sample of Americans aged ≥50 years (N = 30,623). We modeled CHD as a function of childhood and adult SES using maternal and paternal educational level as a proxy for childhood SES. Results: Respondents reporting low childhood SES were significantly more likely to have CHD than respondents reporting high childhood SES. Respondents reporting both low childhood and adult SES were 2.34 times more likely to have CHD than respondents reporting both high childhood and adult SES. People with low childhood SES and high adult SES were 1.60 times more likely than people with high childhood SES and high adult SES to report CHD in the fully adjusted model. High childhood SES and low adult SES increased the likelihood of CHD by 13%, compared with high SES both as a child and adult. Conclusion: Childhood SES is significantly associated with increased risk of CHD in later life among older adult Americans.
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Affiliation(s)
- Minjee Lee
- University of South Carolina, Columbia, SC, USA
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Ighodaro ET, Nelson PT, Kukull WA, Schmitt FA, Abner EL, Caban-Holt A, Bardach SH, Hord DC, Glover CM, Jicha GA, Van Eldik LJ, Byrd AX, Fernander A. Challenges and Considerations Related to Studying Dementia in Blacks/African Americans. J Alzheimers Dis 2017; 60:1-10. [PMID: 28731440 PMCID: PMC5889715 DOI: 10.3233/jad-170242] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Blacks/African Americans have been reported to be ∼2-4 times more likely to develop clinical Alzheimer's disease (AD) compared to Whites. Unfortunately, study design challenges (e.g., recruitment bias), racism, mistrust of healthcare providers and biomedical researchers, confounders related to socioeconomic status, and other sources of bias are often ignored when interpreting differences in human subjects categorized by race. Failure to account for these factors can lead to misinterpretation of results, reification of race as biology, discrimination, and missed or delayed diagnoses. Here we provide a selected historical background, discuss challenges, present opportunities, and suggest considerations for studying health outcomes among racial/ethnic groups. We encourage neuroscientists to consider shifting away from using biologic determination to interpret data, and work instead toward a paradigm of incorporating both biological and socio-environmental factors known to affect health outcomes with the goal of understanding and improving dementia treatments for Blacks/African Americans and other underserved populations.
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Affiliation(s)
- Eseosa T. Ighodaro
- Department of Neuroscience, University of Kentucky, Lexington, KY, USA
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Peter T. Nelson
- Department of Neuroscience, University of Kentucky, Lexington, KY, USA
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Pathology and Laboratory Medicine, Division of Neuropathology, University of Kentucky, Lexington, KY, USA
| | - Walter A. Kukull
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Frederick A. Schmitt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Erin L. Abner
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Epidemiology, University of Kentucky, Lexington, KY, USA
| | - Allison Caban-Holt
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Graduate Center for Gerontology, University of Kentucky, Lexington, KY, USA
| | - Shoshana H. Bardach
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Graduate Center for Gerontology, University of Kentucky, Lexington, KY, USA
| | - Derrick C. Hord
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | - Crystal M. Glover
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Gregory A. Jicha
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
- Department of Neurology, University of Kentucky, Lexington, KY, USA
| | - Linda J. Van Eldik
- Department of Neuroscience, University of Kentucky, Lexington, KY, USA
- Sanders-Brown Center on Aging, University of Kentucky, Lexington, KY, USA
| | | | - Anita Fernander
- Department of Behavioral Science, University of Kentucky, Lexington, KY, USA
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Life course socioeconomic adversities and 10-year risk of cardiovascular disease: cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health. Int J Public Health 2016; 62:283-292. [PMID: 27913814 DOI: 10.1007/s00038-016-0928-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 11/07/2016] [Accepted: 11/17/2016] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To investigate whether life course exposure to adverse socioeconomic positions (SEP) as well as maintaining a low SEP or decreasing the SEP intra- and intergeneration was associated with an increased 10-year cardiovascular disease (CVD) risk predicted by the Framingham Risk Score. METHODS This is a cross-sectional analysis of baseline data (2008-2010) of 13,544 active workers from ELSA-Brasil cohort. Maternal education, leg length, social class of first occupation and education were used to evaluate childhood, youth and adulthood SEP. RESULTS After considering adulthood SEP, exposure to early-life low SEP remained associated with an increased 10-year CVD risk. The 10-year CVD risk also rose as the number of exposures to low SEP throughout life increased. Compared to individuals in high-stable intragenerational trajectory, those in upward, downward, or stable low trajectory presented higher 10-year CVD risk. Increasing individuals' SEP over generation showed no increased risk of 10-year CVD risk compared to individuals in high-stable trajectory. CONCLUSIONS Childhood may be a critical period for exposures to social adversities. Life course low SEP may also affect the 10-year CVD risk via accumulation of risk and social mobility.
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32
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Boen C. The role of socioeconomic factors in Black-White health inequities across the life course: Point-in-time measures, long-term exposures, and differential health returns. Soc Sci Med 2016; 170:63-76. [PMID: 27764654 PMCID: PMC5381512 DOI: 10.1016/j.socscimed.2016.10.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 10/07/2016] [Accepted: 10/09/2016] [Indexed: 02/03/2023]
Abstract
Research links Black-White health disparities to racial differences in socioeconomic status (SES), but understanding of the role of SES in racial health gaps has been restricted by reliance on static measures of health and socioeconomic well-being that mask the dynamic quality of these processes and ignore the racialized nature of the SES-health connection. Utilizing twenty-three years of longitudinal data from the Panel Study of Income Dynamics (1984-2007), this study uses multilevel growth curve models to examine how multiple dimensions of socioeconomic well-being-including long-term economic history and differential returns to SES-contribute to the life course patterning of Black-White health disparities across two critical markers of well-being: body mass index (N = 9057) and self-rated health (N = 11,329). Findings indicate that long-term SES exerts a significant influence on both body mass index and self-rated health, net of point-in-time measures, and that Black-White health gaps are smallest in models that adjust for both long-term and current SES. I also find that Blacks and Whites receive differential health returns to increases in SES, which suggests that other factors-such as neighborhood segregation and exposure racial discrimination-may restrict Blacks from converting increases in SES into health improvements in the same way as Whites. Together, these processes contribute to the life course patterning of Black-White health gaps and raise concerns about previous misestimation of the role of SES in racial health disparities.
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Affiliation(s)
- Courtney Boen
- Department of Sociology and Carolina Population Center, University of North Carolina, 155 Hamilton Hall, CB 3210, Chapel Hill, NC, 27599, USA.
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Hamad R, Rehkopf DH, Kuan KY, Cullen MR. Predicting later life health status and mortality using state-level socioeconomic characteristics in early life. SSM Popul Health 2016; 2:269-276. [PMID: 27713921 PMCID: PMC5047283 DOI: 10.1016/j.ssmph.2016.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 12/26/2022] Open
Abstract
Studies extending across multiple life stages promote an understanding of factors influencing health across the life span. Existing work has largely focused on individual-level rather than area-level early life determinants of health. In this study, we linked multiple data sets to examine whether early life state-level characteristics were predictive of health and mortality decades later. The sample included 143,755 U.S. employees, for whom work life claims and administrative data were linked with early life state-of-residence and mortality. We first created a "state health risk score" (SHRS) and "state mortality risk score" (SMRS) by modeling state-level contextual characteristics with health status and mortality in a randomly selected 30% of the sample (the "training set"). We then examined the association of these scores with objective health status and mortality in later life in the remaining 70% of the sample (the "test set") using multivariate linear and Cox regressions, respectively. The association between the SHRS and adult health status was β=0.14 (95%CI: 0.084, 0.20), while the hazard ratio for the SMRS was 0.96 (95%CI: 0.93, 1.00). The association between the SHRS and health was not statistically significant in older age groups at a p-level of 0.05, and there was a statistically significantly different association for health status among movers compared to stayers. This study uses a life course perspective and supports the idea of "sensitive periods" in early life that have enduring impacts on health. It adds to the literature examining populations in the U.S. where large linked data sets are infrequently available.
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Affiliation(s)
- Rita Hamad
- Stanford University, Department of Medicine, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - David H. Rehkopf
- Stanford University, Department of Medicine, 1070 Arastradero Road, Palo Alto, CA 94304, USA
| | - Kai Y. Kuan
- Stanford University, Department of Statistics, 390 Serra Mall, Stanford, CA 94305, USA
| | - Mark R. Cullen
- Stanford University, Department of Medicine, 1070 Arastradero Road, Palo Alto, CA 94304, USA
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Liu L, Yang X, Long Y, Mallhi AK, Mehta K, Veznedaroglu E, Yin X. Changes in the prevalence of hospitalization and comorbidity in US adults with stroke: A three decade cross-sectional and birth cohort analysis. Int J Stroke 2016; 11:987-998. [PMID: 27412189 DOI: 10.1177/1747493016660107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 06/09/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND PURPOSE Little attention was paid to the transition of care for stroke that may partially explain the long-term trend of stroke rates. We aimed to test the trend of hospitalization attributable to stroke in US adults. METHODS Data from National Hospital Discharge Surveys 1980-2010 in patients aged ≥18 (n = 6,527,304) were analyzed to examine the trend of patients with first-list diagnoses of stroke. Stroke comorbidities were classified in stroke patients with second- to seven-listed diagnoses of coronary heart disease, hypertension, diabetes, arrhythmias, or hyperlipidemia. Stroke trends by survey years and birth cohorts were analyzed using univariate, multivariate, and birth cohorts methods. RESULTS Of the total study sample, the prevalence of hospitalization due to stroke was 22.99%, 30.00%, and 27.03% in years of 1980-1989, 1990-1999, and 2000-2010 in males, and 17.30%, 22.04%, and 19.34% in females, respectively. Overall, hospitalization rates in stroke patients significantly increased among adults aged <65, and decreased in adults aged ≥65. There was an increase in stroke hospitalization rate in the old adults aged ≥65 in recent birth cohorts. Significant increased trends of comorbid hypertension, diabetes, arrhythmias, and hyperlipidemia were observed from 1980 to 2010. CONCLUSION A significant increase in stroke hospitalization rate was observed in adults aged <65 in the past three decades, and in old adults in recent years. Increases in stroke comorbidity rates were observed in all age groups. Findings from the study highlight that both public health and clinical practices face a serious challenge in controlling this unwelcome increased stroke trend.
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Affiliation(s)
- Longjian Liu
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, USA
| | - Xuan Yang
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, USA
| | - Yong Long
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, USA.,Department of Epidemiology, Fourth Military Medical University, Xi'an, China
| | - Arshpreet Kaur Mallhi
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, USA
| | - Kathan Mehta
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, USA.,Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Erol Veznedaroglu
- Drexel Neurosciences Institute and Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, USA
| | - Xiaoyan Yin
- Department of Medicine, University of Pennsylvania, Philadelphia, USA
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Zhang Z, Hayward MD, Yu YL. Life Course Pathways to Racial Disparities in Cognitive Impairment among Older Americans. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2016; 57:184-99. [PMID: 27247126 PMCID: PMC4933020 DOI: 10.1177/0022146516645925] [Citation(s) in RCA: 124] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Blacks are especially hard hit by cognitive impairment at older ages compared to whites. Here, we take advantage of the Health and Retirement Study (1998-2010) to assess how this racial divide in cognitive impairment is associated with the racial stratification of life course exposures and resources over a 12-year period among 8,946 non-Hispanic whites and blacks ages 65 and older in 1998. We find that blacks suffer from a higher risk of moderate/severe cognitive impairment at baseline and during the follow-up. Blacks are also more likely to report childhood adversity and to have grown up in the segregated South, and these early-life adversities put blacks at a significantly higher risk of cognitive impairment. Adulthood socioeconomic status is strongly associated with the risk of cognitive impairment, net of childhood conditions. However, racial disparities in cognitive impairment, though substantially reduced, are not eliminated when controlling for these life course factors.
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Affiliation(s)
| | | | - Yan-Liang Yu
- Michigan State University, East Lansing, MI, USA
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Vable AM, Kawachi I, Canning D, Glymour MM, Jimenez MP, Subramanian SV. Are There Spillover Effects from the GI Bill? The Mental Health of Wives of Korean War Veterans. PLoS One 2016; 11:e0154203. [PMID: 27186983 PMCID: PMC4871362 DOI: 10.1371/journal.pone.0154203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 04/10/2016] [Indexed: 12/01/2022] Open
Abstract
Background The Korean War GI Bill provided economic benefits for veterans, thereby potentially improving their health outcomes. However potential spillover effects on veteran wives have not been evaluated. Methods Data from wives of veterans eligible for the Korean War GI Bill (N = 128) and wives of non-veterans (N = 224) from the Health and Retirement Study were matched on race and coarsened birth year and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78) were assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale. Regression analyses were stratified into low (mother < 8 years schooling / missing data, N = 95) or high (mother ≥ 8 years schooling, N = 257) childhood socio-economic status (cSES) groups, and were adjusted for birth year and childhood health, as well as respondent’s educational attainment in a subset of analyses. Results Husband’s Korean War GI Bill eligibility did not predict depressive symptoms among veteran wives in pooled analysis or cSES stratified analyses; analyses in the low cSES subgroup were underpowered (N = 95, β = -0.50, 95% Confidence Interval: (-1.35, 0.35), p = 0.248, power = 0.28). Conclusions We found no evidence of a relationship between husband’s Korean War GI Bill eligibility and wives’ mental health in these data, however there may be a true effect that our analysis was underpowered to detect.
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Affiliation(s)
- Anusha M. Vable
- Stanford Prevention Research Center, Stanford University, Stanford, CA, United States of America
- * E-mail:
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - David Canning
- Department of Global Health and Populations, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
| | - M. Maria Glymour
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, United States of America
| | - Marcia P. Jimenez
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States of America
| | - S. V. Subramanian
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States of America
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Bijker R, Agyemang C. The influence of early-life conditions on cardiovascular disease later in life among ethnic minority populations: a systematic review. Intern Emerg Med 2016; 11:341-53. [PMID: 26141120 DOI: 10.1007/s11739-015-1272-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 06/10/2015] [Indexed: 11/25/2022]
Abstract
Ethnic minority groups are disproportionately affected by cardiovascular diseases (CVDs). The reasons for the high prevalence of CVD in ethnic minority groups are not fully understood. Recently, the importance of early-life developmental factors and their impact on CVDs in adulthood is increasingly being recognised, but little is known about this among ethnic minority groups. Therefore, the current paper aimed to fill this knowledge gap by reviewing the available literature to assess the influence of early-life conditions on CVDs and its risk factors in ethnic minority populations residing in Western countries. A systematic search was performed in PubMed and EMBASE between 1989 and 2014. In total, 1418 studies were identified of which 19 met the inclusion criteria. Six studies investigated the relationship between early-life anthropometrics and CVD risk factors of which all except one found significant associations between the assessed anthropometric measures and CVD risk factors. Seven studies evaluated the influence of childhood socio-economic status (SES) on CVD and risk factors of which five found significant associations between childhood SES measures and CVD risk factors. Five studies investigated the relationship between other early-life conditions including early-life nutrition, physical development, and childhood psychosocial conditions, and CVD risk factors. Four of these studies found significant associations between the assessed childhood conditions and CVD risk factors. This review reinforces the importance of early-life conditions on adult CVD in ethnic minority groups. Improvement of early-life conditions among ethnic minority groups may contribute to reducing CVD risk in these populations.
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Affiliation(s)
- Rimke Bijker
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public Health, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Boone-Heinonen J, Messer L, Andrade K, Takemoto E. Connecting the Dots in Childhood Obesity Disparities: A Review of Growth Patterns from Birth to Pre-Adolescence. CURR EPIDEMIOL REP 2016; 3:113-124. [PMID: 27172171 DOI: 10.1007/s40471-016-0065-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In this review, we considered how disparities in obesity emerge between birth, when socially disadvantaged infants tend to be small, and later in childhood, when socially disadvantaged groups have high risk of obesity. We reviewed epidemiologic evidence of socioeconomic and racial/ethnic differences in growth from infancy to pre-adolescence. Minority race/ethnicity and lower socioeconomic status was associated with rapid weight gain in infancy but not in older age groups, and social differences in linear growth and relative weight were unclear. Infant feeding practices was the most consistent mediator of social disparities in growth, but mediation analysis was uncommon and other factors have only begun to be explored. Complex life course processes challenge the field of social epidemiology to develop innovative study designs and analytic techniques with which to pose and test challenging yet impactful research questions about how obesity disparities evolve throughout childhood.
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Affiliation(s)
- Janne Boone-Heinonen
- Oregon Health & Science University, OHSU-PSU School of Public Health 3181 SW Sam Jackson Park Road, CB669 Portland, OR 97239-3098
| | - Lynne Messer
- Portland State University; OHSU-PSU School of Public Health 470H Urban Center; 506 SW Mill St. Portland, OR 37201 (P) 503.725.5182 (F) 503.725.5100
| | - Kate Andrade
- University of Minnesota, Division of Epidemiology & Community Health 1300 S 2 St, Ste 300 Minneapolis, MN 55454
| | - Erin Takemoto
- Oregon Health & Science University, OHSU-PSU School of Public Health 3181 SW Sam Jackson Park Road, CB669 Portland, OR 97239-3098 (P) 503-418-9810
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Vable AM, Canning D, Glymour MM, Kawachi I, Jimenez MP, Subramanian SV. Can social policy influence socioeconomic disparities? Korean War GI Bill eligibility and markers of depression. Ann Epidemiol 2016; 26:129-135.e3. [PMID: 26778285 DOI: 10.1016/j.annepidem.2015.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 11/22/2015] [Accepted: 12/11/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE The Korean War GI Bill provided socioeconomic benefits to veterans; however, its association with health is unclear; we hypothesize GI Bill eligibility is associated with fewer depressive symptoms and smaller disparities. METHODS Data from 246 Korean War GI Bill eligible veterans and 240 nonveterans from the Health and Retirement Study were matched on birth year, southern birth, race, height, and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78 years) was assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale, dichotomized to reflect elevated depressive symptoms. Regression analyses were stratified into low (at least one parent < 8 years schooling/missing data, n = 167) or high (both parents ≥ 8 years schooling, n = 319) childhood socioeconomic status (cSES) groups. RESULTS Korean War GI Bill eligibility predicted fewer depressive symptoms among individuals from low cSES backgrounds [β = -0.64, 95% confidence interval (CI) = (-1.18, -0.09), P = .022]. Socioeconomic disparities were smaller among veterans than nonveterans for number of depressive symptoms [β = -0.76, 95% CI = (-1.33, -0.18), P = .010] and elevated depressive symptoms [β = -11.7, 95% CI = (-8.2, -22.6), P = .035]. CONCLUSIONS Korean War GI Bill eligibility predicted smaller socioeconomic disparities in depression markers.
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Affiliation(s)
- Anusha M Vable
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA.
| | - David Canning
- Department of Global Health and Populations, Harvard School of Public Health, Boston, MA
| | - M Maria Glymour
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA; Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| | - Marcia P Jimenez
- Department of Epidemiology, Brown University School of Public Health, Providence, RI
| | - Subu V Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
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Perzynski A, Blixen C, Cage J, Colón-Zimmermann K, Sajatovic M. Informing Policy for Reducing Stroke Health Disparities from the Experience of African-American Male Stroke Survivors. J Racial Ethn Health Disparities 2015; 3:527-36. [PMID: 27294742 DOI: 10.1007/s40615-015-0171-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/01/2015] [Accepted: 09/20/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND The burden of stroke is severe among African-Americans. Despite overall declines in the rate of stroke since 2000, outcomes are largely unimproved or have worsened for African-American men. Adverse psychosocial challenges may hinder adherence to a regimen of risk factor reduction. METHODS AND RESULTS Focus group analysis was combined with a review of current published guidelines and epidemiologic evidence on risk factors to better understand stroke health disparities and potential policy solutions. Transcripts from three focus groups with ten African-American male stroke survivors under age 65 and their care partners (N = 7) were analyzed and compared with existing published data on (a) the burden of stroke (b) trends in clinical risk factors, and (c) trends in behavioral risk factors. Participants described myriad psychosocial barriers that impede reduction of risk indicators, including low trust in providers, poor social support, access difficulties, depression, and distress. CONCLUSIONS In order to be effective, policies and programs must target mechanisms consistent with the challenges faced by African-American men. Infrastructure is needed to better identify and share practices effective for improving cardiovascular outcomes within specific racial and ethnic groups.
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Affiliation(s)
- Adam Perzynski
- Case Western Reserve University, Cleveland, OH, USA. .,Center for Health Care Research and Policy, The MetroHealth System, 2500 MetroHealth Dr. R225A, Cleveland, OH, 44109, USA.
| | - Carol Blixen
- Case Western Reserve University, Cleveland, OH, USA.,Center for Health Care Research and Policy, The MetroHealth System, 2500 MetroHealth Dr. R225A, Cleveland, OH, 44109, USA
| | - Jamie Cage
- Case Western Reserve University, Cleveland, OH, USA
| | | | - Martha Sajatovic
- Case Western Reserve University, Cleveland, OH, USA.,University Hospitals, Cleveland, OH, USA
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Gebreab SY, Diez Roux AV, Brenner AB, Hickson DA, Sims M, Subramanyam M, Griswold ME, Wyatt SB, James SA. The impact of lifecourse socioeconomic position on cardiovascular disease events in African Americans: the Jackson Heart Study. J Am Heart Assoc 2015; 4:e001553. [PMID: 26019130 PMCID: PMC4599524 DOI: 10.1161/jaha.114.001553] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Few studies have examined the impact of lifecourse socioeconomic position (SEP) on cardiovascular disease (CVD) risk among African Americans. Methods and Results We used data from the Jackson Heart Study (JHS) to examine the associations of multiple measures of lifecourse SEP with CVD events in a large cohort of African Americans. During a median of 7.2-year follow-up, 362 new or recurrent CVD events occurred in a sample of 5301 participants aged 21 to 94. Childhood SEP was assessed by using mother’s education, parental home ownership, and childhood amenities. Adult SEP was assessed by using education, income, wealth, and public assistance. Adult SEP was more consistently associated with CVD risk in women than in men: age-adjusted hazard ratios for low versus high income (95% CIs), 2.46 (1.19 to 5.09) in women and 1.50 (0.87 to 2.58) in men, P for interaction=0.1244, and hazard ratio for low versus high wealth, 2.14 (1.39 to 3.29) in women and 1.06 (0.62 to 1.81) in men, P for interaction=0.0224. After simultaneous adjustment for all adult SEP measures, wealth remained a significant predictor of CVD events in women (HR=1.73 [1.04, 2.85] for low versus high). Education and public assistance were less consistently associated with CVD. Adult SEP was a stronger predictor of CVD events in younger than in older participants (HR for high versus low summary adult SEP score 3.28 [1.43, 7.53] for participants ≤50 years, and 1.90 (1.36 to 2.66) for participants >50 years, P for interaction 0.0846). Childhood SEP was not associated with CVD risk in women or men. Conclusions Adult SEP is an important predictor of CVD events in African American women and in younger African Americans. Childhood SEP was not associated with CVD events in this population.
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Affiliation(s)
- Samson Y Gebreab
- Metabolic, Cardiovascular and Inflammatory Disease Genomics Branch, National Human Genome Research Institute (NHGRI), National Institutes of Health, Bethesda, MD (S.Y.G.)
| | - Ana V Diez Roux
- Michigan Center for Integrative Approaches to Health Disparities (CIAHD), Drexel University, Philadelphia, PA (A.V.D.R.) School of Public Health, Drexel University, Philadelphia, PA (A.V.D.R.)
| | - Allison B Brenner
- Department of Epidemiology, School of Public Health, University of Michigan, Jackson, MS (A.B.B.)
| | - DeMarc A Hickson
- School of Medicine, University of Mississippi Medical Center, Jackson, MS (D.M.A.H., M.S., M.E.G., S.B.W.)
| | - Mario Sims
- School of Medicine, University of Mississippi Medical Center, Jackson, MS (D.M.A.H., M.S., M.E.G., S.B.W.)
| | | | - Michael E Griswold
- School of Medicine, University of Mississippi Medical Center, Jackson, MS (D.M.A.H., M.S., M.E.G., S.B.W.)
| | - Sharon B Wyatt
- School of Medicine, University of Mississippi Medical Center, Jackson, MS (D.M.A.H., M.S., M.E.G., S.B.W.) School of Nursing, University of Mississippi Medical Center, Jackson, MS (S.B.W.)
| | - Sherman A James
- Department of Epidemiology, Rollins School ofPublic Health, Emory University, Atlanta, GA (S.A.J.)
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Abner EL, Schmitt FA, Nelson PT, Lou W, Wan L, Gauriglia R, Dodge HH, Woltjer RL, Yu L, Bennett DA, Schneider JA, Chen R, Masaki K, Katz MJ, Lipton RB, Dickson DW, Lim KO, Hemmy LS, Cairns NJ, Grant E, Tyas SL, Xiong C, Fardo DW, Kryscio RJ. The Statistical Modeling of Aging and Risk of Transition Project: Data Collection and Harmonization Across 11 Longitudinal Cohort Studies of Aging, Cognition, and Dementia. OBSERVATIONAL STUDIES 2015; 1:56-73. [PMID: 25984574 PMCID: PMC4431579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Longitudinal cognitive trajectories and other factors associated with mixed neuropathologies (such as Alzheimer's disease with co-occurring cerebrovascular disease) remain incompletely understood, despite being the rule and not the exception in older populations. The Statistical Modeling of Aging and Risk of Transition study (SMART) is a consortium of 11 different high-quality longitudinal studies of aging and cognition (N=11,541 participants) established for the purpose of characterizing risk and protective factors associated with subtypes of age-associated mixed neuropathologies (N=3,001 autopsies). While brain donation was not required for participation in all SMART cohorts, most achieved substantial autopsy rates (i.e., > 50%). Moreover, the studies comprising SMART have large numbers of participants who were followed from intact cognition and transitioned to cognitive impairment and dementia, as well as participants who remained cognitively intact until death. These data provide an exciting opportunity to apply sophisticated statistical methods, like Markov processes, that require large, well-characterized samples. Thus, SMART will serve as an important resource for the field of mixed dementia epidemiology and neuropathology.
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Affiliation(s)
- E L Abner
- Snders-Brown Center on Aging, University of Kentucky
| | - F A Schmitt
- Oregon Center for Aging & Technology, Oregon Health & Science University
| | - P T Nelson
- Rush Alzheimer's Disease Center, Rush University Medical Center
| | | | - L Wan
- Department of Neurology, Albert Einstein College of Medicine
| | - R Gauriglia
- Department of Laboratory Medicine & Pathology, Mayo Clinic Jacksonville
| | - H H Dodge
- Department of Psychiatry, University of Minnesota
| | - R L Woltjer
- Alzheimer's Disease Research Center, Washington University
| | - L Yu
- School of Public Health and Health Systems, University of Waterloo
| | - D A Bennett
- College of Public Health, University of Kentucky
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Patel RC, Baek J, Smith MA, Morgenstern LB, Lisabeth LD. Residential ethnic segregation and stroke risk in Mexican Americans: the Brain Attack Surveillance in Corpus Christi project. Ethn Dis 2015; 25:11-18. [PMID: 25812246 PMCID: PMC4539938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVE Residential ethnic segregation may operate through multiple mechanisms to increase stroke risk. The current study evaluated if residential ethnic segregation was associated with stroke risk in a bi-ethnic population. DESIGN Incident strokes were identified in Nueces County, Texas from 2000 to 2010. Residential ethnic segregation (range: 0-1) was derived for each census tract in the county (n=64) using 2000 US Census data, and categorized into: predominantly non-Hispanic White (NHW, <.3); ethnically mixed (.3-.7); predominantly Mexican American (MA, >.7). Multilevel Poisson regression models were fitted separately for NHWs and MAs to assess the association between residential ethnic segregation (predominantly NHW referent) and relative risk for stroke, adjusted for age category, sex and census tract-level median per capita income. Effect modification by age was also examined. RESULTS In adjusted models, residential ethnic segregation was not associated with stroke risk in either ethnic group. Effect modification by age was significant in both groups. Young MAs and NHWs living in predominantly MA census tracts were at greater relative risk for stroke than those living in predominantly NHW census tracts, but this association was only significant for MAs (MAs: RR = 2.38 [95% CI: 1.31-4.31]; NHWs: RR = 1.53 [95% CI: .92-2.52]). CONCLUSION Our findings demonstrate that residential ethnic segregation may influence downstream stroke risk in young MAs. Pathways between residential ethnic segregation and stroke in young MAs should be explored.
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Insaf TZ, Shaw BA, Yucel RM, Chasan-Taber L, Strogatz DS. Lifecourse Socioeconomic Position and Racial Disparities in BMI Trajectories among Black and White Women: Exploring Cohort Effects in the Americans Changing Lives' Study. J Racial Ethn Health Disparities 2014; 1:309-318. [PMID: 25506543 DOI: 10.1007/s40615-014-0038-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Few studies have analyzed the cohort effects of lifecourse socioeconomic position (SEP) on racial disparities in body mass index (BMI) trajectories. We assessed the contribution of lifecourse SEP on racial differences in BMI trajectories among two different age cohorts of women. METHODS Four waves of the Americans' Changing Lives' study (1986-2002) were used to compute BMI trajectories for 2194 Black and White women. Multivariable associations of lifecourse SEP variables (father's education, perceived childhood family status, education, income, wealth and financial security) with Wave 1(W1) BMI and BMI change were assessed using mixed models. RESULTS Black women had higher W1 BMI than White women in both cohorts (women <40 years in 1986 (+2.6 kg/m2 (95%CI: +1.71, +3.53)) and women>=40 in 1986 (+2.68 kg/m2 (95%CI:+2.12,3.24))); Black women in the younger cohort had a higher change in BMI (+0.73 kg/m2/year (95%CI:+0.17,+1.29)). High education was associated with lower W1 BMI in both cohorts (-1.34 (95%CI:-2.53,-0.15) and -1.08 kg/m2 (95%CI:-0.50,-1.65), respectively). Among the younger cohort, high income was associated with lower W1 BMI (-0.78kg/m2/unit log income (95%CI:-1.32,-0.25)) while among the older cohort, high father's education (-0.78 kg/m2 (95%CI:-0.06,-1.50)) and higher wealth (-0.26 kg/m2(95%CI:-0.43,-0.08))were associated with low W1 BMI. Racial disparities in W1 BMI were attenuated by 20-25% while those for BMI change remained unexplained on adjustment for lifecourse SEP. CONCLUSION In this large population-based dataset, results suggest that the contribution of lifecourse SEP to racial disparities in BMI may be established early in adulthood.
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Affiliation(s)
- Tabassum Z Insaf
- School of Public Health, University at Albany, SUNY, Rensselaer, NY
| | - Benjamin A Shaw
- School of Public Health, University at Albany, SUNY, Rensselaer, NY
| | - Recai M Yucel
- School of Public Health, University at Albany, SUNY, Rensselaer, NY
| | | | - David S Strogatz
- School of Public Health, University at Albany, SUNY, Rensselaer, NY ; Bassett Research Institute, Cooperstown, NY
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Plakht Y, Pertzov B, Gez H, Hellerman M, Ifergane G. Stroke Hospitalizations Over Three Decades: Lower for Men, Unchanged for Women. A Population-Based Study. J Womens Health (Larchmt) 2014; 23:296-301. [DOI: 10.1089/jwh.2013.4591] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ygal Plakht
- Unit of Nursing Research, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Barak Pertzov
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hadar Gez
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Moran Hellerman
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Ifergane
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Neurology, Soroka University Medical Center, Beer-Sheva, Israel
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Wang Q, Mejía-Guevara I, Rist PM, Walter S, Capistrant BD, Glymour MM. Changes in memory before and after stroke differ by age and sex, but not by race. Cerebrovasc Dis 2014; 37:235-43. [PMID: 24686293 DOI: 10.1159/000357557] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 11/26/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Post-stroke memory impairment is more common among older adults, women and blacks. It is unclear whether post-stroke differences reflect differential effects of stroke per se or differences in prestroke functioning. We compare memory trajectories before and after stroke by age, sex and race. METHODS Health and Retirement Study participants aged ≥50 years (n = 17,341), with no stroke history at baseline, were interviewed biennially up to 10 years for first self- or proxy-reported stroke (n = 1,574). Segmented linear regression models were used to compare annual rates of memory change before and after stroke among 1,169 stroke survivors, 405 stroke decedents and 15,767 stroke-free participants. Effect modification was evaluated with analyses stratified by baseline age (≤70 vs. >70), sex and race (white vs. nonwhite), and using interaction terms between age/sex/race indicators and annual memory change. RESULTS Older (>70 years) adults experienced a faster memory decline before stroke (-0.19 vs. -0.10 points/year for survivors, -0.24 vs. -0.13 points/year for decedents, p < 0.001 for both interactions), and among stroke survivors, larger memory decrements (-0.64 vs. -0.26 points, p < 0.001) at stroke and faster memory decline (-0.15 vs. -0.07 points/year, p = 0.003) after stroke onset, compared to younger adults. Female stroke survivors experienced a faster prestroke memory decline than male stroke survivors (-0.14 vs. -0.10 points/year, p < 0.001). However, no sex differences were seen for other contrasts. Although whites had higher post-stroke memory scores than nonwhites, race was not associated with rate of memory decline during any period of time; i.e. race did not significantly modify the rate of decline before or after stroke or the immediate effect of stroke on memory. CONCLUSIONS Older age predicted worse memory change before, at and after stroke onset. Sex and race differences in post-stroke memory outcomes might be attributable to prestroke disparities, which may be unrelated to cerebrovascular disease.
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Affiliation(s)
- Qianyi Wang
- Department of Epidemiology, University of California, San Francisco, Calif., USA
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Insaf TZ, Strogatz DS, Yucel RM, Chasan-Taber L, Shaw BA. Associations between race, lifecourse socioeconomic position and prevalence of diabetes among US women and men: results from a population-based panel study. J Epidemiol Community Health 2013; 68:318-25. [PMID: 24319149 DOI: 10.1136/jech-2013-202585] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Few studies have examined the degree to which racial disparities in the development of diabetes are accounted by differences in lifecourse socioeconomic position (SEP). We assessed the association between race, lifecourse SEP measures and prevalence of diabetes in a representative US sample of black and white adults. METHODS A generalised estimating equations approach was used with a sample of 3497 adults from the Americans' Changing Lives study. Sex-specific models were calculated to compute prevalence ratios (PR) for associations of race and SEP with self-reported diagnoses of diabetes. RESULTS For men, childhood and adult SEP were unrelated to diabetes, and adjustment for lifecourse SEP had little effect on the excess diabetes in blacks (PR=1.56, 95% CI 1.11 to 2.21). Adjustment for measures of lifecourse SEP reduced the PR for the association between race and diabetes in women from 1.96 (95% CI 1.52 to 2.54) to 1.40 (95% CI 1.04 to 1.87) with the respondent's education responsible for most of the reduction in the association. However, diabetes was also inversely associated with father's education, and low SEP throughout the lifecourse was associated with a nearly threefold increase in diabetes (PR=2.89, 95% CI 2.10 to 3.99). CONCLUSIONS Racial disparities in diabetes existed among both men and women, but lifecourse SEP was related to diabetes only among women. The pathway and cumulative hypotheses for lifecourse SEP effects on diabetes may be especially salient for women.
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Affiliation(s)
- T Z Insaf
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, New York, USA
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Cumulative Psychological Stress and Cardiovascular Disease Risk: A Focused Review with Consideration of Black-White Disparities. CURRENT CARDIOVASCULAR RISK REPORTS 2013. [DOI: 10.1007/s12170-013-0338-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Leist AK, Glymour MM, Mackenbach JP, van Lenthe FJ, Avendano M. Time away from work predicts later cognitive function: differences by activity during leave. Ann Epidemiol 2013; 23:455-62. [PMID: 23889855 PMCID: PMC3832060 DOI: 10.1016/j.annepidem.2013.05.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Revised: 05/17/2013] [Accepted: 05/22/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE We sought to examine how different activities performed during employment gaps are associated with later cognitive function and change. METHODS Five cognitive measures were used to indicate cognitive impairment of 18,259 respondents to the Survey of Health, Ageing, and Retirement in Europe (ages 50-73) in 2004/5 or 2006/7. Using complete employment histories, employment gaps of ≥6 months between ages 25 and 65 were identified. RESULTS Controlling for early life socioeconomic status, school performance, and education, higher risk of cognitive impairment was associated with employment gaps described as unemployment (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.04-1.35) and sickness (OR, 1.78; 95% CI, 1.52-2.09). In contrast, lower risk of cognitive impairment was associated with employment gaps described as training (OR, 0.73; 95% CI, 0.52-1.01) or maternity leave (OR, 0.65; 95% CI, 0.57-0.79). In longitudinal mixed effects models, training and maternity leave were associated with lower 2-year aging-related cognitive decline. DISCUSSION Periods away from work described as unemployment or sickness are associated with lower cognitive function, whereas maternity and training leaves are associated with better late-life cognitive function. Both causation and selection mechanisms may explain these findings.
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Affiliation(s)
- Anja K Leist
- Faculty of Language and Literature, Humanities, Arts and Education, University of Luxembourg, Walferdange, Luxembourg.
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Infurna FJ, Gerstorf D, Ram N, Schupp J, Sprangers MAG, Wagner GG. Linking concurrent self-reports and retrospective proxy reports about the last year of life: a prevailing picture of life satisfaction decline. J Gerontol B Psychol Sci Soc Sci 2013; 69:695-709. [PMID: 23766436 DOI: 10.1093/geronb/gbt055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE We examined the extent to which retrospective proxy reports of well-being mirror participant self-reports at 12-24 months before death and how proxy reports of well-being change over the last year of life. We also explored the role of sociodemographic, cognitive, and health factors of both participants and proxies in moderating such associations. METHOD We used retrospective proxy ratings obtained in the German Socio-Economic Panel Study (N = 164; age at death = 19-99 years). RESULTS Results revealed moderate agreement between self- and proxy reports (r = .42), but proxies, on average, overestimated participants' life satisfaction by two thirds of a scale point on a 0-10 scale (or 0.4 SD). Discrepancies were particularly pronounced when proxies themselves reported low life satisfaction. Over the last year of life, participants were viewed to have experienced declines in life satisfaction (-0.54 SD). Declines were stronger for ill participants and proxies who reported low life satisfaction. DISCUSSION Results qualify theoretical expectations and empirical results based on self-report data that are typically available 1 or 2 years before death. We discuss that retrospective proxy reports in panel surveys can be used as a hypothesis-generating tool to gather insights into late life.
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Affiliation(s)
- Frank J Infurna
- German Socio-Economic Panel Study, German Institute for Economic Research (DIW Berlin), Germany. Institute of Psychology, Humboldt University Berlin, Germany.
| | | | - Nilam Ram
- German Socio-Economic Panel Study, German Institute for Economic Research (DIW Berlin), Germany. Department of Human Development and Family Studies, Pennsylvania State University, University Park. Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Jürgen Schupp
- German Socio-Economic Panel Study, German Institute for Economic Research (DIW Berlin), Germany. Institute for Sociology, Free University of Berlin, Germany
| | | | - Gert G Wagner
- German Socio-Economic Panel Study, German Institute for Economic Research (DIW Berlin), Germany. Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany. Department of Economics, Berlin University of Technology, Germany
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