Sex differentials in biological risk factors for chronic disease: estimates from population-based surveys

Dietary Patterns of Off-Reserve Indigenous Peoples in Canada and Their Association with Chronic Conditions

Nationally representative nutrition surveys (Canadian Community Health Survey (CCHS) Cycle 2.2, Nutrition 2004 and 2015) were used to examine dietary patterns and their association with socioeconomic/sociodemographic factors and chronic conditions in off-reserve Indigenous population in Canada. A cluster analysis was used to identify dietary patterns (DPs), and the Nutrient Rich Food Index (NRF 9.3) was used as the diet quality score and stratified by age/gender groups. In 2004 (n = 1528), the dominant DPs among Indigenous adults (age = 41 ± 2.3) were "Mixed" (mean NRF = 450 ± 12) and "Unhealthy" among men (mean NRF = 426 ± 18), "Fruits" among women (mean NRF = 526 ± 29), and "High-Fat/High-Sugar" among children (age = 10.2 ± 0.5) (mean NRF = 457 ± 12). In 2015 (n = 950), the dominant DPs were "Unhealthy" (mean NRF = 466 ± 6), "Mixed" (mean NRF = 485 ± 21), Healthy-Like (mean NRF = 568 ± 37), and "Mixed" (mean NRF = 510 ± 9) among adults (age = 45.6 ± 2.2), men, women, and children (age = 10.9 ± 0.3) respectively. The majority of Indigenous peoples had the "Unhealthy" DP with a low diet quality, which may contribute to a high prevalence of obesity and chronic diseases. The income level and smoking status among adults and physical inactivity among children were recognized as important factors that may be associated with the dietary intake of off-reserve Indigenous population.

The landscape of expression and alternative splicing variation across human traits

Understanding the consequences of individual transcriptome variation is fundamental to deciphering human biology and disease. We implement a statistical framework to quantify the contributions of 21 individual traits as drivers of gene expression and alternative splicing variation across 46 human tissues and 781 individuals from the Genotype-Tissue Expression project. We demonstrate that ancestry, sex, age, and BMI make additive and tissue-specific contributions to expression variability, whereas interactions are rare. Variation in splicing is dominated by ancestry and is under genetic control in most tissues, with ribosomal proteins showing a strong enrichment of tissue-shared splicing events. Our analyses reveal a systemic contribution of types 1 and 2 diabetes to tissue transcriptome variation with the strongest signal in the nerve, where histopathology image analysis identifies novel genes related to diabetic neuropathy. Our multi-tissue and multi-trait approach provides an extensive characterization of the main drivers of human transcriptome variation in health and disease.

Depressive symptoms and allostatic load have a bidirectional association among Puerto Rican older adults

BACKGROUND

Depression is strongly associated with chronic disease; yet, the direction of this relationship is poorly understood. Allostatic load (AL) provides a framework for elucidating depression-disease pathways. We aimed to investigate bidirectional, longitudinal associations of baseline depressive symptoms or AL with 5-year AL or depressive symptoms, respectively.

METHODS

Data were from baseline, 2-year, and 5-year visits of 620 adults (45-75 years) enrolled in the Boston Puerto Rican Health Study. The Center for Epidemiology Studies Depression (CES-D) scale (0-60) captured depressive symptoms, which were categorized at baseline as low (<8), subthreshold (8-15), or depression-likely (⩾16) symptoms. AL was calculated from 11 parameters of biological functioning, representing five physiological systems. Baseline AL scores were categorized by the number of dysregulated parameters: low (0-2), moderate (3-5), or high (⩾6) AL. Multivariable, multilevel random intercept and slope linear regression models were used to examine associations between 3-category baseline CES-D score and 5-year continuous AL score, and between baseline 3-category AL and 5-year continuous CES-D score.

RESULTS

Baseline subthreshold depressive symptoms [(mean (95% CI)): 4.8 (4.5-5.2)], but not depression-likely symptoms [4.5 (4.2-4.9)], was significantly associated with higher 5-year AL scores, compared to low depressive symptoms [4.3 (3.9-4.7)]. Baseline high AL [19.4 (17.6-21.2)], but not low AL [18.5 (16.5-20.6)], was significantly associated with higher 5-year CES-D score, compared to baseline moderate AL [16.9 (15.3-18.5)].

CONCLUSIONS

Depressive symptoms and AL had a bi-directional relationship over time, indicating a nuanced pathway linking depression with chronic diseases among a minority population.

Stress Salivary Biomarkers Variation during the Work Day in Emergencies in Healthcare Professionals

OBJECTIVE

The work of health professionals in hospital emergency rooms is highly demanding due to the decisions they must take. In the present study, we consider assessing stress response in emergency health workers, measuring related biomarkers such as cortisol, dehydroepiandrosterone (DHEA) and salivary α-amylase during the whole working day.

METHOD

An analytical, descriptive and cross-sectional study was carried out. The study was conducted in the emergency rooms of two public hospitals. Ninety-seven professionals participated, 45 corresponding to one hospital and 52 to the other. Four salivary samples were obtained according to circadian rhythms: at 8:00, 12:00, 15:00 and 00:00 h/24 h. The data were subsequently analyzed.

RESULTS

Cortisol levels decreased throughout the working day, with minimum values being at 24 h. A similar pattern was observed in DHEA. The α-amylase levels increased throughout the working day, reaching its peak at 15:00 h, and decreasing at 24 h, compared to the data from the rest of the working day.

CONCLUSIONS

Since reference/baseline values are not presented, this work is focused on a stress situation experienced during one regular working day in emergency rooms with no extreme situations. In this context, stress, measured through cortisol and α-amylase, is present in emergency room doctors and nurses. However, the increase in DHEA, due to its anabolic condition, could counteract their effect, suggesting a positive effect on their professional actions.

Patterns of change in cardiovascular risk assessments and ankle brachial index among Puerto Rican adults

BACKGROUND

Puerto Rican adults have higher odds of peripheral artery disease (PAD) compared with Mexican Americans. Limited studies have examined relationships between clinical risk assessment scores and ABI measures in this population.

METHODS

Using 2004-2015 data from the Boston Puerto Rican Health Study (BPRHS) (n = 370-583), cross-sectional, 5-y change, and patterns of change in Framingham Risk Score (FRS) and allostatic load (AL) with ankle brachial index (ABI) at 5-y follow-up were assessed among Puerto Rican adults (45-75 y). FRS and AL were calculated at baseline, 2-y and 5-y follow-up. Multivariable linear regression models were used to examine cross-sectional and 5-y changes in FRS and AL with ABI at 5-y. Latent growth mixture modeling identified trajectories of FRS and AL over 5-y, and multivariable linear regression models were used to test associations between trajectory groups at 5-y.

RESULTS

Greater FRS at 5-y and increases in FRS from baseline were associated with lower ABI at 5-y (β = -0.149, P = 0.010; β = -0.171, P = 0.038, respectively). AL was not associated with ABI in cross-sectional or change analyses. Participants in low-ascending (vs. no change) FRS trajectory, and participants in moderate-ascending (vs. low-ascending) AL trajectory, had lower 5-y ABI (β = -0.025, P = 0.044; β = -0.016, P = 0.023, respectively).

CONCLUSIONS

FRS was a better overall predictor of ABI, compared with AL. Puerto Rican adults, an understudied population with higher FRS over 5 years, may benefit from intensive risk factor modification to reduce risk of PAD. Additional research examining relationships between FRS and AL and development of PAD is warranted.

Does the choice of Allostatic Load scoring algorithm matter for predicting age-related health outcomes?

Allostatic Load (AL) is posited to provide a measure of cumulative physiological dysregulation across multiple biological systems and demonstrates promise as a sub-clinical marker of overall health. Despite the large heterogeneity of measures employed in the literature to represent AL, few studies have investigated the impact of different AL scoring systems in predicting health. This study uses data for 4477 participants aged 50+ years participating in the Irish Longitudinal Study on Ageing (TILDA) to compare the utility of 14 different scoring algorithms that have been used to operationalise AL (i.e. count-based high-risk quartiles, deciles, two-tailed cut-points, z-scores, system-weighted indices, clinical cut-points, sex-specific scores, and incorporating medication usage). Model fit was assessed using R², Bayesian Information Criterion (BIC), and the area under the Receiver Operating Characteristic curve (AUC). The measure incorporating medications predicted walking speed and SRH marginally better than others. In general, AL was not predictive of grip strength. Overall, the results suggest that the choice of AL scoring algorithm exerts a relatively modest influence in predicting a number of important health outcomes.

Early-life education may help bolster declarative memory in old age, especially for women

Although declarative memory declines with age, sex and education might moderate these weaknesses. We investigated effects of sex and education on nonverbal declarative (recognition) memory in 704 older adults (aged 58-98, 0-17 years of education). Items were drawings of real and made-up objects. Age negatively impacted declarative memory, though this age effect was moderated by sex and object-type: it was steeper for males than females, but only for real objects. Education was positively associated with memory, but also interacted with sex and object-type: education benefited women more than men (countering the age effects, especially for women), and remembering real more than made-up objects. The findings suggest that nonverbal memory in older adults is associated negatively with age but positively with education; both effects are modulated by sex, and by whether learning relates to preexisting or new information. The study suggests downstream benefits from education, especially for girls.

Allostatic load and stress biomarkers in a sample of community-dwelling older adults

BACKGROUND

The idea that cumulative levels of stress can have deleterious effects on health and longevity has led investigators to discuss individual differences in the accumulation of Allostatic Load (AL) during life. Our aim was to evaluate the AL indices and stress biomarkers between genders and to determine which factors were more associated with AL indices.

METHODS

We evaluated 256 subjects, including 88 men and 168 women, aged 65 years or more. AL was measured by 10 biomarkers, including systolic and diastolic blood pressure, waist-hip ratio, glycosylated hemoglobin, salivary cortisol, salivary dehydroepiandrosterone sulphate, urinary epinephrine and norepinephrine, total cholesterol and total cholesterol/HDL. Sociodemographic and clinical characteristics, cognitive function and physical functional variables were additionally analyzed.

RESULTS

The mean age of the participants was 74.1 ± 6.7 years. The AL index was 2.30 ± 1.68, without a significant difference between gender. The final linear regression model controlling for gender, age, years of study and living arrangement showed that AL was associated to a number of chronic conditions (β = 0.24; 95 % CI: 0.08-0.40), mobility disability (β = 0.58; 95 % CI: 0.06-1.14), and handgrip strength (β = 0.06; 95 % CI: 0.06-1.14).

CONCLUSION

As a result of this investigation, Allostatic load was shown to be associated with poor health or physical function for community-dwelling older adults.

Does marriage matter? Racial differences in allostatic load among women

Prior research suggests that there are health benefits associated with marriage, although the physiological implications of marital status for women's health is less clear. Given that recent trends indicate that Black women are less likely to marry than White women, the goal of this study was to evaluate whether marital status accounts for racial differences in women's physical health. Using data from the Nashville Stress and Health Study (2011–2014), we estimated the probability of high allostatic load (AL), a biological indicator of physiological dysregulation, among women aged 18–69. We examined AL scores by race and marital status, evaluated the extent to which Black-White differences persisted after accounting for marital status, and assessed whether the racial disparity in AL varied across marital status groups. Results indicated that Black women had higher AL than White women, although racial differences in AL were not explained by marital status. In addition, marital status was a significant predictor of AL among Black, but not White women. Moreover, the racial disparity in AL was smallest among never married women and largest among currently and formally married women. Taken together, these findings suggest that Black-White inequalities in women's physical health are not explained by racial differences in marital status, despite the widening racial gap in marriage. Nevertheless, marital status may be an influential factor in shaping outcomes among Black women.

Food Insecurity and Odds of High Allostatic Load in Puerto Rican Adults: The Role of Participation in the Supplemental Nutrition Assistance Program During 5 Years of Follow-Up

OBJECTIVE

Limited evidence demonstrates pathways linking food insecurity (FI) to chronic disease. Allostatic load (AL) may elucidate potential pathways, capturing both primary (neuroendocrine, inflammation) and secondary (metabolic, cardiovascular) physiological disturbances. We examined the longitudinal association of FI with 5-year AL and primary and secondary subsystem dysregulation and tested moderation by Supplemental Nutrition Assistance Program (SNAP) participation.

METHODS

We analyzed data from the longitudinal Boston Puerto Rican Health Study among 733 adults aged 45 to 75 years. Participants categorized as food insecure (assessed by US survey module) experienced FI at baseline and/or year 5. AL score comprised 11 biological components (5 primary, 6 secondary). We classified participants as having high scores for AL (≥6 dysregulated components), primary system (≥3), and secondary system (≥4). Multivariate models estimated odds ratios (OR), adjusting for baseline AL, sociodemographic, cultural, and behavioral characteristics.

RESULTS

By study end, 33.8% had experienced FI, 65.5% had participated in SNAP, and 37.5% had high AL. In adjusted models, FI was not associated with AL (OR [95% confidence intervals] = 1.07 [0.70-1.64]) or secondary system (0.82 [0.48-1.40]) scores, but was associated with high primary system scores (1.71 [1.25-2.36]). SNAP participation seemed to moderate the FI-primary system relationship (p = .06); food-insecure participants never receiving SNAP (mean (SE) = 2.06 (0.14)) had higher scores than food-secure participants receiving (1.72 (0.06], p = .02) or never receiving SNAP (1.64 (0.10), p = .01) and food-insecure participants receiving SNAP (1.80 (0.07), p = .08).

CONCLUSIONS

FI is associated with dysregulated components of the primary AL system, and this relationship may be stronger for those not receiving SNAP. Research is needed in additional populations to test AL as a plausible pathway connecting FI to chronic disease and SNAP as a moderator.

Working memory in older adults declines with age, but is modulated by sex and education

Working memory (WM), which underlies the temporary storage and manipulation of information, is critical for multiple aspects of cognition and everyday life. Nevertheless, research examining WM specifically in older adults remains limited, despite the global rapid increase in human life expectancy. We examined WM in a large sample ( N = 754) of healthy older adults (aged 58-89) in a non-Western population (Chinese speakers) in Taiwan, on a digit n-back task. We tested not only the influence of age itself and of load (1-back vs. 2-back) but also the effects of both sex and education, which have been shown to modulate WM abilities. Mixed-effects regression revealed that, within older adulthood, age negatively impacted WM abilities (with linear, not nonlinear, effects), as did load (worse performance at 2-back). In contrast, education level was positively associated with WM. Moreover, both age and education interacted with sex. With increasing age, males showed a steeper WM decline than females; with increasing education, females showed greater WM gains than males. Together with other findings, the evidence suggests that age, sex, and education all impact WM in older adults, but interact in particular ways. The results have both basic research and translational implications and are consistent with particular benefits from increased education for women.

A Longitudinal Analysis of Allostatic Load among a Multi-Ethnic Sample of Midlife Women: Findings from the Study of Women's Health Across the Nation

OBJECTIVES

We examined longitudinal patterns and sociodemographic correlates of allostatic load (AL), a measure of cumulative biological risk and aging, in a sample of midlife women consisting of non-Hispanic White, African American, Chinese, and Japanese women.

METHODS

Longitudinal cohort data from the Study of Women's Health Across the Nation were used to examine AL patterns in midlife women ages 42-53 (n = 1,932). AL measures were created using 10 biomarkers representing cardiovascular, inflammatory, neuroendocrine, and metabolic system functioning. We used longitudinal random effects Poisson regression models to assess change in AL over the 7-year follow-up period and associations between sociodemographic factors and AL.

RESULTS

On average, a woman's AL score increased 2% each year over the course of the study. Baseline measures of African American race, low family income, older age, and ability to read and speak only in English were significantly associated with higher levels of AL over the study period. We did not observe significant differences in rates of change in AL by race/ethnicity or socioeconomic status.

CONCLUSIONS

This study demonstrates that AL increases in a cumulative manner as women age. Midlife is an especially important time in women's life course with respect to health maintenance and healthy aging. AL can be an early warning indicator of subsequent disease burden, pointing to subclinical conditions and the need for implementation of medical and public health interventions earlier in the disease process.

Nativity differences in allostatic load by age, sex, and Hispanic background from the Hispanic Community Health Study/Study of Latinos

Allostatic load (AL), an index of biological "wear and tear" on the body from cumulative exposure to stress, has been little studied in US Hispanics/Latinos. We investigated AL accumulation patterns by age, sex, and nativity in the Hispanic Community Health Study/Study of Latinos. We studied 15,830 Hispanic/Latinos of Mexican, Cuban, Dominican, Puerto Rican, Central and South American descent aged 18-74 years, 77% of whom were foreign-born. Consistent with the conceptualization of AL, we developed an index based upon 16 physiological markers that spanned the cardiometabolic, parasympathetic, and inflammatory systems. We computed mean adjusted AL scores using log-linear models across age-groups (18-44, 45-54, 55-74 years), by sex and nativity status. Among foreign-born individuals, differences in AL by duration of residence in the US (<10, ≥10 years) and age at migration (<24, ≥24 years) were also examined. In persons younger than 55 years old, after controlling for socioeconomic and behavioral factors, AL was highest among US-born individuals, intermediate in foreign-born Hispanics/Latinos with longer duration in the US (≥10 years), and lowest among those with shorter duration in the US (<10 years) (P <0.0001 for increasing trend). Similarly, AL increased among the foreign-born with earlier age at immigration. These trends were less pronounced among individuals ≥55 years of age. Similar patterns were observed across all Hispanic/Latino heritage groups (P for interaction=0.5). Our findings support both a "healthy immigrant" pattern and a loss of health advantage over time among US Hispanics/Latinos of diverse heritages.

Physiological wear-and-tear and later subjective health in mid-life: Findings from the 1958 British birth cohort

OBJECTIVE

Our body adapts continuously to environmental challenges and stressful conditions. Allostatic load (AL) is a concept that aims to capture the overall physiological wear-and-tear of the body triggered by the repeated activation of compensatory physiological mechanisms as a response to chronic stress. Growing evidence has shown a link between AL and later health decline, morbidity and mortality. However, due to the global physiological effect captured by the AL concept, it is particularly pertinent to examine its association with subsequent health by taking a broad definition of the latter. We examined the association between AL at 44 years and general health as measured by a latent multidimensional measure of subjective health at 50 years integrating sleep patterns, physical and mental health.

METHODS

AL was constructed using 14 biomarkers representing four physiological systems on 7573 members of the 1958 British birth cohort. Health status was captured using self-reported information about subjective health and summarized using a principal component analysis including: seven dimensions of the SF-36 questionnaire of health-related quality of life, the sleep subscale of the Medical Outcomes Study characterizing quality of sleep patterns, and a malaise inventory score detecting depressive symptoms.

RESULTS

Higher AL score was gradually associated with worse subjective health, after taking into account classic confounders.

CONCLUSIONS

Using a physiological index to grasp how the environment can "get under the skin" leading to poor health is of great interest, permitting a better understanding of life course origins of disease and social gradients in health.

Feasibility of 24-Hr Urine Collection for Measurement of Biomarkers in Community-Dwelling Older Adults

Biologic markers are becoming a key part of gerontological research, including their measurement at multiple intervals to detect changes over time. This report examined the feasibility and quality of 24-hr urine collection to measure neuroendocrine biomarkers in a community-based sample of older caregivers and non-caregivers. At each interview, participants were instructed on the correct method to collect and store the sample. As incentives, participants selected a day for urine collection within 5 days of the interview, received a reimbursement, and study staff travelled to their home to retrieve the specimen. Between 2008 and 2013, 256 participants were enrolled; all but two participants (99%) provided a baseline urine specimen, of which 93% were considered adequate. Urine collection and quality remained high over three annual follow-up interviews and did not vary by caregiver status or perceived stress level. Our results indicate that 24-hr urine collection is feasible in active, community-dwelling older adults.

Sociodemographic correlates of allostatic load among a national sample of adolescents: findings from the National Health and Nutrition Examination Survey, 1999-2008

PURPOSE

There is growing evidence that racial, ethnic, and socioeconomic status (SES) differentials in health emerge early in life. This study provided a descriptive profile of allostatic load (AL) among adolescents, focusing on sociodemographic correlates and variation in age patterns of AL by race and ethnicity. Allostatic load, an index of cumulative physiological dysregulation, is a construct that measures how individuals' interactions with their environment "get under the skin" to influence health.

METHODS

We used data from 8,052 adolescents ages 12-19 years, from the United States National Health and Nutrition Examination Survey 1999-2008. A summary measure of AL was assessed with biomarkers representing cardiovascular, inflammatory, and metabolic systems. Weighted univariate, bivariate, and multivariable negative binomial regression statistics were employed.

RESULTS

Mean AL increased with age, was higher for blacks than whites or Mexican-Americans, and was higher among adolescents of lower SES. Although black adolescents had higher AL for all ages, the relative advantage of whites and Mexican-Americans declined with age.

CONCLUSIONS

Racial and SES inequalities in AL exist during adolescence. These findings contribute to the understanding of how early life adverse factors "get under the skin," and are potentially translated into disease outcomes and health disparities later in life.

Gender differences in cognitive impairment and mobility disability in old age: a cross-sectional study in Ouagadougou, Burkina Faso

This study aims to examine differences in cognitive impairment and mobility disability between older men and women in Ouagadougou, Burkina Faso, and to assess the extent to which these differences could be attributable to gender inequalities in life course social and health conditions. Data were collected on 981 men and women aged 50 and older in a 2010 cross-sectional health survey conducted in the Ouagadougou Health and Demographic Surveillance System. Cognitive impairment was assessed using the Leganés cognitive test. Mobility disability was self-reported as having any difficulty walking 400 m without assistance. We used logistic regression to assess gender differences in cognitive impairment and mobility disability. Prevalence of cognitive impairment was 27.6% in women and 7.7% in men, and mobility disability was present in 51.7% of women and 26.5% of men. The women to men odds ratio (95% confidence interval) for cognitive impairment and mobility disability was 3.52 (1.98-6.28) and 3.79 (2.47-5.85), respectively, after adjusting for the observed life course social and health conditions. The female excess was only partially explained by gender inequalities in nutritional status, marital status and, to a lesser extent, education. Among men and women, age, childhood hunger, lack of education, absence of a partner and being underweight were independent risk factors for cognitive impairment, while age, childhood poor health, food insecurity and being overweight were risk factors for mobility disability. Enhancing nutritional status and education opportunities throughout life span could prevent cognitive impairment and mobility disability and partly reduce the female excess in these disabilities.

Childhood conscientiousness relates to objectively measured adult physical health four decades later

OBJECTIVE

Many life span personality-and-health models assume that childhood personality traits result in life-course pathways leading through morbidity to mortality. Although childhood conscientiousness in particular predicts mortality, there are few prospective studies that have investigated the associations between childhood personality and objective health status in adulthood. The present study tested this crucial assumption of life span models of personality and health using a comprehensive assessment of the Big Five traits in childhood (M age = 10 years) and biomarkers of health over 40 years later (M age = 51 years).

METHODS

Members of the Hawaii Personality and Health Cohort (N = 753; 368 men, 385 women) underwent a medical examination at mean age 51. Their global health status was evaluated by well-established clinical indicators that were objectively measured using standard protocols, including blood pressure, lipid profile, fasting blood glucose, and body mass index. These indicators were combined to evaluate overall physiological dysregulation and grouped into five more homogeneous subcomponents (glucose intolerance, blood pressure, lipids, obesity, and medications).

RESULTS

Lower levels of childhood conscientiousness predicted more physiological dysregulation (β = -.11, p < .05), greater obesity (β = -.10, p < .05), and worse lipid profiles (β = -.10, p < .05), after controlling for the other Big Five childhood personality traits, gender, ethnicity, parental home ownership, and adult conscientiousness.

CONCLUSIONS

These findings are consistent with a key assumption in life span models that childhood conscientiousness is associated with objective health status in older adults. They open the way for testing mechanisms by which childhood personality may influence mortality through morbidity; mechanisms that could then be targeted for intervention.

Transitions among Health States Using 12 Measures of Successful Aging in Men and Women: Results from the Cardiovascular Health Study

Introduction. Successful aging has many dimensions, which may manifest differently in men and women at different ages. Methods. We characterized one-year transitions among health states in 12 measures of successful aging among adults in the Cardiovascular Health Study. The measures included self-rated health, ADLs, IADLs, depression, cognition, timed walk, number of days spent in bed, number of blocks walked, extremity strength, recent hospitalizations, feelings about life as a whole, and life satisfaction. We dichotomized variables into “healthy” or “sick,” states, and estimated the prevalence of the healthy state and the probability of transitioning from one state to another, or dying, during yearly intervals. We compared men and women and three age groups (65–74, 75–84, and 85–94). Findings. Measures of successful aging showed similar results by gender. Most participants remained healthy even into advanced ages, although health declined for all measures. Recuperation, although less common with age, still occurred frequently. Men had a higher death rate than women regardless of health status, and were also more likely to remain in the healthy state. Discussion. The results suggest a qualitatively different experience of successful aging between men and women. Men did not simply “age faster” than women.

Do Adults Adjust their Socioeconomic Status Identity in Later Life?*

Previous research shows that socioeconomic status (SES) identity, also referred to as perceived or subjective social status, is shaped by objective measures of status, socio-cultural influences and psychological attributes and predicts current and future well-being. Prior studies, however, have not examined whether older adults reassess their SES identity over time. In this study, we use two assessments of subjective social status measured six years apart in a sample of older Taiwanese adults to: 1) determine the degree to which respondents adjust their perceptions of social rank; and 2) identify the characteristics of individuals who are most likely to revise their assessments. We find that many older Taiwanese adults reassess their SES identity, but most respondents show small to moderate levels of change. Females, more highly educated respondents, and those who have a positive economic outlook tend to revise their subjective social status upward relative to their respective counterparts; those who become widowed during the period adjust their rankings downward compared with those who do not become widowed. These findings suggest that SES identity may be dynamic, highlighting the importance of collecting information on socioeconomic status identity at multiple points in the life course.

A meat, processed meat, and French fries dietary pattern is associated with high allostatic load in Puerto Rican older adults

BACKGROUND

Consumption of certain dietary patterns, such as a Western diet, has been associated with unfavorable physiologic outcomes. Diet has been proposed as a contributor to allostatic load, a composite measure of physiological dysregulation.

OBJECTIVE

To determine the association of dietary patterns, defined by "meat and french fries," "traditional Puerto Rican foods" (rice, beans, and oils), or "sweets," with allostatic load, and with the 10 individual physiologic parameters that comprise it.

PARTICIPANTS

Baseline data collected from participants of the Boston Puerto Rican Health Study (n=1,117; aged 45 to 75 years) was used to run linear and logistic regression models, adjusting for age, sex, alcohol intake, smoking, medications, energy intake, and body mass index or physical activity.

RESULTS

Significant trends across increasing quintiles of the meat and french fries pattern were observed for higher allostatic load score (P=0.002), waist circumference (P=0.032), systolic blood pressure (P=0.008), and diastolic blood pressure (P<0.0001). Participants in the highest quintile of the meat and french fries pattern had significantly higher allostatic load score than those in the lowest quintile (mean 4.3±0.11 vs 3.9±0.12, P=0.030), and had higher odds of having high allostatic load (odds ratio [95% confidence interval]: 1.8 [1.2 to 2.9]), low dehydroepiandrosterone sulfate (odds ratio 1.9 [95% confidence interval: 1.2 to 3.1]), and high glycosylated hemoglobin (odds ratio 1.7 (95% confidence interval: 1.0 to 2.9]). The traditional pattern was not associated with allostatic load, whereas a significant association between the sweets pattern and allostatic load disappeared after restricting analysis to participants without diabetes.

CONCLUSIONS

A meat, processed meat, and french fries dietary pattern may contribute to the deregulation of multiple physiologic parameters in Puerto Rican adults. Efforts to limit consumption of this pattern may help prevent further cumulative physiological dysregulation in this high risk population.

Sleep duration, sleep quality, and biomarkers of inflammation in a Taiwanese population

PURPOSE

Short and long sleep duration and sleep quality are associated with health including all-cause mortality, cardiovascular disease, diabetes, and obesity. Inflammation may play a role in mediating these associations.

METHODS

We examined associations between inflammation and self-reported sleep characteristics in 1020 respondents of the 2000 and 2006 Social Environment and Biomarkers of Aging Study, a nationally representative survey of Taiwanese adults ages 53 and over. Regression models were used to estimate cross-sectional relationships between inflammation (interleukin-6, C-reactive protein, fibrinogen, e-selectin, soluble intercellular adhesion molecule-1, albumin, and white blood cell count) and a modified Pittsburgh Sleep Quality Index, index subcomponents, and self-reported sleep duration. Change in inflammatory markers between 2000 and 2006 was also used to predict long or short sleep duration in 2006.

RESULTS

Inflammation was not related to the overall index of sleep quality. However, longer sleep (>8 hr) was associated with higher levels of inflammation. These associations remained after adjustment for waist circumference, self-reported health decline, diabetes, arthritis/rheumatism, heart disease, and depressive symptoms. Increases in inflammation between 2000 and 2006 were associated with long but not short sleep duration in 2006 for several markers.

CONCLUSIONS

Long sleep duration may be a marker of underlying inflammatory illness in older populations. Future studies should explore whether inflammation explains observed relationships between long sleep and mortality.

Racial and ethnic patterns of allostatic load among adult women in the United States: findings from the National Health and Nutrition Examination Survey 1999-2004

OBJECTIVE

This study provides a descriptive sociodemographic profile of allostatic load (AL) among adult women of all age groups, focusing on how age patterns of AL vary across racial/ethnic groups. Allostatic load, an index of cumulative physiological dysregulation, captures how the cumulative impact of physiological stress responses from person-environment interactions causes wear and tear on the body's regulatory systems, which in turn can lead to disease outcomes and health disparities.

METHODS

Using data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004, this study examines AL in a nationally representative sample of women ≥18 years of age (n=5765). Measures of AL using 10 biomarkers representing cardiovascular, inflammatory, and metabolic system functioning were created. Multivariate negative binomial regression models were used, and predicted AL scores were computed.

RESULTS

Black women had the highest predicted AL scores relative to other racial/ethnic groups, and a marked black/white gap in AL persisted across all age groups. Age by race/ethnicity interaction terms revealed significant racial/ethnic differences in AL patterns across age groups. Black women 40-49 years old had AL scores 1.14 times higher than white women 50-59 years old, suggesting earlier health deterioration. Mexican women not born in the United States had lower predicted AL scores than those born in the United States.

CONCLUSIONS

This study provides one of the first descriptive profiles of AL among a nationally representative sample of adult women in the United States and presents racial/ethnic trends in AL across age groups that are useful for identifying demographically and clinically important subgroups at risk of having high cumulative physiological dysregulation.

Sex differences in age trajectories of physiological dysregulation: inflammation, metabolic syndrome, and allostatic load

There is a paucity of knowledge from population data about sex differences and their age variation in physiological determinants of longevity. This study fills this gap using nationally representative samples of 38,000 individuals aged 17+ from the National Health and Nutrition Examination Survey (1988-2006). It examines sex differences in the age trajectories of 14 markers of physiological functions across multiple systems and three summary indices including inflammation burden, metabolic syndrome, and allostatic load. Statistical analyses show substantial sex differences, age variations, and sex by age interaction effects for all variables examined. These patterns remain robust after adjustment of risk factors and shed light on the biological base of the reduction of sex difference in mortality in the post-reproductive life span.

Demographic and socioeconomic status differences in perceptions of difficulty with mobility in late life

OBJECTIVES

This study assesses whether socioeconomic and demographic differences in reported mobility limitations are attributable to differential perceptions of mobility difficulty that result in the differential use of response categories.

METHODS

Data come from the Social Environment and Biomarkers of Aging Study and its parent study, the Taiwan Longitudinal Study of Aging. Ordered probit models with person-specific cut-points are used to test whether, after controlling for underlying mobility using objective performance measures, cut-points for reporting mobility limitations vary across groups defined by demographic and socioeconomic characteristics.

RESULTS

Age is the only characteristic that is consistently associated with the location of the cut-points for reporting mobility difficulty: At the same level of underlying mobility difficulty, older adults are more likely than younger adults are to report difficulty with all tasks except short walks. Other variables showed differences but only for one specific activity, for example, urban residents are more likely to report difficulty running than are rural residents with the same underlying level of mobility function.

DISCUSSION

For most mobility activities, there are no systematic differences in the perception of difficulty by individual characteristics. Thus, for older Taiwanese adults, differences in mobility limitations associated with socioeconomic status are more likely to reflect underlying differences in function than differences in how these groups report the same capacity. The usual loss of mobility with age, however, reflects both a decrease in capacity and a lowering of the threshold for reporting difficulty.

Disability and self-rated health among older women and men in rural Guatemala: the role of obesity and chronic conditions

Unprecedented population aging in poorer settings is coinciding with the rapid spread of obesity and other chronic conditions. These conditions predict disability and poor self-rated health and often are more prevalent in women than men. Thus, gender gaps in obesity and other chronic conditions may account for older women's greater disability and worse self-rated health in poor, rural populations, where aging, obesity, and chronic conditions are rapidly emerging. In a survey of 604 adults 50 years and older in rural Guatemala, we assessed whether gender gaps in obesity and other chronic conditions accounted for gender gaps in disability and self-rated health. Obesity strongly predicted gross mobility (GM) disability, and the number of chronic conditions strongly predicted all outcomes, especially in women. Controlling for gender gaps in body-mass index (BMI) and especially the number of chronic conditions eliminated gender gaps in GM disability, and controlling for gender gaps in the number of chronic conditions eliminated gender gaps in self-rated health. We recommend conducting longitudinal cohort studies to explore interventions that may mitigate adult obesity and chronic conditions among poor, rural older adults. Such interventions also may reduce gender gaps in later-life disability and self-rated health.

Stressors over the life course and neuroendocrine system dysregulation in Costa Rica

OBJECTIVE

A key aspect of the increasingly popular allostatic load (AL) framework is that stressors experienced over the entire life course result in physiological dysregulation. Although core to AL theory, this idea has been little tested, and where it has been tested, the results have been mixed.

METHOD

The study analyzes the Costa Rican Study on Longevity and Healthy Aging (CRELES), a new, cross-sectional, and nationally representative survey of older Costa Rican men and women (aged between 60 and 109 years). The survey period is between 2004 and 2006, and the survey has a sample size of 2,827 individuals. This article focuses on the relationship between a variety of stressors experienced over the life course and cortisol, dehydroepiandrosterone sulfate (DHEAS), epinephrine, and norepinephrine analyzed separately and in an index.

RESULTS

There are some links between certain stressors and worse cortisol levels, but overall, almost all of the stressors examined are not associated with riskier neuroendocrine biomarker profiles.

DISCUSSION

More work is needed, in order to establish the connection between stressors experienced over the life course and resting levels of the neuroendocrine markers.

Modeling multisystem biological risk in young adults: The Coronary Artery Risk Development in Young Adults Study

Although much prior research has focused on identifying the roles of major regulatory systems in health risks, the concept of allostatic load (AL) focuses on the importance of a more multisystems view of health risks. How best to operationalize allostatic load, however, remains the subject of some debate. We sought to test a hypothesized metafactor model of allostatic load composed of a number of biological system factors, and to investigate model invariance across sex and ethnicity. Biological data from 782 men and women, aged 32-47, from the Oakland, CA and Chicago, IL sites of the Coronary Artery Risk Development in Young Adults Study (CARDIA) were collected as part of the Year 15exam in 2000. These include measures of blood pressure, metabolic parameters (glucose, insulin, lipid profiles, and waist circumference), markers of inflammation (interleukin-6, C-reactive protein, and fibrinogen), heart rate variability, sympathetic nervous system activity (12-hr urinary norepinephrine and epinephrine) and hypothalamic-pituitary-adrenal axis activity (diurnal salivary free cortisol). A "metafactor" model of AL as an aggregate measure of six underlying latent biological subfactors was found to fit the data, with the metafactor structure capturing 84% of variance of all pairwise associations among biological subsystems. There was little evidence of model variance across sex and/or ethnicity. These analyses extend work operationalizing AL as a multisystems index of biological dysregulation, providing initial support for a model of AL as a metaconstruct of inter-relationships among multiple biological regulatory systems, that varies little across sex or ethnicity.

Allostatic load is associated with chronic conditions in the Boston Puerto Rican Health Study

Puerto Ricans living in the United States mainland present multiple disparities in prevalence of chronic diseases, relative to other racial and ethnic groups. Allostatic load (AL), or the cumulative wear and tear of physiological responses to stressors such as major life events, social and environmental burden, has been proposed as a possible mechanism for the inequalities observed in minority groups, but has not been studied in Puerto Ricans. The aim of this study was to determine the association of AL to six chronic diseases (abdominal obesity, hypertension, diabetes, and self-reported cardiovascular disease (CVD), arthritis and cancer) in Puerto Ricans, and to contrast AL to metabolic syndrome (MetS). Participants of the Boston Puerto Rican Health Study (n=1116, ages 45-75 years) underwent a home-based interview, where questionnaires were completed and biological samples collected. A summary definition of AL was constructed using clinically-defined cutoffs and medication use for 10 physiological parameters in different body systems. Logistic regression models were run to determine associations between AL score and disease status, controlling for age, sex, smoking, alcohol use, physical activity, total fat intake and energy intake. Parallel models were also run with MetS score replacing AL. We found that increasing categories of AL score were significantly associated with abdominal obesity, hypertension, diabetes and self-reported cardiovascular disease (CVD) and arthritis, but not with self-reported cancer. The strength of associations of AL with all conditions, except diabetes and cancer, was similar to or larger than those of MetS score. In conclusion, Puerto Rican older adults experienced physiological dysregulation that was associated with increased odds of chronic conditions. AL was more strongly associated with most conditions, compared to MetS, suggesting that this cumulative measure may be a better predictor of disease. These results have prospective research implications for Puerto Ricans and other ethnic groups.

Improving mortality prediction using biosocial surveys

The authors used data from a nationally representative survey of 933 adults aged 54 years or older (mean age = 66.2 years; standard deviation, 8.0) in Taiwan to explore whether mortality prediction at older ages is improved by the use of 3 clusters of biomarkers: 1) standard cardiovascular and metabolic risk factors; 2) markers of disease progression; and 3) nonclinical (neuroendocrine and immune) markers. They also evaluated the extent to which these biomarkers account for the female advantage in survival. Estimates from logistic regression models of the probability of dying between 2000 and 2006 (162 deaths; mean length of follow-up = 5.8 years) showed that inclusion of each of the 3 sets of markers significantly (P = 0.024, P = 0.002, and P = 0.003, respectively) improved discriminatory power in comparison with a base model that adjusted for demographic characteristics, smoking, and baseline health status. The set of disease progression markers and the set of nonclinical markers each provided more discriminatory power than standard risk factors. Most of the excess male mortality resulted from the men being more likely than women to smoke, but each of 3 markers related to disease progression or inflammation (albumin, neutrophils, and interleukin-6) explained more than 10% of excess male mortality.

Using physiological dysregulation to assess global health status: associations with self-rated health and health behaviors

Six measures of physiological dysregulation were derived from 11 clinically assessed biomarkers, and related to health outcomes and health behaviors for the Hawaii Personality and Health cohort (N = 470). Measures summing extreme scores at one tail of the biomarker distributions performed better than ones summing both tails, and continuous measures performed better than count scores. Health behaviors predicted men's dysregulation but not women's. Dysregulation and health behaviors predicted self-rated health for both men and women, and depressive symptoms predicted self-rated health only for women. These findings provide preliminary guidelines for constructing valid summary measures of global health status for use in health psychology.

Do biomarkers of stress mediate the relation between socioeconomic status and health?

OBJECTIVES

To test the relation between socioeconomic status (SES) and biomarkers of chronic stress, including basal cortisol, and to test whether these biomarkers account for the relation between SES and health outcomes.

DESIGN

Cross sectional study using data from the 2000 social and environmental biomarkers of aging study (SEBAS).

SETTING

Taiwan.

PARTICIPANTS

Nationally representative sample of 972 men and women aged 54 and older.

MAIN OUTCOME MEASURES

Highest risk quartiles for 13 biomarkers representing functioning of the neuroendocrine system, immune/inflammatory systems, and the cardiovascular system: cortisol, adrenaline (epinephrine), noradrenaline (norepinephrine), serum dihydroepiandrosterone sulphate (DHEA-S), insulin-like growth factor 1 (IGF1), interleukin 6 (IL6), albumin, systolic blood pressure, diastolic blood pressure, waist-hip ratio, total cholesterol-HDL ratio, HDL cholesterol, and glycosylated haemoglobin; self reported health status (1-5) and self reported mobility difficulties (0-6).

RESULTS

Lower SES men have greater odds of falling into the highest risk quartile for only 2 of 13 biomarkers, and show a lower risk for 3 of the 13 biomarkers, with no association between SES and cortisol. Lower SES women have a higher risk for many of the cardiovascular risk factors, but a lower risk for increased basal readings of adrenaline, noradrenaline, and cortisol. Inclusion of all 13 biological markers does not explain the relation between SES and health outcomes in the sample.

CONCLUSIONS

These data do not support the hypothesis that chronic stress, via sustained activation of stress related autonomic and neuroendocrine responses, is an important mediator in the relation between SES and health outcomes. Most notably, lower SES is not associated with higher basal levels of cortisol in either men or women. These results place an increased burden of proof on researchers who assert that psychosocial stress is an important pathway linking SES and health.

Predicting mortality from clinical and nonclinical biomarkers

BACKGROUND

Few studies focus on "preclinical" warning signs associated with mortality. In this article, we investigate associations between all-cause mortality and two clusters of biological risk factors: (i) standard clinical measures related to cardiovascular disease and metabolic function; and (ii) nonclinical measures pertaining to hypothalamic-pituitary-adrenal axis activity, sympathetic nervous system activity, and inflammatory response.

METHODS

Data come from the 2000 Social Environment and Biomarkers of Aging Study, a national sample of Taiwanese persons aged 54 years or older; 1497 persons were interviewed in their homes, and 1023 participated in a hospital examination. The analysis is based on 927 respondents with complete information. Logistic regression models describe the association between biomarkers and the 3-year probability of dying.

RESULTS

Although both groups of biomarkers are significantly associated with mortality, the model with neuroendocrine and immune biomarkers has better explanatory and discriminatory power than the one with clinical measures. The association between these nonclinical measures and mortality remains strong after adjustment for the clinical markers, suggesting that the physiological effects of the nonclinical biomarkers are broader than those captured by the cardiovascular and metabolic system measures included here.

CONCLUSIONS

Nonclinical markers are likely to provide warning signs of deteriorating health and function beyond what can be learned from conventional markers. Our findings are consistent with those of recent studies that (i) demonstrate the importance of neuroendocrine and immune system markers for survival, and (ii) indicate that standard clinical variables are less predictive of mortality in older than in younger populations.

Recent changes in cardiovascular risk factors among women and men

BACKGROUND

The purpose of this study was to examine change over the 1990s in the proportion of men and women with measured high-risk values of cardiovascular risk factors.

METHODS

Change in the prevalence of high-risk conditions based on clinical cutoffs for 10 cardiovascular risk factors was assessed in respondents aged > or =40 from the nationally representative, cross-sectional National Health and Nutrition Examination Surveys (NHANES) III (1988-1994) and IV (1999-2002).

RESULTS

Both sexes experienced a reduction in the prevalence of high-risk levels of cholesterol (total, high-density lipoprotein [HDL], and low-density lipoprotein [LDL]) and high homocysteine and an increase in obesity and high C-reactive protein (CRP). Changes in the prevalence of high total cholesterol and high CRP were more pronounced among women. The percentage of women with high diastolic and systolic blood pressure increased, whereas this percentage decreased among men. During the same time, there was an increase in undiagnosed high blood pressure and in the use of antihypertensive medications without achieving adequate blood pressure control among women. Both sexes increased their use of cholesterol-lowering medication. These changes in diagnosis rates and medication usage did not explain the trends in the prevalence of high-risk blood pressure or high-risk cholesterol, although the larger increase in high CRP among women is related to increased use of postmenopausal hormone therapy over the 1990s.

CONCLUSIONS

We found mixed trends in cardiovascular risk factors for both women and men; some improved and some deteriorated. Changes in medication use and obesity did not explain these trends.

Emerging infectious determinants of chronic diseases

Infectious agents, often through complex systems, likely determine more chronic diseases than is currently appreciated.

Evidence now confirms that noncommunicable chronic diseases can stem from infectious agents. Furthermore, at least 13 of 39 recently described infectious agents induce chronic syndromes. Identifying the relationships can affect health across populations, creating opportunities to reduce the impact of chronic disease by preventing or treating infection. As the concept is progressively accepted, advances in laboratory technology and epidemiology facilitate the detection of noncultivable, novel, and even recognized microbial origins. A spectrum of diverse pathogens and chronic syndromes emerges, with a range of pathways from exposure to chronic illness or disability. Complex systems of changing human behavioral traits superimposed on human, microbial, and environmental factors often determine risk for exposure and chronic outcome. Yet the strength of causal evidence varies widely, and detecting a microbe does not prove causality. Nevertheless, infectious agents likely determine more cancers, immune-mediated syndromes, neurodevelopmental disorders, and other chronic conditions than currently appreciated.

Measurement of cumulative physiological dysregulation in an older population

The allostatic load framework postulates that an important pathway connecting the social environment with health involves biological responses to stressful stimuli and the subsequent dysregulation of interrelated physiological systems. We formulate a new measure for cumulative physiological dysregulation using a grade of membership model estimated with biodemographic data from a national sample of older Taiwanese persons. We investigate associations between the measure and physical, psychological, and cognitive function. The results provide insights into the relationships between a set of biological profiles and various health outcomes, identify limitations of earlier approaches, and underscore next steps in the development of improved for mulations of physiological dysregulation.

Cognitive, physiological, and personality correlates of recurrence of depression

BACKGROUND

The risk of recurrence in depressive disorder is high and increases with the number of episodes. We investigated whether individuals with a history of recurrent depression deviate from individuals with a single episode, as regards risk-related variables in 3 different domains of depression research.

METHODS

Participants were 102 outpatients with major depressive disorder remitted from an episode (60 recurrent, 42 nonrecurrent). We assessed the perception of emotions from vocal stimuli, 24-h urinary free cortisol, and neuroticism.

RESULTS

The recurrent group had higher cortisol levels than the nonrecurrent group, and recurrent women also had a more negative perception than nonrecurrent women. These results were independent of each other, and could also not be accounted for by neuroticism or residual symptoms. Gender differences were found in all 3 domains.

LIMITATIONS

The cross-sectional design limits the possibility to draw conclusions on the causality of the observed effects.

CONCLUSIONS

Remitted outpatients with recurrent depression deviate from remitted outpatients with single episode depression as regards physiology and social cognition, in a way that may increase their risk of the development of subsequent episodes. The results may have implications for prophylactic treatment strategies.

Differences in disability among older women and men in Egypt and Tunisia

Research on child survival and health has indicated disparities between boys and girls in selected Middle Eastern countries. Health disparities in later life are understudied in this region. In this article, we examine differences between women and men in later-life activity limitation in Egypt and Tunisia. Difficulty executing physical tasks is more common for women than for men in both study sites, although differences are smaller after adjustment for underlying illness. Differences in the difficulty of executing physical tasks also are sensitive to environmental controls in variable ways across the study sites. The findings caution against the sole use of reported disability in comparative studies of gender and aging.