The shape of health to come: prospective study of the determinants of 30-year health trajectories in the Alameda County Study

Evolution of the income-related gap in health with old age: evidence from 20 countries in European and Chinese panel datasets

Some studies show that the protective effect of higher income on health weakens with old age (age-as-leveller pattern), whereas others show that it strengthens with old age (cumulative advantage/disadvantage pattern). Many existing studies are limited in that they use single-country and/or single-timepoint designs. To overcome these limitations and better understand how the income-health gradient evolves in older age, we used cross-national and longitudinal data of the Survey of Health, Ageing and Retirement in Europe (2004-2019, N = 73,407) and the China Health and Retirement Longitudinal Study (2011-2018, N = 10,067). We operationalised health using multimorbidity and three alternative indicators (functional disability, mobility disability, and memory). We performed Poisson growth curve modelling to capture the between-participant effects of age and the within-participant effects of aging. We obtained three consistent and robust findings for Europe (patterns were observed in most countries) and China. First, the protective effect of higher income on multimorbidity, functional disability, and mobility disability was weaker for older than for younger adults (between-participant age-as-leveller pattern). Second, only the protective effect of higher income on mobility disability weakened over the later life course (within-participant age-as-leveller pattern). Third, the protective effect of higher income on memory was stronger for older than for younger adults and strengthened over the later life course (between-participant and within-participant cumulative advantage/disadvantage pattern). Longitudinal data, growth curve modelling distinguishing the between-participant from within-participant effect, and adjustments for potential confounders based on the hypothesised causal structure enabled us to better navigate the landscape of causal inference. Findings suggest that the income-related gap in physical health but not in cognitive health narrows in old age for both Europe and China.

Interrelationships between nursing workers' state of nutrition, socio demographic factors, work and health habits

The interrelationships between professional nursing workers' state of nutrition, variables relating to their socio demographic relationships, their professional work, and health behavior, were examined based on a correspondence analysis technique. This is a sectional study carried out involving 917 nursing professionals in a public hospital in Rio de Janeiro. The results show the formation of four groups, three of them grouped under BMI (body mass index) categories. The obese individuals group included poor health, current socio economic conditions, unfavorable past conditions, and former night shift workers. The low/adequate group showed the most favorable conditions, while the group of overweight individuals also included smoking, alcohol consumption, and current night shift work (up to five nights per two-week period). Specifically, among the interrelationships between the states of nutrition levels, we highlight those relating to current and previously evaluated socio economic conditions, and underscore the life-long importance of social indicators.

Cumulative structural disadvantage and racial health disparities: the pathways of childhood socioeconomic influence

Cumulative structural disadvantage theory posits two major sources of endogenous selection in shaping racial health disparities: a race-based version of the theory anticipates a racially distinct selection process, whereas a social class-based version anticipates a racially similar process. To operationalize cumulative structural disadvantage, this study uses data from the 1979 National Longitudinal Survey of Youth in a Latent Class Analysis that demographically profiles health impairment trajectories. This analysis is used to examine the nature of selection as it relates to racial differences in the development of health impairments that are significant enough to hinder one's ability to work. The results provide no direct support for the race-based version of cumulative structural disadvantage theory. Instead, two key findings support the social class-based version of cumulative disadvantage theory. First, the functional form of the different health trajectories are invariant for whites and blacks, suggesting more racial similarly in the developmental process than anticipated by the race-based version of the theory. The extent of the racial disparity in the prevalences across the health impairment trajectories is, however, significant and noteworthy: nearly one-third of blacks (28 %) in the United States experience some form of impairment during their prime working years compared with 18.8 % of whites. Second, racial differences in childhood background mediate this racial health disparity through the indirect pathway of occupational attainment and through the direct pathway of early-life exposure to health-adverse environments. Thus, the selection of individuals into different health trajectories, based largely on childhood socioeconomic background, helps explain racial disparities in the development of health impairments.

Cumulative socioeconomic disadvantage and cardiovascular disease mortality in the Alameda County Study 1965 to 2000

PURPOSE

Socioeconomic disadvantage is often evaluated at single points in the adult life course in health research. Social mobility models suggest that socioeconomic patterns may also influence disease risk. This study examines cumulative socioeconomic disadvantage (CSD) in relation to cardiovascular disease mortality (CVDM).

METHODS

Data were from the Alameda County Study (n = 2530). The CSD indices included father's education, the respondent's education, and either average or latent variable trajectory models of adulthood household income (1965-1994). Proportional hazards models were used to assess the associations between CSD and CVDM.

RESULTS

The CSD measures were not associated with CVDM in men. Among women, the magnitude of the association between CSD and CVDM was greater for the income trajectory (hazard ratio3 vs 0 = 4.73, 95% confidence interval = 2.20-10.18) compared with the average income (hazard ratio3 vs 0 = 3.78, 95% confidence interval = 1.67-8.53) CSD measure.

CONCLUSIONS

Measures of CSD that incorporate patterning of resources over the life course were associated with CVDM for women but not men. Patterning of available socioeconomic resources may differentially influence chronic disease risk and mortality by gender, and future work should continue to investigate how greater patterns variability in available resources influences health outcomes.

Systematic review of occupational engagement and health outcomes among community-dwelling older adults

We conducted this systematic review, one of four related to productive aging, to explore the existing evidence for the health benefits of engagement in occupations and activities among older adults. The review incorporates the breadth of areas of occupation in which older adults engage and the range of health benefits derived from that engagement. The results of this review demonstrate the multidisciplinary appreciation for occupational engagement and associated well-being and elucidate the health effects of engagement in a wide variety of occupations and activities. Additionally, the results of this systematic review support occupational therapy's historical ideologies and core philosophies linking occupational engagement to improved health and well-being. The findings suggest an increasing role for occupational therapy service delivery in community-based health promotion and prevention efforts to meet the everyday activity and health needs of the growing older adult population.

Adolescence to young adulthood: when socioeconomic disparities in substance use emerge

We examined trends in cigarette, alcohol, and marijuana use by eventual educational attainment in 1,902 participants from Project EAT, a 10-year longitudinal study following participants from early adolescence through young adulthood. Generally, for cigarettes and marijuana, disparities were evident by early adolescence with prevalence of use highest among those who had no secondary education. With alcohol, use diverged during young adulthood when the college group reported the most weekly alcohol use while those without postsecondary education reported greatest daily use. When disparities in substance use behaviors first emerge and later escalate can guide how to craft and target interventions.

Socioeconomic mobility in adulthood and cardiovascular disease mortality

PURPOSE

Life course models suggest that socioeconomic mobility is associated with decreased cardiovascular disease (CVD) mortality risk. We examined adult socioeconomic mobility measured by household income in relation to CVD mortality risk among older adults.

METHODS

Data from 2691 (n(men) = 1157; n(women) = 1534) Alameda County Study respondents in 1994 were used in these analyses. Latent growth curve models were used to identify income patterns from 1965 to 1994.

RESULTS

Income patterns were categorized as consistently low, moderately low, increasing, and high. Bivariate models showed that membership in the increasing compared with high pattern was associated with decreased hazards of CVD mortality (hazard ratio, 0.15; 95% confidence interval [CI], 0.04-0.53). Controlling for age, race/ethnicity, marital status, and gender, respondents in the consistently low (HR, 2.1; 95% CI, 1.5-3.1) and high pattern (HR, 2.2; 95% CI, 1.1-4.2) had increased hazards of CVD mortality than those in the moderately low income group.

CONCLUSIONS

Patterns of association were consistent with social mobility models of socioeconomic position, indicating lower CVD mortality risk for those with increasing or higher incomes. Future work should continue to investigate measures that capture the variation in social mobility over the life course, and how these patterns shape chronic disease risk in later life.

Using the temporal self-regulation theory to examine the influence of environmental cues on maintaining a healthy lifestyle

OBJECTIVES

The aim of the current study is to explore the predictive utility of the temporal self-regulation theory (TST) for maintaining a healthy lifestyle (Hall & Fong, 2007, Health Psychology Review, 1, 6). According to TST, the influence of intention, self-regulation, and behavioural prepotency differs depending on the environmental context in which the behaviour is performed. This study examined the influence of perceptions about the supportiveness of the environmental context on TST-related factors.

DESIGN

Temporal self-regulation theory was tested using a prospective design with a 1-week follow-up.

METHODS

One hundred and fifty-two undergraduates were administered three executive functioning tasks and an online questionnaire regarding their intentions to maintain a healthy lifestyle, environmental responsiveness, and previous behaviour. One week later, they completed a follow-up questionnaire.

RESULTS

Participants who were supported by the environment were significantly more likely to maintain a healthy lifestyle than those distracted by the environment. Behavioural prepotency was significantly predictive of behaviour performance for 'supported' participants. Behavioural prepotency, planning, and response inhibition were significantly predictive of 'unsupported' participants' behaviour.

CONCLUSIONS

These findings provided preliminary support for the use of TST for the prediction of healthy lifestyle behaviour. Importantly, this study provided support for the contention that the influence of TST-related factors would vary according to the perceived supportiveness of the environment. These findings suggest that environmental responsiveness may be an important determinant to close the intention-behaviour gap for maintaining a healthy lifestyle.

Clinical disorders in a post war British cohort reaching retirement: evidence from the First National Birth Cohort study

BACKGROUND

The medical needs of older people are growing because the proportion of the older population is increasing and disease boundaries are widening. This study describes the distribution and clustering of 15 common clinical disorders requiring medical treatment or supervision in a representative British cohort approaching retirement, and how health tracked across adulthood.

METHODS AND FINDINGS

The data come from a cohort of 2661 men and women, 84% of the target sample, followed since birth in England, Scotland and Wales in 1946, and assessed at 60-64 years for: cardio and cerebro-vascular disease, hypertension, raised cholesterol, renal impairment, diabetes, obesity, hypothyroidism, hyperthyroidism, anaemia, respiratory disease, liver disease, psychiatric problems, cancers, atrial fibrillation on ECG and osteoporosis. We calculated the proportions disorder-free, with one or more disorders, and the level of undiagnosed disorders; and how these disorders cluster into latent classes and relate to health assessed at 36 years. Participants had, on average, two disorders (range 0-9); only 15% were disorder-free. The commonest disorders were hypertension (54.3%, 95% CI 51.8%-56.7%), obesity (31.1%, 28.8%-33.5%), raised cholesterol (25.6%, 23.1-28.26%), and diabetes or impaired fasting glucose (25.0%, 22.6-27.5%). A cluster of one in five individuals had a high probability of cardio-metabolic disorders and were twice as likely than others to have been in the poorest health at 36 years. The main limitations are that the native born sample is entirely white, and a combination of clinical assessments and self reports were used.

CONCLUSIONS

Most British people reaching retirement already have clinical disorders requiring medical supervision. Widening disease definitions and the move from a disease-based to a risk-based medical model will increase pressure on health services. The promotion of healthy ageing should start earlier in life and consider the individual's ability to adapt to and self manage changes in health.

Changes over time from baseline poor self-rated health: for whom does poor self-rated health not predict mortality?

The aim of this study was to understand for whom and why poor self-rated health (SRH) is a less valid predictor of longevity or future health by examining the predictors of decline in health among people with poor baseline SRH. The sample included 409 participants in the Cross-Sectional and Longitudinal Study of the old-old (75+) in Israel, who were self-respondents and rated their health as poor at baseline and their status was known at follow-up 3.5 years later: deceased/moved to proxy interview/remained in poor SRH/or improved SRH. Baseline measures included self-reported medical status, physical, cognitive, psychological and social functioning. Findings showed that less decline in health was predicted by less difficulty in physical and cognitive functioning at baseline and by a more active physical and social life, after controlling for socio-demographics. Most of the predictors retained a unique contribution in a multivariate model, suggesting that engagement in meaningful activities serves as an indicator of better health and longer survival even within a group of old-old people in poor health. It may reflect greater social support, contribute to fitness and/or provide a sense of mastery, which could explain similar findings regarding gender and race/ethnicity groups for whom SRH is a less potent predictor of mortality.

Neighborhood socioeconomic conditions are associated with psychosocial functioning in older black and white adults

We examined neighborhood socioeconomic status (NSES) in relation to depressive symptoms, perceived stress, and hostility in 5770 community-dwelling older black and white adults (mean age=73 years; 62% female) from 3 contiguous neighborhoods covering 82 census block groups in Chicago, IL. NSES was an average of z-scores of four Census 2000 block-group variables: % public assistance, % households earning <$25,000 annually, % with >college degree, and % owner-occupied dwellings valued >$200,000. NSES was inversely related to hostility (beta=-0.305), stress (beta=-0.333), and depressive symptoms (beta=-0.223) (p<0.001) in multi-level mixed-effects regression models adjusted for age, sex, race, and the number of years in the neighborhood. With further adjustment for education, income, marital status, and health conditions, NSES remained associated with depressive symptoms (beta=-0.078) and hostility (beta=-0.133) (p<0.05); the association with hostility was strongest in non-black neighborhoods. Neighborhood social conditions contribute to the psychosocial well-being of older residents; research is needed to investigate pathways through which neighborhoods influence health outcomes in an aging population.

Individual, social and environmental correlates of physical activity among women living in socioeconomically disadvantaged neighbourhoods

Women living in socioeconomically disadvantaged neighbourhoods are at heightened risk for physical inactivity, but little is known about the correlates of physical activity among this group. Using a social-ecological framework, this study aimed to determine the individual, social and neighbourhood environmental correlates of physical activity amongst women living in such neighbourhoods. During 2007-2008 women (n = 4108) aged 18-45 years randomly selected from urban and rural neighbourhoods of low socioeconomic status in Victoria, Australia completed the International Physical Activity Questionnaire (long). They reported on individual (self-efficacy, enjoyment, intentions, outcome expectancies, skills), social (childcare, social support from family and friends/colleagues, dog ownership) and neighbourhood environmental (neighbourhood cohesion, aesthetics, personal safety, 'walking environment') factors. Multinomial logistic regression was used to examine the odds of increasing categories of leisure time physical activity (LTPA) and transport-related physical activity (TRPA) for each individual, social and environmental factor. In partially adjusted analyses, all individual, social and environmental variables were positively associated with LTPA, while all individual factors, family and friend support and the walking environment were positively associated with TRPA. In fully adjusted multivariable models, all individual and social factors remained significantly associated with LTPA, while self-efficacy, enjoyment, intentions, social support, and neighbourhood 'walking environment' variables remained significantly associated with TRPA. In conclusion, individual and social factors were most important for LTPA, while individual, social and neighbourhood environmental factors were all associated with TRPA. Acknowledging the cross-sectional design, the findings highlight the importance of different levels of potential influence on physical activity in different domains, which should be considered when developing strategies to promote physical activity amongst women living in socioeconomically disadvantaged neighbourhoods.

Comparing the influence of childhood and adult economic status on midlife obesity in Mexican American, white, and African American women

OBJECTIVE

This research addresses the following 2 questions. What is the effect of childhood and adult economic status on midlife obesity in Mexican American women? How do these economic patterns in Mexican American women compare with patterns seen in White women and in African American women?

METHOD

Data were drawn from the U.S. National Longitudinal Survey of Youths 1979-2002 waves. The sample consisted of 422 Mexican Americans, 2,090 Whites, and 1,195 African Americans. The economic indicator used for childhood economic status was parent education; for adult economic status, the participant's own education and adult per capita income were used. Unadjusted and adjusted odds ratios were estimated for the relationship between midlife obesity and economic indicator, stratified by race/ethnic group.

RESULTS

There was an increased risk for midlife obesity with disadvantaged economic status measured during childhood and at midlife in Mexican American women. The economic effects on midlife obesity in Mexican American women were similar to those found for White, but not African American women. Few economic influences on obesity at midlife were found for African American women.

CONCLUSIONS

Strategies that broadly improve the economic conditions of Mexican American women may be one important way to address the obesity epidemic in this population.