Associations Between Self-Reported Visual and Hearing Functioning and Cognitive Function Among Hispanics/Latino: Hispanic Community Health Study

Background and Objectives

To investigate the associations between self-reported visual functioning (VF) and hearing functioning with cognition in the Hispanic/Latino population.

Research Design and Methods

We utilized data from the Miami Ocular Study of Latinos ancillary study to Hispanic Community Health Study/Study of Latinos with 1,056 participants aged 45 and older. The outcomes were cognitive performances assessed by the Digit Symbol Substitution Test (DSST), Word Fluency, Brief-Spanish English Verbal Learning Test-recall (B-SEVLT recall), words recalled over 3 trials, and the Six-Item Screener. VF was measured by National Eye Institute Visual Function Questionnaire (NEI-VFQ), and hearing function was measured by Hearing Handicap Inventory Screening Questionnaire for Adults and Elderly (HHIA/E-S). Multiple regressions were performed for each cognitive outcome while controlling for covariates and complex sampling design.

Results

NEI-VFQ was associated with 3 of the 5 cognitive outcomes. A 4-point NEI-VFQ score difference was associated with a 0.56-point difference in DSST (standard error [SE] = 0.27, p < .001), 0.17 in Word fluency (SE = 0.16, p < .01), and 0.08 in B-SEVLT-recall (SE = 0.07, p < .01). HHIA/E-S was not associated with any of the cognitive measures examined.

Discussion and Implications

These data suggest that impaired VF is associated with worse cognition in the Hispanic/Latino population. Although previous work in this cohort indicated hearing loss assessed by pure tone audiometry was associated with worse cognition, we found self-perceived hearing function was not associated with cognition, suggesting the potential limitation of self-reported hearing function as a proxy for hearing loss in epidemiological research in Hispanic/Latino populations. Results also imply impaired VF and hearing function may be linked to cognition differently in the Hispanic population, and more research is needed to better understand the underlying linking mechanisms. Visual and hearing impairments are common and treatable and represent important modifiable risk factors that can be treated to preserve cognitive function in Hispanics/Latinos.

Factors associated with urinary incontinence among Hispanic/Latina women in the United States: Findings from The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

PURPOSE

To identify factors associated with urinary incontinence (UI) in women of various Hispanic/Latina backgrounds.

MATERIALS AND METHODS

We analyzed data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multicenter, community-based cohort study which includes a health-related questionnaire assessing presence and type of UI. Complex survey logistic regression analysis was used to assess the cross-sectional association of Hispanic/Latina backgrounds and other factors of UI. All estimates accounted for HCHS/SOL survey design.

RESULTS

Of 5027 women, 33.4% answered "yes" to UI. Rates of any UI ranged from approximately 21.9% to 40.3% in women of Dominican and Puerto-Rican background, respectively. Any UI and UI subtypes were associated with age older than 65 years, increasing body mass index, smoking status, any alcohol use, parity ≥3, and postmenopausal status. After controlling for covariates and when compared with women of Mexican background, women of Dominican background were less likely to have any UI (OR = 0.42, 95% CI 0.30-0.57), as were women of Cuban (OR = 0.48, 95% CI 0.37-0.62), Puerto-Rican (OR = 0.79, 95% CI 0.62-1.0), and mixed (OR = 0.62, 95% CI 0.39-0.99) background; and women of every other background except for South American were less likely to have stress UI. In addition, women of Cuban (OR = 0.53, 95% CI 0.32-0.86) and mixed (OR = 0.38, 95% CI 0.16-0.87) background were less likely to have urge UI than women of Mexican background.

CONCLUSIONS

Our study demonstrates differences in UI by Hispanic/Latina background, suggesting collective designation of Hispanics/Latinas as a single ethnic group does not adequately describe UI among this diverse group.

Association of Unfavorable Social Determinants of Health With Stroke/Transient Ischemic Attack and Vascular Risk Factors in Hispanic/Latino Adults: Results From Hispanic Community Health Study/Study of Latinos

BACKGROUND AND PURPOSE

Social determinants of health (SDOH) are non-medical factors that may contribute to the development of diseases, with a higher representation in underserved populations. Our objective is to determine the association of unfavorable SDOH with self-reported stroke/transient ischemic attack (TIA) and vascular risk factors (VRFs) among Hispanic/Latino adults living in the US.

METHODS

We used cross-sectional data from the Hispanic Community Health Study/Study of Latinos. SDOH and VRFs were assessed using questionnaires and validated scales and measurements. We investigated the association between the SDOH (individually and as count: ≤1, 2, 3, 4, or ≥5 SDOH), VRFs and stroke/TIA using regression analyses.

RESULTS

For individuals with stroke/TIA (n=388), the mean age (58.9 years) differed from those without stroke/TIA (n=11,210; 46.8 years; P<0.0001). In bivariate analysis, income <$20,000, education less than high school, no health insurance, perceived discrimination, not currently employed, upper tertile for chronic stress, and lower tertiles for social support and language- and social-based acculturation were associated with stroke/TIA and retained further. A higher number of SDOH was directly associated with all individual VRFs investigated, except for at-risk alcohol, and with number of VRFs (β=0.11, 95% confidence interval [CI]=0.09-0.14). In the fully adjusted model, income, discrimination, social support, chronic stress, and employment status were individually associated with stroke/TIA; the odds of stroke/TIA were 2.3 times higher in individuals with 3 SDOH (95% CI 1.6-3.2) and 2.7 times (95% CI 1.9-3.7) for those with ≥5 versus ≤1 SDOH.

CONCLUSION

Among Hispanic/Latino adults, a higher number of SDOH is associated with increased odds for stroke/TIA and VRFs. The association remained significant after adjustment for VRFs, suggesting involvement of non-vascular mechanisms.

Abstract 32: Physical Activity Fragmentation and Mortality in Hispanics/Latinos: The Hispanic Community Health Study / Study of Latinos (HCHS/SoL)

Background: Physical activity (PA) fragmentation, an emerging concept of PA patterns, indicates the frequency of transitioning from an active to a sedentary state. Whether PA fragmentation provides prognostic information beyond conventional PA measures is unclear, especially in Hispanics/Latinos.

Aim: To examine the association between PA fragmentation and mortality in Hispanics/Latinos.

Methods: We included 9,856 participants (mean age 41.7 [SE 0.27] years; 52.1% women) from HCHS/SOL with baseline PA evaluation from an Actical accelerometer (≥3 days with ≥10 hr/day of wear). We defined sedentary as <10 counts/min and active as ≥10 counts/min. PA fragmentation was calculated using the active-to-sedentary transition probability (ASTP), defined as the reciprocal of the average active bout duration on a minute-level basis across valid days. We used daily mean total log activity counts (TLAC) as a measure of total PA volume. We modeled the residuals of ASTP regressed on TLAC (total-PA-adjusted ASTP) to investigate ASTP independently of total PA. Deaths were identified from annual follow-up contacts until December 31, 2018. We explored multivariable Cox regression models accounting for the multi-stage sampling design.

Results: There were 242 deaths (2.5%) over a mean of 7.1 years. ASTP was associated with mortality in all models ( Table ). Each 0.10-unit increase of ASTP at baseline was associated with a 38% higher mortality risk after accounting for demographic, clinical, and lifestyle factors. Similarly, the highest ASTP tertile indicated a 2-times greater risk of death compared to the lowest tertile. The results were largely similar when we modeled using total-PA-adjusted ASTP. Higher TLAC was also associated with reduced mortality. Similar results were observed after excluding early deaths (first 2 years).

Conclusion: PA fragmentation was robustly associated with mortality, independent of total PA volume. Our findings support PA fragmentation as an emerging novel measure that is informative beyond total PA.

Joint associations of peripheral artery disease and accelerometry-based physical activity with mortality: The Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

BACKGROUND AND AIMS

Peripheral artery disease (PAD) and lower levels of physical activity are both associated with higher mortality. Yet, their joint prognostic impact has not been systematically examined, especially in Hispanics/Latinos, and with objective measures. We aimed to examine the joint associations of PAD and physical activity with mortality in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

METHODS

We studied 7,620 Hispanic/Latino adults aged 45-74 years at baseline (2008-2011) who underwent assessment of PAD with ankle-brachial index (ABI) and physical activity with hip-worn accelerometry. We calculated four physical activity measures: sedentary time, light activity, moderate/vigorous activity, and total activity counts. We quantified the relationship between ABI and mortality overall, and by tertiles of activity measures in restricted cubic splines, using multivariable Cox models accounting for sampling weights. We also assessed cross-categories of ABI and activity measures with mortality.

RESULTS

During a median follow up of 7.1 years, 314 participants died. We observed a U-shaped association of ABI with mortality overall (e.g., hazard ratio 1.80 [95%CI 1.20-2.80] at ABI 0.7 vs 1.2). This U-shaped association was generally consistent after stratifying by activity measures, but an elevated mortality risk for higher ABI was not evident in the most active tertile based on sedentary time, time in light activity, and total activity counts. In the cross-category analysis of ABI and physical activity, the highest mortality risk was consistently seen in abnormal ABI (≤0.9 or >1.4) plus the least active tertile (e.g., HR 5.61 [3.31-9.51] for light activity), compared to referent ABI (0.9-1.4) plus the other more active two tertiles, with no interactions between ABI and activity measure.

CONCLUSIONS

Abnormal ABI and lower accelerometry-based physical activity were independently and jointly associated with mortality in Hispanics, suggesting the importance of simultaneously evaluating leg vascular condition and physical activity.

Associations of Helicobacter pylori and hepatitis A seropositivity with asthma in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL): addressing the hygiene hypothesis

Background

The hygiene hypothesis posits that microbial exposure reduces risk of asthma and other respiratory-related diseases. Helicobacter pylori and hepatitis A virus (HAV) are common fecal–oral infections. Our study aimed to examine associations of seropositivity to these agents with asthma in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL).

Methods

A total of 12,471 HCHS/SOL participants with baseline data on self-reported physician-diagnosed asthma, and antibodies anti-H. pylori and anti-HAV were included in this cross-sectional analysis. Multivariable logistic regression models were used to estimate the odds ratios and 95% confidence intervals for the overall associations of seropositivity to each agent with asthma. Analyses were also stratified by Hispanic/Latino background. Effect modification by smoking status and nativity were tested. An analysis restricted to individuals with spirometry-defined chronic obstructive pulmonary disease (COPD) was also considered.

Results

The weighted overall prevalence of asthma was 16.6%. The weighted seroprevalence of H. pylori was 56.6% and of HAV was 76.6%, and they significantly differed by Hispanic/Latino background. After accounting for age, sex, education and other key confounders, we found no associations between H. pylori or HAV seropositivity with asthma (with and without COPD), either for all individuals combined or for any of the six specific backgrounds. There were no significant interactions by smoking and nativity.

Conclusion

Our findings did not provide support for the role of H. pylori or HAV, as evidence of the hygiene hypothesis in asthma among the large and diverse Hispanic/Latino populations of the HCHS/SOL.

Trial registration NCT02060344

Omega-3 Fatty Acids and Depressive Symptomology and the Influence of Psychosocial Stress: The Hispanic Community Health Study/Study of Latinos

Objectives

The literature on n-3 fatty acid (FA) intake and depressive symptoms is inconsistent, potentially due in part to the influence of psychosocial stress. Some evidence supports that n-3 intake may have greater benefit on depressive symptoms among those with high oxidative stress. We quantified the associations between dietary and plasma n-3 FA and 6-y depressive symptoms and measured the modifying effect of psychosocial stress.

Methods

Data are from the Hispanic Community Health Study/Study of Latinos (age 48 y, 63% female). At baseline (2008–11), EPA, DHA and n-3 very-long-chain FAs (n-3VLCFAs) were estimated using two 24-hr recalls and the NCI method. Plasma n-3 FAs were measured by mass spectrometry. Depressive symptoms were measured at baseline and 6-y follow-up with the 10-item Center for Epidemiological Studies Depression Scale (CESD). Approximately 9 months from baseline, the 10-item Perceived Stress (PSS) and Chronic Burden of Stress scales were obtained. Unstratified and psychosocial stress-stratified associations were analyzed using survey linear regression among those with dietary (n = 3537) and plasma (n = 718) FA data. Model covariates included, but were not limited to, baseline CESD score, ethnicity, study site, antidepressant use, total energy intake, and dietary or plasma n-6 FA.

Results

Baseline DHA and n-3VLCFA intake were inversely associated with 6-y CESD (P &lt; 0.05). All examined dietary n-3 FA exposures were inversely associated with CESD among those in the highest PSS quartile (Q4) (P &lt; 0.05), but this was attenuated after considering n-6 FA intake. DHA and n-3VLCFA intakes were associated with lower CESD among those with 2 chronic stressors, but not &lt;1 or &gt;2 stressors. Plasma n-3 FAs were not associated with CESD in PSS stratified and unstratified analyses. However, plasma n-3 FA were associated with lower CESD score among those with only 2 chronic stressors.

Conclusions

Dietary n-3VLCFAs, but not plasma, were inversely associated with 6-y CESD. Psychosocial stress did not clearly modify these associations. These results provide some evidence that greater n-3VLCFA intake may reduce depressive symptoms among Hispanic/Latino adults. However, considering the limitations of self-reported intake, further research is needed using biomarkers of long-term n-3 consumption and psychosocial stress to confirm our findings.

Funding Sources

None.