@article {10046, title = {A marginal structural model approach to analyse work-related injuries: An example using data from the Health and Retirement Study.}, journal = {Injury Prevention}, year = {2020}, month = {2019 Apr 24}, abstract = {

BACKGROUND: Biases may exist in the limited longitudinal data focusing on work-related injuries among the ageing workforce. Standard statistical techniques may not provide valid estimates when the data are time-varying and when prior exposures and outcomes may influence future outcomes. This research effort uses marginal structural models (MSMs), a class of causal models rarely applied for injury epidemiology research to analyse work-related injuries.

METHODS: 7212 working US adults aged >=50 years, obtained from the Health and Retirement Study sample in the year 2004 formed the study cohort that was followed until 2014. The analyses compared estimates measuring the associations between physical work requirements and work-related injuries using MSMs and a traditional regression model. The weights used in the MSMs, besides accounting for time-varying exposures, also accounted for the recurrent nature of injuries.

RESULTS: The results were consistent with regard to directionality between the two models. However, the effect estimate was greater when the same data were analysed using MSMs, built without the restriction for complete case analyses.

CONCLUSIONS: MSMs can be particularly useful for observational data, especially with the inclusion of recurrent outcomes as these can be incorporated in the weights themselves.

}, keywords = {Survey Methodology, Working conditions}, issn = {1475-5785}, doi = {10.1136/injuryprev-2018-043124}, author = {Navneet Kaur Baidwan and Susan Goodwin Gerberich and Kim, Hyun and Andrew D Ryan and Timothy Church and Benjamin D Capistrant} } @article {9991, title = {A longitudinal study of work-related psychosocial factors and injuries: Implications for the aging United States workforce.}, journal = {American Journal of Industrial Medicine}, volume = {62}, year = {2019}, pages = {212-221}, abstract = {Introduction: This study aimed to identify psychosocial work factors that may individually or, in combination, influence injury outcomes among aging United States (U.S.) workers. Methods: Data from the U.S. Health and Retirement Study (HRS) of 3305 working adults, aged 50 years and above, were used to identify associations between work-related psychosocial factors and injury incidence from 2006 to 2014, using adjusted incidence rate ratios. Results: Employees perceiving their work as high in psychological and physical demands/efforts, low in support, and rewards, compared to those in workplaces with low demands, high support, and high rewards, had a risk of injury two times greater. Males, compared with females, had a greater risk for injuries when interactions among several psychosocial work-related factors were modeled. Conclusions: The fact that important gender-based differences emerged when interactions among the psychosocial factors and injury were modeled, suggests opportunities for further research and potential interventions to enhance the working environment.}, keywords = {Employment and Labor Force, Psychosocial, Risk Factors}, issn = {1097-0274}, doi = {10.1002/ajim.22945}, author = {Navneet Kaur Baidwan and Susan Goodwin Gerberich and Kim, Hyun and Andrew D Ryan and Timothy Church and Benjamin D Capistrant} } @article {9004, title = {Later-Life Disability in Environmental Context: Why Living Arrangements Matter.}, journal = {Gerontologist}, volume = {58}, year = {2018}, month = {04/2018}, abstract = {

Background and Objectives: Household social and environmental context are key elements of the disablement process, yet few studies explicitly examine the relationship between household composition, housing type, and disability progression. This study investigates the risk of older adults{\textquoteright} disability progression by type of living arrangement (e.g., household composition, housing type) and whether the relationship varies by socioeconomic status.

Research Design and Methods: We used Health and Retirement Study data (waves 1998-2012; n = 41,467 total observations) and fit time-series logistic regression models to estimate increases in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) limitations. Because living arrangements are influenced by financial resources, we also stratified analyses by wealth.

Results: Disability rates were highest among those living alone or with nonfamily others and in self-described fair/poor quality housing. Overall, disability risk was more strongly associated with wealth than living arrangements. For more affluent older adults, living alone was associated with a decreased risk of IADL disability; for the least affluent older adults, living alone had the opposite association-increased risk of both ADL and IADL disability.

Discussion and Implications: Later-life disability progression should be understood in the context of both household environment and wealth. Household composition and housing characteristics were associated with disability progression and the risk of increasing disability was consistently higher for those in the lowest wealth quintile. These findings identify where older adults with disabilities live and that comprehensive interventions to reduce disability progression should consider household social and environmental context, as well as wealth.

}, keywords = {Disabilities, Living arrangements, Nursing homes, Older Adults}, issn = {1758-5341}, doi = {10.1093/geront/gnx019}, author = {Carrie Elizabeth Henning-Smith and Shippee, Tetyana and Benjamin D Capistrant} } @article {9867, title = {A longitudinal study of work-related injuries: comparisons of health and work-related consequences between injured and uninjured aging United States adults}, journal = {Injury Epidemiology}, volume = {5}, year = {2018}, month = {Jan-12-2018}, abstract = {Background: Age may affect one{\textquoteright}s susceptibility to the myriad physical hazards that may pose risks for work-related injuries. Aging workers are not only at risk for work-related injuries but, also, at even higher risk for more severe health and work-related consequences. However, limited longitudinal research efforts have focused on such injuries among the aging workforce. This study aimed to investigate the association between physical work-related factors and injuries among United States (U.S.) workers, and then compare the injured and uninjured workers with regard to consequences including, functional limitations, and reduced working hours post injury. A cohort of 7212 U.S. workers aged 50 years and above from the U.S. Health and Retirement Study were retrospectively followed from 2004 to 2014. Data on exposures were lagged by one survey wave prior to the outcome of work-related injuries and consequences, respectively. Crude and adjusted incident rate ratios, and hazard ratios were estimated using generalized estimating equations and Cox models. Results: Risk of experiencing a work-related injury event was over two times greater among those whose job had work requirements for physical effort, lifting heavy loads, and stooping/kneeling/crouching, compared to those who did not. Over time, injured compared to uninjured workers had higher risks of functional limitations and working reduced hours. Conclusions: The aging workforce is at a high risk of experiencing injuries. Further, injured adults were not only more likely to incur a disability prohibiting daily life-related activities, over time, but, also, were more likely to work reduced hours. It will be important to consider accommodations to minimize functional limitations that may impair resulting productivity. {\textcopyright} 2018, The Author(s).}, keywords = {health, Injury, Physical Health, Workers\&$\#$039; compensation}, doi = {10.1186/s40621-018-0166-7}, url = {https://www.scopus.com/record/display.uri?eid=2-s2.0-85053897689\&origin=SingleRecordEmailAlert\&dgcid=raven_sc_search_en_us_email\&txGid=c198e96897366b934b1253093117b258}, author = {Navneet Kaur Baidwan and Susan Goodwin Gerberich and Kim, Hyun and Andrew D Ryan and Timothy Church and Benjamin D Capistrant} } @article {9002, title = {Physical activity, but not body mass index, predicts less disability before and after stroke.}, journal = {Neurology}, volume = {88}, year = {2017}, month = {05/2017}, pages = {1718-1726}, abstract = {

OBJECTIVE: To determine whether physical activity and body mass index (BMI) predict instrumental or basic activities of daily living (I/ADL) trajectories before or after stroke compared to individuals who remained stroke-free.

METHODS: Using a prospective cohort, the Health and Retirement Study, we followed adults without a history of stroke in 1998 (n = 18,117) for up to 14 years. We estimated linear regression models of I/ADL trajectories comparing individuals who remained stroke-free throughout follow-up (n = 16,264), those who survived stroke (n = 1,374), and those who died after stroke and before the next interview wave (n = 479). We evaluated whether I/ADL trajectories differed by physical activity or BMI at baseline (before stroke), adjusting for demographic and socioeconomic covariates.

RESULTS: Compared to those who were physically active, stroke survivors who were physically inactive at baseline had a lower probability of independence in ADLs and IADLs 3 years after stroke (risk difference = -0.18 and -0.16 for ADLs and IADLs, respectively). However, a similar difference in the probability of independence was also present 3 years before stroke, and we observed no evidence that physical activity slowed the rate of decline in independence before or after stroke. Unlike the results for physical activity, we did not observe a consistent pattern for the probability of independence in ADLs or IADLs comparing obese stroke survivors to normal-weight or to overweight stroke survivors 3 years before stroke or 3 years after stroke.

CONCLUSIONS: Physical inactivity predicts a higher risk of being dependent both before and after stroke.

}, keywords = {BMI, Disabilities, Older Adults, Physical activity, Stroke}, issn = {1526-632X}, doi = {10.1212/WNL.0000000000003888}, author = {Pamela M. Rist and Benjamin D Capistrant and Elizabeth R Mayeda and Sze Y Liu and M. Maria Glymour} } @article {8330, title = {Changes in Depressive Symptoms and Incidence of First Stroke Among Middle-Aged and Older US Adults.}, journal = {J Am Heart Assoc}, volume = {4}, year = {2015}, month = {2015 May 13}, publisher = {4}, abstract = {

BACKGROUND: Although research has demonstrated that depressive symptoms predict stroke incidence, depressive symptoms are dynamic. It is unclear whether stroke risk persists if depressive symptoms remit.

METHODS AND RESULTS: Health and Retirement Study participants (n=16 178, stroke free and noninstitutionalized at baseline) were interviewed biennially from 1998 to 2010. Stroke and depressive symptoms were assessed through self-report of doctors{\textquoteright} diagnoses and a modified Center for Epidemiologic Studies - Depression scale (high was >=3 symptoms), respectively. We examined whether depressive symptom patterns, characterized across 2 successive interviews (stable low/no, onset, remitted, or stable high depressive symptoms) predicted incident stroke (1192 events) during the subsequent 2 years. We used marginal structural Cox proportional hazards models adjusted for demographics, health behaviors, chronic conditions, and attrition. We also estimated effects stratified by age (>=65 years), race or ethnicity (non-Hispanic white, non-Hispanic black, Hispanic), and sex. Stroke hazard was elevated among participants with stable high (adjusted hazard ratio 2.14, 95\% CI 1.69 to 2.71) or remitted (adjusted hazard ratio 1.66, 95\% CI 1.22 to 2.26) depressive symptoms compared with participants with stable low/no depressive symptoms. Stable high depressive symptom predicted stroke among all subgroups. Remitted depressive symptoms predicted increased stroke hazard among women (adjusted hazard ratio 1.86, 95\% CI 1.30 to 2.66) and non-Hispanic white participants (adjusted hazard ratio 1.66, 95\% CI 1.18 to 2.33) and was marginally associated among Hispanics (adjusted hazard ratio 2.36, 95\% CI 0.98 to 5.67).

CONCLUSIONS: In this cohort, persistently high depressive symptoms were associated with increased stroke risk. Risk remained elevated even if depressive symptoms remitted over a 2-year period, suggesting cumulative etiologic mechanisms linking depression and stroke.

}, keywords = {Adult, Aged, Aged, 80 and over, Aging, depression, Female, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Proportional Hazards Models, Risk Factors, Sex Factors, Stroke, Time Factors}, issn = {2047-9980}, doi = {10.1161/JAHA.115.001923}, author = {Stefan Walter and Eric J. Tchetgen Tchetgen and Kristen K Patton and J Robin Moon and Benjamin D Capistrant and Jessica R Marden and Laura D Kubzansky and Paola Gilsanz and Ichiro Kawachi and M. Maria Glymour} } @article {6483, title = {Do Physical Activity, Smoking, Drinking, or Depression Modify Transitions from Cognitive Impairment to Functional Disability?}, journal = {Journal of Alzheimer{\textquoteright}s Disease}, volume = {44}, year = {2015}, pages = {1171-1180}, chapter = {1171}, abstract = {Background: Individual-level modifiers can delay onset of limitations in basic activities of daily living (ADLs) among cognitively impaired individuals. We assessed whether these modifiers also delayed onset of limitations in instrumental ADLs (IADLs) among individuals at elevated dementia risk. Objectives: To determine whether modifiable individual-level factors delay incident IADL limitations among adults stratified by dementia risk. Methods: Health and Retirement Study participants aged 65 without activity limitations in 1998 or 2000 (n = 5,219) were interviewed biennially through 2010. Dementia probability, categorized in quartiles, was used to predict incident IADL limitations with Poisson regression. We estimated relative (risk ratio) and absolute (number of limitations) effects from models including dementia, individual-level modifiers (physical inactivity, smoking, no alcohol consumption, and depression) and interaction terms between dementia and individual-level modifiers. Results: Dementia probability quartile predicted incident IADL limitations (relative risk for highest versus lowest quartile = 0.44; 95 CI: 0.28 0.70). Most modifiers did not significantly increase risk of IADL limitations among the cognitively impaired. Physical inactivity (RR = 1.60; 95 CI: 1.16, 2.19) increased the risk of IADL limitations among the cognitively impaired. The interaction between physical inactivity and low dementia probability was statistically significant (p = 0.009) indicating that physical inactivity had significantly larger effects on incident IADLs among cognitively normal than among those with high dementia probability. Conclusion: Physical activity may protect against IADL limitations while smoking, alcohol consumption, and depression do not afford substantial protection among the cognitively impaired. Results highlight the need for extra support for IADLs among individuals with cognitive losses.}, keywords = {Disabilities, Health Conditions and Status, Healthcare}, doi = {10.3233/JAD-141866}, url = {http://dx.doi.org/10.3233/JAD-141866}, author = {Pamela M. Rist and Jessica R Marden and Benjamin D Capistrant and Bei Wu and M. Maria Glymour} } @article {8052, title = {Changes in Memory before and after Stroke Differ by Age and Sex, but Not by Race}, journal = {Cerebrovascular Diseases}, volume = {37}, year = {2014}, note = {Export Date: 21 April 2014 Source: Scopus Article in Press}, pages = {235-243}, publisher = {37}, abstract = {Background: Post-stroke memory impairment is more common among older adults, women and blacks. It is unclear whether post-stroke differences reflect differential effects of stroke per se or differences in prestroke functioning. We compare memory trajectories before and after stroke by age, sex and race. Methods: Health and Retirement Study participants aged 50 years (n = 17,341), with no stroke history at baseline, were interviewed biennially up to 10 years for first self- or proxy-reported stroke (n = 1,574). Segmented linear regression models were used to compare annual rates of memory change before and after stroke among 1,169 stroke survivors, 405 stroke decedents and 15,767 stroke-free participants. Effect modification was evaluated with analyses stratified by baseline age ( 70 vs. 70), sex and race (white vs. nonwhite), and using interaction terms between age/sex/race indicators and annual memory change. Results: Older ( 70 years) adults experienced a faster memory decline before stroke (-0.19 vs. -0.10 points/year for survivors, -0.24 vs. -0.13 points/year for decedents, p 0.001 for both interactions), and among stroke survivors, larger memory decrements (-0.64 vs. -0.26 points, p 0.001) at stroke and faster memory decline (-0.15 vs. -0.07 points/year, p = 0.003) after stroke onset, compared to younger adults. Female stroke survivors experienced a faster prestroke memory decline than male stroke survivors (-0.14 vs. -0.10 points/year, p 0.001). However, no sex differences were seen for other contrasts. Although whites had higher post-stroke memory scores than nonwhites, race was not associated with rate of memory decline during any period of time; i.e. race did not significantly modify the rate of decline before or after stroke or the immediate effect of stroke on memory. Conclusions: Older age predicted worse memory change before, at and after stroke onset. Sex and race differences in post-stroke memory outcomes might be attributable to prestroke disparities, which may be unrelated to cerebrovascular disease. 2014 S. Karger AG, Basel.}, keywords = {Health Conditions and Status, Methodology}, url = {http://www.scopus.com/inward/record.url?eid=2-s2.0-84897121425andpartnerID=40andmd5=22785f81bf8b09c85697670c6a2e2382}, author = {Qianyi Wang and Mej{\'\i}a-Guevara, Iv{\'a}n and Pamela M. Rist and Stefan Walter and Benjamin D Capistrant and M. Maria Glymour} } @article {6475, title = {Dementia and dependence: Do Modifiable Risk Factors Delay Disability?}, journal = {Neurology}, volume = {82}, year = {2014}, month = {04/2014}, pages = {1543-1550}, chapter = {1543}, abstract = {Objective: To identify modifying factors that preserve functional independence among individuals at high dementia risk. Methods: Health and Retirement Study participants aged 65 years or older without baseline activities of daily living (ADL) limitations (n = 4,922) were interviewed biennially for up to 12 years. Dementia probability, estimated from direct and proxy cognitive assessments, was categorized as low (i.e., normal cognitive function), mild, moderate, or high risk (i.e., very impaired) and used to predict incident ADL limitations (censoring after limitation onset). We assessed multiplicative and additive interactions of dementia category with modifiers (previously self-reported physical activity, smoking, alcohol consumption, depression, and income) in predicting incident limitations. Results: Smoking, not drinking, and income predicted incident ADL limitations and had larger absolute effects on ADL onset among individuals with high dementia probability than among cognitively normal individuals. Smoking increased the 2-year risk of ADL limitations onset from 9.9 to 14.9 among the lowest dementia probability category and from 32.6 to 42.7 among the highest dementia probability category. Not drinking increased the 2-year risk of ADL limitations onset by 2.1 percentage points among the lowest dementia probability category and 13.2 percentage points among the highest dementia probability category. Low income increased the 2-year risk of ADL limitations onset by 0.4 among the lowest dementia probability category and 12.9 among the highest dementia probability category. Conclusions: Smoking, not drinking, and low income predict incident dependence even in the context of cognitive impairment. Regardless of cognitive status, reducing these risk factors may improve functional outcomes and delay institutionalization.}, keywords = {Health Conditions and Status, Income}, doi = {10.1212/WNL.0000000000000357}, author = {Pamela M. Rist and Benjamin D Capistrant and Bei Wu and Jessica R Marden and M. Maria Glymour} } @article {7995, title = {The disability burden associated with stroke emerges before stroke onset and differentially affects blacks: results from the health and retirement study cohort.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {69}, year = {2014}, month = {2014 Jul}, pages = {860-70}, publisher = {69}, abstract = {

BACKGROUND: Few longitudinal studies compare changes in instrumental activities of daily living (IADLs) among stroke-free adults to prospectively document IADL changes among adults who experience stroke. We contrast annual declines in IADL independence for older individuals who remain stroke free to those for individuals who experienced stroke. We also assess whether these patterns differ by sex, race, or Southern birthplace.

METHODS: Health and Retirement Study participants who were stroke free in 1998 (n = 17,741) were followed through 2010 (average follow-up = 8.9 years) for self- or proxy-reported stroke. We used logistic regressions to compare annual changes in odds of self-reported independence in six IADLs among those who remained stroke free throughout follow-up (n = 15,888), those who survived a stroke (n = 1,412), and those who had a stroke and did not survive to participate in another interview (n = 442). We present models adjusted for demographic and socioeconomic covariates and also stratified on sex, race, and Southern birthplace.

RESULTS: Compared with similar cohort members who remained stroke free, participants who developed stroke had faster declines in IADL independence and lower probability of IADL independence prior to stroke. After stroke, independence declined at an annual rate similar to those who did not have stroke. The black-white disparity in IADL independence narrowed poststroke.

CONCLUSION: Racial differences in IADL independence are apparent long before stroke onset. Poststroke differences in IADL independence largely reflect prestroke disparities.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Black or African American, Cohort Studies, Disabled Persons, Female, Humans, Male, Prospective Studies, Stroke, United States, White People}, issn = {1758-535X}, doi = {10.1093/gerona/glt191}, url = {http://biomedgerontology.oxfordjournals.org/content/early/2014/01/19/gerona.glt191.abstract}, author = {Benjamin D Capistrant and Nicte I Mejia and Sze Y Liu and Qianyi Wang and M. Maria Glymour} } @article {7982, title = {Does duration of spousal caregiving affect risk of depression onset? Evidence from the Health and Retirement Study.}, journal = {Am J Geriatr Psychiatry}, volume = {22}, year = {2014}, note = {Times Cited: 0}, month = {2014 Aug}, pages = {766-70}, publisher = {22}, abstract = {

OBJECTIVES: To assess the association of current and long-term spousal caregiving with risk of depression in a nationally (U.S.) representative sample of older adults.

METHODS: We studied married and depression-free Health and Retirement Study respondents aged 50 years and older (n~= 9,420) at baseline from 2000 to 2010. Current (>=14 hours per week of help with instrumental/activities of daily living for a spouse in the most recent biennial survey) and long-term caregiving (care at two consecutive surveys) were used to predict onset of elevated depressive symptoms (>=3 on a modified Centers for Epidemiologic Studies Depression scale) with discrete-time hazards models and time-updated exposure and covariate information.

RESULTS: Current caregiving was associated with significant elevations in risk of depression onset (hazard ratio: 1.64; Wald χ(2), 1 df: 28.34; p~<0.0001). Effect estimates for long-term caregiving were similar (hazard ratio: 1.52, Wald χ(2), 1 df: 3.63; p~= 0.06).

CONCLUSIONS: Current spousal caregiving significantly predicted onset of depression; the association was not exacerbated by longer duration of caregiving.

}, keywords = {Aged, Caregivers, depression, Female, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Retirement, Risk Factors, Spouses, Time Factors, United States}, issn = {1545-7214}, doi = {10.1016/j.jagp.2013.01.073}, author = {Benjamin D Capistrant and Lisa F Berkman and M. Maria Glymour} } @article {7796, title = {Does the association between depressive symptoms and cardiovascular mortality risk vary by race? Evidence from the Health and Retirement Study.}, journal = {Ethn Dis}, volume = {23}, year = {2013}, month = {2013 Spring}, pages = {155-60}, publisher = {23}, abstract = {

OBJECTIVE: To test whether the association between depressive symptoms and cardiovascular disease (CVD) mortality is stronger among Blacks than Whites.

DESIGN, SETTING AND PARTICIPANTS: 2,638 Black and 15,132 White participants from a prospective, observational study of community-dwelling Health and Retirement Study participants (a nationally representative sample of U.S. adults aged > or = 50). Average follow-up was 9.2 years.

OUTCOME MEASURE: Cause of death (per ICD codes) and month of death were identified from National Death Index linkages.

METHODS: The associations between elevated depressive symptoms and mortality from stroke, ischemic heart disease (IHD), or total CVD were assessed using Cox proportional hazards models to estimate adjusted hazard ratios (HRs). We used interaction terms for race by depressive symptoms to assess effect modification (multiplicative scale).

RESULTS: For both Whites and Blacks, depressive symptoms were associated with a significantly elevated hazard of total CVD mortality (Whites: HR=1.46; 95\% CI: 1.33, 1.61; Blacks: HR=1.42, 95\% CI: 1.10, 1.83). Adjusting for health and socioeconomic covariates, Whites with elevated depressive symptoms had a 13\% excess hazard of CVD mortality (HR=1.13, 95\% CI: 1.03, 1.25) compared to Whites without elevated depressive symptoms. The HR in Blacks was similar, although the confidence interval included the null (HR=1.12, 95\% CI: .86, 1.46). The hazard associated with elevated depressive symptoms did not differ significantly by race (P>.15 for all comparisons). Patterns were similar in analyses restricted to respondents age > or =65.

CONCLUSION: Clinicians should consider the depressive state of either Black or White patients as a potential CVD mortality risk factor.

}, keywords = {Aged, Black or African American, Cardiovascular Diseases, depression, Female, Humans, Male, Middle Aged, Proportional Hazards Models, Risk Assessment, Risk Factors, White People}, issn = {1049-510X}, author = {Benjamin D Capistrant and Paola Gilsanz and J Robin Moon and Anna Kosheleva and Kristen K Patton and M. Maria Glymour} } @article {7814, title = {Stroke-associated differences in rates of activity of daily living loss emerge years before stroke onset.}, journal = {J Am Geriatr Soc}, volume = {61}, year = {2013}, month = {2013 Jun}, pages = {931-938}, publisher = {61}, abstract = {

OBJECTIVES: To compare typical age-related changes in activities of daily living (ADLs) independence in stroke-free adults with long-term ADL trajectories before and after stroke.

DESIGN: Prospective, observational study.

SETTING: Community-dwelling Health and Retirement Study (HRS) cohort.

PARTICIPANTS: HRS participants who were stroke free in 1998 and were followed through 2008 (average follow-up 7.9 years) (N = 18,441).

MEASUREMENTS: Strokes were assessed using self- or proxy-report of a doctor{\textquoteright}s diagnosis and month and year of event. Logistic regression was used to compare within-person changes in odds of self-reported independence in five ADLs in those who remained stroke free throughout follow-up (n = 16,816), those who survived a stroke (n = 1,208), and those who had a stroke and did not survive to participate in another interview (n = 417). Models were adjusted for demographic and socioeconomic covariates.

RESULTS: Even before stroke, those who later developed stroke had significantly lower ADL independence and were experiencing faster independence losses than similar-aged individuals who remained stroke free. Of those who developed a stroke, survivors experienced slower pre-stroke loss of ADL independence than those who died. ADL independence declined at the time of stroke and decline continued afterwards.

CONCLUSION: In adults at risk of stroke, disproportionate ADL limitations emerge well before stroke onset. Excess disability in stroke survivors should not be entirely attributed to effects of acute stroke or quality of acute stroke care. Although there are many possible causal pathways between ADL and stroke, the association may be noncausal. For example, ADL limitations may be a consequence of stroke risk factors (e.g., diabetes mellitus) or early cerebrovascular ischemia.

}, keywords = {Activities of Daily Living, Age of Onset, Aged, Aged, 80 and over, Bayes Theorem, Disability Evaluation, Disabled Persons, Female, Follow-Up Studies, Geriatric Assessment, Humans, Male, Middle Aged, Morbidity, Prospective Studies, Risk Assessment, Risk Factors, Socioeconomic factors, Stroke, Stroke Rehabilitation, Survival Rate, Survivors, Time Factors, United States}, issn = {1532-5415}, doi = {10.1111/jgs.12270}, author = {Benjamin D Capistrant and Qianyi Wang and Sze Y Liu and M. Maria Glymour} } @article {7625, title = {Current and long-term spousal caregiving and onset of cardiovascular disease.}, journal = {J Epidemiol Community Health}, volume = {66}, year = {2012}, month = {2012 Oct}, pages = {951-6}, abstract = {

BACKGROUND: Prior evidence suggests that caregiving may increase risk of cardiovascular disease (CVD) onset. This association has never been examined in a nationally (USA) representative sample, and prior studies could not fully control for socioeconomic confounders. This paper seeks to estimate the association between spousal caregiving and incident CVD in older Americans.

METHODS: Married, CVD-free Health and Retirement Study respondents aged 50+ years (n=8472) were followed up to 8 years (1669 new stroke or heart disease diagnoses). Current caregiving exposure was defined as assisting a spouse with basic or instrumental activities of daily living >=14 h/week according to the care recipients{\textquoteright} report in the most recent prior biennial survey; we define providing >=14 h/week of care at two consecutive biennial surveys as {\textquoteright}long-term caregiving{\textquoteright}. Inverse probability weighted discrete-time hazard models with time-updated exposure and covariate information (including socioeconomic and cardiovascular risk factors) were used to estimate the effect of caregiving on incident CVD.

RESULTS: Caregiving significantly predicted CVD incidence (HR=1.35, 95\% CI 1.06 to 1.68) in the population overall. Long-term caregiving was associated with double the risk of CVD onset (HR=1.95, 95\% CI 1.19 to 3.18). This association for long-term care givers varied significantly by race (p<0.01): caregiving predicted CVD onset for white (HR=2.37, 95\% CI 1.43 to 3.92) but not for non-white (HR=0.28, 95\% CI 0.06 to 1.28).

CONCLUSIONS: Spousal caregiving independently predicted risk of CVD in a large sample of US adults. There was significant evidence that the effect for long-term care givers differs for non-whites and white.

}, keywords = {Activities of Daily Living, Adult, Aged, Aged, 80 and over, Cardiovascular Diseases, Caregivers, Female, Follow-Up Studies, Humans, Incidence, Interviews as Topic, Long-term Care, Male, Middle Aged, Proportional Hazards Models, Risk Factors, Self Report, Socioeconomic factors, Spouses, Stress, Psychological, United States}, issn = {1470-2738}, doi = {10.1136/jech-2011-200040}, author = {Benjamin D Capistrant and J Robin Moon and Lisa F Berkman and M. Maria Glymour} } @article {7690, title = {Elevated depressive symptoms and incident stroke in Hispanic, African-American, and White older Americans.}, journal = {J Behav Med}, volume = {35}, year = {2012}, month = {2012 Apr}, pages = {211-20}, publisher = {35}, abstract = {

Although depressive symptoms have been linked to stroke, most research has been in relatively ethnically homogeneous, predominantly white, samples. Using the United States based Health and Retirement Study, we compared the relationships between elevated depressive symptoms and incident first stroke for Hispanic, black, or white/other participants (N~=~18,648) and estimated the corresponding Population Attributable Fractions. The prevalence of elevated depressive symptoms was higher in blacks (27\%) and Hispanics (33\%) than whites/others (18\%). Elevated depressive symptoms prospectively predicted stroke risk in the whites/other group (HR~=~1.53; 95\% CI: 1.36-1.73) and among blacks (HR~=~1.31; 95\% CI: 1.05-1.65). The HR was similar but only marginally statistically significant among Hispanics (HR~=~1.33; 95\% CI: 0.92-1.91). The Population Attributable Fraction, indicating the percent of first strokes that would be prevented if the incident stroke rate in those with elevated depressive symptoms was the same as the rate for those without depressive symptoms, was 8.3\% for whites/others, 7.8\% for blacks, and 10.3\% for Hispanics.

}, keywords = {Age Factors, Aged, Black or African American, depression, Female, Health Surveys, Hispanic or Latino, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Predictive Value of Tests, Prevalence, Risk Factors, Stroke, United States, White People}, issn = {1573-3521}, doi = {10.1007/s10865-011-9356-2}, author = {M. Maria Glymour and Jessica J. Yen and Anna Kosheleva and J Robin Moon and Benjamin D Capistrant and Kristen K Patton} } @article {7759, title = {Long-term rate of change in memory functioning before and after stroke onset.}, journal = {Stroke}, volume = {43}, year = {2012}, month = {2012 Oct}, pages = {2561-6}, abstract = {

BACKGROUND AND PURPOSE: Memory impairment is a predictor and a consequence of stroke, but memory decline is common even in healthy elderly individuals. We compared the long-term trajectory of memory functioning before and after stroke with memory change in stroke-free elderly individuals.

METHODS: Health and Retirement Study participants aged 50 years and older (n=17 340) with no stroke history at baseline were interviewed biennially up to 10 years for first self-reported or proxy-reported stroke (n=1574). Age-, sex-, and race-adjusted segmented linear regression models were used to compare annual rates of change in a composite memory score before and after stroke among 3 groups: 1189 stroke survivors; 385 stroke decedents; and 15 766 cohort members who remained stroke-free.

RESULTS: Before stroke onset, individuals who later survived stroke had significantly (P<0.001) faster average annual rates of memory decline (-0.143 points per year) than those who remained stroke-free throughout follow-up (-0.101 points per year). Stroke decedents had even faster prestroke memory decline (-0.212 points per year). At stroke onset, memory declined an average of -0.369 points among stroke survivors, comparable with 3.7 years of age-related decline in stroke-free cohort members. After stroke, memory in stroke survivors continued to decline at -0.142 points per year, similar to their prestroke rates (P=0.93). Approximately 50\% of the memory difference between stroke survivors soon after stroke and age-matched stroke-free individuals was attributable to prestroke memory.

CONCLUSIONS: Although stroke onset induced large decrements in memory, memory differences were apparent years before stroke. Memory declines before stroke, especially among those who did not survive the stroke, were faster than declines among stroke-free adults.

}, keywords = {Aged, Aged, 80 and over, Cohort Studies, disease progression, Female, Follow-Up Studies, Humans, Linear Models, Longitudinal Studies, Male, Memory, Memory Disorders, Middle Aged, Stroke, Survivors, Time Factors}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.112.661587}, author = {Qianyi Wang and Benjamin D Capistrant and Amy Ehntholt and M. Maria Glymour} } @article {7725, title = {Self-reported and measured hypertension among older US- and foreign-born adults.}, journal = {J Immigr Minor Health}, volume = {14}, year = {2012}, note = {Copyright - Springer Science Business Media, LLC 2012 Language of summary - English Location - United States--US Pages - 721-6 ProQuest ID - 1022672464 Document feature - References SubjectsTermNotLitGenreText - United States--US Last updated - 2012-07-11 Place of publication - New York Corporate institution author - White, Kellee; Avenda o, Mauricio; Capistrant, Benjamin D; Robin Moon, J; Liu, Sze Y; Maria Glymour, M DOI - 2699707771; 70149852; 53471; JIMH; 22109587; SPVLJIMH109031449549}, month = {2012 Aug}, pages = {721-6}, publisher = {14}, abstract = {

Self-reported hypertension is frequently used for health surveillance. However, little is known about the validity of self-reported hypertension among older Americans by nativity status. This study compared self-reported and measured hypertension among older black, white, and Hispanic Americans by nativity using the 2006 and 2008 Health and Retirement Study (n~=~13,451). Sensitivity and specificity of self-reported hypertension were calculated using the Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure definition. Sensitivity was high among older blacks (88.9\%), whites (82.8\%), and Hispanics (84.0\%), and both foreign-born (83.2\%) and US-born (84.0\%). Specificity was above 90\% for both US-born and foreign-born, but higher for whites (92.8\%) than blacks (86.0\%). Despite the potential vulnerability of older foreign-born Americans, self-reported hypertension may be considered a reasonable estimate of hypertension status. Future research should confirm these findings in samples with a larger and more ethnically diverse foreign-born population.

}, keywords = {Aged, Black or African American, Blood Pressure Determination, Emigrants and Immigrants, Female, Hispanic or Latino, Humans, Hypertension, Male, Middle Aged, Nutrition Surveys, Reproducibility of Results, Self Report, United States, White People}, issn = {1557-1920}, doi = {10.1007/s10903-011-9549-3}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1022672464?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Aabiglobalandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articl}, author = {White, Kellee and Mauricio Avendano and Benjamin D Capistrant and J Robin Moon and Sze Y Liu and M. Maria Glymour} } @article {7772, title = {Spousal caregiving and incident hypertension.}, journal = {Am J Hypertens}, volume = {25}, year = {2012}, month = {2012 Apr}, pages = {437-43}, publisher = {25}, abstract = {

BACKGROUND: Caring for one{\textquoteright}s spouse has been associated with poor health, including risk of cardiovascular disease (CVD) onset and mortality. However, few studies have assessed the risk of incident hypertension associated with spousal caregiving. This paper investigates this association in a large, nationally representative sample of American older adults.

METHODS: Married, hypertension-free, Health and Retirement Study (HRS) respondents aged 50+ in 2000, (n = 5,708) were followed up to 8 years (1,708 new self-reported hypertension diagnoses). Current caregiving exposure was defined as assisting a spouse with instrumental or basic activities of daily living (IADLs) 14+ h/week; we define providing >=14 h/week of care at two consecutive biennial surveys as "long-term caregiving." We used inverse probability weighted discrete-time hazard models with time-updated exposure and covariates to estimate effects of current and long-term caregiving on incident hypertension. We tested for effect modification by race, gender, and recipient memory illness. Sensitivity analyses restricted to respondents whose spouses had care needs.

RESULTS: After adjusting for demographic, socioeconomic, and health factors, (including risk behaviors, comorbid conditions, and self-rated health), current caregiving significantly predicted hypertension incidence (risk ratio (RR) = 1.36, 95\% confidence interval (CI): 1.01, 1.83). For long-term caregivers, there was significant evidence of risk of hypertension onset associated with caregiving (RR = 2.29, 95\% CI: 1.17, 4.49). The risk of hypertension onset associated with both current and long-term caregiving did not vary by race, gender, or recipient memory illness diagnosis. Sensitivity analyses supported the primary findings.

CONCLUSIONS: Providing IADL care to a spouse significantly predicted hypertension onset in a nationally representative sample of US adults.

}, keywords = {Activities of Daily Living, Aged, Cardiovascular Diseases, Caregivers, Female, Follow-Up Studies, Humans, Hypertension, Male, Memory Disorders, Middle Aged, Odds Ratio, Spouses, Stress, Psychological}, issn = {1941-7225}, doi = {10.1038/ajh.2011.232}, author = {Benjamin D Capistrant and J Robin Moon and M. Maria Glymour} } @article {7745, title = {Stroke incidence in older US Hispanics: is foreign birth protective?}, journal = {Stroke}, volume = {43}, year = {2012}, note = {Moon, J Robin Capistrant, Benjamin D Kawachi, Ichiro Avendano, Mauricio Subramanian, S V Bates, Lisa M Glymour, M Maria T32-HL098048-01/HL/NHLBI NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t United States Stroke. 2012 May;43(5):1224-9. Epub 2012 Feb 21.}, month = {2012 May}, pages = {1224-9}, publisher = {43}, abstract = {

BACKGROUND AND PURPOSE: Although Hispanics are the fastest growing ethnic group in the United States, relatively little is known about stroke risk in US Hispanics. We compare stroke incidence and socioeconomic predictors in US- and foreign-born Hispanics with patterns among non-Hispanic whites.

METHODS: Health and Retirement Study participants aged 50+ years free of stroke in 1998 (mean baseline age, 66.3 years) were followed through 2008 for self- or proxy-reported first stroke (n=15 784; 1388 events). We used discrete-time survival analysis to compare stroke incidence among US-born (including those who immigrated before age 7 years) and foreign-born Hispanics with incidence in non-Hispanic whites. We also examined childhood and adult socioeconomic characteristics as predictors of stroke among Hispanics, comparing effect estimates with those for non-Hispanic whites.

RESULTS: In age- and sex-adjusted models, US-born Hispanics had higher odds of stroke onset than non-Hispanic whites (OR, 1.44; 95\% CI, 1.08-1.90), but these differences were attenuated and nonsignificant in models that controlled for childhood and adulthood socioeconomic factors (OR, 1.07; 95\% CI, 0.80-1.42). In contrast, in models adjusted for all demographic and socioeconomic factors, foreign-born Hispanics had significantly lower stroke risk than non-Hispanic whites (OR, 0.58; 95\% CI, 0.41-0.81). The impact of socioeconomic predictors on stroke did not differ between Hispanics and whites.

CONCLUSIONS: In this longitudinal national cohort, foreign-born Hispanics had lower incidence of stroke incidence than non-Hispanic whites and US-born Hispanics. Findings suggest that foreign-born Hispanics may have a risk factor profile that protects them from stroke as compared with other Americans.

}, keywords = {Age Factors, Aged, Cohort Studies, Emigration and Immigration, Female, Hispanic or Latino, Humans, Incidence, Longitudinal Studies, Male, Middle Aged, Retrospective Studies, Risk Factors, Socioeconomic factors, Stroke, United States, White People}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.111.643700}, author = {J Robin Moon and Benjamin D Capistrant and Ichiro Kawachi and Mauricio Avendano and Subramanian, S V and Lisa M. Bates and M. Maria Glymour} }