@article {11518, title = {Temporal Trends in Stroke-Related Memory Change: Results From a US National Cohort 1998-2016.}, journal = {Stroke}, volume = {52}, year = {2021}, pages = {1702-1711}, abstract = {

BACKGROUND AND PURPOSE: Findings from the Framingham Heart Study suggest that declines in dementia incidence rates over recent decades are partially due to decreases in stroke incidence and mortality; however, whether trends of declining dementia rates extend to survivors of incident stroke remains unclear. We investigated evidence for temporal trends in memory change related to incident stroke in a nationally representative cohort.

METHODS: Adults age 50+ in the HRS (Health and Retirement Study) were followed across three successive 6-year epochs (epoch 1: 1998-2004, n=16 781; epoch 2: 2004-2010, n=15 345; and epoch 3: 2010-2016; n=15 949). Participants were included in an epoch if they were stroke-free at the start of that epoch. Annual rates of change in a composite z-standardized memory score were compared using demographic-adjusted linear regression models for stroke-free participants, those who survived after stroke, and those who died after stroke, considering memory change before stroke, at the time of stroke, and for years following stroke.

RESULTS: Crude stroke incidence rates decreased from 8.5 per 1000 person-years in epoch 1 to 6.8 per 1000 person-years in epoch 3. Rates of memory change before and following stroke onset were similar across epochs. Memory decrement immediately after stroke onset attenuated from -0.37 points (95\% CI, -0.44 to -0.29) in epoch 1 to -0.26 (95\% CI, -0.33 to -0.18) points in epoch 2 and -0.25 (95\% CI, -0.33 to -0.17) points in epoch 3 ( value for linear trend=0.02).

CONCLUSIONS: Decreases in stroke-related dementia in recent years may be partially attributable to smaller memory decrements immediately after stroke onset. Findings suggest reductions in stroke incidence and improvements in stroke care may also reduce population burden of dementia. Further investigations into whether temporal trends are attributable to improvements in stroke care are needed.

}, keywords = {Dementia, Incidence, Memory, Survivors}, issn = {1524-4628}, doi = {10.1161/STROKEAHA.120.031063}, author = {Chloe W Eng and Elizabeth R Mayeda and Paola Gilsanz and Rachel A Whitmer and Kim, Anthony S and M. Maria Glymour} } @article {10071, title = {Is it possible to overcome the {\textquoteright}long arm{\textquoteright} of childhood socioeconomic disadvantage through upward socioeconomic mobility?}, journal = {Journal of Public Health (Oxf)}, year = {2019}, month = {2019 Feb 28}, abstract = {

OBJECTIVES: Socioeconomically disadvantaged children have worse adult health; we test if this {\textquoteright}long arm{\textquoteright} of childhood disadvantage can be overcome through upward socioeconomic mobility in adulthood.

METHODS: Four SES trajectories (stable low, upwardly mobile, downwardly mobile and stable high) were created from median dichotomized childhood socioeconomic status (SES; childhood human and financial capital) and adult SES (wealth at age 67) from Health and Retirement Study respondents (N = 6669). Healthy ageing markers, in tertiles, were walking speed, peak expiratory flow (PEF), and grip strength measured in 2008 and 2010. Multinomial logistic regression models, weighted to be nationally representative, controlled for age, gender, race, birthplace, outcome year and childhood health and social capital.

RESULTS: Upwardly mobile individuals were as likely as the stable high SES group to be in the best health tertile for walking speed (OR = 0.81; 95\% CI: 0.63, 1.05; P = 0.114), PEF (OR = 0.97; 95\% CI: 0.78, 1.21; P = 0.810) and grip strength (OR = 0.97; 95\%CI: 0.74, 1.27; P = 0.980).

DISCUSSION: Findings suggest the {\textquoteright}long arm{\textquoteright} of childhood socioeconomic disadvantage can be overcome for these markers of healthy ageing through upward socioeconomic mobility.

}, keywords = {Childhood adversity, social mobility, Socioeconomic factors}, issn = {1741-3850}, doi = {10.1093/pubmed/fdz018}, author = {Anusha M Vable and Paola Gilsanz and Ichiro Kawachi} } @article {9337, title = {Alzheimer{\textquoteright}s disease genetic risk variants beyond APOE ε4 predict mortality}, journal = {Alzheimer{\textquoteright}s \& Dementia: Diagnosis, Assessment \& Disease Monitoring}, volume = {8}, year = {2017}, pages = {188-195}, abstract = {We hypothesized that, like apolipoprotein E (APOE), other late-onset Alzheimer{\textquoteright}s disease (LOAD) genetic susceptibility loci predict mortality. Methods We used a weighted genetic risk score (GRS) from 21 non-APOE LOAD risk variants to predict survival in the Adult Changes in Thought and the Health and Retirement Studies. We meta-analyzed hazard ratios and examined models adjusted for cognitive performance or limited to participants with dementia. For replication, we assessed the GRS-longevity association in the Cohorts for Heart and Aging Research in Genomic Epidemiology, comparing cases surviving to age >=90 years with controls who died between ages 55 and 80 years. Results Higher GRS predicted mortality (hazard ratio = 1.05; 95\% confidence interval: 1.00{\textendash}1.10, P =.04). After adjusting for cognitive performance or restricting to participants with dementia, the relationship was attenuated and no longer significant. In case-control analysis, the GRS was associated with reduced longevity (odds ratio = 0.64; 95\% confidence interval: 0.41{\textendash}1.00, P =.05). Discussion Non-APOE LOAD susceptibility loci confer risk for mortality, likely through effects on dementia incidence.}, keywords = {Alzheimer{\textquoteright}s disease, APoE4, Cognitive Ability, Genetics, Mortality, Risk Factors}, issn = {23528729}, doi = {10.1016/j.dadm.2017.07.002}, url = {http://linkinghub.elsevier.com/retrieve/pii/S2352872917300416http://api.elsevier.com/content/article/PII:S2352872917300416?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S2352872917300416?httpAccept=text/plain}, author = {Mez, Jesse and Jessica R Marden and Mukherjee, Shubhabrata and Stefan Walter and Laura E Gibbons and Alden L Gross and Laura B Zahodne and Paola Gilsanz and Brewster, Paul and Nho, Kwangsik and Paul K Crane and Eric B Larson and M. Maria Glymour} } @article {8967, title = {Neighborhood Differences in Post-Stroke Mortality.}, journal = {Circulaton. Cardiovascular quality and outcomes}, volume = {10}, year = {2017}, month = {02/2017}, abstract = {

BACKGROUND: Post-stroke mortality is higher among residents of disadvantaged neighborhoods, but it is not known whether neighborhood inequalities are specific to stroke survival or similar to mortality patterns in the general population. We hypothesized that neighborhood disadvantage would predict higher poststroke mortality, and neighborhood effects would be relatively larger for stroke patients than for individuals with no history of stroke.

METHODS AND RESULTS: Health and Retirement Study participants aged >=50 years without stroke at baseline (n=15 560) were followed <=12 years for incident stroke (1715 events over 159 286 person-years) and mortality (5325 deaths). Baseline neighborhood characteristics included objective measures based on census tracts (family income, poverty, deprivation, residential stability, and percent white, black, or foreign-born) and self-reported neighborhood social ties. Using Cox proportional hazard models, we compared neighborhood mortality effects for people with versus people without a history of stroke. Most neighborhood variables predicted mortality for both stroke patients and the general population in demographic-adjusted models. Neighborhood percent white predicted lower mortality for stroke survivors (hazard ratio, 0.75 for neighborhoods in highest 25th percentile versus below, 95\% confidence interval, 0.62-0.91) more strongly than for stroke-free adults (hazard ratio, 0.92; 95\% confidence interval, 0.83-1.02; P=0.04 for stroke-by-neighborhood interaction). No other neighborhood characteristic had different effects for people with versus without stroke. Neighborhood-mortality associations emerged within 3 months after stroke, when associations were often stronger than among stroke-free individuals.

CONCLUSIONS: Neighborhood characteristics predict mortality, but most effects are similar for individuals without stroke. Eliminating disparities in stroke survival may require addressing pathways that are not specific to traditional poststroke care.

}, keywords = {Mortality, Neighborhoods, Older Adults, Stroke}, issn = {1941-7705}, doi = {10.1161/CIRCOUTCOMES.116.002547}, author = {Theresa L Osypuk and Amy Ehntholt and J Robin Moon and Paola Gilsanz and M. Maria Glymour} } @article {9348, title = {Validation of a theoretically motivated approach to measuring childhood socioeconomic circumstances in the Health and Retirement Study.}, journal = {PLoS One}, volume = {12}, year = {2017}, month = {2017}, pages = {e0185898}, abstract = {Childhood socioeconomic status (cSES) is a powerful predictor of adult health, but its operationalization and measurement varies across studies. Using Health and Retirement Study data (HRS, which is nationally representative of community-residing United States adults aged 50+ years), we specified theoretically-motivated cSES measures, evaluated their reliability and validity, and compared their performance to other cSES indices. HRS respondent data (N = 31,169, interviewed 1992-2010) were used to construct a cSES index reflecting childhood social capital (cSC), childhood financial capital (cFC), and childhood human capital (cHC), using retrospective reports from when the respondent was <16 years (at least 34 years prior). We assessed internal consistency reliability (Cronbach{\textquoteright}s alpha) for the scales (cSC and cFC), and construct validity, and predictive validity for all measures. Validity was assessed with hypothesized correlates of cSES (educational attainment, measured adult height, self-reported childhood health, childhood learning problems, childhood drug and alcohol problems). We then compared the performance of our validated measures with other indices used in HRS in predicting self-rated health and number of depressive symptoms, measured in 2010. Internal consistency reliability was acceptable (cSC = 0.63, cFC = 0.61). Most measures were associated with hypothesized correlates (for example, the association between educational attainment and cSC was 0.01, p < 0.0001), with the exception that measured height was not associated with cFC (p = 0.19) and childhood drug and alcohol problems (p = 0.41), and childhood learning problems (p = 0.12) were not associated with cHC. Our measures explained slightly more variability in self-rated health (adjusted R2 = 0.07 vs. <0.06) and number of depressive symptoms (adjusted R2 > 0.05 vs. < 0.04) than alternative indices. Our cSES measures use latent variable models to handle item-missingness, thereby increasing the sample size available for analysis compared to complete case approaches (N = 15,345 vs. 8,248). Adopting this type of theoretically motivated operationalization of cSES may strengthen the quality of research on the effects of cSES on health outcomes.}, keywords = {Childhood adversity, Meta-analyses, Socioeconomic factors, Validation}, issn = {1932-6203}, doi = {10.1371/journal.pone.0185898}, author = {Anusha M Vable and Paola Gilsanz and Thu T Nguyen and Ichiro Kawachi 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 {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 {7834, title = {Early life predictors of atrial fibrillation-related mortality: evidence from the health and retirement study.}, journal = {Health Place}, volume = {21}, year = {2013}, month = {2013 May}, pages = {133-9}, publisher = {21}, abstract = {

Prior research found that Americans born in 6 southeastern states (the AF-risk zone) had elevated risk of AF-related mortality, but no mechanisms were identified. We hypothesized the association between AF-related mortality and AF-risk zone birth is explained by indicators of childhood social disadvantage or adult risk factors. In 24,323 participants in the US Health and Retirement Study, we found that birth in the AF-risk zone was significantly associated with hazard of AF-related mortality. Among whites, the relationship was specific to place of birth, rather than place of adult residence. Neither paternal education nor subjectively assessed childhood SES predicted AF-related mortality. Conventional childhood and adult cardiovascular risk factors did not explain the association between place of birth and AF-related mortality.

}, keywords = {Aged, Atrial Fibrillation, Child, Geography, Medical, Humans, Middle Aged, Risk Factors, Social determinants of health, Socioeconomic factors, Southeastern United States}, issn = {1873-2054}, doi = {10.1016/j.healthplace.2012.12.008}, author = {M. Maria Glymour and Emelia J Benjamin and Anna Kosheleva and Paola Gilsanz and Lesley H Curtis and Kristen K Patton} }