@article {RePEc:gam:jijerp:v:19:y:2022:i:19:p:12059-:d:923426,
	title = {Determinants of COVID-19 Outcome as Predictors of Delayed Healthcare Services among Adults >=50 Years during the Pandemic: 2006{\textendash}2020 Health and Retirement Study},
	journal = {IJERPH},
	volume = {19},
	year = {2022},
	pages = {1-24},
	abstract = {Background: The coronavirus disease 19 (COVID-19) was declared a global pandemic on 11 March 2020. To date, a limited number of studies have examined the impact of this pandemic on healthcare-seeking behaviors of older populations. This longitudinal study examined personal characteristics linked to COVID-19 outcomes as predictors of self-reported delayed healthcare services attributed to this pandemic, among U.S. adults, >=50 years of age. Methods: Secondary analyses were performed using cross-sectional data (1413 participants) and longitudinal data (2881 participants) from Health and Retirement Study (HRS) (2006{\textendash}2018) linked to the 2020 HRS COVID-19 Project (57\% female, mean age: 68 years). Demographic, socioeconomic, lifestyle and health characteristics were evaluated in relation to delayed overall, surgical and non-surgical healthcare services ({\textquotedblleft}Since March 2020, was there any time when you needed medical or dental care, but delayed getting it, or did not get it at all?{\textquotedblright} and {\textquotedblleft}What type of care did you delay{\textquotedblright}) using logistic regression and Ensemble machine learning for cross-sectional data as well as mixed-effects logistic modeling for longitudinal data. Results: Nearly 32.7\% delayed healthcare services, 5.8\% delayed surgical services and 31.4\% delayed non-surgical services. Being female, having a college degree or higher and 1-unit increase in depression score were key predictors of delayed healthcare services. In fully adjusted logistic models, a history of 1 or 2 cardiovascular and/or metabolic conditions (vs. none) was associated with 60{\textendash}70\% greater odds of delays in non-surgical services, with distinct findings for histories of hypertension, cardiovascular disease, diabetes and stroke. Ensemble machine learning predicted surgical better than overall and non-surgical healthcare delays. Conclusion: Among older adults, sex, education and depressive symptoms are key predictors of delayed healthcare services attributed to the COVID-19 pandemic. Delays in surgical and non-surgical healthcare services may have distinct predictors, with non-surgical delays more frequently observed among individuals with a history of 1 or 2 cardiovascular and/or metabolic conditions.},
	keywords = {cardiometabolic, COVID-19, healthcare services, lifestyle, Machine learning, socio-demographic},
	url = {https://EconPapers.repec.org/RePEc:gam:jijerp:v:19:y:2022:i:19:p:12059-:d:923426},
	author = {Beydoun, Hind A. and Beydoun, May A. and Alemu, Brook T. and Weiss, Jordan and Hossain, Sharmin and Gautam, Rana S. and Zonderman, Alan B.}
}
@article {11412,
	title = {Insomnia as a predictor of diagnosed memory problems: 2006-2016 Health and Retirement Study},
	journal = {Sleep Medicine},
	volume = {80},
	year = {2021},
	pages = {158-166},
	abstract = {ObjectiveTo evaluate the longitudinal relationship in insomnia symptoms over time with incident memory problems and dementia diagnoses among U.S. adults aged 65 years and older.MethodsSecondary analyses were performed on 9,518 elderly participants (>=65 years) who completed the 2006 wave of the Health and Retirement Study (HRS) and were followed-up to determine if insomnia symptom scores (2006-2014) were associated with time-to-onset of [1] physician-diagnosed {\textquotedblleft}memory-related disease{\textquotedblright}, {\textquotedblleft}Alzheimer{\textquoteright}s disease{\textquotedblright} and/or {\textquotedblleft}dementia, senility or any other serious memory impairment{\textquotedblright} and [2] diagnosis of dementia based on HRS-specific criteria. Cox proportional hazards models were constructed adjusting for socio-demographic, lifestyle, and health characteristics.ResultsIn fully adjusted models, severe insomnia symptoms were associated with increased risk of physician-diagnosed memory problems. Individuals reporting any change (increase or decrease) in insomnia symptoms during the 2006-2010 period were more likely to be diagnosed with dementia based on HRS criteria. Finally, those who experienced an increase in the severity of insomnia symptoms over time exhibited 41-72\% increased risks of physician-diagnosed memory problems and 45-58\% increased risks of dementia diagnosis based on HRS criteria.ConclusionsWhen severe insomnia symptoms increased over time, physician-diagnosed memory problems and dementia diagnoses also increased among U.S. elderly people over a 10-year follow-up period. More studies are required to confirm these findings using large prospective cohort designs and validated tools.},
	keywords = {Aging, Alzheimer{\textquoteright}s disease, Dementia, insomnia, Neurodegenerative, Sleep},
	isbn = {1389-9457},
	doi = {10.1016/j.sleep.2021.01.038},
	author = {Beydoun, Hind A. and Beydoun, May A. and Weiss, Jordan and Hossain, Sharmin and Huang, Shuyan and Alemu, Brook T. and Alan B Zonderman}
}
