@article {11258, title = {Cardiovascular disease risk prediction for people with type 2 diabetes in a population-based cohort and in electronic health record data}, journal = {Jamia Open}, year = {2020}, abstract = {Electronic health records (EHRs) have become a common data source for clinical risk prediction, offering large sample sizes and frequently sampled metrics. There may be notable differences between hospital-based EHR and traditional cohort samples: EHR data often are not population-representative random samples, even for particular diseases, as they tend to be sicker with higher healthcare utilization, while cohort studies often sample healthier subjects who typically are more likely to participate. We investigate heterogeneities between EHR- and cohort-based inferences including incidence rates, risk factor identifications/quantifications, and absolute risks.This is a retrospective cohort study of older patients with type 2 diabetes using EHR from New York University Langone Health ambulatory care (NYULH-EHR, years 2009{\textendash}2017) and from the Health and Retirement Survey (HRS, 1995{\textendash}2014) to study subsequent cardiovascular disease (CVD) risks. We used the same eligibility criteria, outcome definitions, and demographic covariates/biomarkers in both datasets. We compared subsequent CVD incidence rates, hazard ratios (HRs) of risk factors, and discrimination/calibration performances of CVD risk scores.The estimated subsequent total CVD incidence rate was 37.5 and 90.6 per 1000 person-years since T2DM onset in HRS and NYULH-EHR respectively. HR estimates were comparable between the datasets for most demographic covariates/biomarkers. Common CVD risk scores underestimated observed total CVD risks in NYULH-EHR.EHR-estimated HRs of demographic and major clinical risk factors for CVD were mostly consistent with the estimates from a national cohort, despite high incidences and absolute risks of total CVD outcome in the EHR samples.}, keywords = {Cardiovascular disease, type 2 diabetes}, isbn = {2574-2531}, doi = {https://doi.org/10.1093/jamiaopen/ooaa059}, author = {Szymonifka, Jackie and Conderino, Sarah and Christine T Cigolle and Ha, Jinkyung and Mohammed U Kabeto and Yu, Jaehong and John A. Dodson and Thorpe, Lorna and Caroline S Blaum and Zhong, Judy} } @article {8124, title = {Chronic obstructive pulmonary disease, cognitive impairment, and development of disability: the health and retirement study}, journal = {Annals of the American Thoracic Society}, volume = {11}, year = {2014}, note = {Times Cited: 0 0}, pages = {1362-70}, publisher = {11}, abstract = {RATIONALE: The relationship between chronic obstructive pulmonary disease (COPD) and cognitive impairment in leading to disability has not been characterized. OBJECTIVES: We aimed to investigate the prevalence and cumulative incidence of disability among adults with and without COPD and the association of COPD and cognitive impairment with disability. METHODS: We analyzed 2006-2008 waves of the Health and Retirement Study, a nationally representative longitudinal health survey. COPD was self-reported. Prevalent disability was defined as baseline dependency in one or more activities of daily living (ADLs) and incident disability as one or more additional ADL dependencies. We used a validated performance-based measure of cognition to identify dementia and mild cognitive impairment. Covariates included seven chronic diseases, four geriatric syndromes, and sociodemographics. We used logistic regression to test associations between COPD, cognitive status, and prevalent/incident disability. MEASUREMENTS AND MAIN RESULTS: Of 17,535 participants at least 53 years of age in wave 2006 (representing 77.7 million Americans), 9.5 reported COPD and 13.5 mild cognitive impairment; 17.5 of those with COPD had mild cognitive impairment. Prevalent disability for COPD was 12.8 (5.2 for no-COPD, P 0.001). An additional 9.2 with COPD developed incident disability at 2 years (4.0 for no-COPD, P 0.001). In adjusted models, COPD was associated with baseline (odds ratio, 2.0) and incident disability (odds ratio, 2.1; adjusted for baseline disability). Cognitive impairment had an additive effect to COPD. The COPD-disability association, prevalent/incident, was of similar or greater magnitude than that of other chronic diseases (e.g., stroke, diabetes). The associations were maintained in sensitivity analyses using alternative definitions of disability (dependency in two or more ADLs, dependency in instrumental ADLs), and in analysis excluding respondents with dementia. CONCLUSIONS: Both COPD and mild cognitive impairment increase the risk of disability. The risk conferred by COPD is significant and similar or higher than other chronic diseases.}, keywords = {Disabilities, Health Conditions and Status, Healthcare}, doi = {10.1513/AnnalsATS.201405-187OC}, author = {Martinez, Carlos H. and Richardson, Caroline R. and Han, MeiLan K. and Christine T Cigolle} } @article {7775, title = {Clinical complexity and mortality in middle-aged and older adults with diabetes.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {67}, year = {2012}, month = {2012 Dec}, pages = {1313-20}, publisher = {67}, abstract = {

BACKGROUND: Middle-aged and older adults with diabetes are heterogeneous and may be characterized as belonging to one of three clinical groups: a relatively healthy group, a group having characteristics likely to make diabetes self-management difficult, and a group with poor health status for whom current management targets have uncertain benefit.

METHODS: We analyzed waves 2004-2008 of the Health and Retirement Study and the supplemental Health and Retirement Study 2003 Diabetes Study. The sample included adults with diabetes 51 years and older (n = 3,507, representing 13.6 million in 2004). We investigated the mortality outcomes for the three clinical groups, using survival analysis and Cox proportional hazard models.

RESULTS: The 5-year survival probabilities were Relatively Healthy Group, 90.8\%; Self-Management Difficulty Group, 79.4\%; and Uncertain Benefit Group, 52.5\%. For all age groups and clinical groups, except those 76 years and older in the Uncertain Benefit Group, survival exceeded 50\%.

CONCLUSIONS: This study reveals the substantial survival of middle-aged and older adults with diabetes, regardless of health status. These findings have implications for the clinical management of and future research about diabetes patients with multiple comorbidities.

}, keywords = {Activities of Daily Living, Aged, Comorbidity, Diabetes Complications, Diabetes Mellitus, Female, Health Status, Humans, Male, Middle Aged, Proportional Hazards Models, Self Care}, issn = {1758-535X}, doi = {10.1093/gerona/gls095}, author = {Christine T Cigolle and Mohammed U Kabeto and Pearl G. Lee and Caroline S Blaum} } @article {7452, title = {Clinical complexity in middle-aged and older adults with diabetes: the Health and Retirement Study.}, journal = {Med Care}, volume = {48}, year = {2010}, month = {2010 Apr}, pages = {327-34}, publisher = {48}, abstract = {

BACKGROUND: Some patients with diabetes may have health status characteristics that could make diabetes self-management (DSM) difficult and lead to inadequate glycemic control, or limit the benefit of some diabetes management interventions.

OBJECTIVE: To investigate how many older and middle-aged adults with diabetes have such health status characteristics.

DESIGN: Secondary data analysis of a nationally representative health interview survey, the Health and Retirement Study, and its diabetes mail-out survey.

SETTING/PARTICIPANTS: Americans aged 51 and older with diabetes (n = 3506 representing 13.6 million people); aged 56 and older in diabetes survey (n = 1132, representing 9.9 million).

MEASUREMENTS: Number of adults with diabetes and (a) relatively good health; (b) health status that could make DSM difficult (eg, comorbidities, impaired instrumental activities of daily living; and (c) characteristics like advanced dementia and activities of daily living dependency that could limit benefit of some diabetes management. Health and Retirement Study measures included demographics. Diabetes Survey included self-measured HbA1c.

RESULTS: Nearly 22\% of adults > or =51 with diabetes (about 3 million people) have health characteristics that could make DSM difficult. Another 10\% (1.4 million) may receive limited benefit from some diabetes management. Mail-out respondents with health characteristics that could make DSM difficult had significantly higher mean HbA1c compared with people with relatively good health (7.6\% vs. 7.3\%, P < 0.04.).

CONCLUSIONS: Some middle-aged as well as older adults with diabetes have health status characteristics that might make DSM difficult or of limited benefit. Current diabetes quality measures, including measures of glycemic control, may not reflect what is possible or optimal for all patient groups.

}, keywords = {Aged, Cross-Sectional Studies, Diabetes Complications, Diabetes Mellitus, Type 2, Female, Glycemic Index, Health Status, Health Surveys, Humans, Male, Middle Aged, Quality of Health Care, Self Care, Severity of Illness Index, Treatment Failure, United States}, issn = {1537-1948}, doi = {10.1097/mlr.0b013e3181ca4035}, author = {Caroline S Blaum and Christine T Cigolle and Cynthia Boyd and Jennifer L. Wolff and Zhiyi Tian and Kenneth M. Langa and David R Weir} } @article {7338, title = {Comparing models of frailty: the Health and Retirement Study.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 May}, pages = {830-9}, publisher = {57}, abstract = {

OBJECTIVES: To operationalize and compare three models of frailty, each representing a distinct theoretical view of frailty: as deficiencies in function (Functional Domains model), as an index of health burden (Burden model), and as a biological syndrome (Biologic Syndrome model).

DESIGN: Cross-sectional analysis.

SETTING: 2004 wave of the Health and Retirement Study, a nationally representative, longitudinal health interview survey.

PARTICIPANTS: Adults aged 65 and older (N=11,113) living in the community and in nursing homes in the United States.

MEASUREMENTS: The outcome measure was the presence of frailty, as defined according to each frailty model. Covariates included chronic diseases and sociodemographic characteristics.

RESULTS: Almost one-third (30.2\%) of respondents were frail according to at least one model; 3.1\% were frail according to all three models. The Functional Domains model showed the least overlap with the other models. In contrast, 76.1\% of those classified as frail according to the Biologic Syndrome model and 72.1\% of those according to the Burden model were also frail according to at least one other model. Older adults identified as frail according to the different models differed in sociodemographic and chronic disease characteristics. For example, the Biologic Syndrome model demonstrated substantial associations with older age (adjusted odds ratio (OR)=10.6, 95\% confidence interval (CI)=6.1-18.5), female sex (OR=1.7, 95\% CI=1.2-2.5), and African-American ethnicity (OR=2.1, \% CI=1.0-4.4).

CONCLUSION: Different models of frailty, based on different theoretical constructs, capture different groups of older adults. The different models may represent different frailty pathways or trajectories to adverse outcomes such as disability and death.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Chronic disease, Cross-Sectional Studies, Demography, Disability Evaluation, Frail Elderly, Geriatric Assessment, Health Surveys, Humans, Interviews as Topic, Logistic Models, Models, Theoretical, United States}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2009.02225.x}, author = {Christine T Cigolle and Mary Beth Ofstedal and Zhiyi Tian and Caroline S Blaum} } @article {7330, title = {The co-occurrence of chronic diseases and geriatric syndromes: the health and retirement study.}, journal = {J Am Geriatr Soc}, volume = {57}, year = {2009}, month = {2009 Mar}, pages = {511-6}, publisher = {57}, abstract = {

OBJECTIVES: To analyze the co-occurrence, in adults aged 65 and older, of five conditions that are highly prevalent, lead to substantial morbidity, and have evidence-based guidelines for management and well-developed measures of medical care quality.

DESIGN: Secondary data analysis of the 2004 wave of the Health and Retirement Study (HRS).

SETTING: Nationally representative health interview survey.

PARTICIPANTS: Respondents in the 2004 wave of the HRS aged 65 and older.

MEASUREMENTS: Self-reported presence of five index conditions (three chronic diseases (coronary artery disease, congestive heart failure, and diabetes mellitus) and two geriatric syndromes (urinary incontinence and injurious falls)) and demographic information (age, sex, race, living situation, net worth, and education).

RESULTS: Eleven thousand one hundred thirteen adults, representing 37.1 million Americans aged 65 and older, were interviewed. Forty-five percent were aged 76 and older, 58\% were female, 8\% were African American, and 4\% resided in a nursing home. Respondents with more conditions were older and more likely to be female, single, and residing in a nursing home (all P<.001). Fifty-six percent had at least one of the five index conditions, and 23\% had two or more. Of respondents with one condition, 20\% to 55\% (depending on the index condition) had two or more additional conditions.

CONCLUSION: Five common conditions (3 chronic diseases, 2 geriatric syndromes) often co-occur in older adults, suggesting that coordinated management of comorbid conditions, both diseases and geriatric syndromes, is important. Care guidelines and quality indicators, rather than considering one condition at a time, should be developed to address comprehensive and coordinated management of co-occurring diseases and geriatric syndromes.

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Aged, 80 and over, Angina Pectoris, Comorbidity, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Geriatric Assessment, Health Surveys, Heart Failure, Humans, Male, Myocardial Infarction, Sick Role, Syndrome, United States, Urinary incontinence}, issn = {1532-5415}, doi = {10.1111/j.1532-5415.2008.02150.x}, author = {Pearl G. Lee and Christine T Cigolle and Caroline S Blaum} }