@article {12248, title = {Intersectional Discrimination and Change in Blood Pressure Control Among Older Adults: The Health and Retirement Study.}, journal = {The Journals of Gerontology: Series A }, volume = {77}, year = {2022}, pages = {375-382}, abstract = {

BACKGROUND: Associations between multiple forms of discrimination and blood pressure control in older populations remain unestablished.

METHODS: Participants were 14 582 noninstitutionalized individuals (59\% women) in the Health and Retirement Study aged at least 51 years (76\% non-Hispanic White, 15\% non-Hispanic Black, 9\% Hispanic/Latino). Primary exposures included the mean frequency of discrimination in everyday life, intersectional discrimination (defined as marginalization ascribed to more than one reason), and the sum of discrimination over the life span. We assessed whether discrimination was associated with a change in measured hypertension status (N = 14 582) and concurrent medication use among reported hypertensives (N = 9 086) over 4 years (2008-2014).

RESULTS: There was no association between the frequency of everyday discrimination and change in measured hypertension. Lifetime discrimination was associated with higher odds of hypertension 4 years later among men (odds ratio [OR]: 1.21, 95\% confidence interval [CI]: 1.08-1.36) but not women (OR: 0.98, 95\% CI: 0.86-1.13). Only among men, everyday discrimination due to at least 2 reasons was associated with a 1.44-fold (95\% CI: 1.03-2.01) odds of hypertension than reporting no everyday discrimination, reporting intersectional discrimination was not associated with developing hypertension among women (OR: 0.91, 95\% CI: 0.70-1.20). All 3 discriminatory measures were inversely related to time-averaged antihypertensive medication use, without apparent gender differences (eg, OR for everyday discrimination-antihypertensive use associations: 0.85, 95\% CI: 0.77-0.94).

CONCLUSIONS: Gender differences in marginalization may more acutely elevate hypertensive risk among older men than similarly aged women. Experiences of discrimination appear to decrease the likelihood of antihypertensive medication use among older adults overall.

}, keywords = {cardiovascular, Health Disparities, Risk Factors, Socioeconomic issues}, issn = {1758-535X}, doi = {10.1093/gerona/glab234}, author = {Kendra D Sims and Smit, Ellen and G David Batty and Hystad, Perry W and Michelle C Odden} } @article {11839, title = {Creation and validation of a polysocial score for mortality among community-dwelling older adults in the USA: The Health and Retirement Study.}, journal = {Age and Ageing}, volume = {50}, year = {2021}, pages = {2214-2221}, abstract = {

BACKGROUND: the interrelatedness between social determinants of health impedes researchers to identify important social factors for health investment. A new approach is needed to quantify the aggregate effect of social factors and develop person- centred social interventions.

METHODS: participants ([n = 7,383], 54.5\% female) were aged 65~years or above who complete an additional psychosocial questionnaire in the health and retirement study in 2006 or 2008. Social determinants of health encompassed five social domains: economic stability, neighbourhood and physical environment, education, community and social context, and healthcare system. We used the forward stepwise logistic regression to derive a polysocial score model for 5-year mortality. Indices of goodness-of-fit, discrimination and reclassification were used to assess model performance. We used logistic regression to identify the association between polysocial score and mortality. Subgroup analyses were conducted to examine sex- and race-specific association.

RESULTS: polysocial score was created using 14 social determinants of health. In the training cohort, the C-statistic was 0.71 for the reference model (only age, sex and race/ethnicity) and increased to 0.75 for the continuous and categorical polysocial score. Compared with the reference model, the integrated discrimination index for adding the continuous or categorical polysocial score was both 0.03 (P values < 0.001). Participants with an intermediate (odds ratio [OR] = 0.69; 95\% confidence interval [CI], 0.51-0.82) or high (OR = 0.48; 95\% CI, 0.38-0.60) polysocial score had lower odds of death than those in the low category in the fully adjusted model, respectively.

CONCLUSIONS: the polysocial approach may offer possible solutions to monitor social environments and suggestions for older people to improve their social status for specific health outcomes.

}, keywords = {healthy ageing, polysocial score, Public Health, Social determinants of health}, issn = {1468-2834}, doi = {10.1093/ageing/afab174}, author = {Ping, Yongjing and Michelle C Odden and Stawski, Robert S and Abdel Magid, Hoda S and Wu, Chenkai} } @article {9586, title = {Development, Construct Validity, and Predictive Validity of a Continuous Frailty Scale: Results from Two Large U.S. Cohorts.}, journal = {American Journal of Epidemiology}, volume = {187}, year = {2018}, pages = {1752-1762}, abstract = {Frailty is an age-related clinical syndrome of decreased resilience to stressors. Among numerous assessments of frailty, the frailty phenotype (FP) scale, proposed by Fried and colleagues has been the most widely used one. We aimed to develop a continuous frailty scale that may overcome limitations facing the categorical FP scale and to evaluate its construct validity, predictive validity, and measurement properties. Data were from the Cardiovascular Health Study (N~=~4243) and Health and Retirement Study (N~=~7600). Frailty was conceptualized as a continuous construct, measured by five measures used in FP scale: gait speed, grip strength, exhaustion, physical activity, and weight loss. We used confirmatory factor analysis to investigate the relationship between five indicators and the latent frailty construct. We examined the association of the continuous frailty scale with mortality and disability. The unidimensional model fit the data satisfactorily; similar factor structure was observed across two cohorts. Gait speed and weight loss were the strongest and weakest indicators, respectively; grip strength, exhaustion, and physical activity had similar strength in measuring frailty. In each cohort, the continuous frailty scale was strongly associated with mortality and disability and persisted to be associated with outcomes among robust and prefrail persons classified by the FP scale.}, keywords = {Comparisons, Frailty, Survey Methodology}, issn = {1476-6256}, doi = {10.1093/aje/kwy041}, author = {Wu, Chenkai and G John Geldhof and Xue, Qian-Li and Dae H Kim and Anne B Newman and Michelle C Odden} } @article {8979, title = {Functional Status Modifies the Association of Blood Pressure with Death in Elders: Health and Retirement Study}, journal = {Journal of the American Geriatrics Society}, volume = {65}, year = {2017}, pages = {1482-1489}, abstract = {Objective To examine whether grip strength, gait speed, and the combination of the two physical functioning measures modified the association of systolic BP (SBP) and diastolic BP (DBP) with mortality. Design Nationally representative cohort study. Setting Health and Retirement Study. Participants 7,492 U.S. adults aged >=65 years. Measurements Grip strength was measured by a hand dynamometer and classified as normal (>=16 kg for female; >=26 kg for male) and weak. Gait speed was assessed over a 98.5-inch walk and classified as non-slow (>=0.60 m/s for female; >=0.52 m/s for male) and slow. Results Over an average follow-up time of 6.0 years, 1,870 (25.0\%) participants died. After adjustment for socio-demographic, behavioral, and clinical measures, elevated SBP (>=150 mmHg) and DBP (>=90 mmHg) was associated with a 24\% (95\% CI, 7{\textendash}43\%) and 25\% (95\% CI, 5{\textendash}49\%) higher mortality among participants with normal grip strength. In contrast, elevated SBP and DBP was associated with a 6\% (95\% CI, 31 to -27\%) and a 16\% (95\% CI, 46 to -26\%) lower mortality among those with weak grip strength (P-values of interactions: both=.07). The inverse relations between BP with death were most pronounced among slow walkers with weak grip strength. The HRs of elevated SBP and DBP for death was 0.85 (95\% CI, 0.56{\textendash}1.29) and 0.53 (95\% CI, 0.30{\textendash}0.96), respectively, and was substantially different from non-slow walkers with normal grip strength (HR = 1.24 and 1.15, respectively; P-values of interactions: both <.001). Therefore, associations of BP with death varied modestly by gait speed. Conclusion Grip strength modified the association of BP with death. Combination of grip strength and gait speed has incremental value for modifying the association of BP with death.}, keywords = {Blood pressure, Grip strength, Mortality, Older Adults}, doi = {10.1111/jgs.14816}, url = {http://doi.wiley.com/10.1111/jgs.14816http://onlinelibrary.wiley.com/wol1/doi/10.1111/jgs.14816/fullpdfhttps://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111\%2Fjgs.14816}, author = {Wu, Chenkai and Smit, Ellen and Peralta, Carmen A and Sarathy, Harini and Michelle C Odden} } @article {6497, title = {Association of retirement age with mortality: a population-based longitudinal study among older adults in the USA.}, journal = {J Epidemiol Community Health}, volume = {70}, year = {2016}, month = {2016 Sep}, pages = {917-23}, abstract = {

BACKGROUND: Retirement is an important transitional process in later life. Despite a large body of research examining the impacts of health on retirement, questions still remain regarding the association of retirement age with survival. We aimed to examine the association between retirement age and mortality among healthy and unhealthy retirees and to investigate whether sociodemographic factors modified this association.

METHODS: On the basis of the Health and Retirement Study, 2956 participants who were working at baseline (1992) and completely retired during the follow-up period from 1992 to 2010 were included. Healthy retirees (n=1934) were defined as individuals who self-reported health was not an important reason to retire. The association of retirement age with all-cause mortality was analysed using the Cox model. Sociodemographic effect modifiers of the relation were examined.

RESULTS: Over the study period, 234 healthy and 262 unhealthy retirees died. Among healthy retirees, a 1-year older age at retirement was associated with an 11\% lower risk of all-cause mortality (95\% CI 8\% to 15\%), independent of a wide range of sociodemographic, lifestyle and health confounders. Similarly, unhealthy retirees (n=1022) had a lower all-cause mortality risk when retiring later (HR 0.91, 95\% CI 0.88 to 0.94). None of the sociodemographic factors were found to modify the association of retirement age with all-cause mortality.

CONCLUSIONS: Early retirement may be a risk factor for mortality and prolonged working life may provide survival benefits among US adults.

}, keywords = {Adult, Aged, Female, Health Status, Humans, Life Expectancy, Life Style, Longitudinal Studies, Male, Middle Aged, Mortality, Premature, Retirement, Risk Factors, United States}, issn = {1470-2738}, doi = {10.1136/jech-2015-207097}, url = {http://jech.bmj.com/content/early/2016/03/21/jech-2015-207097.abstract}, author = {Wu, Chenkai and Michelle C Odden and Gwenith G Fisher and Stawski, Robert S} } @article {6436, title = {Responses to Financial Loss During the Great Recession: An Examination of Sense of Control in Late Midlife}, journal = {The Journals of Gerontology Series B: Psychological Sciences and Social Sciences}, volume = {71}, year = {2016}, pages = {734-744}, chapter = {734}, abstract = {Objectives. The Great Recession shocked the primary institutions that help individuals and families meet their needs and plan for the future. This study examines middle-aged adults experiences of financial loss and considers how socioeconomic and interpersonal resources facilitate or hinder maintaining a sense of control in the face of economic uncertainty.Method. Using the 2006 and 2010 waves of the Health and Retirement Study, change in income and wealth, giving help to and receiving help from others, household complexity, and sense of control were measured among middle-aged adults (n = 3,850; age = 51 60 years).Results. Socioeconomic resources predicted both the level of and change in the engagement of interpersonal resources prior to and during the Great Recession. Experiences of financial loss were associated with increased engagement of interpersonal resources and decreased sense of control. The effect of financial loss was dampened by education. Sense of control increased with giving help and decreased with household complexity.Discussion. Findings suggest that, across socioeconomic strata, proportional loss in financial resources resulted in a loss in sense of control. However, responses to financial loss differed by socioeconomic status, which differentiated the ability to maintain a sense of control following financial loss.}, keywords = {Adult children, Demographics, Healthcare, Net Worth and Assets, Other, Public Policy}, doi = {10.1093/geronb/gbv054}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2015/08/21/geronb.gbv054.abstract}, author = {Shannon T. Mejia and Richard A. Settersten Jr. and Michelle C Odden and Hooker, Karen} }