@article {10990, title = {Estimates of the Association of Dementia With US Mortality Levels Using Linked Survey and Mortality Records}, journal = {JAMA Neurology}, volume = {77}, year = {2020}, pages = {1543-1550}, abstract = {Vital statistics are the primary source of data used to understand the mortality burden of dementia in the US, despite evidence that dementia is underreported on death certificates. Alternative estimates, drawing on population-based samples, are needed.To estimate the percentage of deaths attributable to dementia in the US.A prospective cohort study of the Health and Retirement Study of noninstitutionalized US individuals with baseline exposure assessment in 2000 and follow-up through 2009 was conducted. Data were analyzed from November 2018 to May 2020. The sample was drawn from 7489 adults aged 70 to 99 years interviewed directly or by proxy. Ninety participants with missing covariates or sample weights and 57 participants lost to follow-up were excluded. The final analytic sample included 7342 adults.Dementia and cognitive impairment without dementia (CIND) were identified at baseline using Health and Retirement Study self- or proxy-reported cognitive measures and the validated Langa-Weir score cutoff.Hazard ratios relating dementia and CIND status to all-cause mortality were estimated using Cox proportional hazards regression models, accounting for covariates, and were used to calculate population-attributable fractions. Results were compared with information on cause of death from death certificates.Of the 7342 total sample, 4348 participants (60.3\%) were women. At baseline, 4533 individuals (64.0\%) were between ages 70 and 79 years, 2393 individuals (31.0\%) were between 80 and 89 years, and 416 individuals (5.0\%) were between 90 and 99 years; percentages were weighted. The percentage of deaths attributable to dementia was 13.6\% (95\% CI, 12.2\%-15.0\%) between 2000 and 2009. The mortality burden of dementia was significantly higher among non-Hispanic Black participants (24.7\%; 95\% CI, 17.3-31.4) than non-Hispanic White participants (12.2\%; 95\% CI, 10.7-13.6) and among adults with less than a high school education (16.2\%; 95\% CI, 13.2\%-19.0\%) compared with those with a college education (9.8\%; 95\% CI, 7.0\%-12.5\%). Underlying cause of death recorded on death certificates (5.0\%; 95\% CI, 4.3\%-5.8\%) underestimated the contribution of dementia to US mortality by a factor of 2.7. Incorporating deaths attributable to CIND revealed an even greater underestimation.The findings of this study suggest that the mortality burden associated with dementia is underestimated using vital statistics, especially when considering CIND in addition to dementia.}, keywords = {Dementia, Mortality}, isbn = {2168-6149}, doi = {10.1001/jamaneurol.2020.2831}, author = {Andrew C. Stokes and Weiss, Jordan and Lundberg, Dielle J. and Xie, Wubin and Jung K Kim and Samuel H. Preston and Eileen M. Crimmins} } @article {10995, title = {Increases in BMI and Chronic Pain for US Adults in Midlife, 1992 to 2016}, journal = {SSM - Population Health}, year = {2020}, abstract = {Recent unprecedented increases in mortality and morbidity during midlife are often ascribed to rising despair in the US population. An alternative and less often examined explanation is that these trends reflect, at least in part, the lagged effects of the obesity epidemic. Adults in midlife today are more likely to live with obesity and have a greater cumulative exposure to excess adiposity during their lifetime than any previous generation. Prior work has demonstrated a link between obesity and mortality risk at midlife, but the mechanisms remain unclear. Pain may represent one important pathway linking obesity to mortality trends. Pain is a debilitating condition that has increased significantly over recent decades and is associated with both morbidity and mortality, including suicide and opioid-related mortality. Evidence suggests obesity and pain may be linked, but there is little evidence of an association at the population level. In this paper, we examine to what extent increases in overweight and obesity explain the rising trends in chronic pain observed among middle-aged adults in the US from 1992 to 2016. We assess trends in both mild/moderate nonlimiting pain and severe and/or limiting pain. In doing so, we draw attention to one mechanism through which overweight/obesity may have contributed to recent population health trends. Our analysis found that increases in BMI from 1992 to 2016 may account for up to 20\% of the upward trend in mild/moderate nonlimiting pain and 32\% of the trend in severe and/or limiting pain for women, and 10\% and 19\% of the trends respectively for men.}, keywords = {activity limitations, Obesity, pain, Trends}, isbn = {2352-8273}, doi = {https://doi.org/10.1016/j.ssmph.2020.100644}, author = {Andrew C. Stokes and Xie, Wubin and Lundberg, Dielle J. and Hempstead, Katherine and Zajacova, Anna and Zachary Zimmer and Dana A Glei and Meara, Ellen and Samuel H. Preston} } @article {8812, title = {Validating a summary measure of weight history for modeling the health consequences of obesity.}, journal = {Ann Epidemiol}, volume = {26}, year = {2016}, month = {2016 12}, pages = {821-826.e2}, abstract = {

PURPOSE: Data on weight history may enhance the predictive validity of epidemiologic models of the health risks of obesity, but collecting such data is often not feasible. In this study, we investigate the validity of a summary measure of weight history.

METHODS: We evaluated the quality of reporting of maximum weight in a sample of adults aged 50-84~years using data from the Health and Retirement Study. Recalled max body mass index (BMI, measured in kilogram per square meter) based on recalled weight in 2004 was compared with calculated max BMI based on self-reported weight collected biennially between 1992 and 2004. Logistic regression was used to assess similarity between the measures in predicting prevalent conditions.

RESULTS: The correlation coefficient between recalled and calculated max weight in the overall sample was 0.95. Recalled max BMI value was within three BMI units of the calculated value 91.4\% of the time. The proportions of individuals with obese I (BMI: 30.0-34.9), obese II (BMI: 35.0-39.9), and obese III (BMI: 40.0 and above) were 28.8\%, 12.7\%, and 6.6\% using recalled values compared with 27.1\%, 10.5\%, and 4.9\% using calculated values. In multivariate analyses, the two BMI measures similarly predicted disease prevalence across a number of chronic conditions.

CONCLUSIONS: Recalled max BMI was strongly correlated with max BMI calculated over the 12-year period before recall, suggesting that this measure can serve as a reliable summary measure of recent weight status.

}, keywords = {Aged, Aged, 80 and over, Body Mass Index, Body Weight, Chronic disease, Female, Health Surveys, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Obesity, Self Report, United States}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2016.10.005}, url = {http://linkinghub.elsevier.com/retrieve/pii/S1047279716304070http://api.elsevier.com/content/article/PII:S1047279716304070?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S1047279716304070?httpAccept=text/plain}, author = {Andrew C. Stokes and Ni, Yu} }