@article {13768, title = {Dried blood spot based biomarkers in the Health and Retirement Study: 2006 to 2016.}, journal = {American Journal of Human Biology}, volume = {36}, year = {2024}, pages = {e23997}, abstract = {

INTRODUCTION: The Health and Retirement Study (HRS) has collected biomarker data over multiple waves. Such data can help improve our understanding of health changes in individuals and the causal pathways related to health. There are, however, technical challenges to using the HRS dried blood spots (DBS) biomarker data due to changes over time in assay protocols, platforms, and laboratories. We provide technical and summary information on biological indicators collected as part of the HRS from 2006 to 2016 that should be helpful to users of the data.

METHODS: We describe the opportunities and challenges provided by the HRS DBS data as well as insights provided by the data. The HRS collected DBS from its nationally representative sample of respondents 51 years of age or older from 2006 to 2016. DBS-based biomarkers were collected from half the sample in 2006, 2010, and 2014, and from the other half of the sample in 2008, 2012, and 2016. These DBS specimens were used to assay total and HDL cholesterol, glycosylated hemoglobin, C-reactive protein, and cystatin C from 2006 to 2016, and Interleukin 6 was added in 2014/2016. Samples included approximately 6000 individuals at each wave, and completion rates ranged from 81\% to 90\%. HRS transformed DBS values into venous blood equivalents to make them more comparable to those of the whole blood-based assays collected in most other studies and to facilitate longitudinal analysis.

RESULTS: Distribution of changes over time by age shows that total cholesterol levels decreased for each age, while HbA1c levels increased. Cystatin C shows a clear age gradient, but a number of other markers do not. Non-Hispanic Black persons and Hispanic respondents have a higher incidence of risk levels of each biomarker except for CRP among non-Hispanic Black older persons.

CONCLUSION: These public-use DBS data provide analysis opportunities that can be used to improve our understanding of health change with age in both populations and among individuals.

}, keywords = {Biomarkers, C-reactive protein, Cystatin C, Dried Blood Spot Testing, Retirement}, issn = {1520-6300}, doi = {10.1002/ajhb.23997}, author = {Jung K Kim and Faul, Jessica and Weir, David R and Crimmins, Eileen M} } @article {13058, title = {ADHD genetic burden associates with older epigenetic age: mediating roles of education, behavioral and sociodemographic factors among older adults.}, journal = {Clin Epigenetics}, volume = {15}, year = {2023}, pages = {67}, abstract = {

BACKGROUND: Shortened lifespans are associated with having Attention Deficit Hyperactivity Disorder (ADHD), which is likely mediated by related behavioral and sociodemographic factors that are also associated with accelerated physiological aging. Such factors include exhibiting more depressive symptoms, more cigarette smoking, higher body mass index, lower educational attainment, lower income in adulthood, and more challenges with cognitive processes compared to the general population. A higher polygenic score for ADHD (ADHD-PGS) is associated with having more characteristic features of ADHD. The degree to which (1) the ADHD-PGS associates with an epigenetic biomarker developed to predict accelerated aging and earlier mortality is unknown, as are whether (2) an association would be mediated by behavioral and sociodemographic correlates of ADHD, or (3) an association would be mediated first by educational attainment, then by behavioral and sociodemographic correlates. We evaluated these relationships in a population-based sample from the US Health and Retirement Study, among N = 2311 adults age 50 and older, of European-ancestry, with blood-based epigenetic and genetic data. The ADHD-PGS was calculated from a prior genomewide meta-analysis. Epigenome-wide DNA methylation levels that index biological aging and earlier age of mortality were quantified by a blood-based biomarker called GrimAge. We used a structural equation modeling approach to test associations with single and multi-mediation effects of behavioral and contextual indicators on GrimAge, adjusted for covariates.

RESULTS: The ADHD-PGS was significantly and directly associated with GrimAge when adjusting for covariates. In single mediation models, the effect of the ADHD-PGS on GrimAge was partially mediated via smoking, depressive symptoms, and education. In multi-mediation models, the effect of the ADHD-PGS on GrimAge was mediated first through education, then smoking, depressive symptoms, BMI, and income.

CONCLUSIONS: Findings have implications for geroscience research in elucidating lifecourse pathways through which ADHD genetic burden and symptoms can alter risks for accelerated aging and shortened lifespans, when indexed by an epigenetic biomarker. More education appears to play a central role in attenuating negative effects on epigenetic aging from behavioral and sociodemographic risk factors related to ADHD. We discuss implications for the potential behavioral and sociodemographic mediators that may attenuate negative biological system effects.

}, keywords = {Aged, Aging, Attention Deficit Disorder with Hyperactivity, Biomarkers, DNA Methylation, Educational Status, Epigenesis, Genetic, Humans, Middle Aged, sociodemographic factors}, issn = {1868-7083}, doi = {10.1186/s13148-023-01484-y}, author = {Arpawong, Thalida E and Klopack, Eric T and Jung K Kim and Crimmins, Eileen M} } @article {13282, title = {Aging on the job? The association between occupational characteristics and accelerated biological aging.}, journal = {The Journals of Gerontology, Series B}, volume = {78}, year = {2023}, pages = {1236-1245}, abstract = {

OBJECTIVES: There is a common belief that demanding jobs can make workers age faster, but there is little empirical evidence linking occupational characteristics to accelerated biological aging. We examine how occupational categorizations and self-reported working conditions are associated with expanded biological age, which incorporates 22 biomarkers and captures physiologic dysregulation throughout several bodily systems.

METHODS: Data are from 1,133 participants in the Health and Retirement Study (HRS) who were aged 51-60 and working for pay in the 2010 or 2012 wave and who participated in the 2016 Venous Blood Study (VBS). We estimate associations between occupational category (professional/managerial, sales/clerical, service, and manual) and self-reported working conditions (psychosocial demands, job control, heavy lifting, and working 55 or more hours per week) and expanded biological age.

RESULTS: Compared to same-age individuals working in professional or managerial positions, those working in service jobs appear 1.65 years older biologically even after adjusting for social and economic characteristics, self-reported working conditions, health insurance, and lifestyle-related risk factors. Low job control is associated with 1.40 years, heavy lifting with 2.08 years, and long working hours with 1.87 years of accelerated biological aging.

DISCUSSION: Adverse occupational characteristics held at midlife, particularly service work, low job control, heavy lifting, and long work hours, are associated with accelerated biological aging. These findings suggest that work may be important for the overall aging process beyond its associations with specific diseases or risk factors.

}, keywords = {Biomarkers, Functional age, Psychosocial stress, work-related issues}, issn = {1758-5368}, doi = {10.1093/geronb/gbad055}, author = {Andrasfay, Theresa and Jung K Kim and Jennifer A Ailshire and Crimmins, Eileen} } @article {13509, title = {Associations between Change in Kidney Functioning, Age, Race/ethnicity and Health Indicators in the Health and Retirement Study.}, journal = {The Journal of Gerontology, Series A }, volume = {78}, year = {2023}, pages = {2094-2104}, abstract = {

BACKGROUND: The aging process is accompanied by decline in kidney functioning. It remains unknown to what extent age-related decline in kidney functioning can be attributed to health indicators, and whether rate of decline differs across sociodemographic groups.

METHODS: Using data from the Health and Retirement Study from 2006/2008 through 2014/2016, we estimated kidney functioning trajectories, determined by cystatin C, among adults aged over 51 over 8-year. We evaluated the role of age, health conditions/behaviors, and genetics in the decline and also examined sociodemographic differentials.

RESULTS: Kidney function declined with age and accelerated at older ages, even after adjusting for health conditions/behaviors and genetic differences (e.g., 0.019~mg/L annual increase in cystatin C among 70-79 compared to 0.007~mg/L among 52-59 at baseline). Decline occurred faster among those with uncontrolled diabetes (0.008, p=0.009), heart conditions (0.007, p<0.000), and obesity (0.005, p=0.033). Hispanic participants (0.007, p=0.039) declined faster than non-Hispanic White persons due to diabetes, heart conditions, and obesity; non-Hispanic Black participants had worse baseline kidney functioning (0.099, p<0.000), but only one-fourth of this Black-White difference was explained by investigated risk factors. People with higher education experienced slower decline (-0.009, p=0.004).

CONCLUSIONS: Age was a significant predictor of decline in kidney functioning, and its association was not fully explained by health conditions/behaviors, or genetics. Better management of diabetes, heart conditions, and obesity is effective in slowing this decline. Baseline differences in kidney functioning (e.g., between non-Hispanic White and Black persons; those with and without hypertension) suggest disparities occur early in the life course and require early interventions.

}, keywords = {Cystatin C, Kidney function, Metabolism}, issn = {1758-535X}, doi = {10.1093/gerona/glad204}, author = {Zhao, Erfei and Jennifer A Ailshire and Jung K Kim and Wu, Qiao and Crimmins, Eileen M} } @article {13668, title = {Documentation of lnterleukin-6 (IL-6) Assays from Dried Blood Spots 2014 and 2016}, year = {2023}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, MI}, abstract = {This document describes the collection of lnterleukin-6 (IL-6) in 2014 and 2016 Assays from Dried Blood Spots. }, keywords = {User guide}, author = {Crimmins, Eileen and Jessica Faul and Jung K Kim and David R Weir} } @article {12923, title = {Epigenetic-based age acceleration in a representative sample of older Americans: Associations with aging-related morbidity and mortality.}, journal = {PNAS}, volume = {120}, year = {2023}, pages = {e2215840120}, abstract = {

Biomarkers developed from DNA methylation (DNAm) data are of growing interest as predictors of health outcomes and mortality in older populations. However, it is unknown how epigenetic aging fits within the context of known socioeconomic and behavioral associations with aging-related health outcomes in a large, population-based, and diverse sample. This study uses data from a representative, panel study of US older adults to examine the relationship between DNAm-based age acceleration measures in the prediction of cross-sectional and longitudinal health outcomes and mortality. We examine whether recent improvements to these scores, using principal component (PC)-based measures designed to remove some of the technical noise and unreliability in measurement, improve the predictive capability of these measures. We also examine how well DNAm-based measures perform against well-known predictors of health outcomes such as demographics, SES, and health behaviors. In our sample, age acceleration calculated using "second and third generation clocks," PhenoAge, GrimAge, and DunedinPACE, is consistently a significant predictor of health outcomes including cross-sectional cognitive dysfunction, functional limitations and chronic conditions assessed 2 y after DNAm measurement, and 4-y mortality. PC-based epigenetic age acceleration measures do not significantly change the relationship of DNAm-based age acceleration measures to health outcomes or mortality compared to earlier versions of these measures. While the usefulness of DNAm-based age acceleration as a predictor of later life health outcomes is quite clear, other factors such as demographics, SES, mental health, and health behaviors remain equally, if not more robust, predictors of later life outcomes.

}, keywords = {Acceleration, Aging, Biomarkers, Cross-Sectional Studies, DNA Methylation, Epigenesis, genetic}, issn = {1091-6490}, doi = {10.1073/pnas.2215840120}, author = {Jessica Faul and Jung K Kim and Levine, Morgan E and Bharat Thyagarajan and David R Weir and Eileen M. Crimmins} } @article {13607, title = {Parental Divorce in Childhood and the Accelerated Epigenetic Aging for Earlier and Later Cohorts: Role of Mediators of Chronic Depressive Symptoms, Education, Smoking, Obesity, and Own Marital Disruption}, journal = {Journal of Population Ageing}, year = {2023}, abstract = {We examine effects of parental divorce on epigenetic aging in later adulthood for two birth cohorts: one born in the early 20th century and the other born in the later 20th century. Using data from the Health and Retirement Study (n = 1,545), we examine the relationship between parental divorce in childhood and accelerated epigenetic aging in older adulthood as indicated by the Dunedin methylation Pace of Aging score. We assess how this relationship is mediated by chronic depressive symptoms, education, lifetime smoking, body mass index (BMI), and an older adult{\textquoteright}s own divorce. The mean age of the earlier cohort is 85.8 (SD = 3.9) and that of the later cohort is 60.2 (SD = 2.8). We find that parental divorce was related to faster aging in the later-born cohort, and that 56\% of this relationship (b = 0.060) was mediated by chronic depressive symptoms (b = 0.013), lower education levels (b = 0.005), and smoking (b = 0.019). For the earlier cohort, there was no effect of parental divorce on epigenetic aging. Parental divorce in childhood may have lasting effects on later-life health, as reflected in the rate of epigenetic aging. However, the effects and mechanisms of this relationship differ across cohorts living in different social environments. {\textcopyright} 2023, The Author(s).}, keywords = {childhood adversities, Cohort Difference, DunedinPACE, Epigenetic aging}, doi = {10.1007/s12062-023-09434-5}, author = {Jung K Kim and Arpawong, Thalida Em and Klopack, Eric T. and Crimmins, Eileen M.} } @article {12629, title = {Racial/Ethnic Differences in Biological Aging and Their Life Course Socioeconomic Determinants: The 2016 Health and Retirement Study.}, journal = {Journal of Aging and Health}, year = {2023}, abstract = {

This study examined differences in accelerated biological aging among non-Hispanic Blacks, Hispanics, and non-Hispanic Whites in the United States and assessed whether including life course socioeconomic conditions attenuated observed racial/ethnic differences. Data came from the Venous Blood Collection Subsample of the Health and Retirement Study. We used a comprehensive summary measure of biological age (BA-22). We determined whether key lifetime socioeconomic conditions contributed to racial/ethnic differences in biological aging. Findings indicated that non-Hispanic Blacks and Hispanics have accelerated aging, and non-Hispanic Whites have decelerated aging. Racial/ethnic differences were strongly tied to educational attainment. We also observed a significant difference by birthplace for Hispanics. US-born Hispanics had accelerated biological aging, whereas foreign-born Hispanics did not. In age-stratified analyses, these racial/ethnic differences were found for adults aged 56-74, but not for adults aged 75+. These findings provide insight into biological differences underlying racial/ethnic disparities in health.

}, keywords = {accelerated biological aging, racial/ethnic disparities}, issn = {1552-6887}, doi = {10.1177/08982643221120743}, author = {Farina, Mateo P and Jung K Kim and Eileen M. Crimmins} } @article {Kang2023, title = {Shingles Vaccine Uptake Among Older Adults: Identifying Early, Later, and Nonadopters}, journal = {AJPM Focus}, volume = {2}, year = {2023}, abstract = {Introduction: There is growing interest in accelerating adoptions of vaccines. This study examined factors that differentiate the acceptance and timing of uptake of the first shingles vaccine, Zostavax, among older adults in the U.S. Methods: Data from Health and Retirement Study respondents who were aged >=62 years in 2008 were analyzed to determine whether they received a shingles vaccination from 2006 to 2016. Multinomial logistic regression was used to examine the characteristics associated with vaccine uptake and timing. Results: Of those eligible, 15.2\% were vaccinated early (between 2006 and 2010), 20.2\% were vaccinated later, and 64.6\% remained unvaccinated 10 years after the shingles vaccine was introduced. Respondents more likely to be vaccinated were those who had higher education and income, experience with influenza vaccination, more frequent social interaction with friends, or were residing in an area with higher shingles vaccination rates. Conclusions: Shingles vaccination rates vary by social and geographic characteristics. Efforts to improve and expedite vaccination and other new preventive measures should target specific populations and geographic areas.}, keywords = {adoption timing, Health and Retirement Study, Shingles vaccination}, doi = {10.1016/j.focus.2023.100143}, author = {Kang, Alice H. and Jung K Kim and Jennifer A Ailshire and Crimmins, Eileen M.} } @article {11926, title = {Age-related differences in T cell subsets in a nationally representative sample of people over age 55: Findings from the Health and Retirement Study.}, journal = {The Journals of Gerontology, Series A }, volume = {77}, year = {2022}, pages = {927-933}, abstract = {

Though T cell immunosenescence is a major risk factor for age-related diseases, susceptibility to infections, and responses to vaccines, differences in T cells subset counts and representation by age and sex have not been determined for a large sample representative of the national population of the US. We evaluated the counts of T cell subsets including total, CD4+ and CD8+ T cells, and their na{\"\i}ve (Tn), effector memory (Tem) and effector subsets, in the context of age, sex and exposure to cytomegalovirus (CMV) infection among 8,848 Health and Retirement Study (HRS) participants, a nationally representative study of adults over 55 years. Total T cells (CD3+) and CD4+ cells declined markedly with age; CD8+ T cells declined somewhat less. While CD4+ T cell declines with age occurred for both CMV seropositive and CMV seronegative groups, total T cells and CD8+ cells were both substantially higher among the CMV seropositive group. Numbers of Tn CD4+ and CD8+ cells were strongly and inversely related to age, were better conserved among women, and were independent of CMV seropositivity. By contrast, accumulation of the CD8+ and CD4+ Tem and effector subsets was CMV-associated. This is the first study to provide counts of T cell subsets by age and sex in a national sample of older US adults over the age of 55 years. Understanding T cell changes with age and sex is an important first step in determining strategies to reduce its impact on age-related diseases and susceptibility to infection.

}, keywords = {Aging, CMV Seropositivity}, issn = {1758-535X}, doi = {10.1093/gerona/glab300}, author = {Bharat Thyagarajan and Jessica Faul and Vivek, Sithara and Jung K Kim and Nikolich-{\v Z}ugich, Janko and David R Weir and Eileen M. Crimmins} } @article {12878, title = {Links between inflammation and immune functioning with cognitive status among older Americans in the Health and Retirement Study.}, journal = {Brain, Behavior, \& Immunity - Health}, volume = {26}, year = {2022}, pages = {100559}, abstract = {

Elevated inflammation and poor immune functioning are tied to worse cognitive health. Both processes are fundamental to aging and are strongly implicated in the development of age-related health outcomes, including cognitive status. However, results from prior studies evaluating links between indicators of inflammation and immune function and cognitive impairment have been inconsistent due to biomarker selection, sample selection, and cognitive outcome. Using the Health and Retirement Study (HRS), a nationally representative study of older adults in the United States, we assessed how indicators of inflammation (neutrophil-lymphocyte ratio (NLR), albumin, CRP, IL6, IL10, IL-1Ra, sTNFR1, and TGFβ1) and immune functioning (CMV, CD4 T/T and CD8 T/T) are associated with cognitive status. First, to examine the association between each biomarker and cognitive status, we tested whether markers of inflammation and immune functioning varied across cognitive status categories. We found that dementia and cognitive impairment without dementia (CIND) were associated with elevated inflammation and poorer immune functioning across biomarkers except for CD4 T/T. Next, we estimated multinomial logistic regression models to assess which biomarkers would continue to be associated with dementia and CIND, net of each other. In these models, albumin, cytokines, CMV, CD4 T/T and CD8 T/T are associated with cognitive status. Because poor immune functioning and increased inflammation are associated with cognitive impairment, improving immune functioning and reducing inflammation may provide a mechanism for reducing ADRD risk in the population.

}, keywords = {Biomarkers, Dementia, immune functioning, Inflammation}, issn = {2666-3546}, doi = {10.1016/j.bbih.2022.100559}, author = {Farina, Mateo P and Jung K Kim and Hayward, Mark D and Eileen M. Crimmins} } @article {13514, title = {Socioeconomic status and immune aging in older US adults in the health and retirement study.}, journal = {Biodemography and Social Biology}, volume = {67}, year = {2022}, pages = {187-202}, abstract = {

Socioeconomic and demographic factors including educational attainment, race and ethnicity, and childhood socioeconomic status (SES) are powerful predictors of inequalities in aging, morbidity, and mortality. Immune aging, including accumulation of late-differentiated, senescent-like lymphocytes and lower levels of na{\"\i}ve lymphocytes, may play a role in the development of the age-related health inequalities. This study used nationally representative data from more than 9,000 US adults from the Health and Retirement Study to investigate associations between educational attainment, race and ethnicity, and childhood SES and lymphocyte percentages. Respondents with lower educational attainment, Hispanic adults, and those who had a parent with less than a high school education had lymphocyte percentages consistent with more immune aging compared to those with greater educational attainment, non-Hispanic White adults, and respondents who had parents with a high school education, respectively. Associations between education, Hispanic ethnicity, and parents{\textquoteright} education and late differentiated senescent-like T lymphocytes (TemRA) and B cells were largely driven by cytomegalovirus (CMV), suggesting it is a factor in observed SES inequalities in immunosenescence. Na{\"\i}ve T lymphocytes may be particularly affected by socioeconomic position and may therefore be of particular interest to research interested in inequalities in health and aging.

}, keywords = {Child, Educational Status, ethnicity, Hispanic or Latino, Retirement, Social Class}, issn = {1948-5573}, doi = {10.1080/19485565.2022.2149465}, author = {Klopack, Eric T and Bharat Thyagarajan and Jessica Faul and Meier, Helen C S and Ramasubramanian, Ramya and Jung K Kim and Crimmins, Eileen M} } @article {11734, title = {Trends in Dementia Prevalence, Incidence, and Mortality in the United States (2000-2016).}, journal = {Journal of Aging and Health}, volume = {34}, year = {2022}, pages = {100-108}, abstract = {

The prevalence of dementia has declined in the United States; how this parallels to changes in incidence and mortality, and how improvements in educational attainment may have influences these trends, is not known. Using the Health and Retirement Study (2000-2016), we estimated logistic regression models to examine trends in dementia prevalence and incidence, and mortality for those with and without dementia. The relative decline was about 2.4\% per year for dementia prevalence and 1.9\% for dementia incidence. Mortality declined similarly for those with and without dementia. Improved educational attainment accounted for decline in incidence, some of the decline in prevalence, and had a negligible role in mortality. The declines in dementia incidence provide evidence that dementia prevalence should continue to decline in the near future. These declines are most likely largely driven by continued improvements in older adult education.

}, keywords = {dementia incidence, educational composition}, issn = {1552-6887}, doi = {10.1177/08982643211029716}, author = {Mateo P Farina and Yuan S Zhang and Jung K Kim and Mark D Hayward and Eileen M. Crimmins} } @article {11752, title = {Cardiometabolic Risk Trajectory among Older Americans: Findings from the Health and Retirement Study.}, journal = {The Journals of Gerontology, Series A}, volume = {76}, year = {2021}, pages = {2265-2274}, abstract = {

BACKGROUND: Cardiometabolic risk (CMR) is a key indicator of physiological decline with age; but age-related declines in a nationally representative older U.S. population have not been previously examined.

METHODS: We examined the trajectory of cardiometabolic risk (CMR) over 8 years of aging, from 2006/2008 to 2014/2016, among 3,528 people over age 50 in the Health and Retirement Study. We used growth curve models to examine change in total CMR as well as in individual cardiometabolic biomarkers to understand how baseline differences and rates of change vary across sociodemographic characteristics, by smoking status, and medication use.

RESULTS: Total CMR did not change among respondents who survived over 8 years. Despite significant differences in CMR across demographic and education groups at baseline, the pace of change with age did not differ by these characteristics. Among individual biomarkers, risk levels of diastolic blood pressure, resting heart rate, and total cholesterol decreased over 8 years while glycosylated hemoglobin, waist circumference, and pulse pressure increased over that time. Both the statistical significance levels and the magnitudes of the reduction over time with age in diastolic blood pressure, resting heart rate, and total cholesterol in models adjusted for age, race/ethnicity, gender, smoking, and education were reduced after controlling for blood pressure and cholesterol medication.

CONCLUSIONS: The relatively constant total CMR level over 8 years occurred because some indicators improved with age while some deteriorated in this period. Medication use contributed to the improvement in blood pressure, resting heart rate, and total cholesterol.

}, keywords = {cardiovascular, Change with age, Medication, Metabolism}, issn = {1758-535X}, doi = {10.1093/gerona/glab205}, author = {Wu, Qiao and Jennifer A Ailshire and Jung K Kim and Eileen M. Crimmins} } @article {11290, title = {Food and Nutrient Intake and Diet Quality among Older Americans}, journal = {Public Health Nutrition}, volume = {24}, year = {2021}, pages = {1638-1647}, abstract = {A suboptimal diet and nutritional deficiencies can have important influences on health with significant impact among older adults. This study aims to assess the presence of suboptimal dietary intake among older Americans and identify risk and protective factors influencing diet quality. For this study, data from a nationally representative sample of 5,614 community-dwelling older adults over age 54 in the Health and Retirement Study {\textendash} Health Care and Nutrition Survey were used. Descriptive analyses were conducted to assess average intake of 17 food groups and nutrients and the percentage of respondents who consumed an optimal amount of food and nutrients. Differences in diet quality by sociodemographic, psychosocial, environmental, and geographic factors were assessed using chi-square and OLS regression was used to identify risk and protective factors for good quality diet. Overall, only 10.7\% of respondents had a good quality diet (HEI score 81 and above); the majority had diets considered poor or needing improvement. Less than 50\% of respondents met dietary guidelines and nutritional goals for most individual food groups and nutrients. Respondents with low socioeconomic status, fewer psychosocial resources, and those who had limited access to healthy food outlets were more likely to have a diet of suboptimal quality. Efforts to remove identified barriers that put older adults at risk for poor nutrition and to provide resources that increase access to healthy food should be made to encourage healthy eating and enhance diet quality.}, keywords = {diet quality, food, Nutrients}, doi = {10.1017/S1368980021000586}, author = {Choi, Yeon Jin and Eileen M. Crimmins and Jung K Kim and Jennifer A Ailshire} } @article {11396, title = {The Importance of Improving Educational Attainment for Dementia Prevalence Trends from 2000-2014, among Older non-Hispanic Black and White Americans.}, journal = {The Journals of Gerontology, Series B}, volume = {76}, year = {2021}, pages = {1870-1879}, abstract = {

OBJECTIVES: While a number of studies have documented a notable decline in age-standardized prevalence in dementia in the U.S. population, relatively little is known about how dementia has declined for specific age and race groups, and the importance of changing educational attainment on the downward trend. We assess 1) how the trends in dementia prevalence may have differed across age and race groups and 2) the role of changing educational attainment in understanding these trends.

METHOD: This paper estimates a series of logistic regression models using data from the Health and Retirement Study (2000-2014) to assess the relative annual decline in dementia prevalence and the importance of improving educational attainment for non-Hispanic Whites and non-Hispanic Blacks.

RESULTS: Consistent with other studies, we found significant declines in dementia for non-Hispanic Blacks and non-Hispanic Whites across this period. Nonetheless, these declines were not uniform across age and race groups. Non-Hispanic Blacks aged 65-74 had the steepest decline in this period. We also found that improved educational attainment in the population was fundamentally important in understanding declining dementia prevalence in the United States.

DISCUSSION: This study shows the importance of improvement in educational attainment in the early part of the 20 th century to understand the downward trend in dementia prevalence in the United States from 2000 to 2014.

}, keywords = {Cognitive health, Educational attainment}, issn = {1758-5368}, doi = {10.1093/geronb/gbab015}, author = {Mark D Hayward and Mateo P Farina and Yuan S Zhang and Jung K Kim and Eileen M. Crimmins} } @article {11422, title = {Quest for a summary measure of biological age: The Health and Retirement Study.}, journal = {Geroscience}, volume = {43}, year = {2021}, pages = {395-408}, abstract = {

Measures of biological age and its components have been shown to provide important information about individual health and prospective change in health as there is clear value in being able to assess whether someone is experiencing accelerated or decelerated aging. However, how to best assess biological age remains a question. We compare prediction of health outcomes using existing summary measures of biological age with a measure created by adding novel biomarkers related to aging to measures based on more conventional clinical chemistry and exam measures. We also compare the explanatory power of summary biological age measures compared to the individual biomarkers used to construct the measures. To accomplish this, we examine how well biological age, phenotypic age, and expanded biological age and five sets of individual biomarkers explain variability in four major health outcomes linked to aging in a large, nationally representative cohort of older Americans. We conclude that different summary measures of accelerated aging do better at explaining different health outcomes, and that chronological age has greater explanatory power for both cognitive dysfunction and mortality than the summary measures. In addition, we find that there is reduction in the variance explained in health outcomes when indicators are combined into summary measures, and that combining clinical indicators with more novel markers related to aging does best at explaining health outcomes. Finally, it is hard to define a set of assays that parsimoniously explains the greatest amount of variance across the range of health outcomes studied here. All of the individual markers considered were related to at least one of the health outcomes.

}, keywords = {Biological age, Biomarkers, Phenotypic age, TAME markers}, issn = {2509-2723}, doi = {10.1007/s11357-021-00325-1}, author = {Eileen M. Crimmins and Bharat Thyagarajan and Jung K Kim and David R Weir and Jessica Faul} } @inbook {11409, title = {Trends in morbidity, healthy life expectancy, and the compression of morbidity}, booktitle = {Handbook of the Biology of Aging (Ninth Edition)Handbooks of Aging}, year = {2021}, pages = {405-414}, publisher = {Academic Press}, organization = {Academic Press}, chapter = {19}, abstract = {This chapter lays out the dimensions of morbidity and the processes linking morbidity and mortality. It provides evidence of recent trends in morbidity of the older American population: decline in some types of disability but not others, disease, and physiological dysregulation among the older American population. In addition, the chapter uses data from two recent cohorts to look at survival without disease and the age at onset of diseases. We have generally seen an increase in the prevalence and time with disease; but disease appears less disabling now than in the past. In addition, the onset of myocardial infarction appears to have been delayed by the recent control of biological risk. Most of the evidence does not support the idea that we have experienced a recent compression of morbidity; it does support some delay and retarding of progression of the morbidity process.}, keywords = {compression of morbidity, health trends, Healthy life expectancy, Morbidity}, isbn = {978-0-12-815962-0}, doi = {https://doi.org/10.1016/B978-0-12-815962-0.00019-6}, author = {Eileen M. Crimmins and Yuan S Zhang and Jung K Kim and Morgan E. Levine}, editor = {Musi, Nicolas and Hornsby, Peter J.} } @article {11188, title = {Blood Pressure and Mortality: Joint Effect of Blood Pressure Measures}, journal = {Journal of Clinical Cardiology and Cardiovascular Therapy}, volume = {2}, year = {2020}, abstract = {We examine how combinations of systolic and diastolic blood pressure levels and pulse pressure levels predicted mortality risk. Respondents are those aged over 50 from the Health and Retirement Study (N=10,366) who provided blood pressure measures in 2006/2008. Systolic and diastolic blood pressures were measured three times; and we averaged the three readings. Pulse pressure was calculated as systolic minus diastolic blood pressure. Seven combinations of systolic and diastolic blood pressure (low/normal/high of each) and three levels of pulse pressure (low/normal/high) were used to categorize blood pressure. Over 1 to 10 years of follow-up (average follow-up time of 7.8 years), 2,820 respondents died after blood pressure measurement in 2006/2008. Potential covariates including age, gender, education, BMI, total cholesterol, HbA1c, antihypertensive medication intake and lifetime-smoking pack years were adjusted in Cox proportional hazard models and survival curves. The blood pressure subgroup with low systolic blood pressure (<90 mmHg) and low diastolic blood pressure (< 60 mmHg) had the highest relative risk of mortality (HR=2.34, 95\% CI: 1.45-3.80), followed by those with normal systolic blood pressure but low diastolic blood pressure (HR=1.45, 95\% CI: 1.17-1.81) among those with cardiovascular conditions at baseline. For those without cardiovascular conditions at baseline, low blood pressure, either systolic or diastolic, was not related to mortality. Those with high levels of both systolic and diastolic blood pressure had a higher risk of mortality than those with both blood pressures normal but no other subgroups with low blood pressure differed from normal/normal in predicting mortality. Pulse pressure did not predict mortality. How high and low blood pressures are related to mortality needs to be examined by jointly looking at systolic and diastolic blood pressure.}, keywords = {diastolic blood pressure, Mortality, pulse pressure, Systolic blood pressure}, issn = {2633-7916}, doi = {https://doi.org/10.31546/2633-7916.1009}, author = {Jung K Kim and Eileen M. Crimmins} } @article {11295, title = {Cardiometabolic Risk and Biomarker Trajectories Among Older Adults: Findings From the Health and Retirement Study}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {429 }, abstract = {The deterioration of the cardiovascular system is a process associated with aging. Most of the prior works have examined changes in cardiometabolic risk (CMR) while aging at the population level using cross-sectional data, but we study within-person changes for total CMR and separate risk factors, including pulse pressure, resting heart rate, C-reactive protein, glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol, total cholesterol, waist circumference, and obesity. We examine 8-year changes (from 2006 to 2014) among respondents from the Health and Retirement Study biomarker sample (n=19,776). We use growth curve models to identify differences at baseline and the changes while aging, by age, gender, race/ethnicity, and education. Blacks, the old-old, the less educated, and current smokers have higher baseline CMR. The total CMR increases while people age over 8 years. HbA1c, waist circumference, and pulse pressure increase significantly with age. A reduction in total cholesterol can be observed and is likely due to medication. The CMR increase is no longer significant after accounting for socioeconomic status. The next step of this study is to focus on the disparity of risk distribution, in order to identify the individuals that are most in need of specific care and support.}, keywords = {biomarker trajectories, cardiometabolic risk}, isbn = {2399-5300}, doi = {https://doi.org/10.1093/geroni/igaa057.1386}, author = {Wu, Qiao and Eileen M. Crimmins and Jennifer A Ailshire and Jung K Kim and Zhao, Erfei} } @article {11008, title = {Cognitive Function and Cardiometabolic-Inflammatory Risk Factors Among Older Indians and Americans.}, journal = {Journal of the American Geriatrics Society}, volume = {68 }, year = {2020}, pages = {S36-S44}, abstract = {

OBJECTIVES: To investigate how cardiometabolic-inflammatory risk factors are related to cognition among older adults in India and the United States.

DESIGN: The Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) and the Harmonized Cognitive Assessment Protocol of the Health and Retirement Study (HRS-HCAP) in the United States conducted an in-depth assessment of cognition, using protocols designed for international comparison.

SETTING: Cognitive tests were conducted in hospital or household settings in India and in household settings in the United States.

PARTICIPANTS: Respondents aged 60 years and older from LASI-DAD (N = 1,865) and respondents aged 65 years and older from HRS-HCAP (N = 2,111) who provided venous blood specimen.

MEASUREMENTS: We used total composite scores from the common cognitive tests administered. Cardiovascular risk was indicated by systolic and diastolic blood pressure, pulse rate, pro-B-type natriuretic peptide (proBNP), and homocysteine. Metabolic risk was measured by body mass index, glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol, and lipoprotein (a) (only in India). Inflammatory risk was indicted by white blood cell count, C-reactive protein, albumin, and uric acid (only in India).

RESULTS: The distribution of both total cognition scores and of cardiometabolic risk factors differed significantly between India and the United States. In both countries, lower cognition was associated with older age, lower education, elevated homocysteine, elevated proBNP, and lower albumin levels. The associations between HbA1c levels and cognitive measures were statistically significant in both countries, but in the opposite direction, with a coefficient of 1.5 (P < .001) in India and -2.4 (P < .001) in the United States for one percentage increase in absolute HbA1c value.

CONCLUSION: Cardiometabolic-inflammatory biomarkers are associated with cognitive functional levels in each country, but the relationships may vary across countries. J Am Geriatr Soc 68:S36-S44, 2020.

}, keywords = {cardiometabolic risk, Cognition, HCAP, LASI-DAD}, issn = {1532-5415}, doi = {10.1111/jgs.16734}, author = {Hu, Peifeng and Jinkook Lee and Beaumaster, Sidney and Jung K Kim and Dey, Sharmistha and David R Weir and Eileen M. Crimmins} } @article {11302, title = {Diet Quality and Biological Risk in a National Sample of Older Americans}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {920}, abstract = {Biomarkers are sensitive to current health status and capture aspects of health that may precede the development of disease and other health problems. Using comprehensive measures of biological risk, this study aims to investigate the relationship between intake of individual dietary components, overall diet quality, and biological dysregulation. For the analysis, we used nutrition and biomarker data from 3,641 older adults (over age 50) in the Health and Retirement Study. Eleven out of 13 individual dietary components were associated with lower biological risk. After controlling for SES, health behaviors, and access to health care, a high intake of fruits, greens and beans, whole grains, seafood and plant proteins, and fatty acids and a low intake of sodium and saturated fat were still associated with lower biological risk. Respondents with poor/suboptimal quality diet had higher biological risk than those with good quality diet. After controlling for SES, health behaviors, and access to health care, respondents with poor/suboptimal quality diet continued to exhibit higher biological risk than those with good quality diet, though the differences in biological risk were reduced. Findings from this study emphasize the importance of healthy eating in improving health of older adults. Encouraging intake of fruits, greens and beans, whole grains, seafood and plant proteins, and fatty acids, while limiting consumption of sodium and saturated fat would improve overall diet quality and contribute to the prevention of chronic diseases and morbidity.}, keywords = {biological risk, diet quality}, isbn = {2399-5300}, doi = {10.1093/geroni/igaa057.3378}, author = {Choi, Yeon Jin and Jennifer A Ailshire and Jung K Kim and Eileen M. Crimmins} } @article {doi:10.1002/ajhb.23390, title = {Dried blood spots: Effects of less than optimal collection, shipping time, heat, and humidity}, journal = {American Journal of Human Biology}, volume = {32}, year = {2020}, pages = {e23390}, abstract = {Abstract Objectives This study investigates how factors related to collection, storage, transport time, and environmental conditions affect the quality and accuracy of analyses of dried blood spot (DBS) samples. Methods Data come from the 2016 Health and Retirement Study (HRS) DBS laboratory reports and the HRS merged with the National Climatic Data Center (NCDC) Global Historical Climate Network Daily (NCDC GHCN-Daily) and the NCDC Local Climatological Data, by zip code. We ran regression models to examine the associations between assay values based on DBS for five analytes (total cholesterol, high-density lipoprotein (HDL) cholesterol, glycosylated hemoglobin (HbA1c), C-reactive protein (CRP), and cystatin C) and the characteristics of DBS cards and drops, shipping time, and temperature, and humidity at the time of collection. Results We found cholesterol measures to be sensitive to many factors including small spots, shipping time, high temperature and humidity. Small spots in DBS cards are related to lower values across all analytes. Longer DBS transit time before freezing is associated with lower values of total and HDL cholesterol and cystatin C. Results were similar whether or not venous blood sample values were included in equations. Conclusions Small spots, long shipping time, and exposure to high temperature and humidity need to be avoided if possible. Quality of spots and cards and information on shipping time and conditions should be coded with the data to make adjustments in values when necessary. The different results across analytes indicate that results cannot be generalized to all DBS assays.}, keywords = {Dried Blood Spot Testing}, doi = {10.1002/ajhb.23390}, author = {Eileen M. Crimmins and Yuan S Zhang and Jung K Kim and Frochen, Stephen and Kang, Hyewon and Shim, Hyunju and Jennifer A Ailshire and Potter, Alan and Cofferen, Jake and Jessica Faul} } @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 {10830, title = {Female vulnerability to the effects of smoking on health outcomes in older people}, journal = {PloS one}, volume = {15}, year = {2020}, abstract = {Cigarette smoking is among the leading risk factors for mortality and morbidity. While men have a higher smoking prevalence, mechanistic experiments suggest that women are at higher risk for health problems due to smoking. Moreover, the comparison of smoking effects on multiple conditions and mortality for men and women has not yet been done in a population-based group with race/ethnic diversity. We used proportional hazards models and restricted mean survival time to assess differences in smoking effects by sex for multiple health outcomes using data from the U.S. Health and Retirement Study (HRS), a population-representative cohort of individuals aged 50+ (n = 22,708, 1992-2014). Men had experienced more smoking pack-years than women (22.0 vs 15.6 average pack-years). Age of death, onset of lung disorders, heart disease, stroke, and cancer showed dose-dependent effects of smoking for both sexes. Among heavy smokers (>28 pack-years) women had higher risk of earlier age of death (HR = 1.3, 95\%CI:1.03-1.65) and stroke (HR = 1.37, 95\%CI:1.02-1.83). Risk of cancer and heart disease did not differ by sex for smokers. Women had earlier age of onset for lung disorders (HR = 2.83, 95\%CI:1.74-4.6), but men risk due to smoking were higher (Smoking-Sex interaction P<0.02) than women. Passive smoke exposure increased risk of earlier heart disease (HR = 1.33, 95\%CI:1.07-1.65) and stroke (HR:1.54, 95\%CI:1.07-2.22) for non-smokers, mainly in men. Smoking cessation after 15 years partially attenuated the deleterious smoking effects for all health outcomes. In sum, our results suggest that women are more vulnerable to ever smoking for earlier death and risk of stroke, but less vulnerable for lung disorders. From an epidemiological perspective, sex differences in smoking effects are important considerations that could underlie sex differences in health outcomes. These findings also encourage future mechanistic experiments to resolve potential mechanisms of sex-specific cigarette smoke toxicity.}, keywords = {Cardiovascular disease, Smoking, Women{\textquoteright}s Health}, isbn = {1932-6203}, doi = {10.1371/journal.pone.0234015}, url = {https://pubmed.ncbi.nlm.nih.gov/32497122}, author = {Haghani, Amin and Thalida E. Arpawong and Jung K Kim and Lewinger, Juan Pablo and Caleb E Finch and Eileen M. Crimmins} } @article {10097, title = {Racial and educational disparities in cognitive life expectancies.}, journal = {The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences}, volume = {75}, year = {2020}, pages = {e105-e112}, abstract = {

OBJECTIVES: We estimate life expectancy with and without dementia for Americans 65 years and older by education and race to examine how these stratification systems combine to shape disparities in later-life cognitive health.

METHOD: Based on the Health and Retirement Study (2000-2014), we use a multivariate, incidence-based life table approach to estimate life expectancy by cognitive health status for race-education groups. The models also simulate group differences in the prevalence of dementia implied by these rates.

RESULTS: The life table results document notable race-education differences in dementia and dementia-free life expectancy, as well as stark differences in implied dementia prevalence. At each education level, blacks can expect to live more years with dementia and they have significantly higher rates of dementia prevalence. This distribution of disparities in the older population is anchored by two groups -- blacks without a high school diploma and whites with some college or more.

DISCUSSION: Dementia experience and dementia burden differ dramatically along race-education lines. Race and education combine to exaggerate disparities and they both have enduring effects. Future research should explicitly consider how race and education combine to influence dementia in the older American population.

}, keywords = {Cognition \& Reasoning, Mortality, Racial/ethnic differences}, issn = {1758-5368}, doi = {10.1093/geronb/gbz046}, author = {Mateo P Farina and Mark D Hayward and Eileen M. Crimmins and Jung K Kim} } @article {10.1093/gerona/glz075, title = {Changing Disease Prevalence, Incidence, and Mortality Among Older Cohorts: The Health and Retirement Study}, journal = {The Journals of Gerontology: Series A}, volume = {74}, year = {2019}, month = {11}, pages = {S21-S26}, abstract = {This article investigates changes in disease prevalence, incidence, and mortality among four cohorts of older persons in the Health and Retirement Study.We examine two cohorts initially aged 51 to 61, whom we call younger cohorts, and two older cohorts aged 70 to 80 at the start of observation. Each of the paired cohorts was born about 10 years apart. We follow the cohorts for approximately 10 years.The prevalence of cancer, stroke, and diabetes increased in later-born cohorts; while the prevalence of myocardial infarction decreased markedly in both later-born cohorts. The incidence of heart disease, myocardial infarction, and stroke decreased among those in the later-born older cohort; while only the incidence of myocardial infarction decreased in the later-born younger cohort. On the other hand, diabetes incidence increased among those in both later-born cohorts. Death rates among those with heart disease, cancer, and diabetes decreased in the later-born cohorts. The declining incidence of three cardiovascular conditions among those who are over age 70 reflects improving population health and has resulted in stemming the increase in prevalence of people with heart disease and stroke.While these results provide some important signs of improving population health, especially among those over 70; trends for those less than 70 in the United States are not as positive.}, keywords = {disease incidence, disease prevalence, Mortality}, issn = {1079-5006}, doi = {10.1093/gerona/glz075}, url = {https://doi.org/10.1093/gerona/glz075}, author = {Eileen M. Crimmins and Yuan S Zhang and Jung K Kim and Morgan E. Levine} } @article {doi:10.1111/jgs.16163, title = {Cognitive Performance Among Older Persons in Japan and the United States}, journal = {Journal of the American Geriatrics Society}, year = {2019}, abstract = {OBJECTIVE To compare cognitive performance among Japanese and American persons, aged 68 years and older, using two nationally representative studies and to examine whether differences can be explained by differences in the distribution of risk factors or in their association with cognitive performance. DESIGN Nationally representative studies with harmonized collection of data on cognitive functioning. SETTING Nihon University Japanese Longitudinal Study of Aging and the US Health and Retirement Study. PARTICIPANTS A total of 1953 Japanese adults and 2959 US adults, aged 68 years or older. MEASUREMENTS Episodic memory and arithmetic working memory are measured using immediate and delayed word recall and serial 7s. RESULTS Americans have higher scores on episodic memory than Japanese people (0.72 points on a 20-point scale); however, when education is controlled, American and Japanese people did not differ. Level of working memory was higher in Japan (0.36 on a 5-point scale) than in the United States, and the effect of education on working memory was stronger among Americans than Japanese people. There are no differences over the age of 85 years. CONCLUSION Even with large differences in educational attainment and a strong effect of education on cognitive functioning, the overall differences in cognitive functioning between the United States and Japan are modest. Differences in health appear to have little effect on national differences in cognition.}, keywords = {cognitive performance, Education, Japan, Nihon University Japanese Longitudinal Study of Aging, United States}, doi = {10.1111/jgs.16163}, url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16163}, author = {Saito, Yasuhiko and Jung K Kim and Davarian, Shieva and Hagedorn, Aaron and Eileen M. Crimmins} } @article {9591, title = {Educational Differences in the Prevalence of Dementia and Life Expectancy with Dementia: Changes from 2000 to 2010.}, journal = {Journals of Gerontology Series B: Psychological Sciences \& Social Sciences}, volume = {73}, year = {2018}, pages = {S20-S28}, abstract = {

Objectives: This article provides the first estimates of educational differences in age-specific prevalence, and changes in prevalence over time, of dementia by education levels in the United States. It also provides information on life expectancy, and changes in life expectancy, with dementia and cognitively healthy life for educational groups.

Method: Data on cognition from the 2000 and 2010 Health and Retirement Study are used to classify respondents as having dementia, cognitive impairment without dementia (CIND), or being cognitively intact. Vital statistics data are used to estimate life tables for education groups and the Sullivan method is used to estimate life expectancy by cognitive state.

Results: People with more education have lower prevalence of dementia, more years of cognitively healthy life, and fewer years with dementia. Years spent in good cognition increased for most sex-education groups and, conversely, years spent with dementia decreased for some. Mortality reduction was the most important factor in increasing cognitively healthy life. Change in the distribution of educational attainment has played a major role in the reduction of life with dementia in the overall population.

Discussion: Differences in the burden of cognitive loss by education point to the significant cost of low social status both to individuals and to society.

}, keywords = {Dementia, Education, Mortality}, issn = {1758-5368}, doi = {10.1093/geronb/gbx135}, author = {Eileen M. Crimmins and Saito, Yasuhiko and Jung K Kim and Yuan S Zhang and Sasson, Isaac and Mark D Hayward} } @article {9387, title = {Documentation of Blood-Based Biomarkers in the 2014 Health and Retirement Study}, year = {2017}, month = {12/2017}, institution = {Survey Research Center, Institute for Social Research, University of Michigan}, address = {Ann Arbor, MI}, author = {Eileen M. Crimmins and Jessica Faul and Jung K Kim and David R Weir} } @article {8810, title = {Change in Cognitively Healthy and Cognitively Impaired Life Expectancy in the United States: 2000-2010.}, journal = {SSM Popul Health}, volume = {2}, year = {2016}, month = {2016 Dec}, pages = {793-797}, abstract = {

OBJECTIVE: To determine how cognitively healthy and cognitively impaired life expectancy have changed from 2000 to 2010 among American men and women 65 years of age and over.

METHODS: The prevalence of dementia, cognitive impairment without dementia (CIND), and normal cognition is determined from the nationally representative data from the U.S. Health and Retirement Study (HRS). Mortality rates are from U.S. Decennial Life Table for 2000 and the U.S. annual life table for 2010. Life expectancy by cognitive status is estimated using the Sullivan method.

RESULTS: Most of the increase in life expectancy has been concentrated in cognitively healthy years in this 10 year period. The increase in expected years cognitively intact at age 65, which exceeded that in total life expectancy, was 1.8 for men and 1.6 for women.

CONCLUSION: This study provides evidence suggesting that there has been a compression of cognitive morbidity.

}, issn = {2352-8273}, doi = {10.1016/j.ssmph.2016.10.007}, url = {http://linkinghub.elsevier.com/retrieve/pii/S2352827316301148http://api.elsevier.com/content/article/PII:S2352827316301148?httpAccept=text/plainhttp://api.elsevier.com/content/article/PII:S2352827316301148?httpAccept=text/xml}, author = {Eileen M. Crimmins and Saito, Yasuhiko and Jung K Kim} } @article {8519, title = {Documentation of Biomarkers in the 2010 and 2012 Health and Retirement Study}, number = {DR-031}, year = {2015}, month = {04/2015}, pages = {15}, institution = {Survey Research Center, University of Michigan}, address = {Ann Arbor, Michigan}, keywords = {Biomarkers, Meta-analyses, Survey Methodology}, author = {Eileen M. Crimmins and Jessica Faul and Jung K Kim and David R Weir} } @article {8602, title = {Validation of blood-based assays using dried blood spots for use in large population studies.}, journal = {Biodemography Soc Biol}, volume = {60}, year = {2014}, month = {2014}, pages = {38-48}, abstract = {

Assessment of health in large population studies has increasingly incorporated measures of blood-based biomarkers based on the use of dried blood spots (DBS). The validity of DBS assessments made by labs used by large studies is addressed by comparing assay values from DBS collected using conditions similar to those used in the field with values from whole blood samples. The DBS approach generates values that are strongly related to whole blood levels of HbA1c, cystatin C, and C-reactive protein. Assessing lipid levels reliably with DBS appears to be a greater challenge. However, even when DBS values and values from venous blood are highly correlated, they are often on a different scale, and using conventional cutoffs may be misleading.

}, keywords = {Biomarkers, C-reactive protein, Cholesterol, Cholesterol, HDL, Cystatin C, Dried Blood Spot Testing, Glycated Hemoglobin A, Humans, Middle Aged, Reference Values, Reproducibility of Results}, issn = {1948-5573}, doi = {10.1080/19485565.2014.901885}, url = {http://www.tandfonline.com/doi/abs/10.1080/19485565.2014.901885}, author = {Eileen M. Crimmins and Jung K Kim and Heather McCreath and Jessica Faul and David R Weir and Teresa Seeman} } @article {5954, title = {Documentation of Biomarkers in the 2006 and 2008 Health and Retirement Study}, year = {2013}, institution = {Institute for Social Research, University of Michigan}, address = {Ann Arbor, Michigan}, abstract = {Biomarkers refer to the general range of physiological, metabolic, biochemical, endocrine and genetic measures that can be obtained in living organisms. The term is most commonly used to refer to one-time biochemical or hematological measures made on blood or other available bodily fluids, but perhaps the term should be used for a broader range of measures. In 2006 and 2008, HRS included the following biomarkers measurements, administered in this order: Saliva collection for DNA extraction; Blood spot collection for cholesterol, hemoglobin A1C, CRP and cystatin C analysis (results for C-reactive protein and cystatin C are forthcoming). This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions.}, keywords = {Health Conditions and Status, Healthcare, Methodology}, author = {Eileen M. Crimmins and Jessica Faul and Jung K Kim and Heidi M Guyer and Kenneth M. Langa and Mary Beth Ofstedal and Amanda Sonnega and Robert B Wallace and David R Weir} } @article {7631, title = {Assessment of cognition using surveys and neuropsychological assessment: the Health and Retirement Study and the Aging, Demographics, and Memory Study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66 Suppl 1}, year = {2011}, note = {Crimmins, Eileen M Kim, Jung Ki Langa, Kenneth M Weir, David R P30 AG17265/AG/NIA NIH HHS/United States U01 AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States The journals of gerontology. Series B, Psychological sciences and social sciences J Gerontol B Psychol Sci Soc Sci. 2011 Jul;66 Suppl 1:i162-71.}, month = {2011 Jul}, pages = {i162-71}, publisher = {66 Suppl 1}, abstract = {

OBJECTIVES: This study examines the similarity of cognitive assessments using 1 interview in a large population study, the Health and Retirement Study (HRS), and a subsample in which a detailed neuropsychiatric assessment has been performed (Aging, Demographics, and Memory Study [ADAMS]).

METHODS: Respondents are diagnosed in ADAMS as demented, cognitively impaired without dementia (CIND), or as having normal cognitive function. Multinomial logistic analysis is used to predict diagnosis using a variety of cognitive and noncognitive measures from the HRS and additional measures and information from ADAMS.

RESULTS: The cognitive tests in HRS predict the ADAMS diagnosis in 74\% of the sample able to complete the HRS survey on their own. Proxy respondents answer for a large proportion of HRS respondents who are diagnosed as demented in ADAMS. Classification of proxy respondents with some cognitive impairment can be predicted in 86\% of the sample. Adding a small number of additional tests from ADAMS can increase each of these percentages to 84\% and 93\%, respectively.

DISCUSSION: Cognitive assessment appropriate for diagnosis of dementia and CIND in large population surveys could be improved with more targeted information from informants and additional cognitive tests targeting other areas of brain function.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Cognition, Cognition Disorders, Dementia, Educational Status, Female, Humans, Interviews as Topic, Logistic Models, Longitudinal Studies, Male, Multivariate Analysis, Neuropsychological tests, Odds Ratio, Prevalence, Sex Factors, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbr048}, author = {Eileen M. Crimmins and Jung K Kim and Kenneth M. Langa and David R Weir} } @article {7503, title = {Gender differences in health: results from SHARE, ELSA and HRS.}, journal = {Eur J Public Health}, volume = {21}, year = {2011}, month = {2011 Feb}, pages = {81-91}, abstract = {

BACKGROUND: We examine gender differences in health at ages 50 years and older in 11 European countries, England and the USA.

METHODS: We use the Survey of Health, Ageing and Retirement (SHARE) for 11 Continental European countries; the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS) for the USA to examine gender differences in health behaviours, functioning problems, disability, disease prevalence and self-rated health.

RESULTS: Women in all countries are more likely than men to have disabling, non-lethal conditions including functioning problems [odds ratio (OR) indicating the effect of female is 1.57-2.43], IADL difficulties (OR 1.45-2.94), arthritis (OR 1.46-2.90) and depressive symptoms (OR 1.45-3.35). On the other hand, self-reported heart disease is more common among men (OR indicating effect of female ranges from 0.43 to 0.86). These differences are not eliminated by controlling for smoking behaviour and weight. Self-reported hypertension (OR 0.72-1.53) is generally more common among women; stroke and diabetes do not show consistent sex differences. While subjective assessment of health is poorer among women, this is not true when indicators of functioning, disability and diseases are controlled.

CONCLUSION: There is remarkable consistency in direction of gender differences in health across these 13 countries. The size of the differences is affected in many cases by the similarity in behaviours of men and women.

}, keywords = {Activities of Daily Living, Aged, Aging, Body Weights and Measures, Chronic disease, Employment, Female, Global Health, Health Behavior, Health Status, Humans, Male, Middle Aged, Self Report, Sex Factors}, issn = {1464-360X}, doi = {10.1093/eurpub/ckq022}, author = {Eileen M. Crimmins and Jung K Kim and Sole-Auro, Aida} } @article {5919, title = {Results from the Health and Retirement Study Biomarker Validation Project}, year = {2011}, institution = {Ann Arbor, The University of Michigan}, keywords = {Health Conditions and Status, Methodology}, author = {Eileen M. Crimmins and Jung K Kim and Heather McCreath and Teresa Seeman} } @inbook {5238, title = {Are International Differences in Health Similar to International Differences in Life-Expectancy?}, booktitle = {International Differences in Mortality at Older Ages: Dimensions and Sources}, year = {2010}, publisher = {National Academies Press}, organization = {National Academies Press}, chapter = {3}, address = {Washington, D.C.}, abstract = {The question addressed in this chapter is whether people in countries with relatively low life expectancy after age 50 have worse health than those in countries with longer life expectancy. We begin with a short discussion of the theoretical relationships between mortality and population health and the potential complexity of the link between measures of health and mortality. We then examine how indicators of health vary across countries and how closely differences in a set of health indicators correspond to differences in mortality across 10 countries. We note at the outset that most of the data we examine reflect analysis of cross-sectional differences in health; without comparable longitudinal data, there is little we can say about how the differences arose. The countries compared include Australia, Canada, Denmark, England, France, Italy, Japan, the Netherlands, Spain, and the United States. }, keywords = {ELSA, Methodology, SHARE}, url = {https://www.ncbi.nlm.nih.gov/books/NBK62588/$\#$:~:text=Two\%20countries\%20with\%20the\%20same,life\%20expectancy\%20could\%20be\%20higher.}, author = {Eileen M. Crimmins and Krista Garcia and Jung K Kim}, editor = {Eileen M. Crimmins and Samuel H. Preston and Barney Cohen} } @article {7282, title = {Life with and without heart disease among women and men over 50.}, journal = {J Women Aging}, volume = {20}, year = {2008}, month = {2008}, pages = {5-19}, publisher = {20}, abstract = {

This article uses a demographic approach and data from the Health and Retirement Survey, a nationally representative sample of the U.S. population, to investigate sex differences in the length of life lived with heart disease and after a heart attack for persons in the United States age 50 and older. On average, women live longer than men with heart disease. At age 50 women can expect to live 7.9 years and men 6.7 years with heart disease. The average woman experiences heart disease onset three years older and heart attacks 4.4 years older than men.

}, keywords = {Activities of Daily Living, Aged, Female, Health Status, Heart Diseases, Humans, Life Expectancy, Male, Middle Aged, Myocardial Infarction, Patient Education as Topic, Prejudice, Risk Factors, United States, Women{\textquoteright}s Health, Women{\textquoteright}s Health Services}, issn = {0895-2841}, doi = {10.1300/j074v20n01_02}, author = {Eileen M. Crimmins and Mark D Hayward and Ueda, Hiroshi and Saito, Yasuhiko and Jung K Kim} } @article {6845, title = {Life expectancy with cognitive impairment in the older population of the United States.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {58}, year = {2003}, month = {2003 May}, pages = {S179-86}, publisher = {58B}, abstract = {

OBJECTIVES: This article provides estimates of the prevalence of cognitive impairment by age and sex for a nationally representative sample of the U.S. population aged 70 and over. From these estimates, years of life with and without cognitive impairment are calculated.

METHODS: Using data from the Assets and Health Dynamics of the Oldest Old (AHEAD) survey, the prevalence of cognitive impairment is estimated for a sample representing both the community-dwelling and institutionalized older American population. Sullivan{\textquoteright}s method is used to calculate the average number of years an elderly person can expect to live with and without cognitive impairment.

RESULTS: The prevalence of moderate to severe cognitive impairment in the total U.S. population aged 70 and over is 9.5\%. At age 70, the average American can expect 1.5 years with cognitive impairment. Expected length of life with cognitive impairment is longer for women than men because of their longer life expectancy.

DISCUSSION: As total life expectancy continues to increase, the length of life with cognitive impairment for the American population will increase unless age-specific prevalence is reduced. There is great potential for improvement in future early treatment and diagnosis of this condition.

}, keywords = {Aged, Aged, 80 and over, Alzheimer disease, Cross-Sectional Studies, Female, Humans, Life Expectancy, Male, Neuropsychological tests, Probability, Psychometrics, Sex Factors, Survival Analysis, United States}, issn = {1079-5014}, doi = {10.1093/geronb/58.3.s179}, author = {Suthers, Kristen and Jung K Kim and Eileen M. Crimmins} }