@article {12874, title = {Understanding cognitive impairment in the U.S. through the lenses of intersectionality and (un)conditional cumulative (dis)advantage}, number = {WP 2022-029}, year = {2022}, institution = {Max Planck Institute}, abstract = {Grounded in theories of intersectionality and cumulative (dis)advantage, we develop complementary formalizations of (dis)advantage to study disparities in cognitive impairment: Conditional Cumulative (Dis)Advantage that reflects inequalities in outcomes and Unconditional Cumulative (Dis)Advantage that additionally accounts for inequalities in opportunities. We study the properties of these formalizations and show that cumulative disadvantage does not imply cumulative advantage. Using these formalizations and incidence-based multistate models, we analyze the Health and Retirement Study to assess how racial/ethnic, nativity, gender, early-life adversity, and educational (dis)advantages accumulate into three important metrics for characterizing later-life cognitive impairment{\textemdash}lifetime risk, mean age at first impairment, and cognitive health expectancies. We find that the benefits and penalties of one (dis)advantage depend on positionality on the other axes of inequality. Black women and Latinas experience Conditional Cumulative Disadvantage in cognitive impairment: they are penalized more from having lower education than Whites. White men experience Conditional Cumulative Advantage: they benefit more from higher education than Blacks or Latinx. However, when accounting for racial/ethnic inequities in educational opportunities, results ubiquitously show Unconditional Cumulative Disadvantage. Our formalization provides a mathematical grounding for cumulative (dis)advantage, and the empirical results comprehensively document the multi-dimensional, intersecting axes of stratification that perpetuate inequities in cognitive impairment.}, keywords = {cognitive impairment, cumulative (dis)advantage, Dementia, Education, Health Disparities, Intersectionality}, doi = {10.4054/MPIDR-WP-2022-029}, author = {Jo Mhairi Hale and Daniel C Schneider and Neil K Mehta and Mikko Myrskyl{\"a}} } @article {11722, title = {Unmet Expectations About Work at Age 62 and Depressive Symptoms.}, journal = {The Journals of Gerontology, Series B }, volume = {77}, year = {2022}, pages = {615-625}, abstract = {

OBJECTIVES: Exiting the labor force earlier or later than planned is common, with predictable economic consequences. However, the mental health ramifications of such off-time events are not known but are important to promoting well-being in retirement.

METHODS: Using the Health and Retirement Study (1992-2016), we created six groups based on the alignment of expectations about full-time work at age 62 (reported at ages 51-61) with realized labor force status after reaching age 62 (N=10,421). Negative binomial models estimated the adjusted association between unmet expectations about work and depressive symptoms.

RESULTS: Unexpectedly not working was associated with higher depressive symptoms than working as expected after adjusting for sociodemographic, economic, and health factors at the time of expectations (IRR=1.35, 95\% CI:1.17, 1.56). Additionally adjusting for health declines and marriage dissolution between expectations and age 62 partially attenuated the association, but unexpectedly not working remained significantly associated with a 1.16 increase in the incidence rate of depressive symptoms. Unexpectedly working at 62 was not associated with depressive symptoms. Race/ethnicity interacted with expectation alignment (F(15,42)=2.44, p=0.0118) in that Hispanic respondents experienced an increase in depressive symptoms when working after unmet and unsure expectations compared to met expectations, whereas white respondents did not.

DISCUSSION: Unlike working longer than expected, unexpectedly not working at 62 was associated with depressive symptoms, even after accounting for health declines. Public and employer policies should assist workers in remaining in the labor force as long as planned and offer mental health supports for unexpected work exits.

}, keywords = {depression, Expectations, Mental Health, Retirement}, issn = {1758-5368}, doi = {10.1093/geronb/gbab113}, author = {Leah R. Abrams and Philippa J Clarke and Neil K Mehta} } @article {abrams_clarke_mehta_2020, title = {Work at age 62: expectations and realisations among recent cohorts of Americans}, journal = {Ageing and Society}, volume = {42}, year = {2022}, pages = {1213-1233}, abstract = {Much remains unknown about how the 2008 Great Recession, coupled with the ageing baby-boomer cohort, have shaped retirement expectations and realised retirement timing across diverse groups of older Americans. Using the Health and Retirement Study (1992{\textendash}2016), we compared expectations about full-time work at age 62 (reported at ages 51{\textendash}61) with realised labour force status at age 62. Of the 12,049 respondents, 34 per cent reported no chance of working full time at 62 (zero probability) and 21 per cent reported it was very likely (90{\textendash}100 probability). Among those reporting no chance of working, there was a 0.111 probability of unmet expectations; among those with high expectations of working, there was a 0.430 probability of unmet expectations. Black and Hispanic Americans were more likely than white Americans to have unmet expectations of both types. Educational attainment was associated with higher probability of unexpectedly working and lower probability of unexpectedly not working. Baby-boomers experienced fewer unmet expectations than prior cohorts but more uncertainty about work status at 62. Our findings highlight the unpredictability of retirement timing for significant segments of the US population and the role of the Great Recession in contributing to uncertainty. Given the individual and societal benefits of long work lives, special attention should be paid to the high rates of unexpectedly not working at age 62.}, keywords = {birth cohorts, Education, race, retirement timing, unmet expectations, Work}, doi = {10.1017/S0144686X20001531}, author = {Leah R. Abrams and Philippa J Clarke and Neil K Mehta} } @article {HALE2020100577, title = {Cognitive impairment in the U.S.: Lifetime risk, age at onset, and years impaired}, journal = {SSM - Population Health}, volume = {11}, year = {2020}, pages = {100577}, abstract = {Prior studies have analyzed the burden of cognitive impairment, but often use potentially biased prevalence-based methods or measure only years lived with impairment, without estimating other relevant metrics. We use the Health and Retirement Study (1998{\textendash}2014; n = 29,304) and the preferred incidence-based Markov-chain models to assess three key measures of the burden of cognitive impairment: lifetime risk, mean age at onset, and number of years lived impaired. We analyze both mild and severe cognitive impairment (dementia) and gender, racial/ethnic, and educational variation in impairment. Our results paint a multi-dimensional picture of cognitive health, presenting the first comprehensive analysis of the burden of cognitive impairment for the U.S. population age 50 and older. Approximately two out of three Americans experience some level of cognitive impairment at an average age of approximately 70 years. For dementia, lifetime risk for women (men) is 37\% (24\%) and mean age at onset 83 (79) years. Women can expect to live 4.2 years with mild impairment and 3.2 with dementia, men 3.5 and 1.8 years. A critical finding is that for the most advantaged groups (i.e., White and/or higher educated), cognitive impairment is both delayed and compressed toward the very end of life. In contrast, despite the shorter lives of disadvantaged subgroups (Black and/or lower educated), they experience a younger age of onset, higher lifetime risk, and more years cognitively impaired. For example, men with at least an Associate degree have 21\% lifetime dementia risk, compared to 35\% among men with less than high school education. White women have 6 years of cognitively-impaired life expectancy, compared to 12 and 13 years among Black women and Latinas. These educational and racial/ethnic gradients highlight the very uneven burden of cognitive impairment. Further research is required to identify the mechanisms driving these disparities in cognitive impairment.}, keywords = {cognitive impairment, Dementia, Education, Health Disparities, Race/ethnicity}, issn = {2352-8273}, doi = {10.1016/j.ssmph.2020.100577}, author = {Jo Mhairi Hale and Daniel C Schneider and Neil K Mehta and Mikko Myrskyl{\"a}} } @article {10977, title = {Trends in the Risk of Cognitive Impairment in the United States, 1996{\textendash}2014}, journal = {Epidemiology}, volume = {31}, year = {2020}, pages = {745-754}, abstract = {Background: Accumulating evidence suggests risk of cognitive impairment is declining in high-income countries. Much of this research uses longitudinal surveys in which learning over repeated tests may bias results. We analyze trends in cognitive impairment in the United States, accounting for prior test experience and selective mortality. Methods: We use the Health and Retirement Study, a population-based, nationally representative panel dataset and include individuals ages 50 years and older in 1996{\textendash}2014 (n = 32,784). We measure cognitive impairment and dementia using standard cutpoints of the modified Telephone Interview for Cognitive Status. We estimate logistic regression models for any impairment and dementia over time, adjusting for age, sex, and race/ethnicity, comparing models with and without adjustment for practice effects and education. We examine heterogeneity in trends by age, sex, race/ethnicity, and education. Results: Models not controlling for test experience suggest that risk of cognitive impairment and dementia decreased over the study period. Controlling for test experience reverses the trend. In our primary models, prevalence of any cognitive impairment increased for women from 18.7\% to 21.2\% (annual change 0.7\%, 95\% confidence interval [CI], 0.1\%, 1.3\%) and for men from 17.6\% to 21.0\% (annual change 1.0\%, CI, 0.5\%, 1.4\%). For dementia, women{\textquoteright}s annual increase was 1.7\% (CI, 0.8\%, 2.6\%) and men{\textquoteright}s 2.0\% (CI, 1.0\%, 2.9\%). If not for education, the increase would have been stronger. Increased risk was particularly rapid for Latinas, the least educated, and older ages. Conclusions: Risk of cognitive impairment increased from 1996 to 2014. Uncovering determinants of increasing cognitive impairment risk should become a research priority. See video abstract: http://links.lww.com/EDE/B702.}, keywords = {cognitive impairment, Dementia; Learning, Practice effects, Trends}, isbn = {1044-3983}, doi = {10.1097/EDE.0000000000001219}, author = {Jo Mhairi Hale and Daniel C Schneider and Gampe, Jutta and Neil K Mehta and Mikko Myrskyl{\"a}} } @article {10025, title = {Changes in depressive symptoms over age among older Americans: Differences by gender, race/ethnicity, education, and birth cohort}, journal = {SSM - Population Health}, volume = {7}, year = {2019}, abstract = {Despite concerns about recent trends in the health and functioning of older Americans, little is known about dynamics of depression among recent cohorts of U.S. older adults and how these dynamics differ across sociodemographic groups. This study examined sociodemographic differences in mid- and late-life depressive symptoms over age, as well as changes over time. Using nationally representative data from the Health and Retirement Study (1994{\textendash}2014), we estimated mixed effects models to generate depressive symptoms over age by gender, race/ethnicity, education, and birth cohort in 33,280 adults ages 51{\textendash}90 years. Depressive symptoms were measured using the 8-item Center for Epidemiological Studies Depression scale. Women compared to men, low compared to high education groups, and racial/ethnic minorities compared to whites exhibited higher depressive symptoms. The largest disparity resulted from education, with those without high school degrees exhibiting over two more predicted depressive symptoms in midlife compared to those with college degrees. Importantly, war babies and baby boomers (born 1942{\textendash}1959) exhibited slightly higher depressive symptoms with more decreasing symptoms over age than their predecessors (born 1931{\textendash}1941) at ages 51{\textendash}65. We additionally observed an age-as-leveler pattern by gender, whereby females compared to males had higher depressive symptomology from ages 51{\textendash}85, but not at ages 86{\textendash}90. Our findings have implication for gauging the aging population{\textquoteright}s overall well-being, for public health policies aimed at reducing health disparities, and for anticipating demand on an array of health and social services.}, keywords = {Depressive symptoms, Education, Gender Differences, Racial/ethnic differences, Women and Minorities}, issn = {23528273}, doi = {10.1016/j.ssmph.2019.100399}, author = {Leah R. Abrams and Neil K Mehta} } @article {9451, title = {Life expectancy with and without cognitive impairment by diabetes status among older Americans.}, journal = {PLoS One}, volume = {12}, year = {2017}, abstract = {Diabetes affects mortality and cognitive functioning. It is not known how diabetes influences life expectancy (LE) with and without cognitive impairment. We seek to examine age at onset of cognitive impairment and life expectancy (LE) with and without cognitive impairment by diabetes status among middle- and older-aged Americans. Data come from the U.S. Health and Retirement Study 2000-2012 linked to the National Death Index (N = 13,687). We use multinomial regression models stratified by gender and controlling for age, education and race/ethnicity to estimate diabetes-status specific transition probabilities, then use a Markov chain matrix population model to calculate age at onset of cognitive impairment and LE with and without cognitive impairment by diabetes status at age 50. LE at age 50 was 27.6 (men) and 32.1 (women). From age 50, those with diabetes had a first incidence of cognitive impairment 3 (men) and 4 (women) years earlier than those without. Diabetes reduced total LE by 5-7 years and cognitively healthy LE by 4-6 years. Those with diabetes lived one year less in a cognitively impaired state than those without. Over 80\% of the lower LE associated with diabetes is attributable to the loss of cognitively-healthy years. Those with diabetes have a shorter LE with cognitive impairment because of higher mortality. In analyses by educational attainment, education was strongly protective of cognitive health, yet diabetes was associated with lower age of cognitive impairment onset and fewer cognitive healthy years lived in all educational groups. The excess mortality because of diabetes may be decreasing. If the mortality decline is not coupled with a comparable decline in the risk of cognitive impairment, the population level burden of impaired cognition may grow larger.}, keywords = {CIND, Cognitive Ability, Diabetes, Mortality, NDI}, issn = {1932-6203}, doi = {10.1371/journal.pone.0190488}, author = {D{\'\i}az-Venegas, Carlos and Daniel C Schneider and Mikko Myrskyl{\"a} and Neil K Mehta} } @article {9505, title = {Life expectancy with and without cognitive impairment by diabetes status among older Americans}, journal = {PLOS ONE}, volume = {12}, year = {2017}, pages = {e0190488}, abstract = {Diabetes affects mortality and cognitive functioning. It is not known how diabetes influences life expectancy (LE) with and without cognitive impairment. We seek to examine age at onset of cognitive impairment and life expectancy (LE) with and without cognitive impairment by diabetes status among middle-and older-aged Americans. Data come from the U.S. Health and Retirement Study 2000 +/- 2012 linked to the National Death Index (N = 13,687). We use multinomial regression models stratified by gender and controlling for age, education and race/ethnicity to estimate diabetes-status specific transition probabilities, then use a Markov chain matrix population model to calculate age at onset of cognitive impairment and LE with and without cognitive impairment by diabetes status at age 50. LE at age 50 was 27.6 (men) and 32.1 (women). From age 50, those with diabetes had a first incidence of cognitive impairment 3 (men) and 4 (women) years earlier than those without. Diabetes reduced total LE by 5 +/- 7 years and cognitively healthy LE by 4 +/- 6 years. Those with diabetes lived one year less in a cognitively impaired state than those without. Over 80\% of the lower LE associated with diabetes is attributable to the loss of cognitively-healthy years. Those with diabetes have a shorter LE with cognitive impairment because of higher mortality. In analyses by educational attainment, education was strongly protective of cognitive health, yet diabetes was associated with lower age of cognitive impairment onset and fewer cognitive healthy years lived in all educational groups. The excess mortality because of diabetes may be decreasing. If the mortality decline is not coupled with a comparable decline in the risk of cognitive impairment, the population level burden of impaired cognition may grow larger.}, keywords = {Cognitive Ability, Diabetes, Mortality, NDI}, doi = {10.1371/journal.pone.0190488}, author = {D{\'\i}az-Venegas, Carlos and Daniel C Schneider and Mikko Myrskyl{\"a} and Neil K Mehta}, editor = {Stephen D. Ginsberg} } @article {9253, title = {The population health benefits of a healthy lifestyle: Life expectancy increased and onset of disability delayed.}, journal = {Health Affairs}, volume = {36}, year = {2017}, pages = {1495-1502}, abstract = {A key determinant of population health is the behavioral profile of a population. Nearly 80~percent of Americans reach their fifties having smoked cigarettes, been obese, or both. It is unknown to what extent risky behaviors (for example, smoking, having a poor diet, being physically inactive, and consuming an excessive amount of alcohol) collectively are reducing the health and life expectancy of the US population, or what improvements might be achievable in their absence. Using data from the Health and Retirement Study, we studied people ages fifty and older who had never smoked, who were not obese, and who consumed alcohol moderately. Compared to the whole US population, those with such a favorable behavioral profile had a life expectancy at age fifty that was seven years longer, and they experienced a delay in the onset of disability of up to six years. These results provide a benchmark for evaluating the massively damaging effects that behavioral risks have on health at older ages and the importance of prioritizing policies to implement behavioral-based interventions.}, keywords = {Disabilities, Life Expectancy, Mortality, Population Health}, issn = {1544-5208}, doi = {10.1377/hlthaff.2016.1569}, author = {Neil K Mehta and Mikko Myrskyl{\"a}} } @mastersthesis {6001, title = {Contemporary Topics in American Adult Health and Mortality: Obesity and immigration}, year = {2009}, school = {University of Pennsylvania}, address = {Philadelphia, PA}, abstract = {Two contemporary topics in American health and mortality are investigated: obesity and immigration. In the first essay, I investigate mortality attributable to obesity among U.S. middle-aged adults in the Health and Retirement Study. I find that obesity is a small source of attributable mortality challenging the viewpoint that obesity will stem long-term declines in U.S. mortality. In the second essay, I address another controversial issue pertaining to obesity and mortality, namely that of period trends. Across three major U.S. data (NHANES, Framingham, and NHIS), I find systematic evidence that the effect of obesity on mortality declined during 1968-2003. This decline is entirely attributed to a declining effect of obesity on cardiovascular-specific mortality. Therefore, prior studies, which either combine periods or rely on older data, do not provide a contemporary view of the mortality effects of obesity. In the third essay, I investigate the contextual determinants of obesity. In a multilevel framework, I estimate the association between the restaurant environment and BMI. While previous literature focuses on fast food, I investigate fast food and full service restaurants as well as individual- and contextual-level socioeconomic correlates. I find that a higher density of fast food is associated with higher BMI. In contrast, a higher density of full service restaurants is associated with lower BMI, suggesting a need for research into the comparative healthfulness of foods served at different types of restaurants. In the fourth essay, I investigate migrant selection and health among U.S. immigrants from the former Soviet Union (FSU), an understudied group. Unlike other U.S. immigrants, I uncover that FSU immigrants report higher levels of physical limitations compared to U.S.-born whites (ages 50-84). I use changes in immigration policy as a "natural experiment" to investigate the health effects of migrant selection. Results indicate that FSU immigrants who arrived under stricter migration policies, and therefore were more highly selected, display lower levels of physical limitations compared to those who migrated under policies that were more lenient. I compare Russian-born U.S. immigrants to that of nonimmigrants in Russia. Results indicate a positive health selection for Russian-born U.S. immigrants from their originating population.}, keywords = {Demographics, Health Conditions and Status}, url = {https://repository.upenn.edu/dissertations/AAI3381756/}, author = {Neil K Mehta} } @article {7377, title = {Mortality attributable to obesity among middle-aged adults in the United States.}, journal = {Demography}, volume = {46}, year = {2009}, month = {2009 Nov}, pages = {851-72}, publisher = {46}, abstract = {

Obesity is considered a major cause of premature mortality and a potential threat to the longstanding secular decline in mortality in the United States. We measure relative and attributable risks associated with obesity among middle-aged adults using data from the Health and Retirement Study (1992-2004). Although class II/III obesity (BMI > or = or = 35.0 kg/m2) increases mortality by 40\% in females and 62\% in males compared with normal BMI (BMI = 18.5-24.9), class I obesity (BMI = 30.0-34.9) and being overweight (BMI = 25.0-29.9) are not associated with excess mortality. With respect to attributable mortality, class II/III obesity (BMI > or = 35.0) is responsible for approximately 4\% of deaths among females and 3\% of deaths among males. Obesity is often compared with cigarette smoking as a major source of avoidable mortality. Smoking-attributable mortality is much larger in this cohort: about 36\% in females and 50\% in males. Results are robust to confounding by preexisting diseases, multiple dimensions of socioeconomic status (SES), smoking, and other correlates. These findings challenge the viewpoint that obesity will stem the long-term secular decline in U.S. mortality.

}, keywords = {Body Mass Index, Confidence Intervals, Confounding Factors, Epidemiologic, Female, Humans, Male, Middle Aged, Multivariate Analysis, Obesity, Proportional Hazards Models, Risk, Socioeconomic factors, United States}, issn = {0070-3370}, doi = {10.1353/dem.0.0077}, author = {Neil K Mehta and Virginia W Chang} }