@article {10995, title = {Increases in BMI and Chronic Pain for US Adults in Midlife, 1992 to 2016}, journal = {SSM - Population Health}, year = {2020}, abstract = {Recent unprecedented increases in mortality and morbidity during midlife are often ascribed to rising despair in the US population. An alternative and less often examined explanation is that these trends reflect, at least in part, the lagged effects of the obesity epidemic. Adults in midlife today are more likely to live with obesity and have a greater cumulative exposure to excess adiposity during their lifetime than any previous generation. Prior work has demonstrated a link between obesity and mortality risk at midlife, but the mechanisms remain unclear. Pain may represent one important pathway linking obesity to mortality trends. Pain is a debilitating condition that has increased significantly over recent decades and is associated with both morbidity and mortality, including suicide and opioid-related mortality. Evidence suggests obesity and pain may be linked, but there is little evidence of an association at the population level. In this paper, we examine to what extent increases in overweight and obesity explain the rising trends in chronic pain observed among middle-aged adults in the US from 1992 to 2016. We assess trends in both mild/moderate nonlimiting pain and severe and/or limiting pain. In doing so, we draw attention to one mechanism through which overweight/obesity may have contributed to recent population health trends. Our analysis found that increases in BMI from 1992 to 2016 may account for up to 20\% of the upward trend in mild/moderate nonlimiting pain and 32\% of the trend in severe and/or limiting pain for women, and 10\% and 19\% of the trends respectively for men.}, keywords = {activity limitations, Obesity, pain, Trends}, isbn = {2352-8273}, doi = {https://doi.org/10.1016/j.ssmph.2020.100644}, author = {Andrew C. Stokes and Xie, Wubin and Lundberg, Dielle J. and Hempstead, Katherine and Zajacova, Anna and Zachary Zimmer and Dana A Glei and Meara, Ellen and Samuel H. Preston} } @article {9546, title = {Persistent, Consistent, and Extensive: The Trend of Increasing Pain Prevalence in Older Americans.}, journal = {The Journals of Gerontology, Series B}, volume = {75}, year = {2020}, pages = {436-447}, abstract = {

Objectives: Assess trends in pain prevalence from 1992 to 2014 among older U.S. adults and by major population subgroups, and test whether the trends can be explained by changes in population composition.

Methods: Health and Retirement Study data include information on any pain, pain intensity, and limitations in usual activities due to pain. Average annual percent change in prevalence is calculated for any and for 2 levels of pain-mild/moderate and nonlimiting and severe and/or limiting-across demographic and socioeconomic characteristics, and for those with and without specific chronic conditions. Generalized linear latent and mixed models examine trends adjusting for covariates.

Results: Linear and extensive increases in pain prevalence occurred across the total population and subgroups. The average annual percent increase was in the 2\%-3\% range depending upon age and sex. Increases were consistent across subgroups, persistent over time, and not due to changes in population composition. Without increases in educational attainment over time, pain prevalence increases would be even higher.

Discussion: The increases in pain prevalence among older Americans are alarming and potentially of epidemic proportions. Population-health research must monitor and understand these worrisome trends.

}, keywords = {Chronic pain, Gender Differences, Population Health}, issn = {1758-5368}, doi = {10.1093/geronb/gbx162}, author = {Zachary Zimmer and Zajacova, Anna} } @article {9195, title = {Discrete time survival analysis via latent variable modeling: A note on lagged depression links to stroke in middle and late life}, journal = {Structural Equation Modeling: A Multidisciplinary Journal}, volume = {25}, year = {2018}, pages = {115-120}, abstract = {This article is concerned with a latent variable modeling approach to discrete time survival analysis that includes both time-invariant and time-varying covariates. The approach is illustrated with data from the Health and Retirement Study, which are utilized to study further the relationship of depression to stroke in middle and late life. Employing lag-1 depression scores as time-varying covariates, in addition to a set of relevant medical and demographic variables as time-invariant covariates collected at baseline, the article addresses a particular aspect of the prominent vascular depression hypothesis representing an important area in aging research, gerontology, geriatrics, and medicine. The results indicate considerable links of immediately prior depression levels to subsequent occurrences of stroke in middle-aged and older adults. The findings complement those reported by Raykov, Gorelick, Zajacova, and Marcoulides (2017), and are consistent with that hypothesis implying depression as a potential warning sign of an impending stroke.}, keywords = {Depressive symptoms, Latent Variable Modeling, Mortality}, issn = {1070-5511}, doi = {10.1080/10705511.2017.1327817}, url = {https://www.tandfonline.com/doi/full/10.1080/10705511.2017.1327817https://www.tandfonline.com/doi/pdf/10.1080/10705511.2017.1327817}, author = {Raykov, Tenko and Gorelick, Philip B. and Zajacova, Anna and Marcoulides, George A.} } @article {9488, title = {Using Latent Variable Modeling for Discrete Time Survival Analysis: Examining the Links of Depression to Mortality}, journal = {Structural Equation Modeling: A Multidisciplinary Journal}, volume = {25}, year = {2018}, pages = {287-293}, abstract = {Using a latent variable modeling approach to discrete time survival analysis, the dynamics of the relationships of depression and body mass index to mortality are examined with data from the multiwave, nationally representative Health and Retirement Study. A set of medical and demographic variables are employed as time-invariant covariates along with lag-1 depression scores and body mass indexes as time-varying covariates for mortality within an up to 2-year follow-up interval. The results indicate marked links of immediately prior depression levels, as well as notable relations of the body mass indexes, to within-wave mortality in middle-aged and older adults. The approach highlights the benefits of using latent variable modeling for survival analysis, and its findings represent potentially important relationships of clinical and theoretical relevance.}, keywords = {Depressive symptoms, Latent Variable Modeling, Mortality}, issn = {1070-5511}, doi = {10.1080/10705511.2017.1364969}, url = {https://www.tandfonline.com/doi/full/10.1080/10705511.2017.1364969https://www.tandfonline.com/doi/pdf/10.1080/10705511.2017.1364969}, author = {Raykov, Tenko and Zajacova, Anna and Gorelick, Philip B. and Marcoulides, George A.} } @article {9212, title = {Disability rises gradually for a cohort of older Americans}, journal = {The Journals of Gerontology Series B: Psychological Sciences and Social Sciences}, volume = {72}, year = {2017}, pages = {151-161}, abstract = {Objectives: We study changes in average disability over nearly two decades for a large epidemiological cohort of older Americans. As some people exit by mortality, do average disability levels for the living cohort rise rapidly, rise gradually, stay steady, or decline? Method: Data are from the Study of Asset and Health Dynamics Among the Oldest Old (AHEAD) cohort for 1993-2010. Cohort members are aged 70+ in 1993 (mean = 77.5 years), and the survivors are aged 87+ in 2010 (mean = 90.2 years). Personal care disability (activities of daily living), household management disability (instrumental activities of daily living), and physical limitations are studied. We study average disability for the living cohort over time and the disability histories for decedent and survivor groups. Results: Average disability rises gradually over time for the living cohort. Earlier decedent groups have higher average disability than later ones. Near death, disability rises sharply for all decedent groups. Longer surviving groups have less average disability, and slower disability increases, than shorter surviving groups. All results are repeated for younger cohort members (baseline age = 70-79 years), older ones (baseline age = 80+ years), women, and men. Discussion: As a cohort ages, average disability among living members increases gradually, signaling behavioral, psychological, and biological fitness in very old persons.}, keywords = {Disabilities, Mortality, Women and Minorities}, issn = {1079-5014}, doi = {10.1093/geronb/gbw002}, url = {https://academic.oup.com/psychsocgerontology/article-lookup/doi/10.1093/geronb/gbw002https://academic.oup.com/psychsocgerontology/article/2632051/Disability-Rises-Gradually-for-a-Cohort-of-Older}, author = {Verbrugge, Lois M. and Dustin C. Brown and Zajacova, Anna} } @article {9085, title = {On the potential of discrete time survival analysis using latent variable modeling: An application to the study of the vascular depression hypothesis}, journal = {Structural Equation Modeling: A Multidisciplinary Journal}, year = {2017}, month = {Jan-05-2017}, pages = {1 - 10}, abstract = {Analysis and modeling of time to event data have been traditionally associated with nonparametric, semiparametric, or parametric statistical frameworks. Recent advances in latent variable modeling have additionally provided unique analytic opportunities to methodologists and substantive researchers interested in survival time modeling. As a consequence, discrete time survival analyses can now be readily carried out using latent variable modeling, an approach that offers substantively important extensions to conventional survival models. Using data from the Health and Retirement Study, the discussed approach is applied to the study of the increasingly prominent vascular depression hypothesis in gerontology, geriatrics, and aging research, allowing examination of the unique predictive power of depression with respect to time to stroke in middle-aged and older adults.}, keywords = {Depressive symptoms, Survey Methodology}, issn = {1070-5511}, doi = {10.1080/10705511.2017.1315305}, url = {https://www.tandfonline.com/doi/full/10.1080/10705511.2017.1315305https://www.tandfonline.com/doi/pdf/10.1080/10705511.2017.1315305}, author = {Raykov, Tenko and Gorelick, Philip B. and Zajacova, Anna and Marcoulides, George A.} } @article {8325, title = {Long-Term BMI Trajectories and Health in Older Adults: Hierarchical Clustering of Functional Curves}, journal = {Journal of Aging and Health}, volume = {27}, year = {2015}, pages = {1443-1461}, publisher = {27}, abstract = {Objective: This project contributes to the emerging research that aims to identify distinct body mass index (BMI) trajectory types in the population. We identify clusters of long-term BMI curves among older adults and determine how the clusters differ with respect to initial health. Method: Health and Retirement Study cohort (N = 9,893) with BMI information collected in up to 10 waves (1992-2010) is analyzed using a powerful cutting-edge approach: hierarchical clustering of BMI functions estimated via the Principal Analysis by Conditional Expectations (PACE) algorithm. Results: Three BMI trajectory clusters emerged for each gender: stable, gaining, and losing. The initial health of the gaining and stable groups in both genders was comparable; the losing cluster experienced significantly poorer health at baseline. Discussion: BMI trajectories among older adults cluster into distinct types in both genders, and the clusters vary substantially in initial health. Weight loss but not gain is associated with poor initial health in this age group.}, keywords = {Demographics, Health Conditions and Status, Methodology}, doi = {10.1177/0898264315584329}, url = {http://jah.sagepub.com/content/early/2015/04/22/0898264315584329.abstract}, author = {Zajacova, Anna and Huzurbazar, Snehalata and Greenwood, Mark and Nguyen, Huong} } @article {8141, title = {Body Mass Trajectories and Mortality Among Older Adults: A Joint Growth MixtureDiscrete-Time Survival Analysis}, journal = {Gerontologist}, volume = {54}, year = {2014}, note = {Times Cited: 0}, pages = {221-231}, publisher = {54}, abstract = {Purpose of the Study: The aim of this study was to investigate heterogeneity in body weight trajectories among older adults and their association with mortality risks. Design and Methods: Information on body mass index (BMI) and survival come from nine waves of the Health and Retirement Study, a 16-year survey of adults aged 5161 at baseline (N 9,703). We used a sex-stratified joint growth mixture-discrete time survival model to characterize BMI trajectory groups and their associated mortality. Results: Three distinct classes of BMI trajectories were identified: stable overweight, obese gaining, and obese losing. Relative to the stable overweight class, which comprised about 90 of the sample, the obese gaining class had approximately 50 higher mortality risk; the highest mortality was found in the obese losing category (OR 2.7, p .001). The results were similar for men and women. Implications: The findings highlight substantial heterogeneity in weight trajectories of older Americans, as well as large survival differentials across the classes. The direction of weight changes appears inextricably linked to the overall BMI level in terms of predicting older adults longevity. Weight loss is associated with particularly high mortality risk even when the typical BMI change is from obesity to overweight.}, keywords = {Health Conditions and Status}, doi = {10.1093/geront/gns164}, author = {Zajacova, Anna and Jennifer A Ailshire} } @article {7813, title = {Healthier, Wealthier, and Wiser: A Demonstration of Compositional Changes in Aging Cohorts Due to Selective Mortality}, journal = {Population Research and Policy Review}, volume = {32}, year = {2013}, note = {Copyright - Springer Science Business Media Dordrecht 2013 Document feature - References; Tables Last updated - 2013-06-21 Adams P, Hurd MD, McFadden DL, Merrill A, Ribeiro T. Perspectives on the economics of aging. Adams, P; Hurd, M D; McFadden, D; Merrill, A; et al. Healthy, Wealthy, and Wise? Tests for Direct Causal Paths between Health and Socioeconomic Status. British Library Inside Conferences (2004): 415-526 BENGSTON, V.L.; SCHAIE, K.W. Handbook of theories of aging. Handbook of theories of aging. 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TAYLOR and FRANCIS INC}, pages = {311-324}, publisher = {32}, abstract = {The gradual changes in cohort composition that occur as a result of selective mortality processes are of interest to all aging research. We present the first illustration of changes in the distribution of specific cohort characteristics that arise purely as a result of selective mortality. We use data on health, wealth, education, and other covariates from two cohorts (the AHEAD cohort, born 1900-1923 and the HRS cohort, born 1931-1941) included in the Health and Retirement Survey, a nationally representative panel study of older Americans spanning nearly two decades (N = 14,466). We calculate sample statistics for the surviving cohort at each wave. Repeatedly using only baseline information for these calculations so that there are no changes at the individual level (what changes is the set of surviving respondents at each specific wave), we obtain a demonstration of the impact of mortality selection on the cohort characteristics. We find substantial changes in the distribution of all examined characteristics across the nine survey waves. For instance, the median wealth increases from about 90,000 to 130,000 and the number of chronic conditions declines from 1.5 to 1 in the AHEAD cohort. We discuss factors that influence the rate of change in various characteristics. The mortality selection process changes the composition of older cohorts considerably, such that researchers focusing on the oldest old need to be aware of the highly select groups they are observing, and interpret their conclusions accordingly. PUBLICATION ABSTRACT}, keywords = {Health Conditions and Status, Methodology, Net Worth and Assets}, doi = {http://dx.doi.org/10.1007/s11113-013-9273-x}, url = {http://search.proquest.com.proxy.lib.umich.edu/docview/1356972849?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Aabiglobalandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articl}, author = {Zajacova, Anna and Sarah A. Burgard} }