@article {7315, title = {Correlates of improvement in walking ability in older persons in the United States.}, journal = {Am J Public Health}, volume = {99}, year = {2009}, month = {2009 Mar}, pages = {533-9}, publisher = {99}, abstract = {

OBJECTIVES: We analyzed factors associated with improvement in walking ability among respondents to the nationally representative Health and Retirement Study.

METHODS: We analyzed data from 6574 respondents aged 53 years or older who reported difficulty walking several blocks, 1 block, or across the room in 2000 or 2002. We examined associations between improvement (versus no change, deterioration, or death) and baseline health status, chronic conditions, baseline walking difficulty, demographic characteristics, socioeconomic status, and behavioral risk factors.

RESULTS: Among the 25\% of the study population with baseline walking limitations, 29\% experienced improved walking ability, 40\% experienced no change in walking ability, and 31\% experienced deteriorated walking ability or died. In a multivariate analysis, we found positive associations between walking improvement and more recent onset and more severe walking difficulty, being overweight, and engaging in vigorous physical activity. A history of diabetes, having any difficulty with activities of daily living, and being a current smoker were all negatively associated with improvement in walking ability. After we controlled for baseline health, improvement in walking ability was equally likely among racial and ethnic minorities and those with lower socioeconomic status.

CONCLUSIONS: Interventions to reduce smoking and to increase physical activity may help improve walking ability in older Americans.

}, keywords = {Age Factors, Aged, Aged, 80 and over, Confidence Intervals, Female, Health Promotion, Humans, Male, Middle Aged, Motor Activity, Multivariate Analysis, Odds Ratio, Overweight, Smoking Prevention, Social Marketing, Socioeconomic factors, United States, Walking}, issn = {1541-0048}, doi = {10.2105/AJPH.2008.142927}, author = {Joseph Feinglass and Song, Jing and Larry M Manheim and Semanik, Pamela and Rowland W Chang and Dorothy D Dunlop} } @article {7209, title = {Age and racial/ethnic disparities in arthritis-related hip and knee surgeries.}, journal = {Med Care}, volume = {46}, year = {2008}, month = {2008 Feb}, pages = {200-8}, publisher = {46}, abstract = {

BACKGROUND: Nearly 18 million Americans experience limitations due to their arthritis. Documented disparities according to racial/ethnic groups in the use of surgical interventions such as knee and hip arthroplasty are largely based on data from Medicare beneficiaries age 65 or older. Whether there are disparities among younger adults has not been previously addressed.

OBJECTIVE: This study assesses age-specific racial/ethnic differences in arthritis-related knee and hip surgeries.

DESIGN: Longitudinal (1998-2004) Health and Retirement Study.

SETTING: National probability sample of US community-dwelling adults.

SAMPLE: A total of 2262 black, 1292 Hispanic, and 13,159 white adults age 51 and older.

MEASUREMENTS: The outcome is self-reported 2-year use of arthritis-related hip or knee surgery. Independent variables are demographic (race/ethnicity, age, gender), health needs (arthritis, chronic diseases, obesity, physical activity, and functional limitations), and medical access (income, wealth, education, and health insurance). Longitudinal data methods using discrete survival analysis are used to validly account for repeated (biennial) observations over time. Analyses use person-weights, stratum, and sampling error codes to provide valid inferences to the US population.

RESULTS: Black adults under the age of 65 years report similar age/gender adjusted rates of hip/knee arthritis surgeries [hazard ratio (HR) = 1.43, 95\% confidence interval (CI) = 0.87-2.38] whereas older blacks (age 65+) have significantly lower rates (HR = 0.38, CI = 0.16-0.55) compared with whites. These relationships hold controlling for health and economic differences. Both under age 65 years (HR = 0.64, CI = 0.12-1.44) and older (age 65+) Hispanic adults (HR = 0.60, CI = 0.32-1.10) report lower utilization rates, although not statistically different than whites. A large portion of the Hispanic disparity is explained by economic differences.

CONCLUSIONS: These national data document lower rates of arthritis-related hip/knee surgeries for older black versus white adults age 65 or above, consistent with other national studies. However, utilization rates for black versus white under age 65 do not differ. Lower utilization among Hispanics versus whites in both age groups is largely explained by medical access factors. National utilization patterns may vary by age and merit further investigation.

}, keywords = {Age Distribution, Aged, Arthritis, Arthroplasty, Replacement, Hip, Arthroplasty, Replacement, Knee, Black or African American, Female, Health Services Accessibility, Healthcare Disparities, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Proportional Hazards Models, United States, Utilization Review, White People}, issn = {0025-7079}, doi = {10.1097/MLR.0b013e31815cecd8}, author = {Dorothy D Dunlop and Larry M Manheim and Song, Jing and Sohn, Min-Woong and Joseph Feinglass and Huan J. Chang and Rowland W Chang} } @article {7175, title = {Racial/ethnic differences in the development of disability among older adults.}, journal = {Am J Public Health}, volume = {97}, year = {2007}, month = {2007 Dec}, pages = {2209-15}, publisher = {97}, abstract = {

OBJECTIVES: We investigated differences in the development of disability in activities of daily living among non-Hispanic Whites, African Americans, Hispanics interviewed in Spanish, and Hispanics interviewed in English.

METHODS: We estimated 6-year risk for disability development among 8161 participants 65 years or older and free of baseline disability. We evaluated mediating factors amenable to clinical and public health intervention on racial/ethnic difference.

RESULTS: The risk for developing disability among Hispanics interviewed in English was similar to that among Whites (hazard ratio [HR]=0.99; 95\% confidence interval [CI] = 0.6, 1.4) but was substantially higher among African Americans (HR=1.6; 95\% CI=1.3, 1.9) and Hispanics interviewed in Spanish (HR=1.8; 95\% CI=1.4, 2.1). Adjustment for demographics, health, and socioeconomic status reduced a large portion of those disparities (African American adjusted HR=1.1, Spanish-interviewed Hispanic adjusted HR=1.2).

CONCLUSIONS: Higher risks for developing disability among older African Americans, and Hispanics interviewed in Spanish compared with Whites were largely attenuated by health and socioeconomic differences. Language- and culture-specific programs to increase physical activity and promote weight maintenance may reduce rates of disability in activities of daily living and reduce racial/ethnic disparities in disability.

}, keywords = {Activities of Daily Living, Aged, Black or African American, Disabled Persons, Female, Health Behavior, Health Status Disparities, Health Surveys, Hispanic or Latino, Humans, Male, Prevalence, Proportional Hazards Models, Prospective Studies, Risk, Socioeconomic factors, Survival Analysis, United States, White People}, issn = {1541-0048}, doi = {10.2105/AJPH.2006.106047}, author = {Dorothy D Dunlop and Song, Jing and Larry M Manheim and Daviglus, Martha L. and Rowland W Chang} } @article {7107, title = {Gender Differences across Race/Ethnicity in Use of Health Care among Medicare-Aged Americans}, journal = {Journal of Women{\textquoteright}s Health}, volume = {15}, year = {2006}, pages = {1205-1213}, publisher = {15}, abstract = {Background: Despite Medicare, medical services are not equally used by elderly women and men in the United States. Our purpose is to examine gender differences in healthcare utilization among older Americans, the persistence of gender differences across race/ethnicity, and the roles of sociodemographic, health, and economic factors to explain differences. Methods: Data from the 1998 2000 Health and Retirement Study are used to investigate gender differences in use of hospital, outpatient surgery, home health, and physician services. Analyses are controlled for sociodemographic, health (medical conditions, functional health), and economic (income, wealth, education, health insurance) factors. Results: Women are significantly less likely to use hospital service (odds ratio OR =0.83) and outpatient surgery (OR=0.85) but are more likely to use home health care (OR=1.27) and physician services (OR=1.45), controlling for sociodemographics. Differences in health needs and economic resources partially mediate the gender differences in physician and home healthcare utilization but do not explain the gender differences in hospital service and outpatient surgery. Notably, African American, Hispanic, and white women compared with men show significantly less use of hospital services. Conclusions: Gender differences in medical use vary according to the type of services used and are largely consistent across racial/ethnic groups. As the size of the Medicare population increases, promoting equitable use of healthcare resources by both women and men is an important issue in developing healthcare policy and designing public health strategies.}, keywords = {Demographics, Healthcare}, author = {Song, Jing and Chang, Rowland D. and Larry M Manheim and Dorothy D Dunlop} } @article {6932, title = {Arthritis and Heart Disease as Risk Factors for Major Depression: The role of functional limitation}, journal = {Medical Care}, volume = {42}, year = {2004}, pages = {502-511}, publisher = {42}, keywords = {Health Conditions and Status, Risk Taking}, author = {Dorothy D Dunlop and Lyons, J.S. and Larry M Manheim and Song, Jing and Rowland W Chang} } @article {6851, title = {The Costs of Arthritis}, journal = {Arthritis and Rheumatism}, volume = {49}, year = {2003}, pages = {101-113}, publisher = {49}, abstract = {Arthritis and rheumatic conditions (i.e., arthritis) are responsible for major health care expenditures and disability burdens. The impact of arthritis is not restrained by national boundaries. It is one of the most prevalent chronic conditions and is a leading cause of disability in Australia (1), Canada (2,3), Europe (4), the United Kingdom (5), and the United States (6,7), affecting an estimated 3 million Australians, 6 million Canadians, 8 million in the UK, almost 43 million people in the US, and 103 million across Europe. With the aging of the baby boomers, these numbers and the associated disabilities will quickly escalate. By 2020 in the US alone, arthritis is projected to affect 60 million people, and the activities of 12 million people may be limited by arthritis (6). The growing magnitude of people affected by arthritis motivates the need to review what is known about its national costs to identify areas where current information is lacking. In addition, it is important to determine targets for public health efforts that will reduce the costs of and burden from arthritis. This knowledge will facilitate planning research agendas that support informed public policy decisions.}, keywords = {Health Conditions and Status, Healthcare}, doi = {10.1002/art.10913}, author = {Dorothy D Dunlop and Larry M Manheim and Yelin, Edward and Song, Jing and Rowland W Chang} } @article {6881, title = {Health care utilization among older adults with arthritis.}, journal = {Arthritis Rheum}, volume = {49}, year = {2003}, month = {2003 Apr 15}, pages = {164-71}, publisher = {49}, abstract = {

OBJECTIVE: To evaluate the effect of arthritis on subsequent 2-year use of health care services and out-of-pocket costs among older adults and determine if comorbidities or economic resources mitigate that effect.

METHODS: Data were analyzed from 6230 participants interviewed in 1993 and 1995 in the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults. Baseline arthritis status was ascertained from the report of an arthritis-related physician{\textquoteright}s visit or a joint replacement not associated with a hip fracture. The effect of baseline arthritis on the odds of subsequent 2-year health care utilization and high out-of-pocket expenses were estimated from multiple logistic regression controlling for demographic factors, comorbidity, and economic resources.

RESULTS: Older adults with arthritis are significantly more likely to have a physician visit (odds ratio [OR] 3.0), hospital admission (OR 1.6), outpatient surgery (OR 1.3), receive home health care (OR 1.6), and have out-of-pocket cost >5000 US dollars (OR 1.6) compared with contemporaries having similar demographics (age, sex, racial/ethnic group, marital status), comorbid conditions, and economic resources (education, income, wealth, health insurance), but not reporting arthritis.

CONCLUSIONS: Older adults with symptomatic arthritis reported greater medical utilization and cost compared with people not reporting arthritis. These disparities persisted after accounting for differences in demographics, comorbidities, and economic factors. These findings document greater economic burdens on a personal and societal level among people with arthritis. As individuals, older adults with arthritis spend more out-of-pocket dollars for health care than their contemporaries without arthritis. On a societal level, these findings of greater health care utilization among people with arthritis point to increasing future demands on the US health care system due to demographic increases in the numbers of older adults with arthritis and support policies aimed at improving arthritis prevention and treatment as well as reducing the economic disparities between those with and without arthritis.

}, keywords = {Aged, Aged, 80 and over, Ambulatory Surgical Procedures, Arthritis, Comorbidity, Cost of Illness, Female, Health Services, Home Care Services, Hospitals, Humans, Insurance, Health, Longitudinal Studies, Male, Nursing homes, Physicians{\textquoteright} Offices, Social Class}, issn = {0004-3591}, doi = {10.1002/art.11003}, author = {Dorothy D Dunlop and Larry M Manheim and Song, Jing and Rowland W Chang} } @article {6850, title = {Racial disparities in joint replacement use among older adults.}, journal = {Med Care}, volume = {41}, year = {2003}, month = {2003 Feb}, pages = {288-98}, publisher = {41}, abstract = {

BACKGROUND: Although joint replacement can restore function for arthritis patients with severe joint disease, this procedure has not been used equally across racial groups. Differences in joint replacement use are assessed from a national sample.

OBJECTIVE: This study evaluates the role of health conditions and economic access to explain differences in joint replacement among older black and Hispanic minorities relative to white persons.

DESIGN: Longitudinal (1993-1995) Asset and Health Dynamics Among the Oldest Old (AHEAD) study.

SETTING: National probability sample of US community-dwelling older adults.

PATIENT POPULATION: AHEAD participants (n = 6159) aged 69 to 103 years.

MEASUREMENTS: The outcome is subject-reported 2-year use of any arthritis-related joint-replacement. Independent variables are demographics, health needs (arthritis, other medical conditions, functional health), and economic access (income, assets, education, and health insurance).

RESULTS: Older minorities reported arthritis-related joint replacements (black: 0.98\%; Hispanic: 0.97\%, annually) less frequently compared with white persons (1.48\% annually). Older minorities were significantly less likely to use joint replacement compared with white persons (OR, 0.37; 95\% CI, 0.20, 0.71) controlling for demographics, and arthritis and other health needs. Disparities remained significant (OR, 0.46; 95\% CI, 0.22, 0.98) after additionally controlling for economic medical access. Use was lower among people who depended solely on Medicare compared with those with supplemental health insurance (OR, 0.46; 95\% CI, 0.22, 0.95).

CONCLUSIONS: These national data document low rates of arthritis-related joint replacement among older Hispanic persons comparable to black persons. Less use among older minorities compared with white persons is not explained by differences in health needs or economic access. Other cultural and attitudinal factors merit investigation to explain disparities.

}, keywords = {Aged, Aged, 80 and over, Arthroplasty, Replacement, Black or African American, Cohort Studies, Data Interpretation, Statistical, Health Services Accessibility, Health Services Needs and Demand, Health Status, Health Surveys, Hispanic or Latino, Humans, Interviews as Topic, Osteoarthritis, Sampling Studies, United States, White People}, issn = {0025-7079}, doi = {10.1097/01.MLR.0000044908.25275.E1}, author = {Dorothy D Dunlop and Larry M Manheim and Song, Jing and Rowland W Chang} } @article {6882, title = {Racial/ethnic differences in rates of depression among preretirement adults.}, journal = {Am J Public Health}, volume = {93}, year = {2003}, month = {2003 Nov}, pages = {1945-52}, publisher = {93}, abstract = {

OBJECTIVES: We estimated racial/ethnic differences in rates of major depression and investigated possible mediators.

METHODS: Depression prevalence rates among African American, Hispanic, and White adults were estimated from a population-based national sample and adjusted for potential confounders.

RESULTS: African Americans (odds ratio [OR] = 1.16, 95\% confidence interval [CI] = 0.93, 1.44) and Hispanics (OR = 1.44, 95\% CI = 1.02, 2.04) exhibited elevated rates of major depression relative to Whites. After control for confounders, Hispanics and Whites exhibited similar rates, and African Americans exhibited significantly lower rates than Whites.

CONCLUSIONS: Major depression and factors associated with depression were more frequent among members of minority groups than among Whites. Elevated depression rates among minority individuals are largely associated with greater health burdens and lack of health insurance, factors amenable to public policy intervention.

}, keywords = {Aged, Black or African American, Cohort Studies, Comorbidity, Demography, Depressive Disorder, Major, Diagnostic and Statistical Manual of Mental Disorders, Female, Hispanic or Latino, Humans, Male, Middle Aged, Minority Groups, Probability, Risk Factors, Socioeconomic factors, United States, White People}, issn = {0090-0036}, doi = {10.2105/ajph.93.11.1945}, author = {Dorothy D Dunlop and Song, Jing and Lyons, J.S. and Larry M Manheim and Rowland W Chang} } @article {6794, title = {Gender and Ethnic/Racial Disparities in Health Care Utilization Among Older Adults}, journal = {The Journals of Gerontology: Social Sciences}, volume = {57B}, year = {2002}, pages = {S221-33}, publisher = {57B}, abstract = {OBJECTIVE: We examine the role of economic access in gender and ethnic/racial disparities in the use of health services among older adults. METHODS: Data from the 1993-1995 study on the Asset of Health Dynamics Among the Oldest Old (AHEAD) were used to investigate differences in the 2-year use of health services by gender and among non-Hispanic White versus minority (Hispanic and African American) ethnic/racial groups. Analyses account for predisposing factors, health needs, and economic access. RESULTS: African American men had fewer physician contacts; minority and non-Hispanic White women used fewer hospital or outpatient surgery services; minority men used less outpatient surgery; and Hispanic women were less likely to use nursing home care, compared with non-Hispanic White men, controlling for predisposing factors and measures of need. Although economic access was related to some medical utilization, it had little effect on gender/ethnic disparities for services covered by Medicare. However, economic access accounted for minority disparities in dental care, which is not covered by Medicare. DISCUSSION: Medicare plays a significant role in providing older women and minorities access to medical services. Significant gender and ethnic/racial disparities in use of medical services covered by Medicare were not accounted for by economic access among older adults with similar levels of health needs. Other cultural and attitudinal factors merit investigation to explain these gender/ethnic disparities.}, keywords = {Demographics, Health Conditions and Status, Healthcare, Methodology, Other, Women and Minorities}, url = {http://psychsoc.gerontologyjournals.org/contents-by-date.0.shtml}, author = {Dorothy D Dunlop and Larry M Manheim and Song, Jing and Rowland W Chang} } @article {6749, title = {Arthritis prevalence and activity limitations in older adults.}, journal = {Arthritis Rheum}, volume = {44}, year = {2001}, month = {2001 Jan}, pages = {212-21}, publisher = {44}, abstract = {

OBJECTIVE: To evaluate the prevalence of arthritis and activity limitations among older Americans by assessing their demographic, ethnic, and economic characteristics.

METHODS: Data from the Asset and Health Dynamic Survey Among the Oldest Old (AHEAD), a national probability sample of community-dwelling adults born before 1924, were analyzed cross-sectionally. Arthritis that resulted in a physician{\textquoteright}s visit or a joint replacement not associated with a hip fracture was ascertained by self-report.

RESULTS: The prevalence of arthritis in older adults ranged from 25\% in non-Hispanic whites to 40\% in non-Hispanic blacks to 44\% in Hispanics. A higher prevalence of arthritis was associated with less education as well as lower income and less wealth. The prevalence of limitations in activities of daily living (ADL) among non-Hispanic white, non-Hispanic black, and Hispanic adults who reported arthritis only was 29\%, 30\%, and 37\%, respectively, and increased to 48\%, 57\%, and 56\%, respectively, among those reporting arthritis plus other chronic conditions, after adjustment for age and sex.

CONCLUSION: Non-Hispanic black and Hispanic older adults reported having arthritis at a substantially higher frequency than did non-Hispanic whites. In addition, Hispanics reported higher rates of ADL limitations than did non-Hispanic whites with comparable disease burden. Further study is needed to confirm and elucidate the reasons for these racial and economic disparities in older populations.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Arthritis, Data collection, Humans, Prevalence, Racial Groups, Socioeconomic factors, Surveys and Questionnaires}, issn = {0004-3591}, doi = {10.1002/1529-0131(200101)44:1<212::AID-ANR28>3.0.CO;2-Q}, author = {Dorothy D Dunlop and Larry M Manheim and Song, Jing and Rowland W Chang} }