@article {12601, title = {A computational solution for bolstering reliability of epigenetic clocks: implications for clinical trials and longitudinal tracking}, journal = {Nature Aging}, volume = {2}, year = {2022}, pages = {644{\textendash}661}, abstract = {Epigenetic clocks are widely used aging biomarkers calculated from DNA methylation data, but this data can be surprisingly unreliable. Here we show that technical noise produces deviations up to 9 years between replicates for six prominent epigenetic clocks, limiting their utility. We present a computational solution to bolster reliability, calculating principal components (PCs) from CpG-level data as input for biological age prediction. Our retrained PC versions of six clocks show agreement between most replicates within 1.5 years, improved detection of clock associations and intervention effects, and reliable longitudinal trajectories in vivo and in vitro. This method entails only one additional step compared to traditional clocks, requires no replicates or previous knowledge of CpG reliabilities for training, and can be applied to any existing or future epigenetic biomarker. The high reliability of PC-based clocks is critical for applications to personalized medicine, longitudinal tracking, in vitro studies and clinical trials of aging interventions.}, keywords = {Aging, Bioinformatics, computational models, DNA Methylation, predictive markers}, doi = {10.1038/s43587-022-00248-2}, author = {Higgins-Chen, Albert T. and Thrush, Kyra L. and Wang, Yunzhang and Minteer, Christopher J. and Kuo, Pei-Lun and Wang, Meng and Niimi, Peter and Sturm, Gabriel and Lin, Jue and Ann Zenobia Moore and Bandinelli, Stefania and Vinkers, Christiaan H. and Vermetten, Eric and Rutten, Bart P. F. and Geuze, Elbert and Okhuijsen-Pfeifer, Cynthia and van der Horst, Marte and Schreiter, Stefanie and Gutwinski, Stefan and Luykx, Jurjen J. and Picard, Martin and Ferrucci, Luigi and Eileen M. Crimmins and Boks, Marco P. and H{\"a}gg, Sara and Hu-Seliger, Tina T. and Morgan E. Levine} } @article {11930, title = {Cross sectional association between cytomegalovirus seropositivity, inflammation and cognitive impairment in elderly cancer survivors.}, journal = {Cancer Causes \& Control}, volume = {33}, year = {2022}, pages = {81-90}, abstract = {

PURPOSE: The higher prevalence of cognitive impairment/ dementia among cancer survivors is likely multifactorial. Since both exposures to cytomegalovirus (CMV) and inflammation are common among elderly cancer survivors, we evaluated their contribution towards dementia.

METHODS: Data from 1387 cancer survivors and 7004 participants without cancer in the 2016 wave of the Health and Retirement Study (HRS) was used in this study. Two inflammatory biomarkers, C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), were used to create an inflammation score. We used survey logistic regression adjusted for survey design parameters.

RESULTS: CMV seropositivity was not associated with cognitive impairment among cancer survivors (p = 0.2). In addition, inflammation was associated with elevated odds of cognitive impairment (OR = 2.2, 95\% CI [1.2, 4.2]). Cancer survivors who were both CMV seropositive and had increased inflammation had the highest odds of cognitive impairment compared to those who were CMV seronegative and had low inflammation (OR = 3.8, 95\% CI [1.5, 9.4]). The stratified analysis among cancer survivors showed this association was seen only among cancer survivors in whom the cancer was diagnosed within three years of measurement of inflammation score and CMV serostatus (OR = 18.5; 95\% CI [6.1, 56.1]).

CONCLUSION: The CMV seropositivity and high inflammation was associated with higher cognitive impairment among cancer survivors. The stronger associations seen among cancer survivors diagnosed within the last three years suggest that strategies to reduce CMV activation and inflammation during or immediately after cancer treatment may be important in reducing the prevalence of cognitive impairment/ dementia among cancer survivors.

}, keywords = {Cancer survivor, CMV Seropositivity, Dementia, Inflammation}, issn = {1573-7225}, doi = {https://doi.org/10.1007/s10552-021-01504-3}, author = {Vivek, Sithara and Heather Hammond Nelson and Anna Prizment and Jessica Faul and Eileen M. Crimmins and Bharat Thyagarajan} } @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 {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 {9502, title = {Change in cardiometabolic risk among blacks, whites and Hispanics: findings from the Health and Retirement Study}, journal = {The Journals of Gerontology: Series A}, volume = {74}, year = {2019}, pages = {240-246}, abstract = {Background Blacks experience greater multi-system physiological dysregulation, or cumulative biological risk, which is associated with poor cardiometabolic health and mortality. In this study, we assess race differences in change in risk over four years among older whites, blacks and Hispanics. Method We examined race differences in 4-year change in individual biomarkers and a cumulative measure of risk{\textemdash}cardiometabolic risk (CMR){\textemdash}using data for each respondent from two waves of the Health and Retirement Study{\textquoteright}s biomarker assessment (n=5,512). CMR is a count of high-risk cardiovascular and metabolic biomarkers. We estimated mean CMR at baseline and follow-up by race/ethnicity, and used logistic regression to determine whether race differences exist in 4-year transitions between high- and low-risk states for individual biomarkers. Results Blacks had higher baseline CMR than whites and Hispanics and experienced an increase in risk over four years; conversely, CMR decreased among whites and Hispanics. Blacks were more likely to develop high-risk pulse pressure and high-risk hemoglobin A1c, which contributed to increases in CMR. Whites and Hispanics were more likely to become low-risk on C-reactive protein and HDL cholesterol which contributed to declines in CMR. Race differences in transitions between risk states remained after controlling for social, behavioral and health care related factors. However, the racial patterning of these differences was influenced by disease diagnosis and medication use. Conclusions We show that the cardiometabolic health of older blacks worsens as they age both absolutely and relative to that of whites and Hispanics because of poor blood pressure control and diabetes prevention.}, keywords = {Biomarkers, C-reactive protein, Cardiovascular health, Racial/ethnic differences, Risk Factors}, issn = {1079-5006}, doi = {10.1093/gerona/gly026}, url = {https://academic.oup.com/biomedgerontology/advance-article/doi/10.1093/gerona/gly026/4857183http://academic.oup.com/biomedgerontology/advance-article-pdf/doi/10.1093/gerona/gly026/23921802/gly026.pdf}, author = {Uchechi A Mitchell and Jennifer A Ailshire and Eileen M. Crimmins} } @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 {10104, title = {Changing impact of obesity on active life expectancy of older Americans.}, journal = {Journals of Gerontology Series A: Biological Sciences \& Medical Sciences}, year = {2019}, month = {11/2019}, abstract = {

BACKGROUND: The rise in the number and earlier age of onset of obese persons has raised critical concerns about consequences of obesity; however, recent evidence suggests that the impact of obesity on health outcomes may have changed. This study aims to assess the change of the impact of obesity on active life expectancy among Americans 70 years and older over almost two decades, 1993-1998 to 2010-2014.

METHODS: For each period, we use three waves of data from the Health and Retirement Study to estimate age-specific transition probabilities between health states. The average number of years active and disabled are calculated with Interpolated Markov Chain software based on estimated transition probabilities.

RESULTS: Overall obesity and severe obesity increased markedly over time yet active life expectancy expanded for all individuals and the increases are greater among the obese and women. Increases in total and active life expectancy occurred because of the changing association of obesity with disability and mortality.

CONCLUSION: Individuals at age 70 in the later period in each weight group could expect to live a smaller proportion of remaining life with ADL disability than those in the earlier period. High levels of obesity continue to have significant adverse effects on the quality of life. The increasing prevalence of severe obesity and the growing number of older persons may result in substantial additional health care needs and costs. Continued effort to improve cardiovascular health is required to control the burden of obesity in later life in an era of rising obesity.

}, keywords = {Health Trajectories, Longevity, Obesity}, issn = {1758-535X}, doi = {10.1093/gerona/glz133}, author = {Yuan S Zhang and Saito, Yasuhiko and Eileen M. Crimmins} } @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 {9798, title = {Cohort Trends in the Gender Distribution of Household Tasks in the United States and the Implications for Understanding Disability}, journal = {Journal of Aging and Health}, year = {2019}, abstract = {Objectives: Measures of disability depend on health and social roles in a given environment. Yet, social roles can change over time as they have by gender. We document how engagement in Instrumental Activities of Daily Living (IADLs) is shifting by gender and birth cohort among older adults, and the challenges these shifts can create for population-level estimates of disability. Method: We used the Health and Retirement Study (N = 25,047) and multinomial logistic regression models with an interaction term between gender and birth cohort to predict limitation and nonperformance relative to no difficulty conducting IADLs. Results: Nonperformance of IADLs have significantly decreased among younger cohorts. Women in younger cohorts were more likely to use a map, whereas men in younger cohorts were more likely to prepare meals and shop. Discussion: Failing to account for gender and cohort changes in IADL, performance may lead to systematic bias in estimates of population-level disability.}, keywords = {Cohort Studies, Disabilities, Gender Differences, Household, Women and Minorities}, issn = {0898-2643}, doi = {10.1177/0898264318793469}, author = {Connor M Sheehan and Benjamin W Domingue and Eileen M. Crimmins} } @article {10426, title = {COMBINED EFFECT OF CMV SEROPOSITIVITY AND SYSTEMIC INFLAMMATION ON DEMENTIA PREVALENCE IN CANCER SURVIVORS}, journal = {Innovation in Aging}, volume = {3}, year = {2019}, pages = {S461-S461}, abstract = {Though cancer patients treated with multi-modal therapies demonstrate higher levels of systemic inflammation, which is associated with dementia, cancer survivors have not shown a consistent association with dementia. Since several studies reported an independent association between cytomegalovirus (CMV) infection, inflammation and dementia in non-cancer populations, we have evaluated whether CMV infection and systemic inflammation were associated with increased prevalence of dementia in cancer survivors in Health and Retirement Study (HRS). We evaluated prevalence of dementia (using score <=7 on the 27-point scale) among 1607 cancer survivors, in whom we measured CMV seropositivity and two biomarkers of systemic inflammation: C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR). The prevalence of CMV seropositivity was 68.26\% (n=1097), while prevalence of increased systemic inflammation [CRP \>5mg/L and NLR \>4] was 4.23\% (n=68). Using survey logistic regression, adjusted for age, race, gender, BMI (Body Mass Index) and sampling design, cancer survivors who were both CMV seropositive and had increased systemic inflammation had the highest odds of dementia compared to those who were CMV seronegative and had low levels of systemic inflammation (OR=6.59; 95\% CI [2.81, 15.44]; p\<.0001). Cancer survivors who were CMV seropositive without evidence of systemic inflammation had a lower but increased odds of dementia (OR=2.02; 95\% CI [1.17, 3.47]; p=0.01). Odds of dementia among those who were CMV seronegative with elevated systemic inflammation was not significant (p=0.09). Our study demonstrates a possible role for ongoing CMV induced inflammation in determining dementia prevalence among cancer survivors that needs further confirmation.}, keywords = {Cancer, cnv, Dementia, Inflammation, seropositivity}, issn = {2399-5300}, doi = {10.1093/geroni/igz038.1724}, author = {Vivek, Sithara and Bharat Thyagarajan and Heather Hammond Nelson and Anna Prizment and Eileen M. Crimmins and Jessica Faul} } @article {10454, title = {CROSS-COUNTRY COMPARISON OF INTERNET USE AND DEPRESSION BY GENDER: THE ROLE OF INTERGENERATIONAL FACTORS}, journal = {Innovation in Aging}, volume = {3}, year = {2019}, month = {2019/11/08}, pages = {S330 - S331}, abstract = {Technology may offer one approach to reducing depression as it provides medium to maintain connections (Cotton et al., 2014). Yet, depression, internet use, gender roles, and expectation of intergenerational interaction all differ across countries. Using nationally representative data from the U.S (Health and Retirement Study: HRS) and South Korea (Living Profiles of Older People Survey: LPOPS), the study examines 1) association between internet use and depressive symptoms by gender in two countries; 2) and whether intergenerational factors moderated this association. In the U.S., more than half of men and women aged 65+ used the internet, while approximately 30\% of women and 47\% of men used the internet in Korea. Using the internet was associated with lower depression for those living far from the closest child for women in the U.S., and for men in Korea. The findings indicate that the association of internet use on depressive symptoms can be influenced by intergenerational factors that may differentially affect men and women depending on the sociohistorical contexts.}, keywords = {depression, gender, Intergenerational ties, International}, isbn = {2399-5300}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6840073/}, author = {Shim, Hyunju and Jennifer A Ailshire and Eileen M. Crimmins} } @article {9395, title = {Cross-Country Comparisons of Disability and Morbidity: Evidence from the Gateway to Global Aging Data}, journal = {The Journals of Gerontology: Series A}, volume = {73}, year = {2018}, pages = {1519-1524}, abstract = {Background International comparisons of disease prevalence have been useful in understanding what proportion of disease might be preventable and in informing potential policy interventions in different cultural and economic contexts. Using newly available, harmonized data from 20 countries, we compare disability and morbidity of older adults between the ages of 55 and 74. Methods The Gateway to Global Aging Data, a data and information portal, provides access to easy-to-use individual-level longitudinal data from 10 surveys covering over 30 countries. Exploiting harmonized measures available from the Gateway, we descriptively examine how disability and morbidity differ across countries. Results Significant cross-country differences are observed for several health indicators. Comparing countries with the highest and lowest prevalence rates, we observe that hypertension rates vary twofold and stroke rates vary threefold, while disability and arthritis rates vary more than fivefold. Among women, higher gross domestic product and life expectancy are related to lower diabetes, heart disease, and better functioning. Among men, national indicators of economic conditions are not significantly associated with reported disease prevalence. Conclusions We document substantial heterogeneity in disability and morbidity across countries, separately for men and women and after controlling for population age composition and education. Rich data from various surveys across the world offers remarkable opportunities for cross-country analyses, calling for further investigation of what drives observed differences. The Gateway to Global Aging Data provides easy-to-use harmonized data files and tools to facilitate this type of research.}, keywords = {Cross-National, Disabilities, Disease, Gateway to Global Aging}, issn = {1079-5006}, doi = {10.1093/gerona/glx224}, url = {http://academic.oup.com/biomedgerontology/advance-article/doi/10.1093/gerona/glx224/4683782http://academic.oup.com/biomedgerontology/advance-article-pdf/doi/10.1093/gerona/glx224/22474170/glx224.pdf}, author = {Jinkook Lee and Drystan F. Phillips and Wilkens, Jenny and Chien, Sandy and Lin, Yu-Chen and Marco Angrisani and Eileen M. Crimmins} } @article {8936, title = {Clinical Trials Targeting Aging and Age-Related Multimorbidity}, journal = {The Journals of Gerontology Series A: Biological Sciences and Medical Sciences}, volume = {72}, year = {2017}, pages = {355-361}, abstract = {Background: There is growing interest in identifying interventions that may increase health span by targeting biological processes underlying aging. The design of efficient and rigorous clinical trials to assess these interventions requires careful consideration of eligibility criteria, outcomes, sample size, and monitoring plans. Methods: Experienced geriatrics researchers and clinical trialists collaborated to provide advice on clinical trial design. Results: Outcomes based on the accumulation and incidence of age-related chronic diseases are attractive for clinical trials targeting aging. Accumulation and incidence rates of multimorbidity outcomes were developed by selecting at-risk subsets of individuals from three large cohort studies of older individuals. These provide representative benchmark data for decisions on eligibility, duration, and assessment protocols. Monitoring rules should be sensitive to targeting aging-related, rather than disease-specific, outcomes. Conclusions: Clinical trials targeting aging are feasible, but require careful design consideration and monitoring rules.}, keywords = {Chronic disease, Clinical trials, Older Adults}, issn = {1079-5006}, doi = {10.1093/gerona/glw220}, url = {https://academic.oup.com/biomedgerontology/article-lookup/doi/10.1093/gerona/glw220https://academic.oup.com/biomedgerontology/article/2328606/Clinical-Trials-Targeting-Aging-and-AgeRelated}, author = {Mark A. Espeland and Eileen M. Crimmins and Brandon R. Grossardt and Jill P. Crandall and Jonathan A. L. Gelfond and Tamara B Harris and Stephen B Kritchevsky and JoAnn E Manson and Jennifer G Robinson and Walter A Rocca and Temprosa, Marinella and Thomas, Fridtjof and Robert B Wallace and Barzilai, Nir} } @article {8813, title = {A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012.}, journal = {JAMA Intern Med}, volume = {177}, year = {2017}, month = {2017 01 01}, pages = {51-58}, abstract = {

Importance: The aging of the US population is expected to lead to a large increase in the number of adults with dementia, but some recent studies in the United States and other high-income countries suggest that the age-specific risk of dementia may have declined over the past 25 years. Clarifying current and future population trends in dementia prevalence and risk has important implications for patients, families, and government programs.

Objective: To compare the prevalence of dementia in the United States in 2000 and 2012.

Design, Setting, and Participants: We used data from the Health and Retirement Study (HRS), a nationally representative, population-based longitudinal survey of individuals in the United States 65 years or older from the 2000 (n = 10 546) and 2012 (n = 10 511) waves of the HRS.

Main Outcomes and Measures: Dementia was identified in each year using HRS cognitive measures and validated methods for classifying self-respondents, as well as those represented by a proxy. Logistic regression was used to identify socioeconomic and health variables associated with change in dementia prevalence between 2000 and 2012.

Results: The study cohorts had an average age of 75.0 years (95\% CI, 74.8-75.2 years) in 2000 and 74.8 years (95\% CI, 74.5-75.1 years) in 2012 (P = .24); 58.4\% (95\% CI, 57.3\%-59.4\%) of the 2000 cohort was female compared with 56.3\% (95\% CI, 55.5\%-57.0\%) of the 2012 cohort (P < .001). Dementia prevalence among those 65 years or older decreased from 11.6\% (95\% CI, 10.7\%-12.7\%) in 2000 to 8.8\% (95\% CI, 8.2\%-9.4\%) (8.6\% with age- and sex-standardization) in 2012 (P < .001). More years of education was associated with a lower risk for dementia, and average years of education increased significantly (from 11.8 years [95\% CI, 11.6-11.9 years] to 12.7 years [95\% CI, 12.6-12.9 years]; P < .001) between 2000 and 2012. The decline in dementia prevalence occurred even though there was a significant age- and sex-adjusted increase between years in the cardiovascular risk profile (eg, prevalence of hypertension, diabetes, and obesity) among older US adults.

Conclusions and Relevance: The prevalence of dementia in the United States declined significantly between 2000 and 2012. An increase in educational attainment was associated with some of the decline in dementia prevalence, but the full set of social, behavioral, and medical factors contributing to the decline is still uncertain. Continued monitoring of trends in dementia incidence and prevalence will be important for better gauging the full future societal impact of dementia as the number of older adults increases in the decades ahead.

}, keywords = {Aged, Dementia, Female, Humans, Male, Prevalence, Risk Factors, United States}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2016.6807}, url = {http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2016.6807http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2587084}, author = {Kenneth M. Langa and Eric B Larson and Eileen M. Crimmins and Jessica Faul and Deborah A Levine and Mohammed U Kabeto and David R Weir} } @article {9326, title = {Contemporaneous Social Environment and the Architecture of Late-Life Gene Expression Profiles.}, journal = {American Journal of Epidemiology}, volume = {186}, year = {2017}, pages = {503-509}, abstract = {Environmental or social challenges can stimulate a cascade of coordinated physiological changes in stress response systems. Unfortunately, chronic activation of these adaptations under conditions such as low socioeconomic status (SES) can have negative consequences for long-term health. While there is substantial evidence tying low SES to increased disease risk and reduced life expectancy, the underlying biology remains poorly understood. Using pilot data on 120 older adults from the Health and Retirement Study (United States, 2002-2010), we examined the associations between SES and gene expression levels in adulthood, with particular focus on a gene expression program known as the conserved transcriptional response to adversity. We also used a bioinformatics-based approach to assess the activity of specific gene regulation pathways involved in inflammation, antiviral responses, and stress-related neuroendocrine signaling. We found that low SES was related to increased expression of conserved transcriptional response to adversity genes and distinct patterns of proinflammatory, antiviral, and stress signaling (e.g., sympathetic nervous system and hypothalamic-pituitary-adrenal axis) transcription factor activation.}, keywords = {Genetics, Socioeconomic factors}, issn = {1476-6256}, doi = {10.1093/aje/kwx147}, author = {Morgan E. Levine and Eileen M. Crimmins and David R Weir and Steven W. Cole} } @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 {8314, title = {Childhood and later life stressors and increased inflammatory gene expression at older ages.}, journal = {Soc Sci Med}, volume = {130}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Apr}, pages = {16-22}, publisher = {130}, abstract = {

Adverse experiences in early life have the ability to "get under the skin" and affect future health. This study examined the relative influence of adversities during childhood and adulthood in accounting for individual differences in pro-inflammatory gene expression in late life. Using a pilot-sample from the Health and Retirement Study (N = 114) aged from 51 to 95, OLS regression models were run to determine the association between a composite score from three proinflammatory gene expression levels (PTGS2, ILIB, and IL8) and 1) childhood trauma, 2) childhood SES, 3) childhood health, 4) adult traumas, and 5) low SES in adulthood. Our results showed that only childhood trauma was found to be associated with increased inflammatory transcription in late life. Furthermore, examination of interaction effects showed that childhood trauma exacerbated the influence of low SES in adulthood on elevated levels of inflammatory gene expression-signifying that having low SES in adulthood was most damaging for persons who had experienced traumatic events during their childhood. Overall our study suggests that traumas experienced during childhood may alter the stress response, leading to more sensitive reactivity throughout the lifespan. As a result, individuals who experienced greater adversity in early life may be at higher risk of late life health outcomes, particularly if adulthood adversity related to SES persists.

}, keywords = {Adolescent, Age Factors, Aged, Aged, 80 and over, Body Mass Index, Continental Population Groups, Cyclooxygenase 2, Female, Health Status, Health Surveys, Humans, Interleukin-1beta, Interleukin-8, Life Change Events, Male, Middle Aged, Obesity, RNA, Sex Factors, Smoking, Socioeconomic factors, Stress, Psychological}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2015.01.030}, author = {Morgan E. Levine and Steven W. Cole and David R Weir and Eileen M. Crimmins} } @article {7502, title = {Cross-national comparison of sex differences in health and mortality in Denmark, Japan and the US.}, journal = {Eur J Epidemiol}, volume = {25}, year = {2010}, month = {2010 Jul}, pages = {471-80}, publisher = {25}, abstract = {

The present study aims to compare the direction and magnitude of sex differences in mortality and major health dimensions across Denmark, Japan and the US. The Human Mortality Database was used to examine sex differences in age-specific mortality rates. The Danish twin surveys, the Danish 1905-Cohort Study, the Health and Retirement Study, and the Nihon University Japanese Longitudinal Study of Aging were used to examine sex differences in health. Men had consistently higher mortality rates at all ages in all three countries, but they also had a substantial advantage in handgrip strength compared with the same-aged women. Sex differences in activities of daily living (ADL) became pronounced among individuals aged 85+ in all three countries. Depression levels tended to be higher in women, particularly, in Denmark and the HRS, and only small sex differences were observed in the immediate recall test and Mini-Mental State Exam. The present study revealed consistent sex differentials in survival and physical health, self-rated health and cognition at older ages, whereas the pattern of sex differences in depressive symptoms was country-specific.

}, keywords = {Aged, Aged, 80 and over, Denmark, Disability Evaluation, Female, Health Status, Humans, Japan, Male, Middle Aged, Mortality, Sex Distribution, United States}, issn = {1573-7284}, doi = {10.1007/s10654-010-9460-6}, author = {Oksuzyan, Anna and Eileen M. Crimmins and Saito, Yasuhiko and Angela M O{\textquoteright}Rand and James W Vaupel and Christensen, Kaare} } @inbook {5183, title = {Consequences of Educational Change for the Burden of Chronic Health Problems in the Population}, booktitle = {Allocating Public and Private Resources across Generations}, number = {3}, year = {2006}, note = {ProCite field 8 : eds.}, pages = {227-242}, publisher = {Oxford University Press}, organization = {Oxford University Press}, address = {Oxford, UK}, abstract = {Changes in the public and individual burden of chronic health problems have significant implications for the allocation of public and private resources across generations. Preston (1984) noted almost two decades ago that population ageing in the United States was accompanied by the rapid expansion of public programs benefiting the health of elderswhile public programs benefiting children{\textquoteright}s education contracted. Health care is the principal public service provided to the elderly while education is the counterpart for children. Within a historical time period, political choices about the funding of age-targeted service programs have an urgency that oftentimes sweeps aside the fact that investments in children{\textquoteright}s well-being pay substantial dividends decades later when children become the elders of a population. In large part, this reflects a lack of attention both by policy makers and by demographers of these long-run associations. Here, we provide new insights into the longrun consequences of investments in children for the burden of chronic health problems by conducting a thought experiment in which we simulate how sweeping historical changes in a population{\textquoteright}s educational achievement potentially alters active life expectancy and the prevalence of functioning problems in the population.}, keywords = {Educational attainment, Educational Change, Functional Limitation, Functional Problem, Life Table}, isbn = {978-1-4020-4480-9}, doi = {https://doi.org/10.1007/978-1-4020-4481-6_9}, author = {Mark D Hayward and Eileen M. Crimmins and Zhang, Zhenmei}, editor = {Gauthier, Anne H. and Chu, Cyrus and Tuljapurkar, Shripad} }