TY - JOUR T1 - Childhood social and economic well-being and health in older age. JF - Am J Epidemiol Y1 - 2007 A1 - Sandra Y. Moody-Ayers A1 - Lindquist, Karla A1 - Sen, Saunak A1 - Kenneth E Covinsky KW - Aged KW - Aged, 80 and over KW - Black or African American KW - Child KW - Confidence Intervals KW - Educational Status KW - Female KW - Frail Elderly KW - Health Status KW - Health Status Indicators KW - Hispanic or Latino KW - Humans KW - Male KW - Middle Aged KW - Mobility Limitation KW - Odds Ratio KW - Poverty KW - Retrospective Studies KW - Sampling Studies KW - San Francisco KW - Socioeconomic factors KW - Surveys and Questionnaires KW - White People AB -

Childhood socioeconomic status (SES) acts over a lifetime to influence adult health outcomes. Whether the impact of childhood SES differs by age or race/ethnicity is unclear. The authors studied 20,566 community-living US adults aged > or =50 years. Parental education was the main predictor. Outcomes evaluated (1998-2002) included self-reported health and functional limitation. The influence of childhood SES on later-life health was also examined in groups stratified by age and race/ethnicity, with adjustment for demographic factors and current SES. Participants' mean age was 67 years; 57% were women. By race/ethnicity, 76% were White, 14% were Black, and 8% were Latino. The relation between low parental education and fair/poor self-rated health declined with advancing age (age 50-64 years: adjusted odds ratio (AOR) = 1.42, 95% confidence interval (CI): 1.24, 1.63; age > or =80 years: AOR = 1.14, 95% CI: 0.96, 1.36). The relation between low parental education and fair/poor self-rated health differed across racial/ethnic groups and was significant in White (AOR = 1.33, 95% CI: 1.21, 1.47) and Black (AOR = 1.37, 95% CI: 1.14, 1.64) participants but not Latinos. These findings suggest that childhood SES affects health status through midlife but the effects may abate in late life; its effects also may be weaker in Latinos than in Whites or Blacks.

PB - 166 VL - 166 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17720682?dopt=Abstract U4 - childhood conditions/Socioeconomic Status/health status/Activities of Daily Living/Mobility Difficulty/Frail Elderly ER - TY - JOUR T1 - The Relationship Between Self-Rated Health and Mortality in Older Black and White Americans JF - Journal of the American Geriatrics Society Y1 - 2007 A1 - Sei J. Lee A1 - Sandra Y. Moody-Ayers A1 - C. Seth Landefeld A1 - Louise C Walter A1 - Lindquist, Karla A1 - Mark Segal A1 - Kenneth E Covinsky KW - Demographics KW - Health Conditions and Status KW - Women and Minorities AB - PURPOSE: To determine whether the association between self-rated health (SRH) and 4-year mortality differs between black and white Americans and whether education affects this relationship. METHODS: Sixteen thousand four hundred thirty-two subjects (14,004 white, 2,428 black) enrolled in the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling U.S. adults aged 50 and older. Subjects were asked to self-identify their race and their overall health by answering the question, Would you say your health is excellent, very good, good, fair, or poor? Death was determined according to the National Death Index. RESULTS: SRH is a much stronger predictor of mortality in whites than blacks (c -statistic 0.71 vs 0.62). In whites, poor SRH resulted in a markedly higher risk of mortality than excellent SRH (odds ratio (OR)=10.4, 95 confidence interval (CI)=8.0-13.6). In blacks, poor RSH resulted in a much smaller increased risk of mortality (OR=2.9, 95 CI=1.5-5.5). SRH was a stronger predictor of death in white and black subjects with higher levels of education, but differences in education could not account for the observed race differences in the prognostic effect of SRH. CONCLUSIONS: This population-based study found that the relationship between SRH and mortality is stronger in white Americans and in subjects with higher levels of education. Because the association between SRH and mortality appears weakest in traditionally disadvantaged groups, SRH may not be the best measure to identify vulnerable older subjects. PB - 55 VL - 55 IS - 10 U4 - SELF-RATED HEALTH/Mortality/Education/African-Americans ER - TY - JOUR T1 - The relationship between self-rated health and mortality in older black and white Americans. JF - J Am Geriatr Soc Y1 - 2007 A1 - Sei J. Lee A1 - Sandra Y. Moody-Ayers A1 - C. Seth Landefeld A1 - Louise C Walter A1 - Lindquist, Karla A1 - Mark Segal A1 - Kenneth E Covinsky KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Black People KW - Educational Status KW - Female KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Mortality KW - Population Surveillance KW - Prognosis KW - Self Disclosure KW - Sex Distribution KW - United States KW - White People AB -

OBJECTIVES: To determine whether the association between self-rated health (SRH) and 4-year mortality differs between black and white Americans and whether education affects this relationship.

DESIGN: Prospective cohort.

SETTING: Communities in the United States.

PARTICIPANTS: Sixteen thousand four hundred thirty-two subjects (14,004 white, 2,428 black) enrolled in the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling U.S. adults aged 50 and older.

MEASUREMENTS: Subjects were asked to self-identify their race and their overall health by answering the question, "Would you say your health is excellent, very good, good, fair, or poor?" Death was determined according to the National Death Index.

RESULTS: SRH is a much stronger predictor of mortality in whites than blacks (c-statistic 0.71 vs 0.62). In whites, poor SRH resulted in a markedly higher risk of mortality than excellent SRH (odds ratio (OR)=10.4, 95% confidence interval (CI)=8.0-13.6). In blacks, poor RSH resulted in a much smaller increased risk of mortality (OR=2.9, 95% CI=1.5-5.5). SRH was a stronger predictor of death in white and black subjects with higher levels of education, but differences in education could not account for the observed race differences in the prognostic effect of SRH.

CONCLUSION: This population-based study found that the relationship between SRH and mortality is stronger in white Americans and in subjects with higher levels of education. Because the association between SRH and mortality appears weakest in traditionally disadvantaged groups, SRH may not be the best measure to identify vulnerable older subjects.

PB - 55 VL - 55 IS - 10 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17697102?dopt=Abstract U4 - Minorities/African Americans/SELF-RATED HEALTH/EDUCATION/MORTALITY ER - TY - JOUR T1 - Functional impairment, race, and family expectations of death. JF - J Am Geriatr Soc Y1 - 2006 A1 - Brie A Williams A1 - Lindquist, Karla A1 - Sandra Y. Moody-Ayers A1 - Louise C Walter A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Attitude to Death KW - Black or African American KW - Cross-Sectional Studies KW - Disabled Persons KW - Family KW - Female KW - Hispanic or Latino KW - Humans KW - Male KW - White People AB -

OBJECTIVES: To assess the effect of functional impairment on family expectations of death and to examine how this association varies by race.

DESIGN: Cross-sectional.

SETTING: Community based.

PARTICIPANTS: Two thousand two hundred thirty-seven family members of decedents from the Health and Retirement Survey (HRS), a national study of persons aged 50 and older.

MEASUREMENTS: Families were interviewed within 2 years of the HRS participant's death. The primary outcome was whether death was expected. The primary predictors were the decedent's functional status (impairment in any activity of daily living (ADL; eating, dressing, transferring, toileting, or bathing) during the last 3 months of life and the decedent's race.

RESULTS: Overall, 58% of families reported that their family member's death was expected. Expecting death was strongly associated with functional impairment; 71% of families of decedents with ADL disability expected death, compared with 24% of those without ADL disability (P < .01). Death was expected more often in families of white decedents (60%) than African Americans (49%) (P < .01), although the effect of ADL disability was similar in both groups. After adjustment for potentially confounding factors, there were still significant associations between expecting death and functional impairment (odds ratio (OR) = 3.58, 95% confidence interval (CI) 2.73-4.70), and families of African Americans expected death less often than families of white decedents (OR = 0.63, 95% CI = 0.46-0.86).

CONCLUSION: Family members of older adults expected death only 58% of the time. Families of functionally impaired older people were more likely to expect death when it occurred than were families of older people who were not functionally impaired, and the expectation of death was lower for families of African Americans than for whites.

PB - 54 VL - 54 IS - 11 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17087694?dopt=Abstract U4 - Activities of Daily Living/Minorities/Hispanic/African Americans/functional impairment/expectations/death ER - TY - JOUR T1 - Black-White Disparities in Functional Decline in Older Persons: The role of cognitive function JF - The Journals of Gerontology, Series A: Biological Sciences and Medical Sciences Y1 - 2005 A1 - Sandra Y. Moody-Ayers A1 - Kala M. Mehta A1 - Lindquist, Karla A1 - Laura Sands A1 - Kenneth E Covinsky KW - Demographics KW - Health Conditions and Status AB - Background. Black elders have a greater frequency of functional decline than do white elders. The impact of cognitive function on explaining black white disparities in functional decline has not been extensively explored. Methods. To compare the extent to which different risk domains (comorbidity, smoking, socioeconomic status (SES), self-rated health, and cognitive function) explain more frequent functional decline in black elders, we studied 779 black and 4892 white community-dwelling adults aged 70 and older from the Assets and Health Dynamics Among the Oldest Old (AHEAD), a population-based cohort study begun in 1993. Our primary outcome was worse functional status at 2 years than at baseline. We used logistic regression to compare the unadjusted with the adjusted black white odds ratios (ORs) after adjusting for each risk domain. Results. At baseline black participants aged 70 79 had higher rates of smoking, diabetes, and hypertension; lower SES; and worse cognitive function than did white participants (p .05 for all). The mean cognitive score was 15.7 in black and 21.8 in white participants (p .01). Black participants had a higher frequency of 2-year functional decline than did white participants (10.9 vs 4.7 ; OR = 2.61, 95 confidence interval CI , 1.69 4.03 adjusted for age and sex). Adjustment for comorbidity and smoking did not significantly change the black white OR, whereas self-rated health and SES accounted for about half the risk. Adjustment for cognitive function accounted for nearly all the associated decline (OR = 1.10, 95 CI, 0.67 1.79). Among participants aged 80 and over, those who were black had significantly lower risk for functional decline after adjustment for cognitive function (OR = 0.61, 95 CI, 0.38 0.96 vs OR = 1.08, 95 CI, 0.70 1.66 adjusted for age and sex only). Conclusions. Cognitive function mediated the higher frequency of functional decline among black elders. Efforts to understand cognitive function may enhance our understanding of black white disparities in health outcomes. PB - 60 VL - 60 IS - 6 U4 - Cognitive Function/Health Physical/Racial Differences ER -