TY - JOUR T1 - Accelerated epigenetic aging mediates link between adverse childhood experiences and depressive symptoms in older adults: Results from the Health and Retirement Study. JF - SSM Population Health Y1 - 2022 A1 - Klopack, Eric T A1 - Eileen M. Crimmins A1 - Cole, Steve W A1 - Seeman, Teresa E A1 - Carroll, Judith E KW - ACEs KW - Adverse childhood events KW - Ageing KW - depression KW - Epigenetic aging AB -

Adverse childhood experiences (ACEs) increase risk for depression at subsequent ages and have been linked to accelerated biological aging. We hypothesize that accelerated epigenetic aging may partially mediate the link between ACEs and depression. This study examines 3 three second-generation epigenetic aging measures (viz., GrimAge, PhenoAge, and DunedinPoAm38) as mediators of the link between ACEs and depressive symptoms in older adulthood. We utilize structural equation modeling to assess mediation in the Health and Retirement Study (N = 2672). Experiencing ACEs is significantly associated with an older GrimAge and a faster pace of aging via the DunedinPoAm38. Having an older GrimAge and faster DunedinPoAm38 pace of aging were also significantly associated with more depressive symptoms. PhenoAge was not significantly associated with depressive symptoms and was only associated with experiencing three ACEs. These associations were reduced by socioeconomic and lifestyle factors, including obesity and substance use. GrimAge explained between 9 and 14% of the association between ACEs and adult depressive symptoms, and DunedinPoAm38 explained between 2 and 7% of the association between ACEs and adult depressive symptoms. Findings indicate accelerated aging, as measured by GrimAge and DunedinPoAm38, is associated with ACEs and with depressive symptoms in older Americans. Findings also show these epigenetic aging measures mediate a portion of the association between ACEs and adult depressive symptoms. Epigenetic aging may represent a physiological mechanism underlying the link between early life adversity and adult depression. Weight maintenance and substance use are potentially important areas for intervention.

VL - 17 ER - TY - JOUR T1 - A computational solution for bolstering reliability of epigenetic clocks: implications for clinical trials and longitudinal tracking JF - Nature Aging Y1 - 2022 A1 - Higgins-Chen, Albert T. A1 - Thrush, Kyra L. A1 - Wang, Yunzhang A1 - Minteer, Christopher J. A1 - Kuo, Pei-Lun A1 - Wang, Meng A1 - Niimi, Peter A1 - Sturm, Gabriel A1 - Lin, Jue A1 - Ann Zenobia Moore A1 - Bandinelli, Stefania A1 - Vinkers, Christiaan H. A1 - Vermetten, Eric A1 - Rutten, Bart P. F. A1 - Geuze, Elbert A1 - Okhuijsen-Pfeifer, Cynthia A1 - van der Horst, Marte A1 - Schreiter, Stefanie A1 - Gutwinski, Stefan A1 - Luykx, Jurjen J. A1 - Picard, Martin A1 - Ferrucci, Luigi A1 - Eileen M. Crimmins A1 - Boks, Marco P. A1 - Hägg, Sara A1 - Hu-Seliger, Tina T. A1 - Morgan E. Levine KW - Aging KW - Bioinformatics KW - computational models KW - DNA Methylation KW - predictive markers AB - 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. VL - 2 ER - TY - JOUR T1 - Genetic variation in ALDH4A1 is associated with muscle health over the lifespan and across species. JF - Elife Y1 - 2022 A1 - Villa, Osvaldo A1 - Stuhr, Nicole L A1 - Yen, Chia-An A1 - Eileen M. Crimmins A1 - Arpawong, Thalida Em A1 - Curran, Sean P KW - C. elegans KW - evolutionary biology KW - Genetics KW - Genomics AB -

The influence of genetic variation on the aging process, including the incidence and severity of age-related diseases, is complex. Here we define the evolutionarily conserved mitochondrial enzyme ALH-6/ALDH4A1 as a predictive biomarker for age-related changes in muscle health by combining genetics and a gene-wide association scanning (GeneWAS) from older human participants of the US Health and Retirement Study (HRS). In a screen for mutations that activate oxidative stress responses, specifically in the muscle of , we identified 96 independent genetic mutants harboring loss-of-function alleles of , exclusively. Each of these genetic mutations mapped to the ALH-6 polypeptide and led to the age-dependent loss of muscle health. Intriguingly, genetic variants in show associations with age-related muscle-related function in humans. Taken together, our work uncovers mitochondrial as a critical component to impact normal muscle aging across species and a predictive biomarker for muscle health over the lifespan.

VL - 11 ER - TY - JOUR T1 - Genetic variation in ALDH4A1 predicts muscle health over the lifespan and across species JF - Elife Y1 - 2022 A1 - Villa, Osvaldo A1 - Stuhr, Nicole L. A1 - Yen, Chia-An A1 - Eileen M. Crimmins A1 - Thalida E. Arpawong A1 - Curran, Sean P. KW - Genetic Variation KW - muscle health AB - Environmental stress can negatively impact organismal aging, however, the long-term impact of endogenously derived reactive oxygen species from normal cellular metabolism remains less clear. Here we define the evolutionarily conserved mitochondrial enzyme ALH-6/ALDH4A1 as a biomarker for age-related changes in muscle health by combining C. elegans genetics and a gene-wide association study (GeneWAS) from aged human participants of the US Health and Retirement Study (HRS)1–4. In a screen for mutations that activate SKN-1-dependent oxidative stress responses in the muscle of C. elegans5–7, we identified 96 independent genetic mutants harboring loss-of-function alleles of alh-6, exclusively. These genetic mutations map across the ALH-6 polypeptide, which lead to age-dependent loss of muscle health. Intriguingly, genetic variants in ALDH4A1 differentially impact age-related muscle function in humans. Taken together, our work uncovers mitochondrial alh-6/ALDH4A1 as a critical component of normal muscle aging across species and a predictive biomarker for muscle health over the lifespan.Competing Interest StatementThe authors have declared no competing interest. VL - 11 IS - e74308 ER - TY - JOUR T1 - Lifetime exposure to smoking, epigenetic aging, and morbidity and mortality in older adults. JF - Clinical Epigenetics Y1 - 2022 A1 - Klopack, Eric T A1 - Carroll, Judith E A1 - Cole, Steve W A1 - Seeman, Teresa E A1 - Eileen M. Crimmins KW - DNA Methylation KW - Epigenesis KW - genetic KW - Morbidity KW - Smoking KW - Tobacco KW - Venous Blood Study AB -

BACKGROUND: Cigarette smoke is a major public health concern. Epigenetic aging may be an important pathway by which exposure to cigarette smoke affects health. However, little is known about how exposure to smoke at different life stages affects epigenetic aging, especially in older adults. This study examines how three epigenetic aging measures (GrimAge, PhenoAge, and DunedinPoAm38) are associated with parental smoking, smoking in youth, and smoking in adulthood, and whether these epigenetic aging measures mediate the link between smoke exposure and morbidity and mortality. This study utilizes data from the Health and Retirement Study (HRS) Venous Blood Study (VBS), a nationally representative sample of US adults over 50 years old collected in 2016. 2978 participants with data on exposure to smoking, morbidity, and mortality were included.

RESULTS: GrimAge is significantly increased by having two smoking parents, smoking in youth, and cigarette pack years in adulthood. PhenoAge and DunedinPoAm38 are associated with pack years. All three mediate some of the effect of pack years on cancer, high blood pressure, heart disease, and mortality and GrimAge and DunedinPoAm38 mediate this association on lung disease.

CONCLUSIONS: Results suggest epigenetic aging is one biological mechanism linking lifetime exposure to smoking with development of disease and earlier death in later life. Interventions aimed at reducing smoking in adulthood may be effective at weakening this association.

VL - 14 IS - 1 ER - TY - JOUR T1 - Social stressors associated with age-related T lymphocyte percentages in older US adults: Evidence from the US Health and Retirement Study. JF - Proceedings of the National Academy of Sciences Y1 - 2022 A1 - Klopack, Eric T A1 - Eileen M. Crimmins A1 - Cole, Steve W A1 - Seeman, Teresa E A1 - Carroll, Judith E KW - Aging KW - Immunosenescence KW - socioeconomic status KW - Stress AB -

Exposure to stress is a risk factor for poor health and accelerated aging. Immune aging, including declines in naïve and increases in terminally differentiated T cells, plays a role in immune health and tissue specific aging, and may contribute to elevated risk for poor health among those who experience high psychosocial stress. Past data have been limited in estimating the contribution of life stress to the development of accelerated immune aging and investigating mediators such as lifestyle and cytomegalovirus (CMV) infection. This study utilizes a national sample of 5,744 US adults over age 50 to assess the relationship of social stress (viz., everyday discrimination, stressful life events, lifetime discrimination, life trauma, and chronic stress) with flow cytometric estimates of immune aging, including naïve and terminally differentiated T cell percentages and the ratio of CD4 to CD8 cells. Experiencing life trauma and chronic stress was related to a lower percentage of CD4 naïve cells. Discrimination and chronic stress were each associated with a greater percentage of terminally differentiated CD4 cells. Stressful life events, high lifetime discrimination, and life trauma were related to a lower percentage of CD8 naïve cells. Stressful life events, high lifetime discrimination, and chronic stress were associated with a higher percentage of terminally differentiated CD8 cells. High lifetime discrimination and chronic stress were related to a lower CD4:CD8 ratio. Lifestyle factors and CMV seropositivity partially reduced these effects. Results identify psychosocial stress as a contributor to accelerating immune aging by decreasing naïve and increasing terminally differentiated T cells.

VL - 119 IS - 25 ER - TY - JOUR T1 - Dried blood spots: Effects of less than optimal collection, shipping time, heat, and humidity JF - American Journal of Human Biology Y1 - 2020 A1 - Eileen M. Crimmins A1 - Yuan S Zhang A1 - Jung K Kim A1 - Frochen, Stephen A1 - Kang, Hyewon A1 - Shim, Hyunju A1 - Jennifer A Ailshire A1 - Potter, Alan A1 - Cofferen, Jake A1 - Jessica Faul KW - Dried Blood Spot Testing AB - Abstract Objectives This study investigates how factors related to collection, storage, transport time, and environmental conditions affect the quality and accuracy of analyses of dried blood spot (DBS) samples. Methods Data come from the 2016 Health and Retirement Study (HRS) DBS laboratory reports and the HRS merged with the National Climatic Data Center (NCDC) Global Historical Climate Network Daily (NCDC GHCN-Daily) and the NCDC Local Climatological Data, by zip code. We ran regression models to examine the associations between assay values based on DBS for five analytes (total cholesterol, high-density lipoprotein (HDL) cholesterol, glycosylated hemoglobin (HbA1c), C-reactive protein (CRP), and cystatin C) and the characteristics of DBS cards and drops, shipping time, and temperature, and humidity at the time of collection. Results We found cholesterol measures to be sensitive to many factors including small spots, shipping time, high temperature and humidity. Small spots in DBS cards are related to lower values across all analytes. Longer DBS transit time before freezing is associated with lower values of total and HDL cholesterol and cystatin C. Results were similar whether or not venous blood sample values were included in equations. Conclusions Small spots, long shipping time, and exposure to high temperature and humidity need to be avoided if possible. Quality of spots and cards and information on shipping time and conditions should be coded with the data to make adjustments in values when necessary. The different results across analytes indicate that results cannot be generalized to all DBS assays. VL - 32 IS - 5 ER - TY - JOUR T1 - Estimates of the Association of Dementia With US Mortality Levels Using Linked Survey and Mortality Records JF - JAMA Neurology Y1 - 2020 A1 - Andrew C. Stokes A1 - Weiss, Jordan A1 - Lundberg, Dielle J. A1 - Xie, Wubin A1 - Jung K Kim A1 - Samuel H. Preston A1 - Eileen M. Crimmins KW - Dementia KW - Mortality AB - Vital statistics are the primary source of data used to understand the mortality burden of dementia in the US, despite evidence that dementia is underreported on death certificates. Alternative estimates, drawing on population-based samples, are needed.To estimate the percentage of deaths attributable to dementia in the US.A prospective cohort study of the Health and Retirement Study of noninstitutionalized US individuals with baseline exposure assessment in 2000 and follow-up through 2009 was conducted. Data were analyzed from November 2018 to May 2020. The sample was drawn from 7489 adults aged 70 to 99 years interviewed directly or by proxy. Ninety participants with missing covariates or sample weights and 57 participants lost to follow-up were excluded. The final analytic sample included 7342 adults.Dementia and cognitive impairment without dementia (CIND) were identified at baseline using Health and Retirement Study self- or proxy-reported cognitive measures and the validated Langa-Weir score cutoff.Hazard ratios relating dementia and CIND status to all-cause mortality were estimated using Cox proportional hazards regression models, accounting for covariates, and were used to calculate population-attributable fractions. Results were compared with information on cause of death from death certificates.Of the 7342 total sample, 4348 participants (60.3%) were women. At baseline, 4533 individuals (64.0%) were between ages 70 and 79 years, 2393 individuals (31.0%) were between 80 and 89 years, and 416 individuals (5.0%) were between 90 and 99 years; percentages were weighted. The percentage of deaths attributable to dementia was 13.6% (95% CI, 12.2%-15.0%) between 2000 and 2009. The mortality burden of dementia was significantly higher among non-Hispanic Black participants (24.7%; 95% CI, 17.3-31.4) than non-Hispanic White participants (12.2%; 95% CI, 10.7-13.6) and among adults with less than a high school education (16.2%; 95% CI, 13.2%-19.0%) compared with those with a college education (9.8%; 95% CI, 7.0%-12.5%). Underlying cause of death recorded on death certificates (5.0%; 95% CI, 4.3%-5.8%) underestimated the contribution of dementia to US mortality by a factor of 2.7. Incorporating deaths attributable to CIND revealed an even greater underestimation.The findings of this study suggest that the mortality burden associated with dementia is underestimated using vital statistics, especially when considering CIND in addition to dementia. VL - 77 SN - 2168-6149 IS - 12 ER - TY - CHAP T1 - Microsimulation of Health Expectancies, Life Course Health, and Health Policy Outcomes T2 - International Handbooks of Population: International Handbook of Health Expectancies Y1 - 2020 A1 - Laditka, Sarah B. A1 - Laditka, James N. A1 - Jagger, Carol ED - Jagger, Carol ED - Eileen M. Crimmins ED - Saito, Yasuhiko ED - De Carvalho Yokota, Renata Tiene ED - Van Oyen, Herman ED - Robine, Jean-Marie KW - Active life expectancy KW - Forecasting KW - Health expectancy KW - health policy KW - Population Health AB - Active life expectancy measures life expectancy and the proportions of remaining life with and without disease or disability. Microsimulation, a useful tool for life course research, estimates active life expectancy by simulating individual lifetime health biographies, where the individual's status in one or more outcomes is known for each measured unit of life. In this chapter we describe how researchers use microsimulation to study active life expectancy, focusing on research of the past 20 years. We summarize the microsimulation process. We describe how researchers model current and future population health, calculate new active life expectancy measures, and forecast effects of policy change. We illustrate the application of microsimulation to active life expectancy research with a study of interval need, a measure of need for health care and other services focused on resource use. We describe strengths of microsimulation, considerations regarding its use, and directions for future research. JF - International Handbooks of Population: International Handbook of Health Expectancies PB - Springer International Publishing CY - Basel VL - 9 SN - 978-3-030-37668-0 ER - TY - JOUR T1 - Changing impact of obesity on active life expectancy of older Americans. JF - Journals of Gerontology Series A: Biological Sciences & Medical Sciences Y1 - 2019 A1 - Yuan S Zhang A1 - Saito, Yasuhiko A1 - Eileen M. Crimmins KW - Health Trajectories KW - Longevity KW - Obesity AB -

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.

U1 - http://www.ncbi.nlm.nih.gov/pubmed/31120111?dopt=Abstract ER - TY - JOUR T1 - Cognitive Performance Among Older Persons in Japan and the United States JF - Journal of the American Geriatrics Society Y1 - 2019 A1 - Saito, Yasuhiko A1 - Jung K Kim A1 - Davarian, Shieva A1 - Hagedorn, Aaron A1 - Eileen M. Crimmins KW - cognitive performance KW - Education KW - Japan KW - Nihon University Japanese Longitudinal Study of Aging KW - United States AB - 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. UR - https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16163 ER - TY - JOUR T1 - Cohort Trends in the Gender Distribution of Household Tasks in the United States and the Implications for Understanding Disability JF - Journal of Aging and Health Y1 - 2019 A1 - Connor M Sheehan A1 - Benjamin W Domingue A1 - Eileen M. Crimmins KW - Cohort Studies KW - Disabilities KW - Gender Differences KW - Household KW - Women and Minorities AB - 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. JO - J Aging Health ER - TY - JOUR T1 - CROSS-COUNTRY COMPARISON OF INTERNET USE AND DEPRESSION BY GENDER: THE ROLE OF INTERGENERATIONAL FACTORS JF - Innovation in Aging Y1 - 2019 A1 - Shim, Hyunju A1 - Jennifer A Ailshire A1 - Eileen M. Crimmins KW - depression KW - gender KW - Intergenerational ties KW - International AB - 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. VL - 3 SN - 2399-5300 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6840073/ IS - Suppl 1 JO - Innov Aging ER - TY - JOUR T1 - How Does Subjective Age Get “Under the Skin”? The Association Between Biomarkers and Feeling Older or Younger Than One’s Age: The Health and Retirement Study JF - Innovation in Aging Y1 - 2019 A1 - Bharat Thyagarajan A1 - Shippee, Nathan A1 - Parsons, Helen A1 - Vivek, Sithara A1 - Eileen M. Crimmins A1 - Jessica Faul A1 - Shippee, Tetyana KW - Age discrepancy score KW - Biological domains KW - Physiological aging AB - Though subjective age is a well-recognized risk factor for several chronic diseases, the biological basis for these associations remains poorly understood.We used new comprehensive biomarker data from the 2016 wave of the nationally representative Health and Retirement Study (HRS) to evaluate the association between biomarker levels and self-reported subjective age in a subset of 3,740 HRS participants who provided a blood sample. We measured biomarkers in seven biological domains associated with aging: inflammation, glycemia, lipids, liver function, endocrine function, renal function, and cardiac function. The primary outcome was the age discrepancy score (subjective age − chronological age) categorized as those who felt younger, older, or the same as their chronological age (reference group). Analyses adjusted for comprehensive psychosocial factors (chronic stress index, depression score), demographic factors (race, sex, body mass index, marital status, physical activity), and prevalence of chronic health conditions (comorbidity index).The prevalence of clinically relevant reduced levels of albumin concentrations was lower in those who felt younger (8.8\% vs. 16.0\%; p = .006) and higher in those who felt older (20.4\% vs. 16.0\%; p = .03) when compared with the reference category. The prevalence of clinically significant elevation in liver enzymes such as alanine aminotransferase was also significantly lower among those who felt younger (7.1\% vs. 8.6\%; p = .04) when compared with the reference category. Prevalence of clinically elevated levels in cystatin C was also lower among those who felt younger when compared with the reference category (50.0\% vs. 59.1\%; p = .04). There was no association between lipids, glucose, or C-reactive protein (inflammatory marker) and subjective age categories.These results suggest that people who feel younger may have favorable biomarker profiles and as a result may have lower prevalence of age-related diseases when compared with those who feel older or those who feel the same as their chronological age. VL - 3 IS - 4 ER - TY - JOUR T1 - Educational Differences in the Prevalence of Dementia and Life Expectancy with Dementia: Changes from 2000 to 2010. JF - Journals of Gerontology Series B: Psychological Sciences & Social Sciences Y1 - 2018 A1 - Eileen M. Crimmins A1 - Saito, Yasuhiko A1 - Jung K Kim A1 - Yuan S Zhang A1 - Sasson, Isaac A1 - Mark D Hayward KW - Dementia KW - Education KW - Mortality AB -

Objectives: This article provides the first estimates of educational differences in age-specific prevalence, and changes in prevalence over time, of dementia by education levels in the United States. It also provides information on life expectancy, and changes in life expectancy, with dementia and cognitively healthy life for educational groups.

Method: Data on cognition from the 2000 and 2010 Health and Retirement Study are used to classify respondents as having dementia, cognitive impairment without dementia (CIND), or being cognitively intact. Vital statistics data are used to estimate life tables for education groups and the Sullivan method is used to estimate life expectancy by cognitive state.

Results: People with more education have lower prevalence of dementia, more years of cognitively healthy life, and fewer years with dementia. Years spent in good cognition increased for most sex-education groups and, conversely, years spent with dementia decreased for some. Mortality reduction was the most important factor in increasing cognitively healthy life. Change in the distribution of educational attainment has played a major role in the reduction of life with dementia in the overall population.

Discussion: Differences in the burden of cognitive loss by education point to the significant cost of low social status both to individuals and to society.

VL - 73 IS - suppl_1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29669097?dopt=Abstract ER - TY - JOUR T1 - The Health and Retirement Study: Analysis of Associations Between Use of the Internet for Health Information and Use of Health Services at Multiple Time Points JF - Journal of Medical Internet Research Y1 - 2018 A1 - Shim, Hyunju A1 - Jennifer A Ailshire A1 - Elizabeth Zelinski A1 - Eileen M. Crimmins KW - Accessibility KW - Health Behavior KW - Internet usage KW - Survey Methodology AB - Background: The use of the internet for health information among older people is receiving increasing attention, but how it is associated with chronic health conditions and health service use at concurrent and subsequent time points using nationally representative data is less known. Objective: This study aimed to determine whether the use of the internet for health information is associated with health service utilization and whether the association is affected by specific health conditions. Methods: The study used data collected in a technology module from a nationally representative sample of community-dwelling older Americans aged 52 years and above from the 2012 Health and Retirement Study (HRS; N=991). Negative binomial regressions were used to examine the association between use of Web-based health information and the reported health service uses in 2012 and 2014. Analyses included additional covariates adjusting for predisposing, enabling, and need factors. Interactions between the use of the internet for health information and chronic health conditions were also tested. Results: A total of 48.0% (476/991) of Americans aged 52 years and above reported using Web-based health information. The use of Web-based health information was positively associated with the concurrent reports of doctor visits, but not over 2 years. However, an interaction of using Web-based health information with diabetes showed that users had significantly fewer doctor visits compared with nonusers with diabetes at both times. Conclusions: The use of the internet for health information was associated with higher health service use at the concurrent time, but not at the subsequent time. The interaction between the use of the internet for health information and diabetes was significant at both time points, which suggests that health-related internet use may be associated with fewer doctor visits for certain chronic health conditions. Results provide some insight into how Web-based health information may provide an alternative health care resource for managing chronic conditions. VL - 20 UR - http://www.jmir.org/2018/5/e200/ IS - 5 JO - J Med Internet Res ER - TY - JOUR T1 - The Impact of Changes in Population Health and Mortality on Future Prevalence of Alzheimer’s Disease and Other Dementias in the United States JF - The Journals of Gerontology: Series B Y1 - 2018 A1 - Julie M Zissimopoulos A1 - Tysinger, Bryan A1 - Patricia A St Clair A1 - Eileen M. Crimmins KW - Alzheimer's disease KW - Dementia KW - Mortality KW - Population Health AB - Objectives We assessed potential benefits for older Americans of reducing risk factors associated with dementia. Methods A dynamic simulation model tracked a national cohort of persons 51 and 52 years of age to project dementia onset and mortality in risk reduction scenarios for diabetes, hypertension, and dementia. Results We found reducing incidence of diabetes by 50% did not reduce number of years a person ages 51 or 52 lived with dementia and increased the population ages 65 and older in 2040 with dementia by about 115,000. Eliminating hypertension at middle and older ages increased life expectancy conditional on survival to age 65 by almost 1 year, however, it increased years living with dementia. Innovation in treatments that delay onset of dementia by 2 years increased longevity, reduced years with dementia, and decreased the population ages 65 and older in 2040 with dementia by 2.2 million. Conclusions Prevention of chronic disease may generate health and longevity benefits but does not reduce burden of dementia. A focus on treatments that provide even short delays in onset of dementia can have immediate impacts on longevity and quality of life and reduce the number of Americans with dementia over the next decades. VL - 73 UR - https://academic.oup.com/psychsocgerontology/article/73/suppl_1/S38/4971567http://academic.oup.com/psychsocgerontology/article-pdf/73/suppl_1/S38/24626796/gbx147.pdf IS - suppl_1 ER - TY - JOUR T1 - Change in Cognitively Healthy and Cognitively Impaired Life Expectancy in the United States: 2000-2010. JF - SSM Popul Health Y1 - 2016 A1 - Eileen M. Crimmins A1 - Saito, Yasuhiko A1 - Jung K Kim AB -

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.

VL - 2 UR - 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 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27917398?dopt=Abstract JO - SSM - Population Health ER - TY - JOUR T1 - Diagnosis and control of hypertension in the elderly populations of Japan and the United States JF - International Journal of Population Studies Y1 - 2015 A1 - Saito, Yasuhiko A1 - Davarian, Shieva A1 - Takahashi, Atsuhiko A1 - Schneider, Edward A1 - Eileen M. Crimmins KW - Blood pressure KW - Cross-National KW - Health Conditions and Status KW - Heart disease KW - Hypertension KW - Older Adults AB - The Japanese have the highest life expectancy in the world while the United States (U.S.) has relatively low life expectancy. Furthermore, the Americans have relatively poorer health compared to the Japanese. Examination of the treatment of specific conditions such as hypertension in these two countries may provide insights into how the health care system con-tributes to the relative health in these two countries. In this study, we focus on the treatment of hypertension, as this is the most common condition requiring therapeutic interventions in se-niors. This study examines hypertension diagnoses and controls in nationally representative samples of the older populations (68 years old or older) of Japan and the U.S. Data come from two nationally representative samples: the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) (n = 2,309) and the U.S. Health and Retirement (HRS) Study (n = 3,517). The overall prevalence of hypertension is higher in Japan than the U.S. Undiagnosed hyperten-sion is about four times higher in Japan than in the U.S., while the control of blood pressure is more than four times higher in the U.S. than in Japan. Thus, the use of antihypertensive medi-cation is much more frequent and more effective in the U.S. The medical care system seems to be more effective in controlling hypertension in the U.S. than in Japan. This may be due to the more aggressive diagnosis and treatment of hypertension in the U.S. VL - 1 UR - http://ijps.whioce.com/index.php/ijps/article/view/01008 ER - TY - JOUR T1 - Disease incidence and mortality among older Americans and Europeans. JF - Demography Y1 - 2015 A1 - Sole-Auro, Aida A1 - Pierre-Carl Michaud A1 - Michael D Hurd A1 - Eileen M. Crimmins KW - Age Distribution KW - Aged KW - Chronic disease KW - Europe KW - Health Behavior KW - Humans KW - Incidence KW - Middle Aged KW - Neoplasms KW - Prevalence KW - Risk Factors KW - Sex Distribution KW - Socioeconomic factors KW - United States AB -

Recent research has shown a widening gap in life expectancy at age 50 between the United States and Europe as well as large differences in the prevalence of diseases at older ages. Little is known about the processes determining international differences in the prevalence of chronic diseases. Higher prevalence of disease could result from either higher incidence or longer disease-specific survival. This article uses comparable longitudinal data from 2004 and 2006 for populations aged 50 to 79 from the United States and from a selected group of European countries to examine age-specific differences in prevalence and incidence of heart disease, stroke, lung disease, diabetes, hypertension, and cancer as well as mortality associated with each disease. Not surprisingly, we find that Americans have higher disease prevalence. For heart disease, diabetes, and cancer, incidence is lower in Europe when we control for sociodemographic and health behavior differences in risk, and these differences explain much of the prevalence gap at older ages. On the other hand, incidence is higher in Europe for lung disease and not different between Europe and the United States for hypertension and stroke. Our findings do not suggest a survival advantage conditional on disease in Europe compared with the United States. Therefore, the origin of the higher disease prevalence at older ages in the United States is to be found in higher prevalence earlier in the life course and, for some conditions, higher incidence between ages 50 and 79.

VL - 52 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25715676?dopt=Abstract ER - TY - JOUR T1 - Validation of blood-based assays using dried blood spots for use in large population studies. JF - Biodemography Soc Biol Y1 - 2014 A1 - Eileen M. Crimmins A1 - Jung K Kim A1 - Heather McCreath A1 - Jessica Faul A1 - David R Weir A1 - Teresa Seeman KW - Biomarkers KW - C-reactive protein KW - Cholesterol KW - Cholesterol, HDL KW - Cystatin C KW - Dried Blood Spot Testing KW - Glycated Hemoglobin A KW - Humans KW - Middle Aged KW - Reference Values KW - Reproducibility of Results AB -

Assessment of health in large population studies has increasingly incorporated measures of blood-based biomarkers based on the use of dried blood spots (DBS). The validity of DBS assessments made by labs used by large studies is addressed by comparing assay values from DBS collected using conditions similar to those used in the field with values from whole blood samples. The DBS approach generates values that are strongly related to whole blood levels of HbA1c, cystatin C, and C-reactive protein. Assessing lipid levels reliably with DBS appears to be a greater challenge. However, even when DBS values and values from venous blood are highly correlated, they are often on a different scale, and using conventional cutoffs may be misleading.

VL - 60 UR - http://www.tandfonline.com/doi/abs/10.1080/19485565.2014.901885 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24784986?dopt=Abstract JO - Biodemography and Social Biology ER - TY - JOUR T1 - Who cares? A comparison of informal and formal care provision in Spain, England and the USA. JF - Ageing Soc Y1 - 2014 A1 - Sole-Auro, Aida A1 - Eileen M. Crimmins AB -

This paper investigates the prevalence of incapacity in performing daily activities and the associations between household composition and availability of family members and receipt of care among older adults with functioning problems in Spain, England and the United States of America (USA). We examine how living arrangements, marital status, child availability, limitations in functioning ability, age and gender affect the probability of receiving formal care and informal care from household members and from others in three countries with different family structures, living arrangements and policies supporting care of the incapacitated. Data sources include the 2006 Survey of Health, Ageing and Retirement in Europe for Spain, the third wave of the English Longitudinal Study of Ageing (2006), and the eighth wave of the USA Health and Retirement Study (2006). Logistic and multinomial logistic regressions are used to estimate the probability of receiving care and the sources of care among persons age 50 and older. The percentage of people with functional limitations receiving care is higher in Spain. More care comes from outside the household in the USA and England than in Spain. The use of formal care among the incapacitated is lowest in the USA and highest in Spain.

PB - 34 VL - 34 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24550574?dopt=Abstract ER - TY - RPRT T1 - Documentation of Biomarkers in the 2006 and 2008 Health and Retirement Study Y1 - 2013 A1 - Eileen M. Crimmins A1 - Jessica Faul A1 - Jung K Kim A1 - Heidi M Guyer A1 - Kenneth M. Langa A1 - Mary Beth Ofstedal A1 - Amanda Sonnega A1 - Robert B Wallace A1 - David R Weir KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - Biomarkers refer to the general range of physiological, metabolic, biochemical, endocrine and genetic measures that can be obtained in living organisms. The term is most commonly used to refer to one-time biochemical or hematological measures made on blood or other available bodily fluids, but perhaps the term should be used for a broader range of measures. In 2006 and 2008, HRS included the following biomarkers measurements, administered in this order: Saliva collection for DNA extraction; Blood spot collection for cholesterol, hemoglobin A1C, CRP and cystatin C analysis (results for C-reactive protein and cystatin C are forthcoming). This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions. PB - Institute for Social Research, University of Michigan CY - Ann Arbor, Michigan U4 - Biomarker data/survey Methods/health measures ER - TY - JOUR T1 - Trends in late-life activity limitations in the United States: an update from five national surveys. JF - Demography Y1 - 2013 A1 - Vicki A Freedman A1 - Brenda C Spillman A1 - Patricia Andreski A1 - Jennifer C. Cornman A1 - Eileen M. Crimmins A1 - Kramarow, Ellen A1 - Lubitz, James A1 - Linda G Martin A1 - Sharon S. Merkin A1 - Robert F. Schoeni A1 - Teresa Seeman A1 - Timothy A Waidmann KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Disabled Persons KW - Female KW - Health Surveys KW - Humans KW - Male KW - Mobility Limitation KW - Models, Statistical KW - United States AB -

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65-84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.

PB - 50 VL - 50 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23104207?dopt=Abstract U2 - PMC3586750 U4 - methodology/Meta-analysis/ADL and IADL Impairments/Public Policy/health Care Costs/PREVALENCE ER - TY - JOUR T1 - Gender differences in health: results from SHARE, ELSA and HRS. JF - Eur J Public Health Y1 - 2011 A1 - Eileen M. Crimmins A1 - Jung K Kim A1 - Sole-Auro, Aida KW - Activities of Daily Living KW - Aged KW - Aging KW - Body Weights and Measures KW - Chronic disease KW - Employment KW - Female KW - Global Health KW - Health Behavior KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Self Report KW - Sex Factors AB -

BACKGROUND: We examine gender differences in health at ages 50 years and older in 11 European countries, England and the USA.

METHODS: We use the Survey of Health, Ageing and Retirement (SHARE) for 11 Continental European countries; the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS) for the USA to examine gender differences in health behaviours, functioning problems, disability, disease prevalence and self-rated health.

RESULTS: Women in all countries are more likely than men to have disabling, non-lethal conditions including functioning problems [odds ratio (OR) indicating the effect of female is 1.57-2.43], IADL difficulties (OR 1.45-2.94), arthritis (OR 1.46-2.90) and depressive symptoms (OR 1.45-3.35). On the other hand, self-reported heart disease is more common among men (OR indicating effect of female ranges from 0.43 to 0.86). These differences are not eliminated by controlling for smoking behaviour and weight. Self-reported hypertension (OR 0.72-1.53) is generally more common among women; stroke and diabetes do not show consistent sex differences. While subjective assessment of health is poorer among women, this is not true when indicators of functioning, disability and diseases are controlled.

CONCLUSION: There is remarkable consistency in direction of gender differences in health across these 13 countries. The size of the differences is affected in many cases by the similarity in behaviours of men and women.

VL - 21 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20237171?dopt=Abstract U2 - PMC3023013 U4 - cross-national comparison/gender Differences/ELSA_/SHARE/SELF-RATED HEALTH/health Behavior/disease prevalence/DISABILITY/DISABILITY ER - TY - RPRT T1 - Results from the Health and Retirement Study Biomarker Validation Project Y1 - 2011 A1 - Eileen M. Crimmins A1 - Jung K Kim A1 - Heather McCreath A1 - Teresa Seeman KW - Health Conditions and Status KW - Methodology PB - Ann Arbor, The University of Michigan U4 - Survey Methods/Biomarker data ER - TY - JOUR T1 - Cross-national comparison of sex differences in health and mortality in Denmark, Japan and the US. JF - Eur J Epidemiol Y1 - 2010 A1 - Oksuzyan, Anna A1 - Eileen M. Crimmins A1 - Saito, Yasuhiko A1 - Angela M O'Rand A1 - James W Vaupel A1 - Christensen, Kaare KW - Aged KW - Aged, 80 and over KW - Denmark KW - Disability Evaluation KW - Female KW - Health Status KW - Humans KW - Japan KW - Male KW - Middle Aged KW - Mortality KW - Sex Distribution KW - United States AB -

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.

PB - 25 VL - 25 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20495953?dopt=Abstract U2 - PMC2903692 U4 - cross-national comparison/Activities of Daily Living/Sex Differences/depression/SELF-RATED HEALTH/NUJLSOA/NUJLSOA ER - TY - JOUR T1 - Life with and without heart disease among women and men over 50. JF - J Women Aging Y1 - 2008 A1 - Eileen M. Crimmins A1 - Mark D Hayward A1 - Ueda, Hiroshi A1 - Saito, Yasuhiko A1 - Jung K Kim KW - Activities of Daily Living KW - Aged KW - Female KW - Health Status KW - Heart Diseases KW - Humans KW - Life Expectancy KW - Male KW - Middle Aged KW - Myocardial Infarction KW - Patient Education as Topic KW - Prejudice KW - Risk Factors KW - United States KW - Women's Health KW - Women's Health Services AB -

This article uses a demographic approach and data from the Health and Retirement Survey, a nationally representative sample of the U.S. population, to investigate sex differences in the length of life lived with heart disease and after a heart attack for persons in the United States age 50 and older. On average, women live longer than men with heart disease. At age 50 women can expect to live 7.9 years and men 6.7 years with heart disease. The average woman experiences heart disease onset three years older and heart attacks 4.4 years older than men.

PB - 20 VL - 20 IS - 1-2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18581697?dopt=Abstract U2 - PMC2994551 U4 - Activities of Daily Living/health Status/Heart disease/life Expectancy/EDUCATION/risk factors/WOMEN ER - TY - JOUR T1 - Education and Cognitive Decline in Older Americans: Results From the AHEAD Sample. JF - Res Aging Y1 - 2007 A1 - Dawn E Alley A1 - Suthers, Kristen A1 - Eileen M. Crimmins AB -

Although education is consistently related to better cognitive performance, findings on the relationship between education and age-associated cognitive change have been conflicting. Using measures of multiple cognitive domains from four waves of the Asset and Health Dynamics of the Oldest Old study, a representative sample of Americans aged 70 years and older, the authors performed growth curve modeling to examine the relationships between education, initial cognitive score, and the rate of decline in cognitive function. More years of education were linked to better initial performance on each of the cognitive tests, and higher levels of education were linked to slower decline in mental status. However, more education was unrelated to the rate of decline in working memory, and education was associated with somewhat faster cognitive decline on measures of verbal memory. These findings highlight the role of early-life experiences not only in long-term cognitive performance but also in old-age cognitive trajectories.

PB - 29 VL - 29 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19830260?dopt=Abstract U2 - PMC2760835 U4 - cognitive decline/Cognitive Impairment/EDUCATION/growth curve modeling/methodology ER - TY - JOUR T1 - The impact of obesity on active life expectancy in older American men and women. JF - Gerontologist Y1 - 2005 A1 - Sandra L Reynolds A1 - Saito, Yasuhiko A1 - Eileen M. Crimmins KW - Activities of Daily Living KW - Aged KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Life Expectancy KW - Life Tables KW - Logistic Models KW - Male KW - Markov chains KW - Obesity KW - Risk Factors KW - United States AB -

PURPOSE: The purpose of this article is to estimate the effect of obesity on both the length of life and length of nondisabled life for older Americans.

DESIGN AND METHODS: Using data from the first 3 waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, this article develops estimates of total, active, and disabled life expectancy for obese and nonobese older men and women. We used the Interpolation of Markov Chains (IMaCh) method to estimate the average number of years obese and nonobese older persons can expect to live with and without activity of daily living (ADL) disability.

RESULTS: Our findings indicate that obesity has little effect on life expectancy in adults aged 70 years and older. However, the obese are more likely to become disabled. This means that obese older adults live both more years and a higher proportion of their remaining lives disabled.

IMPLICATIONS: The lack of significant differences in life expectancy by obesity status among the old suggests that obesity-related death is less of a concern than disability in this age range. Given steady increases in obesity among Americans at all ages, future disability rates may be higher than anticipated among older U.S. adults. In order to reduce disability among future cohorts of older adults, more research is needed on the causes and treatment of obesity and evaluations done on interventions to accomplish and maintain weight loss.

PB - 45 VL - 45 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16051906?dopt=Abstract U4 - Disability/Disability/Obesity/Life Expectancy ER - TY - CHAP T1 - Integrating Biology into the Study of Health Disparities T2 - Aging, Health, and Public Policy: Demographic and Economic Perspectives Y1 - 2005 A1 - Eileen M. Crimmins A1 - Teresa Seeman ED - Linda J. Waite KW - Methodology JF - Aging, Health, and Public Policy: Demographic and Economic Perspectives T3 - Population and Development Review PB - Population Council CY - New York VL - 30 N1 - ProCite field 6 : In ProCite field 8 : ed. U4 - Health Care Surveys JO - Integrating Biology into the Study of Health Disparities ER - TY - CHAP T1 - Race/Ethnicity, Socioeconomic Status, and Health T2 - Critical Perspectives on Race and Ethnic Differences in Health in Later Life Y1 - 2004 A1 - Eileen M. Crimmins A1 - Mark D Hayward A1 - Teresa Seeman ED - Norman B. Anderson ED - Randy A. Bulatao ED - Barney Cohen KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Women and Minorities AB - Mounting evidence indicates that racial/ethnic differences in morbidity and mortality are tied to socioeconomic resources (Hayward, Crimmins, Miles, and Yu, 2000; Williams and Collins, 1995). Largely because of data availability, most of this evidence is based on the health experiences of blacks and whites, with much less evidence on the role of socioeconomic factors in understanding racial/ethnic disparities when Americans of Asian or Pacific Island descent, Hispanics, and Native Americans are part of the picture. The potential power of the socioeconomic status (SES) paradigm in understanding health disparities—including racial/ethnic disparities—is evident in the fact that socioeconomic differences in health outcomes have been widely documented for most health conditions in most countries. People who are poorer and who have less education are more likely to suffer from diseases, to experience loss of functioning, to be cognitively and physically impaired, and to experience higher mortality rates (Adler, Boyce, Chesney, Folkman, and Syme, 1993; Adler et al., 1994; Marmot, Kogevinas, and Elston, 1987; Marmot, Ryff, Bumpass, Shipley, and Marks, 1997; Preston and Taubman, 1994; Williams, 1990). In the United States, few health problems are more likely to occur among those who are better off, and some health conditions are particularly sensitive to SES. In recent years socioeconomic differences in health also appear to be increasing in the United States and in other developed countries (Crimmins and Saito, 2001; Feldman, Makuc, Kleinman, and Coroni-Huntley, 1989; Manton, 1997; Marmot, 1994; Pappas, Queen, Hadden, and Fisher, 1993; Preston and Elo, 1995). JF - Critical Perspectives on Race and Ethnic Differences in Health in Later Life PB - National Academy of Sciences UR - https://www.ncbi.nlm.nih.gov/books/NBK25526/#:~:text=Socioeconomic%20status%20is%20obviously%20related,health%20outcomes%20relative%20to%20whites. U4 - Racial Differences/socioeconomic Status/African Americans/Hispanic/health disparities/MORTALITY ER - TY - JOUR T1 - Resolving inconsistencies in trends in old-age disability: report from a technical working group. JF - Demography Y1 - 2004 A1 - Vicki A Freedman A1 - Eileen M. Crimmins A1 - Robert F. Schoeni A1 - Brenda C Spillman A1 - Aykan, Hakan A1 - Kramarow, Ellen A1 - Land, Kenneth A1 - Lubitz, James A1 - Kenneth G. Manton A1 - Linda G Martin A1 - Shinberg, Diane A1 - Timothy A Waidmann KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Disabled Persons KW - Female KW - Health Surveys KW - Homemaker Services KW - Humans KW - Male KW - Models, Statistical KW - Self-Help Devices KW - United States AB -

In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1%-2.5% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.

PB - 41 VL - 41 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15461008?dopt=Abstract U4 - Disability/Disability/ADL and IADL Impairments/Elderly/Caregiving ER - TY - JOUR T1 - Life expectancy with cognitive impairment in the older population of the United States. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2003 A1 - Suthers, Kristen A1 - Jung K Kim A1 - Eileen M. Crimmins KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Cross-Sectional Studies KW - Female KW - Humans KW - Life Expectancy KW - Male KW - Neuropsychological tests KW - Probability KW - Psychometrics KW - Sex Factors KW - Survival Analysis KW - United States AB -

OBJECTIVES: This article provides estimates of the prevalence of cognitive impairment by age and sex for a nationally representative sample of the U.S. population aged 70 and over. From these estimates, years of life with and without cognitive impairment are calculated.

METHODS: Using data from the Assets and Health Dynamics of the Oldest Old (AHEAD) survey, the prevalence of cognitive impairment is estimated for a sample representing both the community-dwelling and institutionalized older American population. Sullivan's method is used to calculate the average number of years an elderly person can expect to live with and without cognitive impairment.

RESULTS: The prevalence of moderate to severe cognitive impairment in the total U.S. population aged 70 and over is 9.5%. At age 70, the average American can expect 1.5 years with cognitive impairment. Expected length of life with cognitive impairment is longer for women than men because of their longer life expectancy.

DISCUSSION: As total life expectancy continues to increase, the length of life with cognitive impairment for the American population will increase unless age-specific prevalence is reduced. There is great potential for improvement in future early treatment and diagnosis of this condition.

PB - 58B VL - 58 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12730319?dopt=Abstract U4 - Cognitive Function/Life Expectancy ER - TY - JOUR T1 - Do medical conditions affect cognition in older adults? JF - Health Psychol Y1 - 1998 A1 - Elizabeth Zelinski A1 - Eileen M. Crimmins A1 - Sandra L Reynolds A1 - Teresa Seeman KW - Aged KW - Aged, 80 and over KW - Aging KW - Cerebrovascular Disorders KW - Cognition KW - Diabetes Complications KW - Diabetes Mellitus KW - Female KW - Health Status KW - Humans KW - Hypertension KW - Male KW - Mental Health AB -

Analyses of a nationally representative sample who completed a list recall task (weighted n = 6,446) and 2 mental status tasks (weighted n = 6,646) were conducted to determine whether specific medical conditions such as high blood pressure and diabetes as well as general health ratings predict cognitive performance in adults aged 70 to 103. Presence of stroke and poorer health ratings predicted poorer performance on the 3 tasks. Presence of diabetes predicted poorer performance on recall and 1 mental status task. Age interacted with medical conditions including high blood pressure and diabetes in predicting mental status, with condition-related deficits confined to the younger end of the age continuum. Global health ratings interacted with age, with poorer ratings associated with worse mental status in the younger participants. Findings suggest that stroke and diabetes are associated with cognitive deficits. Some deficits are more pronounced in younger old adults with high blood pressure and poorer health ratings.

PB - 17 VL - 17 UR - https://pubmed.ncbi.nlm.nih.gov/9848800/ IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9848800?dopt=Abstract U4 - Aged, 80 and Over/Aging/Psychology/Cerebrovascular Disorders/Cognition/Diabetes Mellitus/Gender/Health Status/Hypertension/Support, U.S. Government--PHS ER -