TY - JOUR T1 - Association of plasma cystatin C with all-cause and cause-specific mortality among middle-aged and elderly individuals: a prospective community-based cohort study. JF - Scientific Reports Y1 - 2022 A1 - Wu, Jinhua A1 - Liang, Yuemei A1 - Chen, Rong A1 - Xu, Linli A1 - Ou, Zejin A1 - Liang, Haiying A1 - Zhao, Lina KW - Cardiovascular Diseases KW - Cause of Death KW - Cohort Studies KW - Cystatin C KW - Mortality KW - Neoplasms KW - Proportional Hazards Models KW - Prospective Studies KW - Risk Factors AB -

We investigated the associations of plasma cystatin C with all-cause and cause-specific mortality risk and identified potential modifying factors affecting these associations in middle-aged and elderly people (≥ 50 years). This community-based prospective cohort study included 13,913 individuals aged ≥ 50 years from the Health and Retirement Study. Cox proportional hazard models were used to estimate the associations between cystatin C concentrations and the risk of all-cause and cardiovascular and cancer mortality after adjustment for sociodemographic characteristics, lifestyle factors, self-reported medical history, and other potential confounding factors. During a total of 71,988 person-years of follow-up (median: 5.8 years; interquartile range 3.3-7.6 years), 1893 all-cause deaths were documented, including 714 cardiovascular-related and 406 cancer-related deaths. The comparisons of the groups with the highest (quartile 4) and lowest (quartile 1) cystatin C concentrations revealed that the adjusted hazard ratios and 95% confidence intervals were 1.92 (1.62-2.28) for all-cause mortality, 1.98 (1.48-2.65) for cardiovascular mortality, and 1.62 (1.13-2.32) for cancer mortality. The associations of cystatin C concentrations with all-cause, cardiovascular and cancer mortality did not differ substantially when participants were stratified by sex, age, BMI, current smoking status, current alcohol consumption, and regular exercise (all P for interactions > 0.05). Our study indicates that an elevated plasma cystatin C concentration is associated with an increased risk of all-cause, cardiovascular and cancer mortality both men and women among the middle-aged and elderly individuals.

VL - 12 IS - 1 ER - TY - JOUR T1 - Frailty Phenotype and Cause-Specific Mortality in the United States JF - The Journals of Gerontology: Series A Y1 - 2020 A1 - Matthew C. Lohman A1 - Amanda Sonnega A1 - Nicholas V Resciniti A1 - Amanda N Leggett KW - Cause of Death KW - Frailty KW - Incidence KW - Mortality KW - Prefrailty AB - Frailty is a common condition among older adults increasing risk of adverse outcomes including mortality; however, little is known about the incidence or risk of specific causes of death among frail individuals.Data came from the Health and Retirement Study (HRS; 2004–2012), linked to underlying cause-of-death information from the National Death Index (NDI). Community-dwelling HRS participants aged 65 and older who completed a general health interview and physical measurements (n = 10,490) were included in analysis. Frailty was measured using phenotypic model criteria—exhaustion, low weight, low energy expenditure, slow gait, and weakness. Underlying causes of death were determined using International Classification of Diseases, Version 10 codes. We used Cox proportional hazards and competing risks regression models to calculate and compare incidence of cause-specific mortality by frailty status.During follow-up, prefrail and frail older adults had significantly greater hazard of all-cause mortality compared to individuals without symptoms (adjusted hazard ratio [HR] prefrail: 1.85, 95\% CI: 1.51, 2.25; HR frail: 2.75, 95\% CI: 2.14, 3.53). Frailty was associated with 2.96 (95\% CI: 2.17, 4.03), 2.82 (95\% CI: 2.02, 3.94), 3.48 (95\% CI: 2.17, 5.59), and 2.87 (95\% CI: 1.47, 5.59) times greater hazard of death from heart disease, cancer, respiratory illness, and dementia, respectively.Significantly greater risk of mortality from several different causes should be considered alongside the potential costs of screening and intervention for frailty in subspecialty and general geriatric clinical practice. Findings may help investigators estimate the potential impact of frailty reduction approaches on mortality. VL - 75 IS - 10 N1 - glaa025 ER - TY - JOUR T1 - The Effect of Widowhood on Mental Health - an Analysis of Anticipation Patterns Surrounding the Death of a Spouse. JF - Health Econ Y1 - 2017 A1 - Siflinger, Bettina KW - Adaptation, Psychological KW - Aged KW - Bereavement KW - Cause of Death KW - Female KW - Humans KW - Interviews as Topic KW - Male KW - Mental Health KW - Middle Aged KW - Models, Econometric KW - Qualitative Research KW - Spouses KW - Widowhood AB -

This study explores the effects of widowhood on mental health by taking into account the anticipation and adaptation to the partner's death. The empirical analysis uses representative panel data from the USA that are linked to administrative death records of the National Death Index. I estimate static and dynamic specifications of the panel probit model in which unobserved heterogeneity is modeled with correlated random effects. I find strong anticipation effects of the partner's death on the probability of depression, implying that the partner's death event cannot be assumed to be exogenous in econometric models. In the absence of any anticipation effects, the partner's death has long-lasting mental health consequences, leading to a significantly slower adaptation to widowhood. The results suggest that both anticipation effects and adaptation effects can be attributed to a caregiver burden and to the cause of death. The findings of this study have important implications for designing adequate social policies for the elderly US population that alleviate the negative consequences of bereavement. Copyright © 2016 John Wiley & Sons, Ltd.

VL - 26 UR - http://doi.wiley.com/10.1002/hec.3443http://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1002%2Fhec.3443 IS - 12 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27747997?dopt=Abstract JO - Health Econ. ER - TY - JOUR T1 - A Comparison of Educational Differences on Physical Health, Mortality, and Healthy Life Expectancy in Japan and the United States. JF - J Aging Health Y1 - 2016 A1 - Chi-Tsun Chiu A1 - Mark D Hayward A1 - Saito, Yasuhiko KW - Activities of Daily Living KW - Age Distribution KW - Aged KW - Cause of Death KW - Cross-Cultural Comparison KW - Educational Status KW - Employment KW - Family Characteristics KW - Female KW - Health Status KW - Health Surveys KW - Healthy Lifestyle KW - Humans KW - Japan KW - Life Expectancy KW - Life Tables KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Regression Analysis KW - Retirement KW - Sex Distribution KW - United States AB -

OBJECTIVE: This study examined the educational gradient of health and mortality between two long-lived populations: Japan and the United States.

METHOD: This analysis is based on the Nihon University Japanese Longitudinal Study of Aging and the Health and Retirement Study to compare educational gradients in multiple aspects of population health-life expectancy with/without disability, functional limitations, or chronic diseases, using prevalence-based Sullivan life tables.

RESULTS: Our results show that education coefficients from physical health and mortality models are similar for both Japan and American populations, and older Japanese have better mortality and health profiles.

DISCUSSION: Japan's compulsory national health service system since April 1961 and living arrangements with adult children may play an important role for its superior health profile compared with that of the United States.

VL - 28 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27590801?dopt=Abstract ER - TY - JOUR T1 - Late mortality after sepsis: propensity matched cohort study. JF - BMJ Y1 - 2016 A1 - Hallie C Prescott A1 - Osterholzer, John J A1 - Kenneth M. Langa A1 - Angus, Derek C A1 - Theodore J Iwashyna KW - Aged KW - Aged, 80 and over KW - Case-Control Studies KW - Cause of Death KW - Female KW - Hospital Mortality KW - Hospitalization KW - Humans KW - Longitudinal Studies KW - Male KW - Medicare KW - Propensity Score KW - Prospective Studies KW - Sepsis KW - Time Factors KW - United States AB -

OBJECTIVES:  To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.

DEIGN:  Observational cohort study.

SETTING:  US Health and Retirement Study.

PARTICIPANTS:  960 patients aged ≥65 (1998-2010) with fee-for-service Medicare coverage who were admitted to hospital with sepsis. Patients were matched to 777 adults not currently in hospital, 788 patients admitted with non-sepsis infection, and 504 patients admitted with acute sterile inflammatory conditions.

MAIN OUTCOME MEASURES:  Late (31 days to two years) mortality and odds of death at various intervals.

RESULTS:  Sepsis was associated with a 22.1% (95% confidence interval 17.5% to 26.7%) absolute increase in late mortality relative to adults not in hospital, a 10.4% (5.4% to 15.4%) absolute increase relative to patients admitted with non-sepsis infection, and a 16.2% (10.2% to 22.2%) absolute increase relative to patients admitted with sterile inflammatory conditions (P<0.001 for each comparison). Mortality remained higher for at least two years relative to adults not in hospital.

CONCLUSIONS:  More than one in five patients who survives sepsis has a late death not explained by health status before sepsis.

VL - 353 UR - https://www.ncbi.nlm.nih.gov/pubmed/27189000 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27189000?dopt=Abstract ER - TY - JOUR T1 - One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index. JF - J Am Geriatr Soc Y1 - 2016 A1 - Irena Cenzer A1 - Victoria L. Tang A1 - W John Boscardin A1 - Christine S Ritchie A1 - Margaret Wallhagen A1 - Espaldon, Roxanne A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Cause of Death KW - Cohort Studies KW - Comorbidity KW - Disability Evaluation KW - Female KW - Hip Fractures KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Prognosis KW - Retrospective Studies KW - Risk Assessment KW - Survival Analysis KW - United States AB -

OBJECTIVES: To develop a prediction index for 1-year mortality after hip fracture in older adults that includes predictors from a wide range of domains.

DESIGN: Retrospective cohort study.

SETTINGS: Health and Retirement Study (HRS).

PARTICIPANTS: HRS participants who experienced hip fracture between 1992 and 2010 as identified according to Medicare claims data (N = 857).

MEASUREMENTS: Outcome measure was death within 1 year of hip fracture. Predictor measures were participant demographic characteristics, socioeconomic status, social support, health, geriatric symptoms, and function. Variables independently associated with 1-year mortality were identified, and best-subsets regression was used to identify the final model. The selected variables were weighted to create a risk index. The index was internally validated using bootstrapping to estimate model optimism.

RESULTS: Mean age at time of hip fracture was 84, and 76% of the participants were women. There were 235 deaths (27%) during the 1-year follow up. Five predictors of mortality were included in the final model: aged 90 and older (2 points), male sex (2 points), congestive heart failure (2 points), difficulty preparing meals (2 points), and not being able to drive (1 point). The point scores of the index were associated with 1-year mortality, with 0 points predicting 10% risk and 7 to 9 points predicting 66% risk. The c-statistic for the final model was 0.73, with an estimated optimism penalty of 0.01, indicating very little evidence of overfitting.

CONCLUSION: The prognostic index combines demographic, comorbidity, and function variables and can be used to differentiate between individuals at low and high risk of 1-year mortality after hip fracture.

VL - 64 UR - http://www.ncbi.nlm.nih.gov/pubmed/27295578 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27295578?dopt=Abstract ER - TY - JOUR T1 - Death certificates underestimate infections as proximal causes of death in the U.S. JF - PLoS One Y1 - 2014 A1 - Govindan, Sushant A1 - Shapiro, Letitia A1 - Kenneth M. Langa A1 - Theodore J Iwashyna KW - Cause of Death KW - Death Certificates KW - Hospitalization KW - Humans KW - Infections KW - Medicare KW - United States AB -

BACKGROUND: Death certificates are a primary data source for assessing the population burden of diseases; however, there are concerns regarding their accuracy. Diagnosis-Related Group (DRG) coding of a terminal hospitalization may provide an alternative view. We analyzed the rate and patterns of disagreement between death certificate data and hospital claims for patients who died during an inpatient hospitalization.

METHODS: We studied respondents from the Health and Retirement Study (a nationally representative sample of older Americans who had an inpatient death documented in the linked Medicare claims from 1993-2007). Causes of death abstracted from death certificates were aggregated to the standard National Center for Health Statistics List of 50 Rankable Causes of Death. Centers for Medicare and Medicaid Services (CMS)-DRGs were manually aggregated into a parallel classification. We then compared the two systems via 2×2, focusing on concordance. Our primary analysis was agreement between the two data sources, assessed with percentages and Cohen's kappa statistic.

RESULTS: 2074 inpatient deaths were included in our analysis. 36.6% of death certificate cause-of-death codes agreed with the reason for the terminal hospitalization in the Medicare claims at the broad category level; when re-classifying DRGs without clear alignment as agreements, the concordance only increased to 61%. Overall Kappa was 0.21, or "fair." Death certificates in this cohort redemonstrated the conventional top 3 causes of death as diseases of the heart, malignancy, and cerebrovascular disease. However, hospitalization claims data showed infections, diseases of the heart, and cerebrovascular disease as the most common diagnoses for the same terminal hospitalizations.

CONCLUSION: There are significant differences between Medicare claims and death certificate data in assigning cause of death for inpatients. The importance of infections as proximal causes of death is underestimated by current death certificate-based strategies.

PB - 9 VL - 9 IS - 5 N1 - Times Cited: 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24878897?dopt=Abstract U2 - PMC4039437 U4 - Medicare claims/Infection/death certificate/cause of death/survey methods ER - TY - JOUR T1 - Factors influencing the use of intensive procedures at the end of life. JF - J Am Geriatr Soc Y1 - 2014 A1 - Evan C Tschirhart A1 - Qingling Du A1 - Amy Kelley KW - Advance directives KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Cause of Death KW - Chronic disease KW - Critical Care KW - Female KW - Homes for the Aged KW - Humans KW - Life Support Care KW - Logistic Models KW - Male KW - Multivariate Analysis KW - Neoplasms KW - Nursing homes KW - Odds Ratio KW - Terminal Care KW - United States KW - Utilization Review AB -

OBJECTIVES: To examine individual and regional factors associated with the use of intensive medical procedures in the last 6 months of life.

DESIGN: Retrospective cohort study.

SETTING: The Health and Retirement Study (HRS), a longitudinal nationally representative cohort of older adults.

PARTICIPANTS: HRS decedents aged 66 and older (N = 3,069).

MEASUREMENTS: Multivariable logistic regression was used to evaluate associations between individual and regional factors and receipt of five intensive procedures: intubation and mechanical ventilation, tracheostomy, gastrostomy tube insertion, enteral and parenteral nutrition, or cardiopulmonary resuscitation in the last 6 months of life.

RESULTS: Approximately 18% of subjects (n = 546) underwent at least one intensive procedure in the last 6 months of life. Characteristics significantly associated with lower odds of an intensive procedure included aged 85-94 (vs 65-74, adjusted odds ratio (AOR) = 0.67, 95% confidence interval (CI) = 0.51-0.90), Alzheimer's disease (AOR = 0.71, 95% CI = 0.54-0.94), cancer (AOR = 0.60, 95% CI = 0.43-0.85), nursing home residence (AOR = 0.70, 95% CI = 0.50-0.97), and having an advance directive (AOR = 0.71, 95% CI = 0.57-0.89). In contrast, living in a region with higher hospital care intensity (AOR = 2.16, 95% CI = 1.48-3.13) and black race (AOR = 2.02, 95% CI = 1.52-2.69) each doubled one's odds of undergoing an intensive procedure.

CONCLUSION: Individual characteristics and regional practice patterns are important determinants of intensive procedure use in the last 6 months of life. The effect of nonclinical factors highlights the need to better align treatments with individual preferences.

PB - 62 VL - 62 IS - 11 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25376084?dopt=Abstract U2 - PMC4241150 U4 - end-of-life decisions/terminal care/intensive care/Medicare/Advance Directives/regional variations/MEDICARE EXPENDITURES/SUSTAINING TREATMENTS/PATIENT PREFERENCES ER - TY - JOUR T1 - Out-of-pocket spending in the last five years of life. JF - J Gen Intern Med Y1 - 2013 A1 - Amy Kelley A1 - Kathleen McGarry A1 - Sean Fahle A1 - Samuel M Marshall A1 - Qingling Du A1 - Jonathan S Skinner KW - Aged KW - Cause of Death KW - Female KW - Health Expenditures KW - Health Services for the Aged KW - Humans KW - Male KW - Marital Status KW - Medicare KW - Retrospective Studies KW - Socioeconomic factors KW - Terminal Care KW - United States AB -

BACKGROUND: A key objective of the Medicare program is to reduce risk of financial catastrophe due to out-of-pocket healthcare expenditures. Yet little is known about cumulative financial risks arising from out-of-pocket healthcare expenditures faced by older adults, particularly near the end of life.

DESIGN: Using the nationally representative Health and Retirement Study (HRS) cohort, we conducted retrospective analyses of Medicare beneficiaries' total out-of-pocket healthcare expenditures over the last 5 years of life.

PARTICIPANTS: We identified HRS decedents between 2002 and 2008; defined a 5 year study period using each subject's date of death; and excluded those without Medicare coverage at the beginning of this period (n = 3,209).

MAIN MEASURES: We examined total out-of-pocket healthcare expenditures in the last 5 years of life and expenditures as a percentage of baseline household assets. We then stratified results by marital status and cause of death. All measurements were adjusted for inflation to 2008 US dollars.

RESULTS: Average out-of-pocket expenditures in the 5 years prior to death were $38,688 (95 % Confidence Interval $36,868, $40,508) for individuals, and $51,030 (95 % CI $47,649, $54,412) for couples in which one spouse dies. Spending was highly skewed, with the median and 90th percentile equal to $22,885 and $89,106, respectively, for individuals, and $39,759 and $94,823, respectively, for couples. Overall, 25 % of subjects' expenditures exceeded baseline total household assets, and 43 % of subjects' spending surpassed their non-housing assets. Among those survived by a spouse, 10 % exceeded total baseline assets and 24 % exceeded non-housing assets. By cause of death, average spending ranged from $31,069 for gastrointestinal disease to $66,155 for Alzheimer's disease.

CONCLUSION: Despite Medicare coverage, elderly households face considerable financial risk from out-of-pocket healthcare expenses at the end of life. Disease-related differences in this risk complicate efforts to anticipate or plan for health-related expenditures in the last 5 years of life.

PB - 28 VL - 28 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22948931?dopt=Abstract U2 - PMC3614143 U4 - Public policy/Medicare/End of life/health expenditures/out of pocket costs ER - TY - JOUR T1 - Situational versus chronic loneliness as risk factors for all-cause mortality. JF - Int Psychogeriatr Y1 - 2010 A1 - Sharon Shiovitz-Ezra A1 - Liat Ayalon KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Aging KW - Cause of Death KW - Female KW - Geriatric Assessment KW - Health Surveys KW - Humans KW - Israel KW - Life Change Events KW - Loneliness KW - Male KW - Middle Aged KW - Risk Factors KW - social isolation KW - Surveys and Questionnaires KW - Time Factors AB -

BACKGROUND: Several international studies have substantiated the role of loneliness as a risk factor for mortality. Although both theoretical and empirical research has supported the classification of loneliness as either situational or chronic, research to date has not evaluated whether this classification has a differential impact upon mortality.

METHODS: To establish the definition of situational vs. chronic loneliness, we used three waves of the Health and Retirement Study (HRS), a nationally representative sample of Americans over the age of 50 years. Baseline data for the present study were collected in the years 1996, 1998, and 2000. The present study concerns the 7,638 individuals who completed all three waves; their loneliness was classified as either not lonely, situational loneliness or chronic loneliness. Mortality data were available through to the year 2004.

RESULTS: Those identified as "situationally lonely" (HR = 1.56; 95% CI: 1.52-1.62) as well as those identified as "chronically lonely" (HR = 1.83; 95% CI: 1.71-1.87) had a greater risk for all cause mortality net of the effect of possible demographic and health confounders. Nonetheless, relative to those classified as "situationally lonely," individuals classified as "chronically lonely" had a slightly greater mortality risk.

CONCLUSIONS: The current study emphasizes the important role loneliness plays in older adults' health. The study further supports current division into situational vs. chronic loneliness, yet suggests that both types serve as substantial mortality risks.

PB - 22 VL - 22 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20003631?dopt=Abstract U3 - 20003631 U4 - Loneliness/Older Adults/Isolation/Death/Demography/Dying/chronic loneliness/mortality/situational loneliness ER - TY - JOUR T1 - Self-rated health trajectories and mortality among older adults. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2007 A1 - Thomas R Miller A1 - Frederic D Wolinsky KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Attitude to Health KW - Cardiovascular Diseases KW - Cause of Death KW - Female KW - Follow-Up Studies KW - Health Status KW - Health Status Indicators KW - Humans KW - Logistic Models KW - Longitudinal Studies KW - Lung Diseases KW - Male KW - Mortality KW - Multivariate Analysis KW - Risk Factors KW - Sex Factors KW - Smoking KW - Socioeconomic factors KW - Survival Analysis KW - United States AB -

OBJECTIVES: For this article, we evaluated whether measures of prior self-rated health (SRH) trajectories had associations with subsequent mortality that were independent of current SRH assessment and other covariates.

METHODS: We used multivariable logistic regression that incorporated four waves of interview data (1993, 1995, 1998, and 2000) from the Asset and Health Dynamics Among the Oldest Old Survey in order to predict mortality during 2000-2002. We defined prior SRH trajectories for each individual based on the slope estimated from a simple linear regression of their own SRH between 1993 and 1998 and the variance around that slope. In addition to SRH reported in 2000, other covariates included in the mortality models reflected health status, health-related behaviors, and individual resources.

RESULTS: Among the 3,129 respondents in the analytic sample, SRH in 2000 was significantly (p <.0001) associated with mortality, but the measures of prior SRH trajectories were not. Prior SRH trajectory was, however, a significant determinant of current SRH. We observed significant independent associations with mortality for age, sex, education, lung disease, and having ever smoked.

DISCUSSION: Although measures of prior SRH trajectories did not have significant direct associations with mortality, they did have important indirect effects via their influence on current SRH.

PB - 62 VL - 62 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/17284562?dopt=Abstract U4 - SELF-RATED HEALTH/mortality ER -