%0 Journal Article %J Circulaton. Cardiovascular quality and outcomes %D 2017 %T Neighborhood Differences in Post-Stroke Mortality. %A Theresa L Osypuk %A Amy Ehntholt %A J Robin Moon %A Paola Gilsanz %A M. Maria Glymour %K Mortality %K Neighborhoods %K Older Adults %K Stroke %X

BACKGROUND: Post-stroke mortality is higher among residents of disadvantaged neighborhoods, but it is not known whether neighborhood inequalities are specific to stroke survival or similar to mortality patterns in the general population. We hypothesized that neighborhood disadvantage would predict higher poststroke mortality, and neighborhood effects would be relatively larger for stroke patients than for individuals with no history of stroke.

METHODS AND RESULTS: Health and Retirement Study participants aged ≥50 years without stroke at baseline (n=15 560) were followed ≤12 years for incident stroke (1715 events over 159 286 person-years) and mortality (5325 deaths). Baseline neighborhood characteristics included objective measures based on census tracts (family income, poverty, deprivation, residential stability, and percent white, black, or foreign-born) and self-reported neighborhood social ties. Using Cox proportional hazard models, we compared neighborhood mortality effects for people with versus people without a history of stroke. Most neighborhood variables predicted mortality for both stroke patients and the general population in demographic-adjusted models. Neighborhood percent white predicted lower mortality for stroke survivors (hazard ratio, 0.75 for neighborhoods in highest 25th percentile versus below, 95% confidence interval, 0.62-0.91) more strongly than for stroke-free adults (hazard ratio, 0.92; 95% confidence interval, 0.83-1.02; P=0.04 for stroke-by-neighborhood interaction). No other neighborhood characteristic had different effects for people with versus without stroke. Neighborhood-mortality associations emerged within 3 months after stroke, when associations were often stronger than among stroke-free individuals.

CONCLUSIONS: Neighborhood characteristics predict mortality, but most effects are similar for individuals without stroke. Eliminating disparities in stroke survival may require addressing pathways that are not specific to traditional poststroke care.

%B Circulaton. Cardiovascular quality and outcomes %V 10 %8 02/2017 %G eng %N 2 %R 10.1161/CIRCOUTCOMES.116.002547 %0 Journal Article %J J Am Heart Assoc %D 2015 %T Changes in Depressive Symptoms and Incidence of First Stroke Among Middle-Aged and Older US Adults. %A Stefan Walter %A Eric J. Tchetgen Tchetgen %A Kristen K Patton %A J Robin Moon %A Benjamin D Capistrant %A Jessica R Marden %A Laura D Kubzansky %A Paola Gilsanz %A Ichiro Kawachi %A M. Maria Glymour %K Adult %K Aged %K Aged, 80 and over %K Aging %K depression %K Female %K Humans %K Incidence %K Longitudinal Studies %K Male %K Middle Aged %K Proportional Hazards Models %K Risk Factors %K Sex Factors %K Stroke %K Time Factors %X

BACKGROUND: Although research has demonstrated that depressive symptoms predict stroke incidence, depressive symptoms are dynamic. It is unclear whether stroke risk persists if depressive symptoms remit.

METHODS AND RESULTS: Health and Retirement Study participants (n=16 178, stroke free and noninstitutionalized at baseline) were interviewed biennially from 1998 to 2010. Stroke and depressive symptoms were assessed through self-report of doctors' diagnoses and a modified Center for Epidemiologic Studies - Depression scale (high was ≥3 symptoms), respectively. We examined whether depressive symptom patterns, characterized across 2 successive interviews (stable low/no, onset, remitted, or stable high depressive symptoms) predicted incident stroke (1192 events) during the subsequent 2 years. We used marginal structural Cox proportional hazards models adjusted for demographics, health behaviors, chronic conditions, and attrition. We also estimated effects stratified by age (≥65 years), race or ethnicity (non-Hispanic white, non-Hispanic black, Hispanic), and sex. Stroke hazard was elevated among participants with stable high (adjusted hazard ratio 2.14, 95% CI 1.69 to 2.71) or remitted (adjusted hazard ratio 1.66, 95% CI 1.22 to 2.26) depressive symptoms compared with participants with stable low/no depressive symptoms. Stable high depressive symptom predicted stroke among all subgroups. Remitted depressive symptoms predicted increased stroke hazard among women (adjusted hazard ratio 1.86, 95% CI 1.30 to 2.66) and non-Hispanic white participants (adjusted hazard ratio 1.66, 95% CI 1.18 to 2.33) and was marginally associated among Hispanics (adjusted hazard ratio 2.36, 95% CI 0.98 to 5.67).

CONCLUSIONS: In this cohort, persistently high depressive symptoms were associated with increased stroke risk. Risk remained elevated even if depressive symptoms remitted over a 2-year period, suggesting cumulative etiologic mechanisms linking depression and stroke.

%B J Am Heart Assoc %I 4 %V 4 %8 2015 May 13 %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/25971438?dopt=Abstract %2 PMC4599421 %4 depressive Symptoms/stroke risk/CES Depression Scale/CES Depression Scale/depression/stroke %$ 999999 %R 10.1161/JAHA.115.001923 %0 Journal Article %J J Public Health (Oxf) %D 2014 %T Short- and long-term associations between widowhood and mortality in the United States: longitudinal analyses. %A J Robin Moon %A M. Maria Glymour %A Anusha M Vable %A Sze Y Liu %A S. V. Subramanian %K Bereavement %K Female %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Mortality %K Risk Factors %K Sex Factors %K Socioeconomic factors %K Time Factors %K United States %K Widowhood %X

BACKGROUND: Past research shows that spousal death results in elevated mortality risk for the surviving spouse. However, most prior studies have inadequately controlled for socioeconomic status (SES), and it is unclear whether this 'widowhood effect' persists over time.

METHODS: Health and Retirement Study participants aged 50+ years and married in 1998 (n = 12 316) were followed through 2008 for widowhood status and mortality (2912 deaths). Discrete-time survival analysis was used to compare mortality for the widowed versus the married.

RESULTS: Odds of mortality during the first 3 months post-widowhood were significantly higher than in the continuously married (odds ratio (OR) for men = 1.87, 95% CI: 1.27, 2.75; OR for women = 1.47, 95% CI: 0.96, 2.24) in models adjusted for age, gender, race and baseline SES (education, household wealth and household income), behavioral risk factors and co-morbidities. Twelve months following bereavement, men experienced borderline elevated mortality (OR = 1.16, 95% CI: 1.00, 1.35), whereas women did not (OR = 1.07, 95% CI: 0.90, 1.28), though the gender difference was non-significant.

CONCLUSION: The 'widowhood effect' was not fully explained by adjusting for pre-widowhood SES and particularly elevated within the first few months after widowhood. These associations did not differ by sex.

%B J Public Health (Oxf) %I 36 %V 36 %P 382-9 %8 2014 Sep %G eng %U http://jpubhealth.oxfordjournals.org/content/early/2013/10/27/pubmed.fdt101.abstract %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/24167198?dopt=Abstract %2 PMC4181424 %4 Widowhood/Spousal Loss/Mortality/Longitudinal Studies/Socioeconomic Status %$ 999999 %R 10.1093/pubmed/fdt101 %0 Journal Article %J Ethn Dis %D 2013 %T Does the association between depressive symptoms and cardiovascular mortality risk vary by race? Evidence from the Health and Retirement Study. %A Benjamin D Capistrant %A Paola Gilsanz %A J Robin Moon %A Anna Kosheleva %A Kristen K Patton %A M. Maria Glymour %K Aged %K Black or African American %K Cardiovascular Diseases %K depression %K Female %K Humans %K Male %K Middle Aged %K Proportional Hazards Models %K Risk Assessment %K Risk Factors %K White People %X

OBJECTIVE: To test whether the association between depressive symptoms and cardiovascular disease (CVD) mortality is stronger among Blacks than Whites.

DESIGN, SETTING AND PARTICIPANTS: 2,638 Black and 15,132 White participants from a prospective, observational study of community-dwelling Health and Retirement Study participants (a nationally representative sample of U.S. adults aged > or = 50). Average follow-up was 9.2 years.

OUTCOME MEASURE: Cause of death (per ICD codes) and month of death were identified from National Death Index linkages.

METHODS: The associations between elevated depressive symptoms and mortality from stroke, ischemic heart disease (IHD), or total CVD were assessed using Cox proportional hazards models to estimate adjusted hazard ratios (HRs). We used interaction terms for race by depressive symptoms to assess effect modification (multiplicative scale).

RESULTS: For both Whites and Blacks, depressive symptoms were associated with a significantly elevated hazard of total CVD mortality (Whites: HR=1.46; 95% CI: 1.33, 1.61; Blacks: HR=1.42, 95% CI: 1.10, 1.83). Adjusting for health and socioeconomic covariates, Whites with elevated depressive symptoms had a 13% excess hazard of CVD mortality (HR=1.13, 95% CI: 1.03, 1.25) compared to Whites without elevated depressive symptoms. The HR in Blacks was similar, although the confidence interval included the null (HR=1.12, 95% CI: .86, 1.46). The hazard associated with elevated depressive symptoms did not differ significantly by race (P>.15 for all comparisons). Patterns were similar in analyses restricted to respondents age > or =65.

CONCLUSION: Clinicians should consider the depressive state of either Black or White patients as a potential CVD mortality risk factor.

%B Ethn Dis %I 23 %V 23 %P 155-60 %8 2013 Spring %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/23530295?dopt=Abstract %2 PMC3616329 %4 cardiovascular disease/Racial Differences/Depressive Disorder/Depression in old age/Mortality/African Americans/Proportional Hazards Models/risk assessment/risk Factors %$ 68946 %0 Journal Article %J J Epidemiol Community Health %D 2012 %T Current and long-term spousal caregiving and onset of cardiovascular disease. %A Benjamin D Capistrant %A J Robin Moon %A Lisa F Berkman %A M. Maria Glymour %K Activities of Daily Living %K Adult %K Aged %K Aged, 80 and over %K Cardiovascular Diseases %K Caregivers %K Female %K Follow-Up Studies %K Humans %K Incidence %K Interviews as Topic %K Long-term Care %K Male %K Middle Aged %K Proportional Hazards Models %K Risk Factors %K Self Report %K Socioeconomic factors %K Spouses %K Stress, Psychological %K United States %X

BACKGROUND: Prior evidence suggests that caregiving may increase risk of cardiovascular disease (CVD) onset. This association has never been examined in a nationally (USA) representative sample, and prior studies could not fully control for socioeconomic confounders. This paper seeks to estimate the association between spousal caregiving and incident CVD in older Americans.

METHODS: Married, CVD-free Health and Retirement Study respondents aged 50+ years (n=8472) were followed up to 8 years (1669 new stroke or heart disease diagnoses). Current caregiving exposure was defined as assisting a spouse with basic or instrumental activities of daily living ≥14 h/week according to the care recipients' report in the most recent prior biennial survey; we define providing ≥14 h/week of care at two consecutive biennial surveys as 'long-term caregiving'. Inverse probability weighted discrete-time hazard models with time-updated exposure and covariate information (including socioeconomic and cardiovascular risk factors) were used to estimate the effect of caregiving on incident CVD.

RESULTS: Caregiving significantly predicted CVD incidence (HR=1.35, 95% CI 1.06 to 1.68) in the population overall. Long-term caregiving was associated with double the risk of CVD onset (HR=1.95, 95% CI 1.19 to 3.18). This association for long-term care givers varied significantly by race (p<0.01): caregiving predicted CVD onset for white (HR=2.37, 95% CI 1.43 to 3.92) but not for non-white (HR=0.28, 95% CI 0.06 to 1.28).

CONCLUSIONS: Spousal caregiving independently predicted risk of CVD in a large sample of US adults. There was significant evidence that the effect for long-term care givers differs for non-whites and white.

%B J Epidemiol Community Health %V 66 %P 951-6 %8 2012 Oct %G eng %N 10 %1 http://www.ncbi.nlm.nih.gov/pubmed/22080816?dopt=Abstract %3 22080816 %4 Spousal care/cardiovascular disease/Socioeconomic Differences/risk Factors/Activities Of Daily Living/IADLs %$ 62688 %R 10.1136/jech-2011-200040 %0 Journal Article %J J Behav Med %D 2012 %T Elevated depressive symptoms and incident stroke in Hispanic, African-American, and White older Americans. %A M. Maria Glymour %A Jessica J. Yen %A Anna Kosheleva %A J Robin Moon %A Benjamin D Capistrant %A Kristen K Patton %K Age Factors %K Aged %K Black or African American %K depression %K Female %K Health Surveys %K Hispanic or Latino %K Humans %K Incidence %K Longitudinal Studies %K Male %K Middle Aged %K Predictive Value of Tests %K Prevalence %K Risk Factors %K Stroke %K United States %K White People %X

Although depressive symptoms have been linked to stroke, most research has been in relatively ethnically homogeneous, predominantly white, samples. Using the United States based Health and Retirement Study, we compared the relationships between elevated depressive symptoms and incident first stroke for Hispanic, black, or white/other participants (N = 18,648) and estimated the corresponding Population Attributable Fractions. The prevalence of elevated depressive symptoms was higher in blacks (27%) and Hispanics (33%) than whites/others (18%). Elevated depressive symptoms prospectively predicted stroke risk in the whites/other group (HR = 1.53; 95% CI: 1.36-1.73) and among blacks (HR = 1.31; 95% CI: 1.05-1.65). The HR was similar but only marginally statistically significant among Hispanics (HR = 1.33; 95% CI: 0.92-1.91). The Population Attributable Fraction, indicating the percent of first strokes that would be prevented if the incident stroke rate in those with elevated depressive symptoms was the same as the rate for those without depressive symptoms, was 8.3% for whites/others, 7.8% for blacks, and 10.3% for Hispanics.

%B J Behav Med %I 35 %V 35 %P 211-20 %8 2012 Apr %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21656258?dopt=Abstract %2 PMC3305882 %4 depression/stroke/African American/Hispanics/Population Attributable Fraction/Population Attributable Fraction %$ 62836 %R 10.1007/s10865-011-9356-2 %0 Journal Article %J J Immigr Minor Health %D 2012 %T Self-reported and measured hypertension among older US- and foreign-born adults. %A White, Kellee %A Mauricio Avendano %A Benjamin D Capistrant %A J Robin Moon %A Sze Y Liu %A M. Maria Glymour %K Aged %K Black or African American %K Blood Pressure Determination %K Emigrants and Immigrants %K Female %K Hispanic or Latino %K Humans %K Hypertension %K Male %K Middle Aged %K Nutrition Surveys %K Reproducibility of Results %K Self Report %K United States %K White People %X

Self-reported hypertension is frequently used for health surveillance. However, little is known about the validity of self-reported hypertension among older Americans by nativity status. This study compared self-reported and measured hypertension among older black, white, and Hispanic Americans by nativity using the 2006 and 2008 Health and Retirement Study (n = 13,451). Sensitivity and specificity of self-reported hypertension were calculated using the Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure definition. Sensitivity was high among older blacks (88.9%), whites (82.8%), and Hispanics (84.0%), and both foreign-born (83.2%) and US-born (84.0%). Specificity was above 90% for both US-born and foreign-born, but higher for whites (92.8%) than blacks (86.0%). Despite the potential vulnerability of older foreign-born Americans, self-reported hypertension may be considered a reasonable estimate of hypertension status. Future research should confirm these findings in samples with a larger and more ethnically diverse foreign-born population.

%B J Immigr Minor Health %I 14 %V 14 %P 721-6 %8 2012 Aug %G eng %U http://search.proquest.com.proxy.lib.umich.edu/docview/1022672464?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004andctx_enc=info:ofi/enc:UTF-8andrfr_id=info:sid/ProQ 3Aabiglobalandrft_val_fmt=info:ofi/fmt:kev:mtx:journalandrft.genre=articl %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/22109587?dopt=Abstract %3 22109587 %4 Social policy/self assessed health/Hypertension/African-americans/Hispanics/Ethnic Interests %$ 69514 %R 10.1007/s10903-011-9549-3 %0 Journal Article %J Am J Hypertens %D 2012 %T Spousal caregiving and incident hypertension. %A Benjamin D Capistrant %A J Robin Moon %A M. Maria Glymour %K Activities of Daily Living %K Aged %K Cardiovascular Diseases %K Caregivers %K Female %K Follow-Up Studies %K Humans %K Hypertension %K Male %K Memory Disorders %K Middle Aged %K Odds Ratio %K Spouses %K Stress, Psychological %X

BACKGROUND: Caring for one's spouse has been associated with poor health, including risk of cardiovascular disease (CVD) onset and mortality. However, few studies have assessed the risk of incident hypertension associated with spousal caregiving. This paper investigates this association in a large, nationally representative sample of American older adults.

METHODS: Married, hypertension-free, Health and Retirement Study (HRS) respondents aged 50+ in 2000, (n = 5,708) were followed up to 8 years (1,708 new self-reported hypertension diagnoses). Current caregiving exposure was defined as assisting a spouse with instrumental or basic activities of daily living (IADLs) 14+ h/week; we define providing ≥14 h/week of care at two consecutive biennial surveys as "long-term caregiving." We used inverse probability weighted discrete-time hazard models with time-updated exposure and covariates to estimate effects of current and long-term caregiving on incident hypertension. We tested for effect modification by race, gender, and recipient memory illness. Sensitivity analyses restricted to respondents whose spouses had care needs.

RESULTS: After adjusting for demographic, socioeconomic, and health factors, (including risk behaviors, comorbid conditions, and self-rated health), current caregiving significantly predicted hypertension incidence (risk ratio (RR) = 1.36, 95% confidence interval (CI): 1.01, 1.83). For long-term caregivers, there was significant evidence of risk of hypertension onset associated with caregiving (RR = 2.29, 95% CI: 1.17, 4.49). The risk of hypertension onset associated with both current and long-term caregiving did not vary by race, gender, or recipient memory illness diagnosis. Sensitivity analyses supported the primary findings.

CONCLUSIONS: Providing IADL care to a spouse significantly predicted hypertension onset in a nationally representative sample of US adults.

%B Am J Hypertens %I 25 %V 25 %P 437-43 %8 2012 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/22189941?dopt=Abstract %3 22189941 %4 ADL/IADL/caregiving/Spousal death/Spousal death/Hypertension/mortality/Hazard model %$ 69708 %R 10.1038/ajh.2011.232 %0 Journal Article %J Stroke %D 2012 %T Stroke incidence in older US Hispanics: is foreign birth protective? %A J Robin Moon %A Benjamin D Capistrant %A Ichiro Kawachi %A Mauricio Avendano %A Subramanian, S V %A Lisa M. Bates %A M. Maria Glymour %K Age Factors %K Aged %K Cohort Studies %K Emigration and Immigration %K Female %K Hispanic or Latino %K Humans %K Incidence %K Longitudinal Studies %K Male %K Middle Aged %K Retrospective Studies %K Risk Factors %K Socioeconomic factors %K Stroke %K United States %K White People %X

BACKGROUND AND PURPOSE: Although Hispanics are the fastest growing ethnic group in the United States, relatively little is known about stroke risk in US Hispanics. We compare stroke incidence and socioeconomic predictors in US- and foreign-born Hispanics with patterns among non-Hispanic whites.

METHODS: Health and Retirement Study participants aged 50+ years free of stroke in 1998 (mean baseline age, 66.3 years) were followed through 2008 for self- or proxy-reported first stroke (n=15 784; 1388 events). We used discrete-time survival analysis to compare stroke incidence among US-born (including those who immigrated before age 7 years) and foreign-born Hispanics with incidence in non-Hispanic whites. We also examined childhood and adult socioeconomic characteristics as predictors of stroke among Hispanics, comparing effect estimates with those for non-Hispanic whites.

RESULTS: In age- and sex-adjusted models, US-born Hispanics had higher odds of stroke onset than non-Hispanic whites (OR, 1.44; 95% CI, 1.08-1.90), but these differences were attenuated and nonsignificant in models that controlled for childhood and adulthood socioeconomic factors (OR, 1.07; 95% CI, 0.80-1.42). In contrast, in models adjusted for all demographic and socioeconomic factors, foreign-born Hispanics had significantly lower stroke risk than non-Hispanic whites (OR, 0.58; 95% CI, 0.41-0.81). The impact of socioeconomic predictors on stroke did not differ between Hispanics and whites.

CONCLUSIONS: In this longitudinal national cohort, foreign-born Hispanics had lower incidence of stroke incidence than non-Hispanic whites and US-born Hispanics. Findings suggest that foreign-born Hispanics may have a risk factor profile that protects them from stroke as compared with other Americans.

%B Stroke %I 43 %V 43 %P 1224-9 %8 2012 May %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/22357712?dopt=Abstract %3 22357712 %4 Hispanic/stroke/Socioeconomic Factors/survival Analysis %$ 69592 %R 10.1161/STROKEAHA.111.643700 %0 Journal Article %J Soc Sci Med %D 2012 %T Transition to retirement and risk of cardiovascular disease: prospective analysis of the US health and retirement study. %A J Robin Moon %A M. Maria Glymour %A Subramanian, S V %A Mauricio Avendano %A Ichiro Kawachi %K Age Factors %K Aged %K Cardiovascular Diseases %K Female %K Health Behavior %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Prospective Studies %K Retirement %K Risk Factors %K Sex Factors %K Socioeconomic factors %K Survival Analysis %K Time Factors %K United States %X

Transitioning from work to retirement could be either beneficial or harmful for health. We investigated the association between transition to retirement and risk of stroke and myocardial infarction (MI). We followed US Health and Retirement Study participants age 50+ working full-time for pay and free of major cardiovascular disease (n = 5422) in 1998 up to 10 years for transition to full retirement and self- or proxy-report of either stroke or MI (CVD; 665 events). We used discrete-time survival analysis to compare the CVD incidence for the fully retired versus the full-time working population. To distinguish short-term from long-term risks, we compared the association in the first year after retirement to estimates 2+ years after retirement. In the full model adjusting for age, sex, childhood and adult SES, behavior, and co-morbidities, being retired was associated with elevated odds of CVD onset (OR = 1.40, 95% CI: 1.04, 1.90) compared to those remaining in the full-time labor force. The odds ratio for CVD incidence within the first year of retirement was 1.55 (95% CI: 1.03, 2.33). From the second year post-retirement and thereafter, the retired had marginally elevated risk of CVD compared to those still working (OR = 1.35; 95% CI: 0.96, 1.91). Although confidence intervals were wide for some sub-groups, there were no significant interactions by sex or socioeconomic status. Results suggest that CVD risk is increased after retirement.

%B Soc Sci Med %I 75 %V 75 %P 526-30 %8 2012 Aug %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/22607954?dopt=Abstract %2 PMC3367095 %4 Transitions/Retirement/Risk factors/Cardiovascular disease/Survival analysis/Medical research/Myocardial Infarction/Stroke %$ 69428 %R 10.1016/j.socscimed.2012.04.004