%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 Dementia and Geriatric Cognitive Disorders %D 2015 %T Estimating the Cognitive Effects of Prevalent Diabetes, Recent Onset Diabetes, and the Duration of Diabetes among Older Adults %A Bei Wu %A Eric J. Tchetgen Tchetgen %A Theresa L Osypuk %A Weuve, Jennifer %A White, Kellee %A Mujahid, Mahasin %A M. Maria Glymour %K Health Conditions and Status %X Background: Little evidence is available on the effects of incident diabetes or diabetes duration on cognitive aging. Methods: We evaluated the effects of prevalent and incident diabetes on deteriorations in cognitive function, based on participants (n = 8,671) aged 65 in the Health and Retirement Study in 2000. Inverse probability weighting was used to account for selective attrition and time-varying confounding of incident diabetes. Results: Prevalent diabetes predicted higher odds of dementia odds ratio 1.27; 95 confidence interval (CI) 1.03-1.58 and worse memory (-0.06 in z-score units; 95 CI -0.10 to -0.02), but incident diabetes or diabetes duration up to 8 years of follow-up was not predictive. Conclusion: Prevalent diabetes predicted lower cognition but not recent onset diabetes. (C) 2015 S. Karger AG, Basel %B Dementia and Geriatric Cognitive Disorders %I 39 %V 39 %P 239-249 %G eng %N 3-4 %4 Diabetes/Cognitive Function/Dementia %$ 999999 %R 10.1159/000368654 %0 Journal Article %J Alzheimer Dis Assoc Disord %D 2013 %T Combining direct and proxy assessments to reduce attrition bias in a longitudinal study. %A Bei Wu %A Tchetgen Tchetgen, Eric J %A Theresa L Osypuk %A White, Kellee %A Mujahid, Mahasin %A M. Maria Glymour %K Aged %K Bias %K Caregivers %K Dementia %K Female %K Humans %K Longitudinal Studies %K Male %K Neuropsychological tests %K Prevalence %K Proxy %X

Retaining severely impaired individuals poses a major challenge in longitudinal studies of determinants of dementia or memory decline. In the Health and Retirement Study (HRS), participants complete direct memory assessments biennially until they are too impaired to complete the interview. Thereafter, proxy informants, typically spouses, assess the subject's memory and cognitive function using standardized instruments. Because there is no common scale for direct memory assessments and proxy assessments, proxy reports are often excluded from longitudinal analyses. The Aging, Demographics, and Memory Study (ADAMS) implemented full neuropsychological examinations on a subsample (n=856) of HRS participants, including respondents with direct or proxy cognitive assessments in the prior HRS core interview. Using data from the ADAMS, we developed an approach to estimating a dementia probability and a composite memory score on the basis of either proxy or direct assessments in HRS core interviews. The prediction model achieved a c-statistic of 94.3% for DSM diagnosed dementia in the ADAMS sample. We applied these scoring rules to HRS core sample respondents born 1923 or earlier (n=5483) for biennial assessments from 1995 to 2008. Compared with estimates excluding proxy respondents in the full cohort, incorporating information from proxy respondents increased estimated prevalence of dementia by 12 percentage points in 2008 (average age=89) and suggested accelerated rates of memory decline over time.

%B Alzheimer Dis Assoc Disord %I 27 %V 27 %P 207-12 %8 2013 Jul-Sep %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/22992720?dopt=Abstract %2 PMC3731387 %4 Dementia/Memory decline/dementia probability/composite memory score/Cognitive assessments/Proxy informants %$ 69200 %R 10.1097/WAD.0b013e31826cfe90