%0 Journal Article %J Jamia Open %D 2020 %T Cardiovascular disease risk prediction for people with type 2 diabetes in a population-based cohort and in electronic health record data %A Szymonifka, Jackie %A Conderino, Sarah %A Christine T Cigolle %A Ha, Jinkyung %A Mohammed U Kabeto %A Yu, Jaehong %A John A. Dodson %A Thorpe, Lorna %A Caroline S Blaum %A Zhong, Judy %K Cardiovascular disease %K type 2 diabetes %X Electronic health records (EHRs) have become a common data source for clinical risk prediction, offering large sample sizes and frequently sampled metrics. There may be notable differences between hospital-based EHR and traditional cohort samples: EHR data often are not population-representative random samples, even for particular diseases, as they tend to be sicker with higher healthcare utilization, while cohort studies often sample healthier subjects who typically are more likely to participate. We investigate heterogeneities between EHR- and cohort-based inferences including incidence rates, risk factor identifications/quantifications, and absolute risks.This is a retrospective cohort study of older patients with type 2 diabetes using EHR from New York University Langone Health ambulatory care (NYULH-EHR, years 2009–2017) and from the Health and Retirement Survey (HRS, 1995–2014) to study subsequent cardiovascular disease (CVD) risks. We used the same eligibility criteria, outcome definitions, and demographic covariates/biomarkers in both datasets. We compared subsequent CVD incidence rates, hazard ratios (HRs) of risk factors, and discrimination/calibration performances of CVD risk scores.The estimated subsequent total CVD incidence rate was 37.5 and 90.6 per 1000 person-years since T2DM onset in HRS and NYULH-EHR respectively. HR estimates were comparable between the datasets for most demographic covariates/biomarkers. Common CVD risk scores underestimated observed total CVD risks in NYULH-EHR.EHR-estimated HRs of demographic and major clinical risk factors for CVD were mostly consistent with the estimates from a national cohort, despite high incidences and absolute risks of total CVD outcome in the EHR samples. %B Jamia Open %@ 2574-2531 %G eng %R https://doi.org/10.1093/jamiaopen/ooaa059 %0 Journal Article %J J Gen Intern Med %D 2011 %T Geriatric conditions develop in middle-aged adults with diabetes. %A Christine T Cigolle %A Pearl G. Lee %A Kenneth M. Langa %A Lee, Yuo-Yu %A Zhiyi Tian %A Caroline S Blaum %K Accidental Falls %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Diabetes Mellitus %K Dizziness %K Female %K Geriatric Assessment %K Health Status %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K pain %K Urinary incontinence %X

BACKGROUND: Geriatric conditions, collections of symptoms common in older adults and not necessarily associated with a specific disease, increase in prevalence with advancing age. These conditions are important contributors to the complex health status of older adults. Diabetes mellitus is known to co-occur with geriatric conditions in older adults and has been implicated in the pathogenesis of some conditions.

OBJECTIVE: To investigate the prevalence and incidence of geriatric conditions in middle-aged and older-aged adults with diabetes.

DESIGN: Secondary analysis of nationally-representative, longitudinal health interview survey data (Health and Retirement Study waves 2004 and 2006).

PARTICIPANTS: Respondents 51 years and older in 2004 (n=18,908).

MAIN MEASURES: Diabetes mellitus. Eight geriatric conditions: cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment, pain.

KEY RESULTS: Adults with diabetes, compared to those without, had increased prevalence and increased incidence of geriatric conditions across the age spectrum (p< 0.01 for each age group from 51-54 years old to 75-79 years old). Differences between adults with and without diabetes were most marked in middle-age. Diabetes was associated with the two-year cumulative incidence of acquiring new geriatric conditions (odds ratio, 95% confidence interval: 1.8, 1.6-2.0). A diabetes-age interaction was discovered: as age increased, the association of diabetes with new geriatric conditions decreased.

CONCLUSIONS: Middle-aged, as well as older-aged, adults with diabetes are at increased risk for the development of geriatric conditions, which contribute substantially to their morbidity and functional impairment. Our findings suggest that adults with diabetes should be monitored for the development of these conditions beginning at a younger age than previously thought.

%B J Gen Intern Med %I 26 %V 26 %P 272-9 %8 2011 Mar %G eng %N 3 %L newpubs20110418_Cigolle.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/20878496?dopt=Abstract %2 PMC3043187 %4 geriatric conditions/diabetes/cognitive Impairment/falls/Incontinence/Vision Disorders/Hearing Disorders %$ 24780 %R 10.1007/s11606-010-1510-y %0 Journal Article %J Med Care %D 2010 %T Clinical complexity in middle-aged and older adults with diabetes: the Health and Retirement Study. %A Caroline S Blaum %A Christine T Cigolle %A Cynthia Boyd %A Jennifer L. Wolff %A Zhiyi Tian %A Kenneth M. Langa %A David R Weir %K Aged %K Cross-Sectional Studies %K Diabetes Complications %K Diabetes Mellitus, Type 2 %K Female %K Glycemic Index %K Health Status %K Health Surveys %K Humans %K Male %K Middle Aged %K Quality of Health Care %K Self Care %K Severity of Illness Index %K Treatment Failure %K United States %X

BACKGROUND: Some patients with diabetes may have health status characteristics that could make diabetes self-management (DSM) difficult and lead to inadequate glycemic control, or limit the benefit of some diabetes management interventions.

OBJECTIVE: To investigate how many older and middle-aged adults with diabetes have such health status characteristics.

DESIGN: Secondary data analysis of a nationally representative health interview survey, the Health and Retirement Study, and its diabetes mail-out survey.

SETTING/PARTICIPANTS: Americans aged 51 and older with diabetes (n = 3506 representing 13.6 million people); aged 56 and older in diabetes survey (n = 1132, representing 9.9 million).

MEASUREMENTS: Number of adults with diabetes and (a) relatively good health; (b) health status that could make DSM difficult (eg, comorbidities, impaired instrumental activities of daily living; and (c) characteristics like advanced dementia and activities of daily living dependency that could limit benefit of some diabetes management. Health and Retirement Study measures included demographics. Diabetes Survey included self-measured HbA1c.

RESULTS: Nearly 22% of adults > or =51 with diabetes (about 3 million people) have health characteristics that could make DSM difficult. Another 10% (1.4 million) may receive limited benefit from some diabetes management. Mail-out respondents with health characteristics that could make DSM difficult had significantly higher mean HbA1c compared with people with relatively good health (7.6% vs. 7.3%, P < 0.04.).

CONCLUSIONS: Some middle-aged as well as older adults with diabetes have health status characteristics that might make DSM difficult or of limited benefit. Current diabetes quality measures, including measures of glycemic control, may not reflect what is possible or optimal for all patient groups.

%B Med Care %I 48 %V 48 %P 327-34 %8 2010 Apr %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/20355264?dopt=Abstract %2 PMC3153504 %4 Data analysis/Patients/Diabetes/Glycemic index/Older people/Middle age %$ 22430 %R 10.1097/mlr.0b013e3181ca4035 %0 Journal Article %J J Am Geriatr Soc %D 2009 %T Comparing models of frailty: the Health and Retirement Study. %A Christine T Cigolle %A Mary Beth Ofstedal %A Zhiyi Tian %A Caroline S Blaum %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Chronic disease %K Cross-Sectional Studies %K Demography %K Disability Evaluation %K Frail Elderly %K Geriatric Assessment %K Health Surveys %K Humans %K Interviews as Topic %K Logistic Models %K Models, Theoretical %K United States %X

OBJECTIVES: To operationalize and compare three models of frailty, each representing a distinct theoretical view of frailty: as deficiencies in function (Functional Domains model), as an index of health burden (Burden model), and as a biological syndrome (Biologic Syndrome model).

DESIGN: Cross-sectional analysis.

SETTING: 2004 wave of the Health and Retirement Study, a nationally representative, longitudinal health interview survey.

PARTICIPANTS: Adults aged 65 and older (N=11,113) living in the community and in nursing homes in the United States.

MEASUREMENTS: The outcome measure was the presence of frailty, as defined according to each frailty model. Covariates included chronic diseases and sociodemographic characteristics.

RESULTS: Almost one-third (30.2%) of respondents were frail according to at least one model; 3.1% were frail according to all three models. The Functional Domains model showed the least overlap with the other models. In contrast, 76.1% of those classified as frail according to the Biologic Syndrome model and 72.1% of those according to the Burden model were also frail according to at least one other model. Older adults identified as frail according to the different models differed in sociodemographic and chronic disease characteristics. For example, the Biologic Syndrome model demonstrated substantial associations with older age (adjusted odds ratio (OR)=10.6, 95% confidence interval (CI)=6.1-18.5), female sex (OR=1.7, 95% CI=1.2-2.5), and African-American ethnicity (OR=2.1, % CI=1.0-4.4).

CONCLUSION: Different models of frailty, based on different theoretical constructs, capture different groups of older adults. The different models may represent different frailty pathways or trajectories to adverse outcomes such as disability and death.

%B J Am Geriatr Soc %I 57 %V 57 %P 830-9 %8 2009 May %G eng %N 5 %L newpubs20090908_Cigolle_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/19453306?dopt=Abstract %3 19453306 %4 FRAILTY/Models, Theoretical %$ 20440 %R 10.1111/j.1532-5415.2009.02225.x %0 Journal Article %J Ann Intern Med %D 2007 %T Geriatric conditions and disability: the Health and Retirement Study. %A Christine T Cigolle %A Kenneth M. Langa %A Mohammed U Kabeto %A Zhiyi Tian %A Caroline S Blaum %K Accidental Falls %K Activities of Daily Living %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Chronic disease %K Cognition Disorders %K Comorbidity %K Cross-Sectional Studies %K Disability Evaluation %K Dizziness %K Female %K Geriatric Assessment %K Geriatrics %K Hearing Disorders %K Humans %K Male %K Prevalence %K Retirement %K Urinary incontinence %K Vision Disorders %X

BACKGROUND: Geriatric conditions, such as incontinence and falling, are not part of the traditional disease model of medicine and may be overlooked in the care of older adults. The prevalence of geriatric conditions and their effect on health and disability in older adults has not been investigated in population-based samples.

OBJECTIVE: To investigate the prevalence of geriatric conditions and their association with dependency in activities of daily living by using nationally representative data.

DESIGN: Cross-sectional analysis.

SETTING: Health and Retirement Study survey administered in 2000.

PARTICIPANTS: Adults age 65 years or older (n = 11 093, representing 34.5 million older Americans) living in the community and in nursing homes.

MEASUREMENTS: Geriatric conditions (cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment, hearing impairment) and dependency in activities of daily living (bathing, dressing, eating, transferring, toileting).

RESULTS: Of adults age 65 years or older, 49.9% had 1 or more geriatric conditions. Some conditions were as prevalent as common chronic diseases, such as heart disease and diabetes. The association between geriatric conditions and dependency in activities of daily living was strong and significant, even after adjustment for demographic characteristics and chronic diseases (adjusted risk ratio, 2.1 [95% CI, 1.9 to 2.4] for 1 geriatric condition, 3.6 [CI, 3.1 to 4.1] for 2 conditions, and 6.6 [CI, 5.6 to 7.6] for > or =3 conditions).

LIMITATIONS: The study was cross-sectional and based on self-reported data. Because measures were limited by the survey questions, important conditions, such as delirium and frailty, were not assessed. Survival biases may influence the estimates.

CONCLUSIONS: Geriatric conditions are similar in prevalence to chronic diseases in older adults and in some cases are as strongly associated with disability. The findings suggest that geriatric conditions, although not a target of current models of health care, are important to the health and function of older adults and should be addressed in their care.

%B Ann Intern Med %I 147 %V 147 %P 156-64 %8 2007 Aug 07 %G eng %N 3 %L newpubs20071002_Cigolle_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17679703?dopt=Abstract %4 ADL and IADL Impairments/Geriatrics/Chronic Disease/Health care %$ 18010 %R 10.7326/0003-4819-147-3-200708070-00004