%0 Journal Article %J Eur J Epidemiol %D 2011 %T Higher education delays and shortens cognitive impairment: a multistate life table analysis of the US Health and Retirement Study. %A Mieke Reuser %A Frans J Willekens %A Luc G Bonneux %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Cognition Disorders %K Educational Status %K Female %K Health Surveys %K Humans %K Incidence %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K Prevalence %K Proportional Hazards Models %K Retirement %K Sex Factors %K Smoking %K Time Factors %K United States %X

Improved health may extend or shorten the duration of cognitive impairment by postponing incidence or death. We assess the duration of cognitive impairment in the US Health and Retirement Study (1992-2004) by self reported BMI, smoking and levels of education in men and women and three ethnic groups. We define multistate life tables by the transition rates to cognitive impairment, recovery and death and estimate Cox proportional hazard ratios for the studied determinants. 95% confidence intervals are obtained by bootstrapping. 55 year old white men and women expect to live 25.4 and 30.0 years, of which 1.7 [95% confidence intervals 1.5; 1.9] years and 2.7 [2.4; 2.9] years with cognitive impairment. Both black men and women live 3.7 [2.9; 4.5] years longer with cognitive impairment than whites, Hispanic men and women 3.2 [1.9; 4.6] and 5.8 [4.2; 7.5] years. BMI makes no difference. Smoking decreases the duration of cognitive impairment with 0.8 [0.4; 1.3] years by high mortality. Highly educated men and women live longer, but 1.6 years [1.1; 2.2] and 1.9 years [1.6; 2.6] shorter with cognitive impairment than lowly educated men and women. The effect of education is more pronounced among ethnic minorities. Higher life expectancy goes together with a longer period of cognitive impairment, but not for higher levels of education: that extends life in good cognitive health but shortens the period of cognitive impairment. The increased duration of cognitive impairment in minority ethnic groups needs further study, also in Europe.

%B Eur J Epidemiol %I 26 %V 26 %P 395-403 %8 2011 May %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/21337033?dopt=Abstract %2 PMC3109265 %4 Cognitive ability/Life tables/Body mass index/Smoking/Educational attainment/Minority groups/ethnic Groups %$ 69390 %R 10.1007/s10654-011-9553-x %0 Journal Article %J Obesity (Silver Spring) %D 2009 %T Smoking kills, obesity disables: a multistate approach of the US Health and Retirement Survey. %A Mieke Reuser %A Luc G Bonneux %A Frans J Willekens %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Body Mass Index %K Disability Evaluation %K Educational Status %K Female %K Health Surveys %K Humans %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K Obesity %K Proportional Hazards Models %K Prospective Studies %K Smoking %K United States %K White People %X

Increasing BMI causes concerns about the consequences for health care. Decreasing cardiovascular mortality has lowered obesity-related mortality, extending duration of disability. We hypothesized increased duration of disability among overweight and obese individuals. We estimated age-, risk-, and state-dependent probabilities of activities of daily living (ADL) disability and death and calculated multistate life tables, resulting in the comprehensive measure of life years with and without ADL disability. We used prospective data of 16,176 white adults of the Health and Retirement Survey (HRS). Exposures were self-reported BMI and for comparison smoking status and levels of education. Outcomes were years to live with and without ADL disability at age 55. The reference categories were high normal weight (BMI: 23-24.9), nonsmoking and high education. Mild obesity (BMI: 30-34.9) did not change total life expectancy (LE) but exchanged disabled for disability-free years. Mild obesity decreased disability-free LE with 2.7 (95% confidence limits 1.2; 3.2) year but increased LE with disability with 2.0 (0.6; 3.4) years among men. Among women, BMI of 30 to 34.9 decreased disability-free LE with 3.6 (2.1; 5.1) year but increased LE with disability with 3.2 (1.6;4.8) years. Overweight (BMI: 25-29.9) increases LE with disability for women only, by 2.1 (0.8; 3.3) years). Smoking compressed disability by high mortality. Smoking decreased LE with 7.2 years, and LE with disability with 1.3 (0.5; 2.5) years (men) and 1.4 (0.3; 2.6) years (women). A lower education decreased disability-free life, but not duration of ADL disability. In the aging baby boom, higher BMI will further increase care dependence.

%B Obesity (Silver Spring) %I 17 %V 17 %P 783-9 %8 2009 Apr %G eng %N 4 %L newpubs20100129 %1 http://www.ncbi.nlm.nih.gov/pubmed/19165165?dopt=Abstract %3 19165165 %4 Obesity/Smoking/Body Mass Index/DISABILITY/DISABILITY/Mortality %$ 21690 %R 10.1038/oby.2008.640 %0 Journal Article %J Eur J Epidemiol %D 2008 %T The burden of mortality of obesity at middle and old age is small. A life table analysis of the US Health and Retirement Survey. %A Mieke Reuser %A Luc G Bonneux %A Frans J Willekens %K Aged %K Aged, 80 and over %K Body Mass Index %K Educational Status %K Female %K Health Surveys %K Humans %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K Multivariate Analysis %K Obesity %K Proportional Hazards Models %K Smoking %K United States %K Weight Gain %K Weight Loss %X

The evidence of effect of overweight and obesity on mortality at middle and old age is conflicting. The increased relative risk of cardiovascular disease and diabetes for overweight and obese individuals compared to normal weight is well documented, but the absolute risk of cardiovascular death has decreased spectacularly since the 1980s. We estimate the burden of mortality of obesity among middle and old aged adults in the Health and Retirement Survey (HRS), a US prospective longitudinal study. We calculate univariate and multivariate age-specific probabilities and proportional hazard ratios of death in relation to self-reported body mass index (BMI), smoking and education. The life table translates age specific adjusted event rates in survival times, dependent on risk factor distributions (smoking, levels of education and self reported BMI). 95% confidence intervals are calculated by bootstrapping. The highest life expectancy at age 55 was found in overweight (BMI 25-29.9), highly educated non smokers: 30.7 (29.5-31.9) years (men) and 33.2 (32.1-34.3) (women), slightly higher than a BMI 23-24.9 in both sexes. Smoking decreased the population life expectancy with 3.5 (2.7-4.4) years (men) and 1.8 (1.0-2.5) years (women). Less than optimal education cost men and women respectively 2.8 (2.1-3.6) and 2.6 (1.6-3.6) years. Obesity and low normal weight decreased population life expectancy respectively by 0.8 (0.2-1.3) and 0.8 (0.0-1.5) years for men and women in a contemporary, US population. The burden of mortality of obesity is limited, compared to smoking and low education.

%B Eur J Epidemiol %I 23 %V 23 %P 601-7 %8 2008 %G eng %N 9 %L newpubs20081014_Reuser_EJEP_2008.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18584293?dopt=Abstract %3 18584293 %4 Mortality/Obesity/Education/Smoking/Life Expectancy %$ 19400 %R 10.1007/s10654-008-9269-8