@article {12247, title = {Multimorbidity Accumulation Among Middle-Aged Americans: Differences by Race/Ethnicity and Body Mass Index.}, journal = {The Journals of Gerontology: Series A }, volume = {77}, year = {2022}, pages = {e89-e97}, abstract = {

BACKGROUND: Obesity and multimorbidity are more prevalent among U.S. racial/ethnic minority groups. Evaluating racial/ethnic disparities in disease accumulation according to body mass index (BMI) may guide interventions to reduce multimorbidity burden in vulnerable racial/ethnic groups.

METHOD: We used data from the 1998-2016 Health and Retirement Study on 8 106 participants aged 51-55 at baseline. Disease burden and multimorbidity (>=2 co-occurring diseases) were assessed using 7 chronic diseases: arthritis, cancer, heart disease, diabetes, hypertension, lung disease, and stroke. Four BMI categories were defined per convention: normal, overweight, obese class 1, and obese class 2/3. Generalized estimating equations models with inverse probability weights estimated the accumulation of chronic diseases.

RESULTS: Overweight and obesity were more prevalent in non-Hispanic Black (82.3\%) and Hispanic (78.9\%) than non-Hispanic White (70.9 \%) participants at baseline. The baseline burden of disease was similar across BMI categories, but disease accumulation was faster in the obese class 2/3 and marginally in the obese class 1 categories compared with normal BMI. Black participants across BMI categories had a higher initial burden and faster accumulation of disease over time, while Hispanics had a lower initial burden and similar rate of accumulation, compared with Whites. Black participants, including those with normal BMI, reach the multimorbidity threshold 5-6 years earlier compared with White participants.

CONCLUSIONS: Controlling weight and reducing obesity early in the lifecourse may slow the progression of multimorbidity in later life. Further investigations are needed to identify the factors responsible for the early and progressing nature of multimorbidity in Blacks of nonobese weight.

}, keywords = {Body Mass Index, Disease accumulation, multimorbidity, Race/ethnicity}, issn = {1758-535X}, doi = {10.1093/gerona/glab116}, author = {Anda Botoseneanu and Markwardt, Sheila and Corey L Nagel and Allore, Heather G and Jason T Newsom and David A Dorr and Ana R Qui{\~n}ones} } @article {11796, title = {Physical Activity as a Mediator between Race/Ethnicity and Changes in Multimorbidity.}, journal = {The Journals of Gerontology, Series B}, volume = {77}, year = {2022}, pages = {1529-1538}, abstract = {

OBJECTIVES: Studies report racial/ethnic disparities in multimorbidity (>=2 chronic conditions) and their rate of accumulation over time as well as differences in physical activity. Our study aimed to investigate whether racial/ethnic differences in the accumulation of multimorbidity were mediated by physical activity among middle-aged and older adults.

METHODS: We assessed racial/ethnic differences in the accumulation of multimorbidity (of nine conditions) over twelve years (2004-2016) in the Health and Retirement Study (HRS; N = 18,264, mean age = 64.4 years). Structural equation modeling was used to estimate latent growth curve models of changes in multimorbidity and investigate whether the relationship of race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White participants) to changes in the number of chronic conditions was mediated by physical activity after controlling for age, sex, education, marital status, household wealth, insurance coverage, smoking, alcohol, and body-weight.

RESULTS: There was a significant increase in multimorbidity over time. Initial levels and changes in multimorbidity over time varied significantly across individuals. Indirect effects of the relationship between race/ethnicity and changes in multimorbidity as mediated by physical activity were significant, consistent with the mediational hypothesis. Black respondents engaged in significantly lower levels of physical activity than White respondents after controlling for covariates, but there were no differences between Hispanic and White respondents once education was included. These results provide important new information for understanding how modifiable lifestyle factors may help explain disparities in multimorbidity in mid-to-late life, suggesting greater need to intervene to reduce sedentary behavior and increase physical activity.

}, keywords = {Chronic illness, Disparities, Exercise}, issn = {1758-5368}, doi = {10.1093/geronb/gbab148}, author = {Jason T Newsom and Denning, Emily C and Elman, Miriam R and Anda Botoseneanu and Heather G. Allore and Corey L Nagel and David A Dorr and Ana R Qui{\~n}ones} } @article {11616, title = {Are there sex differences in potentially inappropriate prescribing in adults with multimorbidity?}, journal = {Journal of the American Geriatrics Society}, volume = {69}, year = {2021}, pages = {2163-2175}, abstract = {

BACKGROUND/OBJECTIVES: Limited knowledge exists regarding sex differences in prescribing potentially inappropriate medications (PIMs) for various multimorbidity patterns. This study sought to determine sex differences in PIM prescribing in older adults with cardiovascular-metabolic patterns.

DESIGN: Retrospective cohort study.

SETTING: Health and Retirement Study (HRS) 2004-2014 interview data, linked to HRS-Medicare claims data annualized for 2005-2014.

STUDY SAMPLE: Six thousand three-hundred and forty-one HRS participants aged 65 and older with two and more chronic conditions.

MEASUREMENTS: PIM events were calculated using 2015 American Geriatrics Society Beers Criteria. Multimorbidity patterns included: "cardiovascular-metabolic only," "cardiovascular-metabolic plus other physical conditions," "cardiovascular-metabolic plus mental conditions," and "no cardiovascular-metabolic disease" patterns. Logistic regression models were used to determine the association between PIM and sex, including interaction between sex and multimorbidity categories in the model, for PIM overall and for each PIM drug class.

RESULTS: Women were prescribed PIMs more often than men (39.4\% vs 32.8\%). Overall, women had increased odds of PIM (Adj. odds ratio [OR]~=~1.30, 95\% confidence interval [CI]: 1.16-1.46). Women had higher odds of PIM than men with cardiovascular-metabolic plus physical patterns (Adj. OR~=~1.25, 95\% CI: 1.07-1.45) and cardiovascular-metabolic plus mental patterns (Adj. OR~=~1.25, 95\% CI: 1.06-1.48), and there were no sex differences in adults with a cardiovascular-metabolic only patterns (Adj. OR~=~1.13, 95\% CI: 0.79-1.62). Women had greater odds of being prescribed the following PIMs: anticholinergics, antidepressants, antispasmodics, benzodiazepines, skeletal muscle relaxants, and had lower odds of being prescribed pain drugs and sulfonylureas compared with men.

CONCLUSION: This study evaluated sex differences in PIM prescribing among adults with complex cardiovascular-metabolic multimorbidity patterns. The effect of sex varied across multimorbidity patterns and by different PIM drug classes. This study identified important opportunities for future interventions to improve medication prescribing among older adults at risk for PIM.

}, keywords = {multimorbidity patterns, potentially inappropriate medications, Sex differences}, issn = {1532-5415}, doi = {10.1111/jgs.17194}, author = {Ukhanova, Maria and Markwardt, Sheila and Furuno, Jon P and Davis, Laura and Noble, Brie N and Ana R Qui{\~n}ones} } @article {12065, title = {Birth Cohort Differences in Multimorbidity Burden Among Aging U.S. Adults }, journal = {Innovation in Aging}, volume = {5}, year = {2021}, pages = {257}, abstract = {Multimorbidity is the co-occurrence of two or more chronic health conditions and affects more than half of the US population aged 65 and older. Recent trends suggest increased risk of poor self-reported health, physical disability, cognitive impairment, and mortality among later born birth cohorts, yet we are unaware of work examining cohort trends in multimorbidity among aging US adults. Observations were drawn from the Health and Retirement Study (2000{\textendash}2018) and included adults aged 51 and older across 7 birth cohorts (1923 and earlier, 1924{\textendash}1930, 1931{\textendash}1941, 1942{\textendash}1947, 1948{\textendash}1953, 1954{\textendash}1959, and 1960{\textendash}1965). Multimorbidity was measured as a count of 9 chronic conditions including heart disease, hypertension, stroke, diabetes, arthritis, lung disease, cancer (excluding skin cancer), depression, and cognitive impairment. General linear models adjusting for repeated measures and covariates including age, sex, race/ethnicity, and education were used to identify whether trends in multimorbidity varied across birth cohort. 31,923 adults contributed 153,940 total observations, grand mean age was 68.0 (SD=10.09), and mean multimorbidity was 2.19 (SD=1.49). In analyses adjusted for age and other covariates, adults born 1948{\textendash}1953 reported .34 more chronic conditions (SE=.03, p<.001), adults born 1954{\textendash}1959 reported .42 more chronic conditions (SE=.03, p<.001), and adults born 1960{\textendash}1965 reported .55 more chronic conditions (SE=.03, p<.001), than those born 1931{\textendash}1941, respectively. Our preliminary results confirm increasing multimorbidity among later birth cohorts of older Americans and should help guide policy to manage impending health declines among older Americans.}, keywords = {birth cohort, multimorbidity}, doi = {https://doi.org/10.1093/geroni/igab046.987}, author = {Nicholas J Bishop and Steven A Haas and Ana R Qui{\~n}ones} } @article {12062, title = {MULTIMORBIDITY TRAJECTORY CLASSES AS PREDICTED BY RACE, ETHNICITY, AND SOCIAL RELATIONSHIP QUALITY}, journal = {Innovation in Aging}, volume = {5}, year = {2021}, pages = {873}, abstract = {Growth mixture modeling was used to classify multimorbidity (>=2 chronic conditions) trajectories over a 10-year period (2006-2016) in the Health and Retirement Study (N = 7,151, mean age = 68.6 years). Race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White) and social relationship quality (positive social support and negative social exchanges, such as criticisms) were then used to predict trajectory class membership, controlling for age, sex, education, and wealth. We identified three trajectory classes: initial low levels and rapid accumulation of multimorbidity (increasing: 12.6\%), initial high levels and gradual accumulation of multimorbidity (high: 19.5\%), and initial low levels and gradual accumulation of multimorbidity (low: 67.9\%). Blacks were more than twice as likely to be in the increasing (OR = 2.04, CI[1.29,3.21]) and high (OR = 2.28 CI[1.58,3.206]) multimorbidity groups compared with Whites, but there were no significant differences between Hispanics and Whites for either trajectory class (OR = .84 CI[.47,1.51]and OR = .74 CI[.41,1.34], respectively). Increments in perceived support were associated with significantly lower risk of membership in the increasing (OR = .59, CI[.46,.78]) and high classes (OR = .54 CI[.42,.69]), and increments in negative exchanges were associated with significantly higher risk of membership in the increasing (OR = 1.64 CI[1.19,2.25]) and high classes (OR = 2.22 CI[1.64,3.00]). These results provide important new information for understanding health disparities and the role of social relationships associated with multimorbidity in middle and later life that may aid in identifying those most at risk and suggesting possible interventions for mitigating that risk.}, keywords = {multimorbidity, Race/ethnicity, social relationship}, url = {https://watermark.silverchair.com/igab046.3157.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAw4wggMKBgkqhkiG9w0BBwagggL7MIIC9wIBADCCAvAGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMvYWi7nxZ2T3DhQ7tAgEQgIICwQjhrrWTdWJufk1mgdVsBv4wjBsKIMO8ZZuAA3KbKU}, author = {Newson, Jason and O{\textquoteright}Neill, AnneMarie and Denning, Emily C and Anda Botoseneanu and Allore, Heather G and Corey L Nagel and David A Dorr and Ana R Qui{\~n}ones} } @article {11580, title = {Racial and Ethnic Differences in Multimorbidity Changes Over Time.}, journal = {Medical Care}, volume = {59}, year = {2021}, pages = {402-409}, abstract = {

BACKGROUND: Our understanding of how multimorbidity progresses and changes is nascent.

OBJECTIVES: Assess multimorbidity changes among racially/ethnically diverse middle-aged and older adults.

DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study using latent class analysis to identify multimorbidity combinations over 16 years, and multinomial logistic models to assess change relative to baseline class membership. Health and Retirement Study respondents (age 51 y and above) in 1998 and followed through 2014 (N=17,297).

MEASURES: Multimorbidity latent classes of: hypertension, heart disease, lung disease, diabetes, cancer, arthritis, stroke, high depressive symptoms.

RESULTS: Three latent classes were identified in 1998: minimal disease (45.8\% of participants), cardiovascular-musculoskeletal (34.6\%), cardiovascular-musculoskeletal-mental (19.6\%); and 3 in 2014: cardiovascular-musculoskeletal (13\%), cardiovascular-musculoskeletal-metabolic (12\%), multisystem multimorbidity (15\%). Remaining participants were deceased (48\%) or lost to follow-up (12\%) by 2014. Compared with minimal disease, individuals in cardiovascular-musculoskeletal in 1998 were more likely to be in multisystem multimorbidity in 2014 [odds ratio (OR)=1.78, P<0.001], and individuals in cardiovascular-musculoskeletal-mental in 1998 were more likely to be deceased (OR=2.45, P<0.001) or lost to follow-up (OR=3.08, P<0.001). Hispanic and Black Americans were more likely than White Americans to be in multisystem multimorbidity in 2014 (OR=1.67, P=0.042; OR=2.60, P<0.001, respectively). Black compared with White Americans were more likely to be deceased (OR=1.62, P=0.01) or lost to follow-up (OR=2.11, P<0.001) by 2014.

CONCLUSIONS AND RELEVANCE: Racial/ethnic older adults are more likely to accumulate morbidity and die compared with White peers, and should be the focus of targeted and enhanced efforts to prevent and/or delay progression to more complex multimorbidity patterns.

}, keywords = {multimorbidity, race and ethnicity}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000001527}, author = {Ana R Qui{\~n}ones and Jason T Newsom and Elman, Miriam R and Markwardt, Sheila and Corey L Nagel and David A Dorr and Heather G. Allore and Anda Botoseneanu} } @article {11160, title = {Annual Wellness Visits and Influenza Vaccinations among Older Adults in the US.}, journal = {Journal of Primary Care \& Community Health}, volume = {11}, year = {2020}, abstract = {

OBJECTIVES: Investigate whether combinations of sociodemographic factors, chronic conditions, and other health indicators pose barriers for older adults to access Annual Wellness Visits (AWVs) and influenza vaccinations.

METHODS: Data on 4999 individuals aged >=65 years from the 2012 wave of the Health and Retirement Study linked with Medicare claims were analyzed. Conditional Inference Tree (CIT) and Random Forest (CIRF) analyses identified the most important predictors of AWVs and influenza vaccinations. Multivariable logistic regression (MLR) was used to quantify the associations.

RESULTS: Two-year uptake was 22.8\% for AWVs and 65.9\% for influenza vaccinations. For AWVs, geographical region and wealth emerged as the most important predictors. For influenza vaccinations, number of somatic conditions, race/ethnicity, education, and wealth were the most important predictors.

CONCLUSIONS: The importance of geographic region for AWV utilization suggests that this service was unequally adopted. Non-Hispanic black participants and/or those with functional limitations were less likely to receive influenza vaccination.

}, keywords = {annual wellness visits, influenza vaccinations, machine learning methods, preventive healthcare utilization}, issn = {2150-1327}, doi = {10.1177/2150132720962870}, author = {J{\o}rgensen, Terese Sara H{\o}j and Heather G. Allore and Elman, Miriam R and Corey L Nagel and Zhang, Mengran and Markwardt, Sheila and Ana R Qui{\~n}ones} } @article {10070, title = {Diabetes-multimorbidity combinations and disability among middle-aged and older adults.}, journal = {Journal of General Internal Medicine}, year = {2019}, month = {2019 Feb 27}, abstract = {

BACKGROUND: Older adults with diabetes rarely have only one chronic disease. As a result, there is a need to re-conceptualize research and clinical practice to address the growing number of older Americans with diabetes and concurrent chronic diseases (diabetes-multimorbidity).

OBJECTIVE: To identify prevalent multimorbidity combinations and examine their association with poor functional status among a nationally representative sample of middle-aged and older adults with diabetes.

DESIGN: A prospective cohort study of the 2012-2014 Health and Retirement Study (HRS) data. We identified the most prevalent diabetes-multimorbidity combinations and estimated negative binomial models of diabetes-multimorbidity on prospective disability.

PARTICIPANTS: Analytic sample included 3841 HRS participants with diabetes, aged 51~years and older.

MAIN MEASURES: The main outcome measure was the combined activities of daily living (ADL)-instrumental activities of daily living (IADL) index (range 0-11; higher index denotes higher disability). The main independent variables were diabetes-multimorbidity combination groups, defined as the co-occurrence of diabetes and at least one of six somatic chronic diseases (hypertension, cardiovascular disease, lung disease, cancer, arthritis, and stroke) and/or two mental chronic conditions (cognitive impairment and high depressive symptoms (CESD score >= 4).

KEY RESULTS: The three most prevalent multimorbidity combinations were, in rank-order diabetes-arthritis-hypertension (n = 694, 18.1\%); diabetes-hypertension (n = 481, 12.5\%); and diabetes-arthritis-hypertension-heart disease (n = 383, 10\%). Diabetes-multimorbidity combinations that included high depressive symptoms or stroke had significantly higher counts of ADL-IADL limitations compared with diabetes-only. In head-to-head comparisons of diabetes-multimorbidity combinations, high depressive symptoms or stroke added to somatic multimorbidity combinations was associated with a higher count of ADL-IADL limitations (diabetes-arthritis-hypertension-high depressive symptoms vs. diabetes-arthritis-hypertension: IRR = 1.95 [1.13, 3.38]; diabetes-arthritis-hypertension-stroke vs. diabetes-arthritis-hypertension: IRR = 2.09 [1.15, 3.82]) even after adjusting for age, gender, education, race/ethnicity, BMI, baseline ADL-IADL, and diabetes duration. Coefficients were robust to further adjustment for diabetes treatment.

CONCLUSIONS: Depressive symptoms or stroke added onto other multimorbidity combinations may pose a substantial functional burden for middle-aged and older adults with diabetes.

}, keywords = {Chronic disease, Comorbidity, Diabetes, Disabilities}, issn = {1525-1497}, doi = {10.1007/s11606-019-04896-w}, author = {Ana R Qui{\~n}ones and Markwardt, Sheila and Anda Botoseneanu} } @article {10129, title = {Disputes of self-reported chronic disease over time: The role of race, ethnicity, nativity, and language of interview.}, journal = {Medical Care}, volume = {57}, year = {2019}, pages = {625-632}, abstract = {

BACKGROUND: Respondents in longitudinal health interview surveys may inconsistently report their chronic diseases across interview waves. Racial/ethnic minority adults have an increased burden of chronic diseases and may dispute chronic disease reports more frequently.

OBJECTIVE: We evaluated the longitudinal association between race/ethnicity, nativity, and language of interview with disputing previously reported chronic diseases.

METHODS: We performed secondary data analysis of nationally representative longitudinal data (Health and Retirement Study, 1998-2010) of adults 51 years or older (n=23,593). We estimated multilevel mixed-effects logistic models of disputes of previously reported chronic disease (hypertension, heart disease, lung disease, diabetes, cancer, stroke, arthritis).

RESULTS: Approximately 22\% of Health and Retirement Study respondents disputed prior chronic disease self-reports across the entire study period; 21\% of non-Latino white, 20.5\% of non-Latino black, and 28\% of Latino respondents disputed. In subgroup comparisons of model-predicted odds using postestimation commands, Latinos interviewed in Spanish have 34\% greater odds of disputing compared with non-Latino whites interviewed in English and 35\% greater odds of dispute relative to non-Latino blacks interviewed in English.

CONCLUSIONS: The odds of disputing a prior chronic disease report were substantially higher for Latinos who were interviewed in Spanish compared with non-Latino white or black counterparts interviewed in English, even after accounting for other sociodemographic factors, cognitive declines, and time-in-sample considerations. Our findings point toward leveraging of multiple sources of data to triangulate information on chronic disease status as well as investigating potential mechanisms underlying the higher probability of dispute among Spanish-speaking Latino respondents.

}, keywords = {Chronic conditions, Racial/ethnic differences, Survey Methodology}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000001148}, author = {Ana R Qui{\~n}ones and Melekin, Amanuel and Christine T Cigolle and Corey L Nagel} } @article {10147, title = {Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults.}, journal = {PLoS One}, volume = {14}, year = {2019}, pages = {e0218462}, abstract = {

BACKGROUND: Multimorbidity-having two or more coexisting chronic conditions-is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies differences in rates of chronic disease accumulation and multimorbidity development among non-Hispanic white, non-Hispanic black, and Hispanic study participants starting in middle-age and followed up to 16 years.

METHODS AND FINDINGS: We analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly-available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic disease burden among 8,872 non-Hispanic black, non-Hispanic white, and Hispanic participants who were 51-55 years of age at their first interview any time during the study period (1998-2014) and all subsequent follow-up observations until 2014. Multimorbidity was defined as having two or more of seven somatic chronic diseases: arthritis, cancer, heart disease (myocardial infarction, coronary heart disease, angina, congestive heart failure, or other heart problems), diabetes, hypertension, lung disease, and stroke. We used negative binomial generalized estimating equation models to assess the trajectories of multimorbidity burden over time for non-Hispanic black, non-Hispanic white, and Hispanic participants. In covariate-adjusted models non-Hispanic black respondents had initial chronic disease counts that were 28\% higher than non-Hispanic white respondents (IRR 1.279, 95\% CI 1.201, 1.361), while Hispanic respondents had initial chronic disease counts that were 15\% lower than non-Hispanic white respondents (IRR 0.852, 95\% CI 0.775, 0.938). Non-Hispanic black respondents had rates of chronic disease accumulation that were 1.1\% slower than non-Hispanic whites (IRR 0.989, 95\% CI 0.981, 0.998) and Hispanic respondents had rates of chronic disease accumulation that were 1.5\% faster than non-Hispanic white respondents (IRR 1.015, 95\% CI 1.002, 1.028). Using marginal effects commands, this translates to predicted values of chronic disease for white respondents who begin the study period with 0.98 chronic diseases and end with 2.8 chronic diseases; black respondents who begin the study period with 1.3 chronic diseases and end with 3.3 chronic diseases; and Hispanic respondents who begin the study period with 0.84 chronic diseases and end with 2.7 chronic diseases.

CONCLUSIONS: Middle-aged non-Hispanic black adults start at a higher level of chronic disease burden and develop multimorbidity at an earlier age, on average, than their non-Hispanic white counterparts. Hispanics, on the other hand, accumulate chronic disease at a faster rate relative to non-Hispanic white adults. Our findings have important implications for improving primary and secondary chronic disease prevention efforts among non-Hispanic black and Hispanic Americans to stave off greater multimorbidity-related health impacts.

}, keywords = {Chronic conditions, Comorbidity, Racial/ethnic differences}, issn = {1932-6203}, doi = {10.1371/journal.pone.0218462}, author = {Ana R Qui{\~n}ones and Anda Botoseneanu and Markwardt, Sheila and Corey L Nagel and Jason T Newsom and David A Dorr and Heather G. Allore} } @article {10450, title = {TRACKING CHANGES IN MULTIMORBIDITY AMONG RACIALLY AND ETHNICALLY DIVERSE POPULATIONS}, journal = {Innovation in Aging}, volume = {3}, year = {2019}, pages = {S354-S354}, abstract = {Multimorbidity is widely recognized as having adverse effects on health and wellbeing above and beyond the risk attributable to individual chronic disease. Much of what is known about multimorbidity rests on research that has largely focused on one point-in-time, or from a static perspective, with little consideration to issues involved in assessing longitudinal changes in multimorbidity. In addition, less focus has been placed on assessing racial and ethnic variations in longitudinal changes of multimorbidity. Addressing this knowledge gap, we highlight important issues and considerations in addressing multimorbidity research from a longitudinal perspective and present findings from longitudinal models that examine differences in the rate of chronic disease accumulation and multimorbidity onset between non-Hispanic white (white), non-Hispanic black (black), and Hispanic study participants in the Health and Retirement Study starting in middle-age and followed for up to 16 years.}, keywords = {multimorbidity, race-ethnicity, Racial and ethnic differences}, isbn = {2399-5300}, doi = {10.1093/geroni/igz038.1285}, author = {Ana R Qui{\~n}ones and Anda Botoseneanu and Markwardt, Sheila and Corey L Nagel and Jason T Newsom and David A Dorr and Heather G. Allore} } @article {8552, title = {Inconsistency in the Self-report of Chronic Diseases in Panel Surveys: Developing an Adjudication Method for the Health and Retirement Study.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {73}, year = {2018}, month = {2018 06 14}, pages = {901-912}, abstract = {

Objectives: Chronic disease data from longitudinal health interview surveys are frequently used in epidemiologic studies. These data may be limited by inconsistencies in self-report by respondents across waves. We examined disease inconsistencies in the Health and Retirement Study and investigated a multistep method of adjudication. We hypothesized a greater likelihood of inconsistences among respondents with cognitive impairment, of underrepresented race/ethnic groups, having lower education, or having less income/wealth.

Method: We analyzed Waves 1995-2010, including adults 51 years and older (N = 24,156). Diseases included hypertension, heart disease, lung disease, diabetes, cancer, stroke, and arthritis. We used questions about the diseases to formulate a multistep adjudication method to resolve inconsistencies across waves.

Results: Thirty percent had inconsistency in their self-report of diseases across waves, with cognitive impairment, proxy status, age, Hispanic ethnicity, and wealth as key predictors. Arthritis and hypertension had the most frequent inconsistencies; stroke and cancer, the fewest. Using a stepwise method, we adjudicated 60\%-75\% of inconsistent responses.

Discussion: Discrepancies in the self-report of diseases across multiple waves of health interview surveys are common. Differences in prevalence between original and adjudicated data may be substantial for some diseases and for some groups, (e.g., the cognitively impaired).

}, keywords = {Aged, Chronic disease, Data Accuracy, Epidemiologic Methods, Female, Health Surveys, Humans, Interviews as Topic, Longitudinal Studies, Male, Middle Aged, Self Report}, issn = {1758-5368}, doi = {10.1093/geronb/gbw063}, url = {https://www.ncbi.nlm.nih.gov/pubmed/27260670}, author = {Christine T Cigolle and Corey L Nagel and Caroline S Blaum and Jersey Liang and Ana R Qui{\~n}ones} } @article {8904, title = {Racial and ethnic differences in smoking changes after chronic disease diagnosis among middle-aged and older adults in the United States.}, journal = {BMC Geriatrics}, volume = {17}, year = {2017}, month = {2017 Feb 08}, pages = {48}, abstract = {

BACKGROUND: Middle-aged and older Americans from underrepresented racial and ethnic backgrounds are at risk for greater chronic disease morbidity than their white counterparts. Cigarette smoking increases the severity of chronic illness, worsens physical functioning, and impairs the successful management of symptoms. As a result, it is important to understand whether smoking behaviors change after the onset of a chronic condition. We assessed the racial/ethnic differences in smoking behavior change after onset of chronic diseases among middle-aged and older adults in the US.

METHODS: We use longitudinal data from the Health and Retirement Study (HRS 1992-2010) to examine changes in smoking status and quantity of cigarettes smoked after a new heart disease, diabetes, cancer, stroke, or lung disease diagnosis among smokers.

RESULTS: The percentage of middle-aged and older smokers who quit after a new diagnosis varied by racial/ethnic group and disease: for white smokers, the percentage ranged from 14\% after diabetes diagnosis to 32\% after cancer diagnosis; for black smokers, the percentage ranged from 15\% after lung disease diagnosis to 40\% after heart disease diagnosis; the percentage of Latino smokers who quit was only statistically significant after stoke, where 38\% quit. In logistic models, black (OR = 0.43, 95\% CI: 0.19-0.99) and Latino (OR = 0.26, 95\% CI: 0.11-0.65) older adults were less likely to continue smoking relative to white older adults after a stroke, and Latinos were more likely to continue smoking relative to black older adults after heart disease onset (OR = 2.69, 95\% CI [1.05-6.95]). In models evaluating changes in the number of cigarettes smoked after a new diagnosis, black older adults smoked significantly fewer cigarettes than whites after a new diagnosis of diabetes, heart disease, stroke or cancer, and Latino older adults smoked significantly fewer cigarettes compared to white older adults after newly diagnosed diabetes and heart disease. Relative to black older adults, Latinos smoked significantly fewer cigarettes after newly diagnosed diabetes.

CONCLUSIONS: A large majority of middle-aged and older smokers continued to smoke after diagnosis with a major chronic disease. Black participants demonstrated the largest reductions in smoking behavior. These findings have important implications for tailoring secondary prevention efforts for older adults.

}, keywords = {Chronic disease, Health Conditions and Status, Older Adults, Racial/ethnic differences, Smoking}, issn = {1471-2318}, doi = {10.1186/s12877-017-0438-z}, author = {Ana R Qui{\~n}ones and Corey L Nagel and Jason T Newsom and Nathalie Huguet and Sheridan, Paige and Stephen M Thielke} } @article {7629, title = {How does the trajectory of multimorbidity vary across Black, White, and Mexican Americans in middle and old age?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {66}, year = {2011}, note = {Quinones, Ana R Liang, Jersey Bennett, Joan M Xu, Xiao Ye, Wen F31-AG029783/AG/NIA NIH HHS/United States R01-AG015124/AG/NIA NIH HHS/United States R01-AG028116/AG/NIA NIH HHS/United States Comparative Study Research Support, N.I.H., Extramural United States The journals of gerontology. Series B, Psychological sciences and social sciences J Gerontol B Psychol Sci Soc Sci. 2011 Nov;66(6):739-49. Epub 2011 Oct 3.}, month = {2011 Nov}, pages = {739-49}, publisher = {66}, abstract = {

OBJECTIVES: This research examines intra- and interpersonal differences in multiple chronic conditions reported by Americans aged 51 and older for a period up to 11 years. It focuses on how changes in multimorbidity vary across White, Black, and Mexican Americans.

METHODS: Data came from 17,517 respondents of the Health and Retirement Study (1995-2006) with up to 5 repeated observations. Hierarchical linear models were employed to analyze ethnic variations in temporal changes of reported comorbidities.

FINDINGS: Middle-aged and older Americans have on average nearly 2 chronic diseases at the baseline, which increased to almost 3 conditions in 11 years. White Americans differ from Black and Mexican Americans in terms of level and rate of change of multimorbidity. Mexican Americans demonstrate lower initial levels and slower accumulation of comorbidities relative to Whites. In contrast, Blacks showed an elevated level of multimorbidity throughout the 11-year period of observation, although their rate of change slowed relative to Whites.

DISCUSSION: These results suggest that health differences between Black Americans and other ethnic groups including White and Mexican Americans persist in the trajectory of multimorbidity even when population heterogeneity is adjusted. Further research is needed concerning the impact of health disadvantages and differential mortality that may have occurred before middle age as well as exploring the role of nativity, the nature of self-reported diseases, and heterogeneity underlying the average trajectory of multimorbidity for ethnic elders.

}, keywords = {Aged, Aged, 80 and over, Aging, Black or African American, Chronic disease, Female, Follow-Up Studies, Health Behavior, Health Status Disparities, Hispanic or Latino, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, United States, White People}, issn = {1758-5368}, doi = {10.1093/geronb/gbr106}, author = {Ana R Qui{\~n}ones and Jersey Liang and Joan M. Bennett and Xiao Xu and Wen Ye} } @article {7636, title = {Multiple trajectories of depressive symptoms in middle and late life: racial/ethnic variations.}, journal = {Psychol Aging}, volume = {26}, year = {2011}, note = {Liang, Jersey Xu, Xiao Quinones, Ana R Bennett, Joan M Ye, Wen 5P30AG024824/AG/NIA NIH HHS/United States R01-AG015124/AG/NIA NIH HHS/United States R01-AG028116/AG/NIA NIH HHS/United States UL1RR024986/RR/NCRR NIH HHS/United States Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov{\textquoteright}t Research Support, U.S. Gov{\textquoteright}t, Non-P.H.S. United States Psychology and aging Psychol Aging. 2011 Dec;26(4):761-77. Epub 2011 Aug 29.}, month = {2011 Dec}, pages = {761-77}, publisher = {26}, abstract = {

This research aims to identify distinct courses of depressive symptoms among middle-aged and older Americans and to ascertain how these courses vary by race/ethnicity. Data came from the 1995-2006 Health and Retirement Study which involved a national sample of 17,196 Americans over 50 years of age with up to six repeated observations. Depressive symptoms were measured by an abbreviated version of the Center for Epidemiologic Studies Depression scale. Semiparametric group based mixture models (Proc Traj) were used for data analysis. Six major trajectories were identified: (a) minimal depressive symptoms (15.9\%), (b) low depressive symptoms (36.3\%), (c) moderate and stable depressive symptoms (29.2\%), (d) high but decreasing depressive symptoms (6.6\%), (e) moderate but increasing depressive symptoms (8.3\%), and (f) persistently high depressive symptoms (3.6\%). Adjustment of time-varying covariates (e.g., income and health conditions) resulted in a similar set of distinct trajectories. Relative to White Americans, Black and Hispanic Americans were significantly more likely to be in trajectories of more elevated depressive symptoms. In addition, they were more likely to experience increasing and decreasing depressive symptoms. Racial and ethnic variations in trajectory groups were partially mediated by SES, marital status, and health conditions, particularly when both interpersonal and intrapersonal differences in these variables were taken into account.

}, keywords = {Age Factors, Aged, Black or African American, depression, disease progression, Female, Health Status Disparities, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Models, Statistical, Socioeconomic factors, Time Factors, United States, White People}, issn = {1939-1498}, doi = {10.1037/a0023945}, author = {Jersey Liang and Xiao Xu and Ana R Qui{\~n}ones and Joan M. Bennett and Wen Ye} } @article {7406, title = {Ethnicity and changing functional health in middle and late life: a person-centered approach.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {65}, year = {2010}, month = {2010 Jul}, pages = {470-81}, publisher = {65}, abstract = {

OBJECTIVES: Following a person-centered approach, this research aims to depict distinct courses of disability and to ascertain how the probabilities of experiencing these trajectories vary across Black, Hispanic, and White middle-aged and older Americans.

METHODS: Data came from the 1995-2006 Health and Retirement Study, which involved a national sample of 18,486 Americans older than 50 years of age. Group-based semiparametric mixture models (Proc Traj) were used for data analysis.

RESULTS: Five trajectories were identified: (a) excellent functional health (61\%), (b) good functional health with small increasing disability (25\%), (c) accelerated increase in disability (7\%), (d) high but stable disability (4\%), and (e) persistent severe impairment (3\%). However, when time-varying covariates (e.g., martial status and health conditions) were controlled, only 3 trajectories emerged: (a) healthy functioning (53\%), moderate functional decrement (40\%), and (c) large functional decrement (8\%). Black and Hispanic Americans had significantly higher probabilities than White Americans in experiencing poor functional health trajectories, with Blacks at greater risks than Hispanics.

CONCLUSIONS: Parallel to the concepts of successful aging, usual aging, and pathological aging, there exist distinct courses of changing functional health over time. The mechanisms underlying changes in disability may vary between Black and Hispanic Americans.

}, keywords = {Age Factors, Aged, Black or African American, Disabled Persons, disease progression, ethnicity, Female, Health Status, Health Status Disparities, Health Surveys, Hispanic or Latino, Humans, Likelihood Functions, Male, Marital Status, Middle Aged, Time Factors, United States, White People}, issn = {1758-5368}, doi = {10.1093/geronb/gbp114}, author = {Jersey Liang and Xiao Xu and Joan M. Bennett and Wen Ye and Ana R Qui{\~n}ones} } @article {7252, title = {Gender differences in functional status in middle and older age: are there any age variations?}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {63}, year = {2008}, month = {2008 Sep}, pages = {S282-92}, publisher = {63B}, abstract = {

OBJECTIVES: The present study examines gender differences in changes in functional status after age 50 and how such differences vary across different age groups.

METHODS: Data came from the Health and Retirement Study, involving up to six repeated observations of a national sample of Americans older than 50 years of age between 1995 and 2006. We employed hierarchical linear models with time-varying covariates in depicting temporal variations in functional status between men and women.

RESULTS: As a quadratic function, the worsening of functional status was more accelerated in terms of the intercept and rate of change among women and those in older age groups. In addition, gender differences in the level of functional impairment were more substantial in older persons than in younger individuals, although differences in the rate of change between men and women remained constant across age groups.

DISCUSSION: A life course perspective can lead to new insights regarding gender variations in health within the context of intrapersonal and interpersonal differences. Smaller gender differences in the level of functional impairment in the younger groups may reflect improvement of women{\textquoteright}s socioeconomic status, greater rate of increase in chronic diseases among men, and less debilitating effects of diseases.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Disabled Persons, Female, Health Status, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Sex Factors, United States}, issn = {1079-5014}, doi = {10.1093/geronb/63.5.s282}, author = {Jersey Liang and Joan M. Bennett and Benjamin A Shaw and Ana R Qui{\~n}ones and Wen Ye and Xiao Xu and Mary Beth Ofstedal} }