@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 {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 {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 {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 {8409, title = {Multimorbidity Combinations and Disability in Older Adults}, journal = {The Journals of Gerontology Series A: Biological Sciences and Medical Sciences}, volume = {71}, year = {2016}, pages = {823-830}, publisher = {71}, abstract = {Background: Multimorbidity (multiple co-occurring chronic diseases) is associated with greater likelihood of disability and mortality, above and beyond the risk attributable to individual diseases. This study identifies prevalent multimorbidity patterns and evaluates their association with disability among U.S. older adults.Methods: Prospective cohort study using longitudinal Health and Retirement Study data (2010 2012). We included 8,782 participants aged 65 years and older and used negative binomial models to examine prospective disability, measured by the combined activities of daily living instrumental activities of daily living index. Multimorbidity was defined as the co-occurring combination of at least two of the following chronic diseases: hypertension, cardiovascular disease, lung disease, diabetes, cancer, arthritis, stroke, cognitive impairment, or high depressive symptoms (CES-D score 4).Results: We found 291 unique disease combinations with 1 to 1,167 older adults per disease combination. The three most prevalent combinations were: (a) hypertension and arthritis (n = 1,167); (b) hypertension, arthritis, and cardiovascular disease (n = 510); and (c) hypertension, arthritis, and diabetes (n = 430). Only one of the prevalent combinations included depressive symptoms (in combination with arthritis, hypertension; n = 129). This group showed the highest level of activities of daily living instrumental activities of daily living disability compared to healthy participants or participants with a single disease (either included in the combination or different from diseases in the combination) even after adjusting for age, gender, education, race/ethnicity, and body mass index.Conclusions: Clinicians stand to gain from a better understanding of which disease combinations are more and less disabling among older adults. Understanding how multimorbidity combinations relate to functional status is an important step towards reducing disability and sustaining independent living among older adults.}, keywords = {Disabilities, Health Conditions and Status}, doi = {10.1093/gerona/glw035}, url = {http://biomedgerontology.oxfordjournals.org/content/71/6/823.abstract}, author = {A. R. Quinones and Markwardt, Sheila and Anda Botoseneanu} } @article {6460, title = {Racial/Ethnic Differences in Trajectories of Cognitive Function in Older Adults.}, journal = {J Aging Health}, volume = {28}, year = {2016}, month = {2016 Dec}, pages = {1382-1402}, abstract = {

OBJECTIVE: The objective of this study is to (a) examine racial/ethnic differences in trajectories of cognitive function and (b) evaluate the role of education and health behaviors (physical activity [PA] and smoking) as mediators of racial/ethnic differences in the rate of decline in cognitive function in older adults.

METHOD: Data for this study came from the Health and Retirement Study ( n = 3,424). Hierarchical linear models were used to define the trajectory of cognitive function between 2002 and 2008. Participants were classified based on PA as non-vigorously active, intermittent vigorously active, and consistently vigorously active.

RESULTS: After adding education, the Hispanic{\textquoteright}s and Black{\textquoteright}s disparities in cognitive performance were slightly attenuated (Hispanics, β = -1.049, p < .001; Blacks, β = -3.397, p < .001) but were still different from Whites. Smoking was not associated with the cognition intercept or rate of decline.

DISCUSSION: We found education had a partial mediating effect on racial differences in levels of cognition but not on the rate of change over time.

}, keywords = {Aged, Aged, 80 and over, Black People, Cognition, Cognition Disorders, Female, Health Behavior, Hispanic or Latino, Humans, Male, White People}, issn = {1552-6887}, doi = {10.1177/0898264315620589}, url = {http://jah.sagepub.com/content/early/2015/12/29/0898264315620589.abstract}, author = {Elizabeth Vasquez and Anda Botoseneanu and Joan M. Bennett and Benjamin A Shaw} } @article {8272, title = {Socioeconomic stratification and multidimensional health trajectories: evidence of convergence in later old age.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 Jul}, pages = {661-71}, publisher = {70}, abstract = {

OBJECTIVES: This research sought to examine socioeconomic stratification in the joint trajectories of physical, emotional, and cognitive functioning among older Americans and how it differs by age groups.

METHODS: We used data from a nationally representative sample of 9,237 Americans age 65 or older from the Health and Retirement Study, who were observed biennially from 1998 to 2010. Joint trajectories of physical, emotional, and cognitive functioning were characterized using a group-based mixture model. We then applied multinomial logistic regression analysis to evaluate their linkages with socioeconomic status and how the linkages differ by age groups.

RESULTS: We identified four distinct patterns of joint changes in physical, emotional, and cognitive functioning over time. Accounting for 29.3\%, 23.5\%, 24.5\%, and 22.6\% of the older Americans, respectively, these trajectory patterns characterized groups of individuals experiencing minimal to severe levels of impairment and deterioration. Lower education, income, and net worth were associated with trajectories featuring greater impairment or more rapid deterioration in these functional dimensions. Disparities based on education, however, attenuated in later old age, whereas health benefits associated with higher income and higher net worth persisted into advanced age.

DISCUSSION: Distinct patterns of joint trajectories of physical, emotional, and cognitive functioning exist in old age. There were significant socioeconomic differences in the joint trajectories, with education-based inequality in health converging in later old age. Further research identifying strategies to alleviate the disproportionate burden of poor multidimensional health trajectories in lower socioeconomic groups is important.

}, keywords = {Aged, Aged, 80 and over, Aging, Cognition Disorders, Disabled Persons, Educational Status, Female, Health Status, Humans, Male, Social Class, United States}, issn = {1758-5368}, doi = {10.1093/geronb/gbu095}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/08/25/geronb.gbu095.abstract}, author = {Xiao Xu and Jersey Liang and Joan M. Bennett and Anda Botoseneanu and Heather G. Allore} } @article {7913, title = {Latent heterogeneity in long-term trajectories of body mass index in older adults.}, journal = {J Aging Health}, volume = {25}, year = {2013}, month = {2013 Mar}, pages = {342-63}, publisher = {25}, abstract = {

OBJECTIVE: To evaluate latent heterogeneity in long-term trajectories of body weight in older adults.

METHODS: We analyzed 14-year longitudinal data on 10,314 older adults from the Health and Retirement Study. Semiparametric mixture models identified latent subgroups of similar trajectories of body mass index (BMI).

RESULTS: Five distinct trajectory subgroups emerged: normal starting-BMI with accelerated increase over time (trajectory $\#$1), overweight and increasing (trajectory $\#$2), borderline-obese and increasing (trajectory $\#$3), obese and increasing (trajectory $\#$4), and morbidly obese with decelerating gain (trajectory $\#$5). Blacks and Hispanics had greater risk of membership in ascending high-BMI trajectory groups. Females had approximately half the risk of following overweight and obese increasing BMI trajectories compared with males.

DISCUSSION: Distinct latent subgroups of BMI trajectories and significant racial/ethnic and gender trajectory heterogeneity exist in the older adult population. The propensity of men and minorities to experience high-risk BMI trajectories may exacerbate existing disparities in morbidity/ mortality in older age.

}, keywords = {Aging, Black or African American, Body Mass Index, Female, Hispanic or Latino, Humans, Longitudinal Studies, Male, Middle Aged, Obesity, Obesity, Morbid, Overweight, Risk Factors, Sex Distribution, United States}, issn = {1552-6887}, doi = {10.1177/0898264312468593}, author = {Anda Botoseneanu and Jersey Liang} } @article {7746, title = {The effect of stability and change in health behaviors on trajectories of body mass index in older Americans: a 14-year longitudinal study.}, journal = {J Gerontol A Biol Sci Med Sci}, volume = {67}, year = {2012}, month = {2012 Oct}, pages = {1075-84}, abstract = {

BACKGROUND: Obesity is increasingly prevalent among older adults, yet little is known about the impact of health behaviors on the trajectories of body weight in this age group.

METHODS: We examined the effect of time-varying smoking, physical activity (PA), alcohol use, and changes thereof, on the 14-year (1992-2006) trajectory of body- mass index (BMI) in a cohort of 10,314 older adults from the Health and Retirements Study, aged 51-61 years at baseline. Hierarchical linear modeling (HLM) quantifies the effect of smoking, PA, and alcohol use (user status, initiation and cessation) on intercept and rate-of-change in BMI trajectory, and tests for variations in the strength of association between each behavior and BMI.

RESULTS: Over 14 years (82,512 observations), BMI increased approximated by a quadratic function. Smoking and PA (user status and initiation) were associated with significantly lower BMI trajectories over time. Cessation of smoking and PA resulted in higher BMI trajectories over time. The weight-gaining effect of smoking cessation increased, while the strength of association between BMI trajectories and PA or alcohol use were constant over time. Socio-economic and health status differences explained the effects of alcohol use on BMI trajectory.

CONCLUSIONS: In older adults, smoking and PA, and changes thereof, vary in their long-term effect on trajectories of BMI. Barring increases in PA levels, older smokers who quit today are expected to gain significantly more weight than two decades ago. This knowledge is essential for the design of smoking cessation, physical activityPA, and weight-control interventions in older adults.

}, keywords = {Aged, Aging, Alcohol Drinking, Body Mass Index, Cohort Studies, Female, Health Behavior, Health Status, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Motor Activity, Smoking, Socioeconomic factors, United States}, issn = {1758-535X}, doi = {10.1093/gerona/gls073}, author = {Anda Botoseneanu and Jersey Liang} } @article {7591, title = {Social stratification of body weight trajectory in middle-age and older americans: results from a 14-year longitudinal study.}, journal = {J Aging Health}, volume = {23}, year = {2011}, month = {2011 Apr}, pages = {454-80}, publisher = {23}, abstract = {

OBJECTIVE: To depict the trajectory of BMI from middle to late adulthood and to examine social variations in BMI trajectories.

METHOD: Eight waves (1992-2006) of the Health and Retirement Study involving a nationally representative sample of Americans aged 51 to 61 years at baseline were used. Changes in BMI were analyzed using hierarchical linear modeling with time-constant and time-varying covariates.

RESULTS: BMI increased linearly over time. Compared with Caucasians, African-Americans had higher BMI levels, while Hispanics had similar BMI levels, but lower rates of increase over time. Higher education predicted lower BMI levels and was not associated with the rate of change. Younger age-at-baseline predicted lower BMI level and lower rate of increase. No gender differences were found.

DISCUSSION: Observed racial/ethnic and educational differences in BMI trajectory from middle to old age inform policies and interventions aimed at modifying health risks and reducing health disparities in old age.

}, keywords = {Age Factors, Aged, Aging, Body Mass Index, ethnicity, Female, Health Status Disparities, Humans, Linear Models, Longitudinal Studies, Male, Middle Aged, Multivariate Analysis, Obesity, Psychometrics, Risk Assessment, Self Report, Social Class, Socioeconomic factors, Time Factors, United States}, issn = {1552-6887}, doi = {10.1177/0898264310385930}, author = {Anda Botoseneanu and Jersey Liang} } @mastersthesis {6225, title = {Successful Aging and Obesity: Social and Developmental Heterogeneity in Trajectories of Body Weight from Middle to Older Ages}, volume = {Ph.D.}, year = {2011}, pages = {172}, school = {University of Michigan}, address = {Ann Arbor, MI}, abstract = {Obesity is increasingly prevalent among older adults, yet little is known about the distribution of long-term trajectories of body-weight in this age group. The three essays included in this dissertation aim to depict the trajectories of body-mass index (BMI) from middle to old age and to examine social and behavioral variations in these trajectories. Eight waves (1992-2006) of the Health and Retirement Study involving a nationally representative cohort of Americans aged 51 to 61 years at baseline were used. Changes in BMI were analyzed using alternatively hierarchical linear modeling or semiparametric mixture modeling, with adjustment for time-constant and time-varying covariates. First study finds that over 14 years, respondents followed a linearly increasing BMI trajectory. Compared with Caucasians, African-Americans had higher BMI levels, while Hispanics had similar BMI levels, but lower rates of increase over time. Higher education predicted lower BMI levels and was not associated with the rate of change. Older age-at-baseline predicted lower BMI levels and lower rates of increase. No gender differences were found. The second study shows that smoking and vigorous physical activity (user status and initiation) were associated with significantly lower BMI trajectories over time. Cessation of smoking and physical activity resulted in higher BMI trajectories over time. The weight-gaining effect of smoking cessation increased during the study period, while the strength of association between BMI trajectories and PA or alcohol use were constant. In the third study, five distinct BMI trajectories are identified, differing primarily in their intercept: normal BMI trajectory (19.9\% of sample), overweight (43.8\%), borderline-obese (25.4\%), obese (8.9\%), and morbidly-obese (2.1\%). Each trajectory showed an upward trend over the study period, although the rate-ofincrease varied between trajectories. Compared with Whites, Blacks and Hispanics had greater probabilities of membership in the higher BMI trajectory groups. Females had approximately half the risk of following the overweight and obese BMI trajectories compared with males. In conclusion, significant racial/ethnic, gender and educational heterogeneity in BMI trajectories exists in older adults. Health behaviors provide beneficial modifications in BMI trajectories. Tailoring of public health and clinical interventions to trajectory group characteristics may reduce obesity-related health disparities in aging.}, keywords = {Health Conditions and Status, Healthcare, Women and Minorities}, url = {http://hdl.handle.net/2027.42/86419}, author = {Anda Botoseneanu} }