@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 {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 {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} }