@article {12004, title = {Explaining the variance in cardiovascular disease risk factors: A comparison of demographic, socioeconomic, and genetic predictors.}, journal = {Epidemiology}, volume = {33}, year = {2022}, pages = {25-33}, abstract = {

BACKGROUND: Efforts to explain the burden of cardiovascular disease (CVD) often focus on genetic factors or social determinants of health. There is little evidence on the comparative predictive value of each, which could guide clinical and public health investments in measuring genetic versus social information. We compared the variance in CVD-related outcomes explained by genetic versus socioeconomic predictors.

METHODS: Data were drawn from the Health and Retirement Study (N=8,720). We examined self-reported diabetes, heart disease, depression, smoking, and body mass index, and objectively measured total and high-density lipoprotein cholesterol. For each outcome, we compared the variance explained by demographic characteristics, socioeconomic position (SEP), and genetic characteristics including a polygenic score for each outcome and principal components (PCs) for genetic ancestry. We used R-squared values derived from race-stratified multivariable linear regressions to evaluate the variance explained.

RESULTS: The variance explained by models including all predictors ranged from 3.7\% to 14.3\%. Demographic characteristics explained more than half this variance for most outcomes. SEP explained comparable or greater variance relative to the combination of the polygenic score and PCs for most conditions among both white and Black participants. The combination of SEP, polygenic score, and PCs performed substantially better, suggesting that each set of characteristics may independently contribute to prediction of CVD related outcomes.

CONCLUSIONS: Focusing on genetic inputs into personalized medicine predictive models, without considering measures of social context that have clear predictive value, needlessly ignores relevant information that is more feasible and affordable to collect on patients in clinical settings.

}, keywords = {Cardiovascular disease, Demographics, Genetics, Risk Factors, socioeconomics}, issn = {1531-5487}, doi = {10.1097/EDE.0000000000001425}, author = {Hamad, Rita and M. Maria Glymour and Calmasini, Camilla and Thu T Nguyen and Stefan Walter and David Rehkopf} } @article {10141, title = {Differential associations between state-level educational quality and cardiovascular health by race: Early-life exposures and late-life health.}, journal = {SSM Population Health}, volume = {8}, year = {2019}, pages = {100418}, abstract = {Cardiovascular diseases (CVD) are patterned by educational attainment but educational quality is rarely examined. Educational quality differences may help explain racial disparities. Health and Retirement Study respondent data (1992-2014; born 1900-1951) were linked to state- and year-specific educational quality measures when the respondent was 6 years old. State-level educational quality was a composite of state-level school term length, student-to-teacher ratio, and per-pupil expenditure. CVD-related outcomes were self-reported (N = 24,339) obesity, heart disease, stroke, ever-smoking, high blood pressure, diabetes and objectively measured (N = 10,704) uncontrolled blood pressure, uncontrolled blood sugar, total cholesterol, high-density lipoprotein cholesterol (HDL), and C-reactive protein. Race/ethnicity was classified as White, Black, or Latino. Cox models fit for dichotomous time-to-event outcomes and generalized estimating equations for continuous outcomes were adjusted for individual and state-level confounders. Heterogeneities by race were evaluated using state-level educational quality by race interaction terms; race-pooled, race by educational quality interaction, and race-specific estimates were calculated. In race-pooled analyses, higher state-level educational quality was protective for obesity (HR = 0.92; 95\%CI(0.87,0.98)). In race-specific estimates for White Americans, state-level educational quality was protective for high blood pressure (HR = 0.95; 95\%CI(0.91,0.99). Differential relationships among Black compared to White Americans were observed for obesity, heart disease, stroke, smoking, high blood pressure, and HDL cholesterol. In race-specific estimates for Black Americans, higher state-level educational quality was protective for obesity (HR = 0.88; 95\%CI(0.84,0.93)), but predictive of heart disease (HR = 1.07; 95\%CI(1.01,1.12)), stroke (HR = 1.20; 95\%CI(1.08,1.32)), and smoking (HR = 1.05; 95\%CI(1.02,1.08)). Race-specific hazard ratios for Latino and Black Americans were similar for obesity, stroke, and smoking. Better state-level educational quality had differential associations with CVD by race. Among minorities, better state-level educational quality was predominately associated with poorer CVD outcomes. Results evaluate the 1900-1951 birth cohorts; secular changes in the racial integration of schools since the 1950s, means results may not generalize to younger cohorts.}, keywords = {Cardiovascular health, Education, Heart disease, Late-life Health, Racial/ethnic differences}, issn = {2352-8273}, doi = {10.1016/j.ssmph.2019.100418}, author = {Anusha M Vable and Thu T Nguyen and David Rehkopf and M. Maria Glymour and Hamad, Rita} } @article {9970, title = {Discrimination in health care and biomarkers of cardiometabolic risk in U.S. adults}, journal = {SSM - Population Health}, volume = {7}, year = {2019}, pages = {100306}, abstract = {Introduction: Discrimination in health care settings is associated with poor health outcomes and may be especially harmful to older adults who are more likely to have existing risk factors or medical conditions that require on-going care. The purpose of this study is to investigate the associations between patient-reported health care discrimination and biomarkers of cardiometabolic risk. Methods: We used 2008{\textendash}2014 data from the Health and Retirement Study, a nationally representative study of US adults ages 50+ (n=12,695 participants contributing up to 16,179 observations) to examine the association between patient-reported experiences of health care discrimination and biomarkers of cardiometabolic risk: high sensitivity C-reactive protein (CRP), Hemoglobin A1c (HbAlc), high-density lipoprotein (HDL), total cholesterol, cystatin C and blood pressure and whether relationships were modified by race/ethnicity (non-Hispanic White, non-Hispanic Black, or Hispanic) or gender. We fit generalized estimating equation (GEE) models specifying a binomial distribution and logit link to account for dependency of repeated measures on individuals. Results: Health care discrimination was associated with higher odds of CRP>3 mg/L (OR: 1.20 (95\% CI: 1.10, 1.30) and HbA1c>6.5\% (OR: 1.23 (95\% CI: 1.10, 1.38) but not associated with other biomarkers of cardiometabolic health in the sample as a whole. However, subgroup differences were detected. While health care discrimination was positively associated with elevated HbA1c for non-Hispanics, it was inversely associated with HbA1c for Hispanics. Conclusions: Health care discrimination was associated with increased cardiometabolic risk based on selected biomarkers.}, keywords = {Biomarkers, Discrimination, Racism, Risk Factors}, issn = {23528273}, doi = {10.1016/j.ssmph.2018.10.006}, author = {Thu T Nguyen and Anusha M Vable and M. Maria Glymour and Allen, Amani M.} } @article {10144, title = {Educational attainment and cardiovascular disease in the United States: A quasi-experimental instrumental variables analysis.}, journal = {PLoS Medicine}, volume = {16}, year = {2019}, month = {2019 Jun}, pages = {e1002834}, abstract = {

BACKGROUND: There is ongoing debate about whether education or socioeconomic status (SES) should be inputs into cardiovascular disease (CVD) prediction algorithms and clinical risk adjustment models. It is also unclear whether intervening on education will affect CVD, in part because there is controversy regarding whether education is a determinant of CVD or merely correlated due to confounding or reverse causation. We took advantage of a natural experiment to estimate the population-level effects of educational attainment on CVD and related risk factors.

METHODS AND FINDINGS: We took advantage of variation in United States state-level compulsory schooling laws (CSLs), a natural experiment that was associated with geographic and temporal differences in the minimum number of years that children were required to attend school. We linked census data on educational attainment (N = approximately 5.4 million) during childhood with outcomes in adulthood, using cohort data from the 1992-2012 waves of the Health and Retirement Study (HRS; N = 30,853) and serial cross-sectional data from 1971-2012 waves of the National Health and Nutrition Examination Survey (NHANES; N = 44,732). We examined self-reported CVD outcomes and related risk factors, as well as relevant serum biomarkers. Using instrumental variables (IV) analysis, we found that increased educational attainment was associated with reduced smoking (HRS β -0.036, 95\%CI: -0.06, -0.02, p < 0.01; NHANES β -0.032, 95\%CI: -0.05, -0.02, p < 0.01), depression (HRS β -0.049, 95\%CI: -0.07, -0.03, p < 0.01), triglycerides (NHANES β -0.039, 95\%CI: -0.06, -0.01, p < 0.01), and heart disease (HRS β -0.025, 95\%CI: -0.04, -0.002, p = 0.01), and improvements in high-density lipoprotein (HDL) cholesterol (HRS β 1.50, 95\%CI: 0.34, 2.49, p < 0.01; NHANES β 0.86, 95\%CI: 0.32, 1.48, p < 0.01), but increased BMI (HRS β 0.20, 95\%CI: 0.002, 0.40, p = 0.05; NHANES β 0.13, 95\%CI: 0.01, 0.32, p = 0.05) and total cholesterol (HRS β 2.73, 95\%CI: 0.09, 4.97, p = 0.03). While most findings were cross-validated across both data sets, they were not robust to the inclusion of state fixed effects. Limitations included residual confounding, use of self-reported outcomes for some analyses, and possibly limited generalizability to more recent cohorts.

CONCLUSIONS: This study provides rigorous population-level estimates of the association of educational attainment with CVD. These findings may guide future implementation of interventions to address the social determinants of CVD and strengthen the argument for including educational attainment in prediction algorithms and primary prevention guidelines for CVD.

}, keywords = {Cardiovascular health, Education, NHANES}, issn = {1549-1676}, doi = {10.1371/journal.pmed.1002834}, author = {Hamad, Rita and Thu T Nguyen and Bhattacharya, Jay and M. Maria Glymour and David Rehkopf} } @article {9512, title = {Chronic disease burden predicts food insecurity among older adults.}, journal = {Public Health Nutrition}, volume = {21}, year = {2018}, pages = {1737-1742}, abstract = {

OBJECTIVE: Increased out-of-pocket health-care expenditures may exert budget pressure on low-income households that leads to food insecurity. The objective of the present study was to examine whether older adults with higher chronic disease burden are at increased risk of food insecurity.

DESIGN: Secondary analysis of the 2013 Health and Retirement Study (HRS) Health Care and Nutrition Study (HCNS) linked to the 2012 nationally representative HRS.

SETTING: USA.

SUBJECTS: Respondents of the 2013 HRS HCNS with household incomes <300 \% of the federal poverty line (n 3552). Chronic disease burden was categorized by number of concurrent chronic conditions (0-1, 2-4, >=5 conditions), with multiple chronic conditions (MCC) defined as >=2 conditions.

RESULTS: The prevalence of food insecurity was 27{\textperiodcentered}8 \%. Compared with those having 0-1 conditions, respondents with MCC were significantly more likely to report food insecurity, with the adjusted odds ratio for those with 2-4 conditions being 2{\textperiodcentered}12 (95 \% CI 1{\textperiodcentered}45, 3{\textperiodcentered}09) and for those with >=5 conditions being 3{\textperiodcentered}64 (95 \% CI 2{\textperiodcentered}47, 5{\textperiodcentered}37).

CONCLUSIONS: A heavy chronic disease burden likely exerts substantial pressure on the household budgets of older adults, creating an increased risk for food insecurity. Given the high prevalence of food insecurity among older adults, screening those with MCC for food insecurity in the clinical setting may be warranted in order to refer to community food resources.

}, keywords = {Chronic conditions, Comorbidity, Food insecurity}, issn = {1475-2727}, doi = {10.1017/S1368980017004062}, author = {Jih, Jane and Stijacic-Cenzer, Irena and Hilary K Seligman and W John Boscardin and Thu T Nguyen and Christine S Ritchie} } @article {9460, title = {Trends for Reported Discrimination in Health Care in a National Sample of Older Adults with Chronic Conditions.}, journal = {Journal of General Internal Medicine}, volume = {33}, year = {2018}, month = {03/2018}, pages = {291-297}, abstract = {

BACKGROUND: Discrimination in health care settings is associated with poor health outcomes and may be especially harmful to individuals with chronic conditions, who need ongoing clinical care. Although efforts to reduce discrimination are growing, little is known about national trends in discrimination in health care settings.

METHODS: For Black, White, and Hispanic respondents with chronic disease in the 2008-2014 Health and Retirement Study (N~=~13,897 individuals and 21,078 reports), we evaluated trends in patient-reported discrimination, defined based on frequency of receiving poorer service or treatment than other people from doctors or hospitals ("never" vs. all other). Respondents also reported the perceived reason for the discrimination. In addition, we evaluated whether wealth predicted lower prevalence of discrimination for Blacks or Whites. We used generalized estimating equation models to account for dependency of repeated measures on individuals and wave-specific weights to represent the US non-institutionalized population aged 54+~.

RESULTS: The estimated prevalence of experiencing discrimination in health care among Blacks with a major chronic condition was 27\% (95\% CI: 23, 30) in 2008 and declined to 20\% (95\% CI: 17, 22) in 2014. Reports of receiving poorer service or treatment were stable for Whites (17\%, 95\% CI: 16, 19 in 2014). The Black-White difference in reporting any health care discrimination declined from 8.2\% (95\% CI: 4.5, 12.0) in 2008 to 2.5\% (95\% CI: -1.1, 6.0) in 2014. There was no clear trend for Hispanics. Blacks reported race and Whites reported age as the most common reason for discrimination.

CONCLUSIONS: Findings suggest national declines in patient-reported discrimination in health care among Blacks with chronic conditions from 2008 to 2014, although reports of discrimination remain common for all racial/ethnic groups. Our results highlight the critical importance of monitoring trends in reports of discrimination in health care to advance equity in health care.

}, keywords = {Chronic conditions, Discrimination, Healthcare}, issn = {1525-1497}, doi = {10.1007/s11606-017-4209-5}, author = {Thu T Nguyen and Anusha M Vable and M. Maria Glymour and Nuru-Jeter, Amani} } @article {9237, title = {The role of literacy in the association between educational attainment and depressive symptoms}, journal = {SSM - Population Health}, volume = {3}, year = {2017}, pages = {586-593}, abstract = {There is a consistent association between education and depressive symptoms, but research on the mechanisms to explain this association remains limited. No study has formally evaluated the extent to which the association between education and depressive symptoms is mediated through a foundational skill such as literacy. Inverse odds ratio weighting (IORW) was used to estimate total, natural direct, and natural indirect effects in examining literacy as a mediator of the association between education and depressive symptoms. Health and Retirement Study participants born in the U.S. between 1900 and 1947 were interviewed biennially for up to 12 years (N = 16,718). Literacy was assessed with a brief vocabulary measure. Depressive symptoms were measured using the 8-item Centers for Epidemiologic Studies-Depression (CES-D) scale. Decomposition estimates were derived using regression analyses of repeated measures of depressive symptoms. Standard errors were obtained using a nonparametric bootstrap with the individual as the independent unit to account for dependence of observations within an individual. In a large cohort of older Americans, a one standard deviation difference in educational attainment (~ 3 years) was associated with a 0.35-point decrement in CES-D score (95\% CI: -0.38, -0.32). This decrement represents a 0.22 standard deviation difference in depressive symptoms. Using IORW, the estimated effect of education on depressive symptoms mediated through literacy was -0.10 (95\% CI: -0.18, -0.01), which represents 28\% of the total effect. Education confers many benefits; as demonstrated by this study for depressive symptoms, one important benefit is literacy.}, keywords = {Depressive symptoms, Education, Literacy}, issn = {23528273}, doi = {10.1016/j.ssmph.2017.07.002}, url = {http://linkinghub.elsevier.com/retrieve/pii/S2352827316301197http://api.elsevier.com/content/article/PII:S2352827316301197?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S2352827316301197?httpAccept=text/plain}, author = {Thu T Nguyen and Eric J. Tchetgen Tchetgen and Ichiro Kawachi and Stephen E. Gilman and Stefan Walter and M. Maria Glymour} } @article {9348, title = {Validation of a theoretically motivated approach to measuring childhood socioeconomic circumstances in the Health and Retirement Study.}, journal = {PLoS One}, volume = {12}, year = {2017}, month = {2017}, pages = {e0185898}, abstract = {Childhood socioeconomic status (cSES) is a powerful predictor of adult health, but its operationalization and measurement varies across studies. Using Health and Retirement Study data (HRS, which is nationally representative of community-residing United States adults aged 50+ years), we specified theoretically-motivated cSES measures, evaluated their reliability and validity, and compared their performance to other cSES indices. HRS respondent data (N = 31,169, interviewed 1992-2010) were used to construct a cSES index reflecting childhood social capital (cSC), childhood financial capital (cFC), and childhood human capital (cHC), using retrospective reports from when the respondent was <16 years (at least 34 years prior). We assessed internal consistency reliability (Cronbach{\textquoteright}s alpha) for the scales (cSC and cFC), and construct validity, and predictive validity for all measures. Validity was assessed with hypothesized correlates of cSES (educational attainment, measured adult height, self-reported childhood health, childhood learning problems, childhood drug and alcohol problems). We then compared the performance of our validated measures with other indices used in HRS in predicting self-rated health and number of depressive symptoms, measured in 2010. Internal consistency reliability was acceptable (cSC = 0.63, cFC = 0.61). Most measures were associated with hypothesized correlates (for example, the association between educational attainment and cSC was 0.01, p < 0.0001), with the exception that measured height was not associated with cFC (p = 0.19) and childhood drug and alcohol problems (p = 0.41), and childhood learning problems (p = 0.12) were not associated with cHC. Our measures explained slightly more variability in self-rated health (adjusted R2 = 0.07 vs. <0.06) and number of depressive symptoms (adjusted R2 > 0.05 vs. < 0.04) than alternative indices. Our cSES measures use latent variable models to handle item-missingness, thereby increasing the sample size available for analysis compared to complete case approaches (N = 15,345 vs. 8,248). Adopting this type of theoretically motivated operationalization of cSES may strengthen the quality of research on the effects of cSES on health outcomes.}, keywords = {Childhood adversity, Meta-analyses, Socioeconomic factors, Validation}, issn = {1932-6203}, doi = {10.1371/journal.pone.0185898}, author = {Anusha M Vable and Paola Gilsanz and Thu T Nguyen and Ichiro Kawachi and M. Maria Glymour} } @article {6513, title = {Are self-reported neighbourhood characteristics associated with onset of functional limitations in older adults with or without memory impairment?}, journal = {J Epidemiol Community Health}, volume = {70}, year = {2016}, month = {2016 Oct}, pages = {1017-23}, abstract = {

BACKGROUND: Neighbourhood resources may preserve functional independence in older adults, but little is known about whether benefits differ for individuals with normal and impaired memory. We evaluated the extent to which neighbourhood context was related to onset of instrumental and basic activities of daily living (I/ADL) limitations and whether relationships were modified by memory impairment.

METHODS: Health and Retirement Study participants 50+ years of age without baseline I/ADL limitations (n=8726 for IADL and n=8345 for ADL models) were interviewed biennially for up to 8 years. Self-reported neighbourhood characteristics were scaled from 0 (worst) to 1 (best). Memory, assessed by direct and proxy cognitive assessments, was dichotomised at the 20th centile. We used pooled logistic regression models, adjusted for demographics and individual characteristics.

RESULTS: Low neighbourhood physical disorder (OR=0.51 (95\% CI: 0.37 to 0.69)), high social cohesion (OR=0.46 (0.34 to 0.62)), and high safety (OR=0.59 (0.46 to 0.76)) were associated with reduced incidence of IADL limitations. These neighbourhood characteristics were also associated with lower incidence of ADL limitations (disorder OR=0.59 (0.43 to 0.81)); social cohesion OR=0.60 (0.45 to 0.81)); safety OR=0.74 (0.58 to 0.93)). High social ties were not related to ADLs (OR=1.01(0.80 to 1.28)) or IADLs (OR=0.93(0.74 to 1.17)). The benefits of these neighbourhood characteristics for ADLs were similar among those with and without memory impairment but primarily observed among those without memory impairment for IADLs.

CONCLUSIONS: Older adults living in neighbourhoods with low physical disorder, high social cohesion and high safety experience lower incidence of IADL and ADL limitations. Memory status modified the estimated effects of neighbourhood characteristics on IADL but not ADL limitations.

}, keywords = {Activities of Daily Living, Aged, Female, Humans, Independent Living, Interviews as Topic, Longitudinal Studies, Male, Memory Disorders, Middle Aged, Mobility Limitation, Residence Characteristics, Risk Factors, United States}, issn = {1470-2738}, doi = {10.1136/jech-2016-207241}, url = {http://jech.bmj.com/content/early/2016/05/06/jech-2016-207241.abstract}, author = {Thu T Nguyen and Rist, Pamela M and M. Maria Glymour} } @article {8498, title = {Comparing Alternative Effect Decomposition Methods: The Role of Literacy in Mediating Educational Effects on Mortality.}, journal = {Epidemiology}, volume = {27}, year = {2016}, month = {2016 09}, pages = {670-6}, abstract = {

BACKGROUND: Inverse odds ratio weighting, a newly proposed tool to evaluate mediation in exposure-disease associations, may be valuable for a host of research questions, but little is known about its performance in real data. We compare this approach to a more conventional Baron and Kenny type of decomposition on an additive hazards scale to estimate total, direct, and indirect effects using the example of the role of literacy in mediating the effects of education on mortality.

METHODS: Health and Retirement Study participants born in the United States between 1900 and 1947 were interviewed biennially for up to 12 years (N = 17,054). Literacy was measured with a brief vocabulary assessment. Decomposition estimates were derived based on Aalen additive hazards models.

RESULTS: A 1 standard deviation difference in educational attainment (3 years) was associated with 6.7 fewer deaths per 1000 person-years (β = -6.7, 95\% confidence interval [CI]: -7.9, -5.4). Of this decrease, 1.3 fewer deaths (β = -1.3, 95\% CI: -4.0, 1.2) were attributed to the literacy pathway (natural indirect), representing 19\% of the total effect. Baron and Kenny estimates were consistent with inverse odds ratio weighting estimates but were less variable (natural indirect effect: -1.2 [95\% CI: -1.7, -0.69], representing 18\% of total effect).

CONCLUSION: In a cohort of older Americans, literacy partially mediated the effect of education on mortality. See Video Abstract at http://links.lww.com/EDE/B78.

}, keywords = {Aged, Aged, 80 and over, Educational Status, Female, Humans, Literacy, Longitudinal Studies, Male, Middle Aged, Mortality, Odds Ratio, Proportional Hazards Models, United States}, issn = {1531-5487}, doi = {10.1097/EDE.0000000000000517}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27280331}, author = {Thu T Nguyen and Eric J. Tchetgen Tchetgen and Ichiro Kawachi and Stephen E. Gilman and Stefan Walter and M. Maria Glymour} } @article {8342, title = {Instrumental variable approaches to identifying the causal effect of educational attainment on dementia risk.}, journal = {Ann Epidemiol}, volume = {26}, year = {2016}, note = {Times Cited: 0 0}, month = {2016 Jan}, pages = {71-6.e1-3}, publisher = {26}, abstract = {

PURPOSE: Education is an established correlate of cognitive status in older adulthood, but whether expanding educational opportunities would improve cognitive functioning remains unclear given limitations of prior studies for causal inference. Therefore, we conducted instrumental variable (IV) analyses of the association between education and dementia risk, using for the first time in this area, genetic variants as instruments as well as state-level school policies.

METHODS: IV analyses in the Health and Retirement Study cohort (1998-2010) used two sets of instruments: (1) a genetic risk score constructed from three single-nucleotide polymorphisms (SNPs; n = 7981); and (2) compulsory schooling laws (CSLs) and state school characteristics (term length, student teacher ratios, and expenditures; n = 10,955).

RESULTS: Using the genetic risk score as an IV, there was a 1.1\% reduction in dementia risk per year of schooling (95\% confidence interval, -2.4 to 0.02). Leveraging compulsory schooling laws and state school characteristics as IVs, there was a substantially larger protective effect (-9.5\%; 95\% confidence interval, -14.8 to -4.2). Analyses evaluating the plausibility of the IV assumptions indicated estimates derived from analyses relying on CSLs provide the best estimates of the causal effect of education.

CONCLUSIONS: IV analyses suggest education is protective against risk of dementia in older adulthood.

}, keywords = {Aged, Aged, 80 and over, Dementia, Education, Nonprofessional, Educational Status, Female, Genetic Predisposition to Disease, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Polymorphism, Single Nucleotide, Protective factors, Risk Factors, Schools, United States}, issn = {1873-2585}, doi = {10.1016/j.annepidem.2015.10.006}, author = {Thu T Nguyen and Eric J. Tchetgen Tchetgen and Ichiro Kawachi and Stephen E. Gilman and Stefan Walter and Sze Y Liu and Jennifer J Manly and M. Maria Glymour} } @article {8378, title = {Modifiable risk factors for nursing home admission among individuals with high and low dementia risk}, journal = {Archives of Gerontology and Geriatrics}, volume = {65}, year = {2016}, pages = {140-145}, publisher = {65}, abstract = {AbstractBackground Strategies to prevent or delay nursing home admission in individuals with cognitive impairment are urgently needed. We hypothesized that physical inactivity, not consuming alcohol (as opposed to moderate alcohol use), and having a history of smoking predict nursing home admission among individuals with normal cognitive function, but these behavioral factors would have attenuated associations with nursing home admission among individuals with impaired cognition. Methods We performed a prospective cohort study among 7631 Health and Retirement Study participants aged 65 at baseline. Baseline dementia risk (high versus low, based on brief psychometric assessments and proxy reports) and modifiable risk factors (physical inactivity, ever smoking, and not consuming alcohol) were used to predict nursing home admission in pooled logistic regression models. We evaluated whether estimated effects of modifiable factors varied by dementia risk, comparing both relative and absolute effects using interaction terms between dementia risk and each modifiable risk factor. Results Low dementia probability was associated with lower nursing home admission risk (RR = 0.49; 95 CI: 0.41, 0.59). Physical inactivity (RR = 1.27; 95 CI: 1.15, 1.41), ever smoking (RR = 1.12; 95 CI: 1.01, 1.25), and not consuming alcohol (RR = 1.28; 95 CI: 1.13, 1.45) predicted increased relative risk of nursing home admission regardless of cognitive status. The relative effects of modifiable risk factors were similar for those with low and high dementia risk. Conclusion Although cognitive impairment associated with incipient dementia strongly predicts nursing home admission, this risk can be partially ameliorated with modifiable risk factors such as physical activity.}, keywords = {Health Conditions and Status, Healthcare, Risk Taking}, doi = {10.1016/j.archger.2016.03.016}, url = {http://www.sciencedirect.com/science/article/pii/S0167494316300565}, author = {Pamela M. Rist and Thu T Nguyen and Rachel A Whitmer and M. Maria Glymour} } @article {8612, title = {Genetic vulnerability to diabetes and obesity: does education offset the risk?}, journal = {Soc Sci Med}, volume = {127}, year = {2015}, month = {2015 Feb}, pages = {150-8}, abstract = {

The prevalence of type 2 diabetes (T2D) and obesity has recently increased dramatically. These common diseases are likely to arise from the interaction of multiple genetic, socio-demographic and environmental risk factors. While previous research has found genetic risk and education to be strong predictors of these diseases, few studies to date have examined their joint effects. This study investigates whether education modifies the association between genetic background and risk for type 2 diabetes (T2D) and obesity. Using data from non-Hispanic Whites in the Health and Retirement Study (HRS, n~=~8398), we tested whether education modifies genetic risk for obesity and T2D, offsetting genetic effects; whether this effect is larger for individuals who have high risk for other (unobserved) reasons, i.e., at higher quantiles of HbA1c and BMI; and whether effects differ by gender. We measured T2D risk using Hemoglobin A1c (HbA1c) level, and obesity risk using body-mass index (BMI). We constructed separate genetic risk scores (GRS) for obesity and diabetes respectively based on the most current available information on the single nucleotide polymorphism (SNPs) confirmed as genome-wide significant predictors for BMI (29 SNPs) and diabetes risk (39 SNPs). Linear regression models with years of schooling indicate that the effect of genetic risk on HbA1c is smaller among people with more years of schooling and larger among those with less than a high school (HS) degree compared to HS degree-holders. Quantile regression models show that the GRS~{\texttimes}~education effect systematically increased along the HbA1c outcome distribution; for example the GRS~{\texttimes}~years of education interaction coefficient was~-0.01 (95\% CI~=~-0.03, 0.00) at the 10th percentile compared to~-0.03 (95\% CI~=~-0.07, 0.00) at the 90th percentile. These results suggest that education may be an important socioeconomic source of heterogeneity in responses to genetic vulnerability to T2D.

}, keywords = {Aged, Body Mass Index, Diabetes Mellitus, Type 2, Educational Status, European Continental Ancestry Group, Female, Genetic Predisposition to Disease, Genotype, Glycated Hemoglobin A, Health Status Disparities, Humans, Male, Middle Aged, Obesity, Risk Factors, Social determinants of health}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2014.09.009}, url = {http://www.sciencedirect.com/science/article/pii/S0277953614005760}, author = {Sze Y Liu and Stefan Walter and Jessica R Marden and David Rehkopf and Laura D Kubzansky and Thu T Nguyen and M. Maria Glymour} }