@article {12037, title = {Effect of cognitive impairment on risk of death in Hispanic/Latino adults over the age of 50 residing in the United States with and without diabetes: Data from the Health and Retirement Study 1995-2014.}, journal = {Alzheimer{\textquoteright}s \& Dementia: The Journal of the Alzheimer{\textquoteright}s Association}, volume = {18}, year = {2022}, pages = {1616-1624}, abstract = {

OBJECTIVE: To understand the relationship between mortality and cognitive function among older US Hispanic adults with and without diabetes.

METHODS: Data from the Health and Retirement Study (1995-2014) were analyzed. Cox proportional hazard models were used to estimate the association between mortality and cognitive function. Models were stratified by diabetes.

RESULTS: Four thousand thirteen older US Hispanic adults were included. Fully adjusted models for individuals with diabetes showed those with mild cognitive impairment (MCI; hazard ratio [HR]: 1.61; 95\% confidence interval [CI]: 1.06, 2.45; P~=~.025) and dementia (HR: 2.14; 95\% CI: 1.25, 3.67; P~=~.006) had increased mortality compared to normal cognition. Fully adjusted models for individuals without diabetes showed those with MCI (HR: 1.87; 95\% CI: 1.28, 2.74; P~=~.001) and dementia (HR: 3.25; 95\% CI: 1.91, 5.55; P~<~.001) had increased mortality compared to normal cognition.

CONCLUSIONS: Cognitive impairment is associated with increased mortality in older US Hispanic adults with and without diabetes. Clinicians should regularly assess cognitive function in this group to quickly identify declines and make appropriate referrals for support to optimize health and reduce mortality.

}, keywords = {cognitive function, cognitive impairment, Hispanics, Mortality}, issn = {1552-5279}, doi = {10.1002/alz.12521}, author = {Martinez, Martin and Aprill Z Dawson and Lu, Kevin and Rebekah J Walker and Leonard E Egede} } @article {12088, title = {Explanatory role of sociodemographic, clinical, behavioral, and social factors on cognitive decline in older adults with diabetes.}, journal = {BMC Geriatrics}, volume = {22}, year = {2022}, pages = {39}, abstract = {

BACKGROUND: The aim of the study was to examine the explanatory role of sociodemographic, clinical, behavioral, and social factors on racial/ethnic differences in cognitive decline among adults with diabetes.

METHODS: Adults aged 50+ years with diabetes from the Health and Retirement Survey were assessed for cognitive function (normal, mild cognitive impairment [MCI], and dementia). Generalized estimating equation (GEE) logistic regression models were used to account for repeating measures over time. Models were adjusted for sociodemographic (gender, age, education, household income and assets), behavioral (smoking), clinical (ie. comorbidities, body mass index), and social (social support, loneliness, social participation, perceived constraints and perceived mastery on personal control) factors.

RESULTS: Unadjusted models showed non-Hispanic Blacks (NHB) and Hispanics were significantly more likely to progress from normal cognition to dementia (NHB OR: 2.99, 95\%CI 2.35-3.81; Hispanic OR: 3.55, 95\%CI 2.77-4.56), and normal cognition to MCI (NHB OR = 2.45, 95\%CI 2.14-2.82; Hispanic OR = 2.49, 95\%CI 2.13-2.90) compared to non-Hispanic Whites (NHW). Unadjusted models for the transition from mild cognitive decline to dementia showed Hispanics were more likely than NHW to progress (OR = 1.43, 95\%CI 1.11-1.84). After adjusting for sociodemographic, clinical/behavioral, and social measures, NHB were 3.75 times more likely (95\%CI 2.52-5.56) than NHW to reach dementia from normal cognition. NHB were 2.87 times more likely (95\%CI 2.37-3.48) than NHW to reach MCI from normal. Hispanics were 1.72 times more likely (95\%CI 1.17-2.52) than NHW to reach dementia from MCI.

CONCLUSION: Clinical/behavioral and social factors did not explain racial/ethnic disparities. Racial/ethnic disparities are less evident from MCI to dementia, emphasizing preventative measures/interventions before cognitive impairment onset are important.

}, keywords = {Cognitive decline, Diabetes, Health Disparities}, issn = {1471-2318}, doi = {10.1186/s12877-021-02740-7}, author = {O{\textquoteright}Toole, Sean M and Rebekah J Walker and Emma Garacci and Aprill Z Dawson and Campbell, Jennifer A and Leonard E Egede} } @article {11614, title = {The relationship between financial hardship and incident diabetic kidney disease in older US adults - a longitudinal study.}, journal = {BMC Nephrology}, volume = {22}, year = {2021}, pages = {167}, abstract = {

BACKGROUND: Financial hardship is associated with poor health, however the association of financial hardship and incident diabetic kidney disease (DKD) is unknown. This study aimed to examine the longitudinal relationship between financial hardship and incident DKD among older adults with diabetes.

METHODS: Analyses were conducted in 2735 adults age 50 or older with diabetes and no DKD using four waves of data (2006-2012) from the Health and Retirement Study, a national longitudinal cohort. The primary outcome was incident DKD. Financial hardship was based on three measures: 1) difficulty paying bills; 2) food insecurity; and 3) cost-related medication non-adherence using validated surveys. A dichotomous financial hardship variable (0 vs 1 or more) was constructed based on all three measures. Cox regression models were used to estimate the association between financial hardship, change in financial hardship experience and incident DKD adjusting for demographics, socioeconomic status, and comorbidities.

RESULTS: During the median follow-up period of 4.1 years, incident DKD rate was higher in individuals with versus without financial hardship (41.2 versus 27/1000 person years). After adjustment, individuals with financial hardship (HR 1.32, 95\% CI 1.04-1.68) had significantly increased likelihood of developing DKD compared to individuals without financial hardship. Persistent financial hardship (adjusted HR 1.52 95\% CI 1.06-2.18) and negative financial hardship (adjusted HR 1.54 95\% CI 1.02-2.33) were associated with incident DKD compared with no financial hardship experience. However, positive financial hardship was not statistically significant in unadjusted and adjusted (adjusted HR 0.89 95\% CI 0.55-1.46) models. Cost-related medication non-adherence (adjusted HR 1.43 95\% CI 1.07-1.93) was associated with incident DKD independent of other financial hardship measures.

CONCLUSIONS: Financial hardship experience is associated with a higher likelihood of incident DKD in older adults with diabetes. Future studies investigating factors that explain the relationship between financial hardship and incident DKD are needed.

}, keywords = {Diabetes, Financial hardship}, issn = {1471-2369}, doi = {10.1186/s12882-021-02373-3}, author = {Corwin, Timothy R and Mukoso N. Ozieh and Emma Garacci and Palatnik, Anna and Leonard E Egede} } @article {Walker2020, title = {Relationship Between Multiple Measures of Financial Hardship and Glycemic Control in Older Adults With Diabetes}, journal = {Journal of Applied Gerontology}, volume = {40}, year = {2021}, pages = {162-169}, type = {Journal}, abstract = {Aim: To examine the relationship between multiple measures of financial hardship and glycemic control in older adults with diabetes. Methods: Using data from Health and Retirement Study (HRS), we investigated four measures of financial hardship: difficulty paying bills, ongoing financial strain, decreasing food intake due to money, and taking less medication due to cost. Using linear regression models, we investigated the relationship between each measure, and a cumulative score of hardships per person, on glycemic control (HbA1c). Results: After adjustment, a significant relationship existed with each increasing number of hardships associated with increasing HbA1c (0.09, [95\%CI 0.04, 0.14]). Difficulty paying bills (0.25, [95\%CI 0.14, 0.35]) and decreased medication usage due to cost (0.17, [95\%CI 0.03, 0.31]) remained significantly associated with HbA1c. Conclusion: In older adults, difficulty paying bills and cost-related medication nonadherence is associated with glycemic control, and every additional financial hardship was associated with an increased HbA1c by nearly 0.1\%. {\textcopyright} The Author(s) 2020.}, keywords = {Chronic illness, Diabetes, socioeconomic status}, issn = {07334648}, doi = {10.1177/0733464820911545}, author = {Walker, R.J. and Emma Garacci and Campbell, J.A. and Harris, M. and Mosley-Johnson, E. and Leonard E Egede} } @article {10889, title = {1407-P: Predictors of Glycemic Control among Older Adults with Type 2 Diabetes Stratified by Living Environment}, journal = {Diabetes}, volume = {69}, year = {2020}, abstract = {About 50\% of adults with diabetes are ages 50 and older. As individuals age, their living situation changes which may impact self-care and glycemic control (GC). We examined predictors of GC among older adults with diabetes stratified by living environment; defined as living independently, living at home with a caregiver, or living in a nursing home. Data on 2370 adults ages 50 and older with diabetes from the Health and Retirement Study (2006 - 2014) was analyzed. Generalized estimating equations were used to assess the association between HbA1c and living environment. GC was the outcome and living environment was the primary independent variable. Covariates were socioeconomic factors, cognitive impairment, functional limitations, health status, lifestyle, and comorbidities. We also identified predictors of GC stratified by living environment. Unadjusted models showed no difference in HbA1c for individuals living with a caregiver compared to those living independently. Living in a nursing home was associated with lower HbA1c (β -0.33; p=0.011), however after adjusting for covariates the relationship was not significant. Predictors of GC among older adults living independently were: age (β -0.018; p<0.001), being female (β -0.20; p=0.007), non-Hispanic Black (β 0.53; p<0.001), Hispanic/Other (β 0.47; p<0.001), no physical activity (β -0.20; p=0.032). Predictors of GC among older adults living at home with a caregiver were: having a GED/high school diploma (β -0.49; p=0.029), not being physically active (β -0.45; p=0.013), and ADLs (β 0.12; p=0.03). Predictors of GC among older adults living in a nursing home were being Hispanic/Other (β 0.94; p=0.048). In this nationally representative sample, type of living environment does not have an effect on GC, however predictors of GC varied across living environment. Interventions need to be tailored to living environment of seniors.}, keywords = {Caregivers, Cognitive Ability, Diabetes, Diabetes mellitus (non-insulin dependent), Hispanics, Medical Sciences{\textendash}Endocrinology, Nursing, Nursing homes, Older people, Physical activity, Socio-economic aspects}, isbn = {00121797}, doi = {10.2337/db20-1407-P}, author = {Aprill Z Dawson and Lu,Kaiwei and Rebekah J Walker and Leonard E Egede} } @article {10890, title = {1493-P: The Impact of Adverse Social Determinants on Health Care Utilization and Expenditures among U.S. Adults with DKD}, journal = {Diabetes}, volume = {69}, year = {2020}, abstract = {Introduction: This study examined whether adverse social determinants of health (SDOH) are associated with higher health care utilization and out of pocket (OOP) expenditures in U.S. adults with diabetic kidney disease (DKD). Methods: Data from 458 adults with self-reported DKD age >=50 from the Health and Retirement Study 2008-2012 was analyzed. Primary outcomes were number of hospital overnight stays (HOS), number of physician visits (PV) and OOP expenditures. Primary independent variables were nine adverse SDOH factors clustered around three SDOH domains: psychosocial (depression, perceived social support and discrimination); financial hardship (difficulty paying bills, food insecurity, medication cost non-adherence); neighborhood (neighborhood social cohesion, social participation and physical disorder). Two variables were created, a continuous 0-9 and a categorical variable of 0, 1-2, 3+. We used negative binomial regression and marginalized two-part models to determine the impact of adverse SDOH on outcomes. Results: In the unadjusted model, compared to adults with no adverse SDOH, adults with 3+ adverse SDOH had 3\% lower likelihood of PV (95\%CI 0.72-1.29), 75\% (95\%CI 1.10-2.79) and 87\% (95\%CI 1.31-2.65) higher likelihood of HOS and OOP expenditures respectively. In the adjusted model, having 3+ adverse SDOH was not significantly associated with PV (Ratio 0.94 95\%CI 0.69-1.29) or HOS (Ratio 1.53 95\%CI 0.93-2.49) but was associated with a 2-fold higher likelihood of OOP expenditures (95\% CI 1.60-3.31). Adverse neighborhood factors were associated with 63\% higher likelihood of HOS (adjusted 95\% CI 1.19-2.24) and financial hardship factors were associated with 85\% higher likelihood of OOP expenditures (adjusted 95\% CI 1.42-2.41). Conclusions: Our findings suggest having 3+ adverse SDOH especially financial hardship impacts OOP expenditures in adults with DKD. Interventions targeting adults with 3+ adverse SDOH may significantly decrease OOP expenditures in DKD.}, keywords = {Diabetes Mellitus, Expenditures, Food security, Health Services Utilization, Kidney diseases, Medical Sciences{\textendash}Endocrinology, Neighborhoods, Regression Analysis, Social interactions, United States{\textendash}US}, isbn = {00121797}, doi = {10.2337/db20-1493-P}, author = {Mukoso N. Ozieh and Emma Garacci and Rebekah J Walker and Leonard E Egede} } @article {Walkerdc191586, title = {The Longitudinal Influence of Social Determinants of Health on Glycemic Control in Elderly Adults With Diabetes}, journal = {Diabetes Care}, year = {2020}, abstract = {OBJECTIVE This study aimed to understand the longitudinal relationship between financial, psychosocial, and neighborhood social determinants and glycemic control (HbA1c) in older adults with diabetes.RESEARCH DESIGN AND METHODS Data from 2,662 individuals with self-reported diabetes who participated in the Health and Retirement Study (HRS) were used. Participants were followed from 2006 through 2014. Financial hardship, psychosocial, and neighborhood-level social determinant factors were based on validated surveys from the biennial core interview and RAND data sets. All social determinant factors and measurements of HbA1c from the time period were used and treated as time varying in analyses. SAS Proc Glimmix was used to fit a series of hierarchical linear mixed models. Models controlled for nonindependence among the repeated observations using a random intercept and treating each individual participant as a random factor. Survey methods were used to apply HRS weighting.RESULTS Before adjustment for demographics, difficulty paying bills (0.18 [95\% CI 0.02, 0.24]) and medication cost nonadherence (0.15 [0.01, 0.29]) were independently associated with increasing HbA1c over time, and social cohesion (-0.05 [-0.10, -0.001]) was independently associated with decreasing HbA1c over time. After adjusting for both demographics and comorbidity count, difficulty paying bills (0.13 [0.03, 0.24]) and religiosity (0.04 [0.001, 0.08]) were independently associated with increasing HbA1c over time.CONCLUSIONS Using a longitudinal cohort of older adults with diabetes, this study found that financial hardship factors, such as difficulty paying bills, were more consistently associated with worsening glycemic control over time than psychosocial and neighborhood factors.}, keywords = {Diabetes}, issn = {0149-5992}, doi = {10.2337/dc19-1586}, url = {https://care.diabetesjournals.org/content/early/2020/02/06/dc19-1586}, author = {Rebekah J Walker and Emma Garacci and Palatnik, Anna and Mukoso N. Ozieh and Leonard E Egede} }