@conference {11822, title = {Associations of Long-term Air Pollution Exposure and Incident Late-Life Disability in Older U.S. Adults: The Health Retirement Study}, booktitle = {ISEE Conference Abstracts}, volume = {2021}, year = {2021}, abstract = {Late-life disability is of critical concern to older adults and can reflect the cumulative burden of chronic disease over the lifespan. Although air pollution has been associated with many common chronic conditions, associations with disability are understudied. We aimed to quantify associations between long-term exposures to air pollution and late-life disability. METHODS: We used biennial data between 2000 and 2016 on self-reported Activities of Daily Living (ADL) from participants 65 years from the nationally representative Health and Retirement Study. Using a spatiotemporal prediction model, we estimated 10-year PM2.5, PM10-2.5, NO2, and O3 concentrations at participant residences. We then estimated the risk of incident ADL disability as a function of time-varying air pollution, adjusting for individual and area-level confounders and sampling weights in a Cox model. We fitted single- and two-pollutant models. RESULTS:Our study population of 16,927 adults (70+6.4 years) was predominantly non-Hispanic White (76\%), Non-Hispanic Black (14\%), and Hispanic White (8\%) and 32\% reported a new disability during follow-up. Overall, we found some evidence that air pollution was associated with an increased risk of ADL disability. After adjustment for place and PM2.5, we found that interquartile increases in PM10-2.5 and NO2 were associated with 8\% (HR: 1.08 per 5 {\textmu}g/m3, 95\% CI: 1.01, 1.17) and 9\% (HR: 1.09 per 6 ppb, 95\% CI: 1.00, 1.19) greater hazards of ADL, respectively, with similar findings in the single pollutant models. PM2.5 and O3 were not associated with higher hazards of ADL in single or multipollutant models after detailed adjustment for place. CONCLUSIONS:This prospective study in a nationally representative sample of older adults found some evidence that higher levels of some but not all long-term air pollutants assessed are associated with increased risk of late-life disability.}, keywords = {Activities of Daily Living, Air Pollution, Long-Term Exposure}, url = {https://ehp.niehs.nih.gov/action/doSearch?AllField=Associations+of+Long-term+Air+Pollution+Exposure+and+Incident+Late-Life+Disability+in+Older+U.S.+Adults\%3A+The+Health+Retirement+Study}, author = {Gao, Jiaqi and Carlos F. Mendes de Leon and D{\textquoteright}Souza, Jennifer and Zhang, Boya and Szpiro, Adam and Young, Michael and Weuve, Jennifer and Kenneth M. Langa and Jessica Faul and Kaufman, Joel and Richard A Hirth and Sara Dubowsky Adar} } @article {11116, title = {Grandparenthood and risk of mortality: Findings from the Health and Retirement Study.}, journal = {Social Science \& Medicine}, volume = {268}, year = {2021}, pages = {113371}, abstract = {

Grandparenthood constitutes a significant role for older adults and may have important health implications. Our study examines the grandparenthood-mortality nexus, controlling for an array of potentially confounding variables. Longitudinal survey data from the Health and Retirement Study (HRS) were used, comprising twelve biennial waves from 1992 to 2014 with linked data on vital status derived from the National Death Index. The sample included 27,463 participants aged >=51 years with at least one child. Cox proportional hazard models tested the association between grandparenthood and mortality risk with adjustment for socio-demographic variables, for social variables including characteristics of and contact with children, and for health variables, including measures of general, functional and mental health. Grandparenthood overall was unassociated with mortality risk in both women and men. However, the subpopulation of younger, partnered grandmothers with a larger number of grandchildren tended to exhibit a substantial increase in mortality risk as compared to women without grandchildren.

}, keywords = {Aging, Longitudinal research, Social Relationships, Survival, Well-being}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2020.113371}, author = {Ellwardt, Lea and Hank, Karsten and Carlos F. Mendes de Leon} } @conference {11821, title = {Long-Term Air Pollution Exposures and Major Depression in Older U.S. Adults: The Health and Retirement Study}, booktitle = {ISEE Conference Abstracts}, volume = {2021}, year = {2021}, abstract = {Major depression is a leading cause of morbidity worldwide, especially during later life. Since heritability is modest (40-50\%), there is interest in understanding risk from environmental factors like air pollution. However, research examining this issue is scarce, and often does not use clinical diagnostic criteria. Here, we aimed to quantify associations of air pollution with prevalent major depression in a cohort that deploys diagnostic assessments. METHODS: We conducted a repeated measure analysis of 2008-2016 interviews from the Health and Retirement Study, a nationally representative cohort of older adults in the United States. Major depression status was determined biennially using the Composite International Diagnostic Interview Short Form, with a cutoff of 5. We estimated 1-year average PM2.5, PM10-2.5, NO2, and O3 concentrations at participant residences using fine-scale spatiotemporal models. To estimate prevalence ratios, we fit generalized linear models that accounted for sample weights and clustering by participant. All models included demographic characteristics, individual and neighborhood socioeconomic status, calendar time, and geographic area. RESULTS:Among 25,305 participants with complete data, there was a mean age of 63 years, 53\% were female, and most were Non-Hispanic White (73\%), with some Black (11\%) and Hispanic participants. Eight percent reported major depression. In fully adjusted models, we observed that higher PM2.5 and NO2 concentrations were associated with a greater prevalence of major depression (PR: 1.13 per 3 {\textmu}g/m{\textthreesuperior} PM2.5, 95\% CI: 1.03, 1.23; PR: 1.23 per 5 ppb NO2, 95\% CI: 1.06, 1.20). Only the association with NO2 was robust to adjustment for other pollutants, however, and no associations were observed with PM10-2.5 or O3. CONCLUSIONS:Overall, we observed a robust association of major depression prevalence with long-term exposure to NO2 but not with other air pollutants. This suggests that traffic may be a modifiable risk factor that could be targeted to reduce socioeconomic disparities in mental health. }, keywords = {Health Disparities, Major depression, Psychiatric epidemiology, Traffic-Related Air Pollution}, url = {https://ehp.niehs.nih.gov/doi/abs/10.1289/isee.2021.O-LT-071}, author = {Rachel S. Bergmans and D{\textquoteright} Souza, Jennifer and Fossa, Alan and Szpiro, Adam and Young, Michael T and Carlos F. Mendes de Leon and Kaufman, Joel and Richard A Hirth and Sara Dubowsky Adar} } @article {vanZon2020705, title = {Multimorbidity and the Transition Out of Full-Time Paid Employment: A Longitudinal Analysis of the Health and Retirement Study}, journal = {The Journals of Gerontology: Series B}, volume = {75}, year = {2020}, pages = {705-715}, abstract = {OBJECTIVES: This study aims to examine whether older workers aged 50-64 years with multimorbidity are at increased risk to transition from full-time paid employment to part-time employment, partial retirement, unemployment, disability, economic inactivity, full retirement or die than workers without a chronic health condition and workers with one chronic health condition, and whether socioeconomic position (SEP) modifies these transitions. METHOD: Using data from the Health and Retirement Study (1992-2014; n = 10,719), sub-distribution hazard ratios with 95\% confidence intervals were calculated with a time-varying Fine and Gray competing-risks survival regression model to examine exit from full-time paid employment. We investigated the modifying effect of SEP by examining its interaction with multimorbidity. RESULTS: Workers with multimorbidity had a higher risk of transitioning to partial retirement (1.45; 1.22, 1.72), disability (1.84; 1.21, 2.78) and full retirement (1.63; 1.47, 1.81), and they had a higher mortality risk (2.58; 1.71, 3.88) than workers without chronic disorders. Compared to workers with one chronic health condition, workers with multimorbidity had an increased risk for partial (1.19; 1.02, 1.40) and full retirement (1.29; 1.17, 1.42), and mortality (1.49; 1.09, 2.04). Only SEP measured as educational level modified the relationship between multimorbidity and mortality. DISCUSSION: Workers with multimorbidity seem more prone to leave full-time paid employment than workers without or with one a chronic health condition. Personalized work accommodations may be necessary to help workers with multimorbidity prolong their working life. {\textcopyright} The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America.}, keywords = {chronic health, condition labor market participation, socioeconomic position, Transition}, doi = {10.1093/geronb/gbz061}, author = {Sander K. R. van Zon and Reijneveld, S.A. and Galaurchi, A. and Carlos F. Mendes de Leon and Josue Almansa and B{\"u}ltmann, U.} } @article {9562, title = {Association of a Negative Wealth Shock With All-Cause Mortality in Middle-aged and Older Adults in the United States.}, journal = {JAMA}, volume = {319}, year = {2018}, pages = {1341-1350}, abstract = {

Importance: A sudden loss of wealth-a negative wealth shock-may lead to a significant mental health toll and also leave fewer monetary resources for health-related expenses. With limited years remaining to regain lost wealth in older age, the health consequences of these negative wealth shocks may be long-lasting.

Objective: To determine whether a negative wealth shock was associated with all-cause mortality during 20 years of follow-up.

Design, Setting, and Participants: The Health and Retirement Study, a nationally representative prospective cohort study of US adults aged 51 through 61 years at study entry. The study population included 8714 adults, first assessed for a negative wealth shock in 1994 and followed biennially through 2014 (the most recent year of available data).

Exposures: Experiencing a negative wealth shock, defined as a loss of 75\% or more of total net worth over a 2-year period, or asset poverty, defined as 0 or negative total net worth at study entry.

Main Outcomes and Measures: Mortality data were collected from the National Death Index and postmortem interviews with family members. Marginal structural survival methods were used to account for the potential bias due to changes in health status that may both trigger negative wealth shocks and act as the mechanism through which negative wealth shocks lead to increased mortality.

Results: There were 8714 participants in the study sample (mean [SD] age at study entry, 55 [3.2] years; 53\% women), 2430 experienced a negative wealth shock during follow-up, 749 had asset poverty at baseline, and 5535 had continuously positive wealth without shock. A total of 2823 deaths occurred during 80 683 person-years of follow-up. There were 30.6 vs 64.9 deaths per 1000 person-years for those with continuously positive wealth vs negative wealth shock (adjusted hazard ratio [HR], 1.50; 95\% CI, 1.36-1.67). There were 73.4 deaths per 1000 person-years for those with asset poverty at baseline (adjusted HR, 1.67; 95\% CI, 1.44-1.94; compared with continuously positive wealth).

Conclusions and Relevance: Among US adults aged 51 years and older, loss of wealth over 2 years was associated with an increased risk of all-cause mortality. Further research is needed to better understand the possible mechanisms for this association and determine whether there is potential value for targeted interventions.

}, keywords = {Mortality, NDI, Wealth Shocks}, issn = {1538-3598}, doi = {10.1001/jama.2018.2055}, author = {Lindsay R Pool and Sarah A. Burgard and Belinda L Needham and Michael R. Elliott and Kenneth M. Langa and Carlos F. Mendes de Leon} } @article {9144, title = {The influence of psychosocial and cognitive factors on perceived threat of Alzheimer{\textquoteright}s Disease}, journal = {American Journal of Alzheimer{\textquoteright}s Disease \& Other Dementias}, volume = {32}, year = {2017}, pages = {289-299}, abstract = {This study explored psychosocial and cognitive predictors of perceived threat of Alzheimer{\textquoteright}s disease (AD). Respondents were 1641 adults (mean age: 64.4; 54\% female; 82\% white) who completed a module in the Health and Retirement Study, a nationally representative survey of adults aged >=50. Findings show that perceived threat was significantly higher for those aged 50 to 64 (P < .001) and 65 to 74 (P < .05) than for those >=75. Respondents with a family history of AD had significantly greater perceived threat (P < .001) than those with no experience. Stronger endorsement of the beliefs that stress (P < .01) or genetics (P < .01) are important AD risk factors was significantly associated with greater perceived threat, as was having more depressive symptoms (P < .01), poorer self-rated memory (P < .01), and lower cognitive function (P < .01). Personal experience moderated the relationship between perceived threat and 2 variables: age and self-rated memory. Understanding perceived AD threat may inform practice and policies centered on early and accurate diagnosis.}, keywords = {Alzheimer{\textquoteright}s disease, Perception, Psychosocial}, issn = {1533-3175}, doi = {10.1177/1533317517714552}, url = {http://journals.sagepub.com/doi/10.1177/1533317517714552}, author = {Jenny E Ostergren and Steven G Heeringa and Carlos F. Mendes de Leon and Cathleen M. Connell and J Scott Roberts} } @article {9040, title = {Negative wealth shock and short-term changes in depressive symptoms and medication adherence among late middle-aged adults.}, journal = {Journal of Epidemiology and Community Health}, volume = {71}, year = {2017}, pages = {758-763}, abstract = {

BACKGROUND: Experiencing a negative wealth shock in late middle age may cause high levels of stress and induce reductions in health-related consumption.

METHODS: We used data on late middle age individuals (51-64 years) from the longitudinal US-based Health and Retirement Study (N=19 281) to examine the relationship between negative wealth shock and short-term outcomes that serve as markers of the pathways from wealth shock to health: elevated depressive symptoms, as a marker of the stress pathway and cost-related medication non-adherence (CRN), as a marker of the consumption pathway. Negative wealth shock was considered to be a loss of total net worth of 75\% or more.

RESULTS: Using a nested cross-over approach-a within-person design among exposed individuals only that adjusts by design for all time-invariant individual characteristics-we found that negative wealth shock was significantly associated with increased odds of elevated depressive symptoms (OR=1.50, CI 1.10 to 2.05), but was not significantly associated with higher odds of CRN (OR=1.18, CI 0.76 to 1.82), even after further adjustment for time-varying sociodemographic and health covariates.

CONCLUSIONS: Negative wealth shock during late middle age confers an increased risk of elevated depressive symptoms, but does not change levels of CRN. Personal and policy factors that may buffer the mental health risks of negative wealth shock, such as social support and social welfare policy, should be considered.

}, keywords = {Depressive symptoms, Middle age, Prescription Medication, Wealth Shocks}, issn = {1470-2738}, doi = {10.1136/jech-2016-208347}, author = {Lindsay R Pool and Belinda L Needham and Sarah A. Burgard and Michael R. Elliott and Carlos F. Mendes de Leon} } @article {8702, title = {Functional health decline before and after retirement: A longitudinal analysis of the Health and Retirement Study.}, journal = {Soc Sci Med}, volume = {170}, year = {2016}, month = {2016 12}, pages = {26-34}, chapter = {26-34}, abstract = {

OBJECTIVES: The aims of this study are to examine the pattern of pre- and post-retirement changes in functional health and to examine the degree to which socioeconomic position (SEP) modifies pre- and post-retirement changes in functional health.

METHOD: This longitudinal study was conducted using data from the Health and Retirement Study from 1992 to 2012. Piecewise linear regression analyses with generalised estimating equations were used to calculate trajectories of limitations in mobility and large muscle functions before and after retirement spanning a time period of 16 years. Interaction terms of three indicators of SEP with time before and after retirement were examined to investigate the modifying effect of SEP on changes in functional health before and after retirement.

RESULTS: Average levels of limitations in mobility and large muscle functions increased significantly in the years prior to retirement. This increase slowed down after retirement, most prominently for limitations in large muscle functions. Higher SEP was associated with a slower increase of functional limitations prior to retirement. After retirement, a less clear pattern was found as only wealth modified the increase of limitations in mobility functions.

DISCUSSION: Prevention of functional decline in older working adults may be essential in achieving longer and healthier working lives. Such strategies may have to give special consideration to lower SEP adults, as they tend to experience functional health declines prior to retirement at a greater rate than higher SEP adults.

}, keywords = {Aged, Aging, Female, Health Status, Humans, Longitudinal Studies, Male, Middle Aged, Regression Analysis, Retirement, Social Class, United States}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2016.10.002}, url = {http://www.sciencedirect.com/science/article/pii/S0277953616305615}, author = {Sander K. R. van Zon and B{\"u}ltmann, Ute and Reijneveld, Sijmen A and Carlos F. Mendes de Leon} }