@article {13742, title = {Does the revised LDCT lung cancer screening guideline bridge the racial disparities gap: Results from the health and retirement study.}, journal = {Journal of the National Medical Association}, year = {Forthcoming}, abstract = {

PURPOSE: This study examined racial/ethnic disparities in lung cancer screening eligibility rates using 2013 US Preventive Services Task Force (USPSTF) guidelines for lung cancer with low-dose computed tomography (LDCT) and the revised 2021 guidelines.

METHODS: The study utilized a retrospective and cross-sectional research design by analyzing data from the Health and Retirement Study (HRS). N = 2,823 respondents aged 50-80 who self-reported current smoking were included in the analyses. Binary logistic regression analysis was conducted to examine the changed status of LDCT screening eligibility based on the revised 2021 guidelines by race/ethnicity after adjusting for respondent demographics.

RESULTS: Our study found substantial increases in screening eligibility rates across racial and ethnic groups when comparing the original and revised guidelines. The largest increase was observed among Black people (174\%), Hispanics (152\%), those in the other category (118\%), and Whites who smoke (80.8\%). When comparing original screening guidelines to revised guidelines, Whites who smoke had the highest percentage of changes from "not eligible" to "eligible" (28.3\%), followed by individuals in the "other" category (28.1\%), Black people (23.2\%) and Hispanics who smoke (18.3\%) (p < 0.001). Binary logistic regression results further showed that Black people who smoke (OR = 0.71, p = 0.001), as well as Hispanics who smoke (OR=0.54, p < 0.001), were less likely to change from not eligible to eligible for screening compared to Whites who smoke after adopting the revised screening guidelines. Based on the absolute differences in screening eligibility rates between Whites and other racial/ethnic groups, the disparities may have widened under the new guidelines, particularly with larger absolute differences observed between Whites, Black people, and Hispanics.

CONCLUSIONS: Our study highlights racial/ethnic disparities in LDCT screening eligibility among people who currently smoke. While the revised USPSTF guidelines increased screening eligibility for racial and ethnic minorities, they did not eliminate these disparities and may have widened under the new guidelines. Targeted interventions and policies are necessary to address barriers faced by underrepresented populations and promote equitable access to lung cancer screening.

}, keywords = {Disparities, Lung cancer screening, Race/ethnicity, Uscreening guidelines}, issn = {1943-4693}, doi = {10.1016/j.jnma.2024.01.008}, author = {Li, Chien-Ching and Manella, Jason and Kefi, Safa El and Matthews, Alicia K} } @article {13492, title = {Disparities Growing Between Low- and High-Income Retirement Accounts: GAO}, year = {2023}, publisher = {American Society of Pension Professionals \& Actuaries }, keywords = {Disparities, Income, retirement account}, url = {https://www.asppa-net.org/news/disparities-growing-between-low-and-high-income-retirement-accounts-gao}, author = {Godbout, Ted} } @article {13418, title = {Disparities in advance care planning among older US immigrants.}, journal = {J Am Geriatr Soc}, year = {2023}, abstract = {

BACKGROUND: Despite known racial disparities in advance care planning (ACP), little is known about ACP disparities experienced by US immigrants.

METHODS: We used data from the 2016 wave of the Health and Retirement Study. We defined ACP engagement as self-reported end-of-life (EOL) discussions, designation of a power of attorney (DPOA), documented living will, or "any" of the three behaviors. Immigration status was determined by respondent-reported birth outside the United States. Time in the United States was calculated by subtracting the year of arrival in the United States from the survey year of 2016. We used multivariable logistic regression to estimate the association between ACP engagement and immigration status and the relationship of acculturation to ACP engagement, adjusting for sociodemographics, religiosity, and life expectancy.

RESULTS: Of the total cohort (N = 9928), 10\% were immigrants; 45\% of immigrants identified as Hispanic. After adjustment, immigrants had significantly lower adjusted probability of any ACP engagement (immigrants: 74\% vs. US-born: 83\%, p < 0.001), EOL discussions (67\% vs. 77\%, p < 0.001), DPOA designation (50\% vs. 59\%, p = 0.001) and living will documentation (50\% vs. 56\%, p = 0.03). Among immigrants, each year in the United States was associated with a 4\% increase in the odds of any ACP engagement (aOR 1.04, 95\% CI 1.03-1.06), ranging from 36\% engaged 10 years after immigration to 78\% after 70 years.

CONCLUSION: ACP engagement was lower for US immigrants compared to US-born older adults, particularly for those that recently immigrated. Future studies should explore strategies to reduce disparities in ACP and the unique ACP needs among different immigrant populations.

}, keywords = {care planning, Disparities, Immigrants, United States}, issn = {1532-5415}, doi = {10.1111/jgs.18498}, author = {Mindo-Panusis, Dallas and Sudore, Rebecca L and Cenzer, Irena and Smith, Alexander K and Kotwal, Ashwin A} } @article {13674, title = {Disparities in LTSS Needs and Supportive Resources at Age 55, and Outcome Disparities During the Next Decade}, year = {2023}, institution = {ATI Advisory}, abstract = {Our research highlights disparities and differences in the prevalence of long-term services and supports (LTSS) needs and related resources among U.S. adults aged 55 and living in the community. We examine private finances, insurance coverage, and social supports, as well as long-term health, LTSS and financial outcomes over the next decade. Disparities and differences occurred along racial and ethnic, gender, and geographic lines. This report analyzes data from the University of Michigan Health and Retirement Study (HRS).}, keywords = {Disparities, Long-term services and supports}, url = {https://atiadvisory.com/resources/disparities-in-ltss-needs-and-supportive-resources-at-age-55-and-outcome-disparities-during-the-next-decade/}, author = {ATI Advisory} } @article {12486, title = {Gender Disparities in Healthy Aging: A Cross-National Comparative Study in the United States and South Korea from 2006 to 2016.}, journal = {The International Journal of Aging and Human Development}, year = {2023}, abstract = {

Using the 2006-2016 wave of Health and Retirement Study and Korean Longitudinal Study of Aging, this study explores the gender disparities in the health of older adults in the United States and South Korea. A logit model is adopted to explore the differences in the likelihood of aging healthily by gender in two countries. Results indicate that older females in the United States have a significantly higher probability of healthy aging than their male counterparts. However, the opposite finding is demonstrated among the older population in South Korea. These results are verified using various robustness check methods. The heterogeneities in the gender disparities in healthy aging across age groups and income levels are further explored. The gender effect in each healthy aging domain is investigated to understand the underlying causes of gender disparities. These findings can provide cross-national insights for policymakers to establish targeted aging policies with a gender perspective.

}, keywords = {cross-national studies, Disparities, gender, health, KLoSA, Policy}, issn = {1541-3535}, doi = {10.1177/00914150221106643}, author = {Chu, Lanlan and Lor, Anjelynt and Moisan, Mary-Genevieve and Phi, Kieu My} } @article {12641, title = {Psychiatric history and later-life cognitive change: effect modification by sex, race and ethnicity.}, journal = {Aging \& Mental Health}, year = {2023}, abstract = {

We explored associations between psychiatric history and cognitive functioning, and differences by sex and race/ethnicity (SRE) in 20,155 Health and Retirement Study (1995-2014) participants aged 65 or older. Multi-level growth curve models examined cognition scores and their trajectories over time by SRE. A history of psychiatric, emotional, or nervous problems was significantly related to cognition scores and rates of decline. Hispanic and Black participants had significantly lower cognition scores at age 75 and steeper rates of decline than White females, and Black race and the Hispanic race/ethnicity-sex interaction erased the protective effects of being female. Future research should include specific psychiatric diagnoses. Population level findings as reported here, along with aggregate findings from similar studies, can inform interventions and policies regarding support for populations that are vulnerable to mental illness and to subsequent cognitive decline.

}, keywords = {Cognitive decline, Disparities, Mental Health, social determinants, Trajectories}, issn = {1364-6915}, doi = {10.1080/13607863.2022.2116398}, author = {Brown, Maria T and Mutambudzi, Miriam} } @article {13204, title = {Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans.}, journal = {SSM Popul Health}, volume = {22}, year = {2023}, pages = {101375}, abstract = {

INTRODUCTION: Multimorbidity, the presence of multiple chronic health conditions, generally starts in middle and older age but there is considerable heterogeneity in the trajectory of morbidity accumulation. This study aimed to clarify the number of distinct trajectories and the potential associations between race/ethnicity and socioeconomic status and these trajectories.

METHODS: Data from 13,699 respondents (age >=51) in the Health and Retirement Study between 1998 and 2016 were analyzed with growth mixture models. Nine prevalent self-reported morbidities (arthritis, cancer, cognitive impairment, depressive symptoms, diabetes, heart disease, hypertension, lung disease, stroke) were summed for the morbidity count.

RESULTS: Three trajectories of morbidity accumulation were identified: low [starting with few morbidities and accumulating them slowly (i.e., low intercept and low slope); 80\% of sample], increasing (i.e., low intercept and high slope; 9\%), and high (i.e., high intercept and low slope; 11\%). Compared to non-Hispanic (NH) White adults in covariate-adjusted models, NH Black adults had disadvantages while Hispanic adults had advantages. Our results suggest a protective effect of education for NH Black adults (i.e., racial health disparities observed at low education were ameliorated and then eliminated at increasing levels of education) and a reverse pattern for Hispanic adults (i.e., increasing levels of education was found to dampen the advantages Hispanic adults had at low education). Compared with NH White adults, higher levels of wealth were protective for both NH Black adults (i.e., reducing or reversing racial health disparities observed at low wealth) and Hispanic adults (i.e., increasing the initial health advantages observed at low wealth).

CONCLUSION: These findings have implications for addressing health disparities through more precise targeting of public health interventions. This work highlights the imperative to address socioeconomic inequalities that interact with race/ethnicity in complex ways to erode health.

}, keywords = {Disparities, ethnic, Older Americans, racial, socioeconomic}, issn = {2352-8273}, doi = {10.1016/j.ssmph.2023.101375}, author = {O{\textquoteright}Neill, AnnaMarie S and Newsom, Jason T and Trubits, Em F and Elman, Miriam R and Botoseneanu, Anda and Allore, Heather G and Nagel, Corey L and Dorr, David A and Qui{\~n}ones, Ana R} } @article {13108, title = {Social Determinants of Health Contribute to Racial and Ethnic Disparities in Depression, Cognition}, year = {2023}, publisher = {Psychiatry Advisor}, keywords = {Cognition, depression, Disparities, health, Race/ethnicity, social determinants}, url = {https://www.psychiatryadvisor.com/home/topics/general-psychiatry/sdoh-contribute-racial-ethnic-disparities-depression-cognition/}, author = {Nye, Jessica} } @article {12506, title = {Subjective Memory Decline Predicts Incident Cognitive Impairment among White-but Not Black or Hispanic-Older Adults.}, journal = {The Gerontologist}, year = {2023}, abstract = {

BACKGROUND AND OBJECTIVES: This study investigates whether subjective memory decline in a racially diverse sample of older adults without cognitive impairment at baseline is associated with incident cognitive impairment during a 12-year follow-up period.

RESEARCH DESIGN AND METHODS: With panel data from a national sample (N=9,244) of cognitively-intact Black, White, and Hispanic Americans 65 years or older in 2004, we examine if subjective memory decline is associated with the loss of normal cognition by 2016. Cognitive status was assessed every two years with a modified version of the Telephone Interview for Cognitive Status to identify the transition from normal cognition to cognitive impairment.

RESULTS: Estimates from Weibull accelerated failure-time models reveal that subjective memory decline is associated with earlier incident cognitive impairment (time ratio = 0.96, p<.05). In subsequent models stratified by race-ethnicity, this association was evident among White respondents (time ratio = 0.95, p<.01) but not among Black, US-born Hispanic, or foreign-born Hispanic respondents.

DISCUSSION AND IMPLICATIONS: Given that the prognostic validity of subjective memory decline differs by race and ethnicity, caution is warranted when using it as a screening or clinical tool in diverse populations.

}, keywords = {cognitive function, Disparities, Racial-ethnic differences, Self-reported memory}, issn = {1758-5341}, doi = {10.1093/geront/gnac086}, author = {Ferraro, Kenneth F and Sauerteig-Rolston, Madison R and Barnes, Lisa L and Friedman, Elliot and Sands, Laura P and Thomas, Patricia A} } @article {13352, title = {The value of Medicare coverage on depressive symptoms among older immigrants.}, journal = {Gerontologist}, year = {2023}, abstract = {

BACKGROUND AND OBJECTIVES: The immigrant population, the primary driver of U.S. population growth, is aging and many immigrants remain uninsured. Lack of health insurance limits access to care, aggravating the already high level of depression for older immigrants. However, there is scarce evidence on how health insurance, particularly Medicare, affects their mental health. Using the Health and Retirement Study, this study examines the effect of Medicare coverage on depressive symptoms of older immigrants in the U.S.

RESEARCH DESIGN AND METHODS: Exploiting the fact that many immigrants are not covered by Medicare after passing age 65, we use a difference-in-difference model with propensity score weighting to compare differences in depressive symptoms pre- and post-age-65. We further stratify the sample by socioeconomic status and by race/ethnicity.

RESULTS: Medicare coverage was significantly associated with a reduction in the probability of reporting depressive symptoms for immigrants with low socioeconomic status, especially for those below median wealth levels. The beneficial effect of Medicare coverage was also statistically significant for non-White immigrants - Black, Hispanic, and Asian/Pacific Islander - even when holding socioeconomic status constant.

DISCUSSION AND IMPLICATIONS: Our findings imply that immigration policies that expand healthcare protection to older immigrants can lead to further health benefits and reduce existing disparities for the aging population. Policy reforms such as providing limited Medicare access to immigrants who paid sufficient taxes but are still awaiting permanent residency status could increase coverage for the uninsured and improve participation of immigrants in the payroll system.

}, keywords = {depression, Disparities, Health Insurance}, issn = {1758-5341}, doi = {10.1093/geront/gnad070}, author = {Jun, Hankyung and Mattke, Soeren and Chen, Alice and Aguila, Emma} } @article {13673, title = {When Disparities and Differences in Resources Abound, Medicaid Acts as Stopgap}, year = {2023}, publisher = {Skilled Nursing News}, keywords = {Disparities, Medicaid}, url = {https://skillednursingnews.com/2023/12/when-disparities-and-differences-in-resources-abound-medicaid-acts-as-stopgap/}, author = {Stulick, Amy} } @article {12808, title = {Dementia Rate Declining Among Older Americans: Study}, year = {2022}, publisher = {U.S. News \& World Report}, keywords = {Dementia, Disparities, rate}, url = {https://www.usnews.com/news/health-news/articles/2022-11-08/dementia-rate-declining-among-older-americans-study}, author = {Murez, Cara} } @article {12262, title = {Experiences of care coordination among older adults in the United States: Evidence from the Health and Retirement Study.}, journal = {Patient Education and Counseling}, volume = {105}, year = {2022}, pages = {2429-2435}, abstract = {

INTRODUCTION: The goal of this study was to examine variation in patient experiences and perceptions of care coordination across sociodemographic and health factors.

METHODS: Data come from the 2016 Health and Retirement Study (N~=~1, 216). Three domains of coordination were assessed: 1) Perceptions (e.g., patient impressions of provider-provider communication), 2) Tangible supports (e.g., meeting with a care coordinator, being accompanied to appointments), and 3) Technical supports (e.g., use of a "patient portal"). Logistic regression was used to quantify the frequency of each domain and examine variation by racial minority status, socioeconomic status, and health status.

RESULTS: Approximately 42\% of older adults perceived poor care coordination, including 14.8\% who reported receiving seemingly conflicting advice from different providers. Only one-third had ever met with a formal care coordinator, and 40\% were occasionally accompanied to appointments. Although racial minorities were less likely to have access to technical supports, they were more likely to use them. Better perceived coordination was associated with higher care satisfaction (Odds Ratio: 1.43, 95\% CI: 1.27-1.61).

CONCLUSIONS: Important gaps in care coordination remain for older adults.

PRACTICE IMPLICATIONS: Providers should consider assessing patient perceptions of care coordination to address these gaps in an equitable manner.

}, keywords = {Care coordination, Care management, Disparities, Patient-Centered Care}, issn = {1873-5134}, doi = {10.1016/j.pec.2022.03.015}, author = {Eastman, Marisa R and Viktoryia A Kalesnikava and Briana Mezuk} } @article {11931, title = {Observational study of patient characteristics associated with a timely diagnosis of dementia and mild cognitive impairment without dementia.}, journal = {Journal of General Internal Medicine}, volume = {37}, year = {2022}, pages = {2957-2965}, abstract = {

BACKGROUND: Timely diagnosis of cognitive impairment is a key goal of the National Plan to Address Alzheimer{\textquoteright}s Disease, but studies of factors associated with a timely diagnosis are limited.

OBJECTIVE: To identify patient characteristics associated with a timely diagnosis of dementia and mild cognitive impairment (MCI).

DESIGN: Retrospective observational study using survey data from the Health and Retirement Study (HRS) from 1995-2016 (interview waves 3-13).

PARTICIPANTS: 4,760 respondents with incident dementia and 1,864 with incident MCI identified using longitudinal measures of cognitive functioning.

MAIN MEASURES: Timely or delayed diagnosis based on the timing of a self or proxy report of a healthcare provider diagnosis in relation to respondents first dementia or MCI-qualifying cognitive score, sociodemographic characteristics, health status, health care utilization, insurance provider, and year of first qualifying score.

KEY RESULTS: Only 26.0\% of the 4,760 respondents with incident dementia and 11.4\% of the 1,864 respondents with incident MCI received a timely diagnosis. Non-Hispanic Black respondents and respondents with less than a college degree were significantly less likely to receive a timely diagnosis of either dementia or MCI than Non-Hispanic White respondents (dementia odds ratio (OR): 0.61, 95\% CI: 0.50, 0.75; MCI OR: 0.40, 95\% CI: 0.23, 0.70) and those with a college degree (dementia OR for less than high school degree: 0.30, 95\% CI: 0.23, 0.38; MCI OR: 0.36, 95\% CI: 0.22, 0.60). Respondents that lived alone were also less likely to receive a timely diagnosis of dementia (OR: 0.69, 95\% CI: 0.59, 0.81), though not MCI. Timely diagnosis of both conditions increased over time.

CONCLUSIONS: Targeting resources for timely diagnosis of cognitive impairment to individuals from racial and ethnic minorities, lower educational attainment, and living alone may improve detection and reduce disparities around timely diagnosis of dementia and MCI.

}, keywords = {cognitive impairment, Dementia, Diagnosis, Disparities}, issn = {1525-1497}, doi = {https://doi.org/10.1007/s11606-021-07169-7}, author = {White, Lindsay and Ingraham, Bailey and Eric B Larson and Fishman, Paul and Park, Sungchul and Norma B Coe} } @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 {12751, title = {Time to dementia diagnosis by race: a retrospective cohort study.}, journal = {Journal of the American Geriatrics Society}, year = {2022}, abstract = {

BACKGROUND: Non-Hispanic Black individuals may be less likely to receive a diagnosis of dementia compared to non-Hispanic White individuals. These findings raise important questions regarding which factors may explain this observed association and any differences in the time to which disparities emerge following dementia onset.

METHODS: We conducted a retrospective cohort study using survey data from the 1995 to 2016 Health and Retirement Study linked with Medicare fee-for-service claims. Using the Hurd algorithm (a regression-based approach), we identified dementia onset among older adult respondents (age >=65 years) from the Telephone Interview for Cognitive Status and proxy respondents. We determined date from dementia onset to diagnosis using Medicare data up to 3 years following onset using a list of established diagnosis codes. Cox Proportional Hazards modeling was used to examine the association between an individual{\textquoteright}s reported race and likelihood of diagnosis after accounting for sociodemographic characteristics, income, education, functional status, and healthcare use.

RESULTS: We identified 3435 older adults who experienced a new onset of dementia. Among them, 30.1\% received a diagnosis within 36 months of onset. In unadjusted analyses, the difference in cumulative proportion diagnosed by race continued to increase across time following onset, p-value <0.001. 23.8\% of non-Hispanic Black versus 31.4\% of non-Hispanic White participants were diagnosed within 36 months of dementia onset, Hazard Ratio~=~0.73 (95\% CI: 0.61, 0.88). The association persisted after adjustment for functional status and healthcare use; however, these factors had less of an impact on the strength of the association than income and level of education.

CONCLUSION: Lower diagnosis rates of dementia among non-Hispanic Black individuals persists after adjustment for sociodemographic characteristics, functional status, and healthcare use. Further understanding of barriers to diagnosis that may be related to social determinants of health is needed to improve dementia-related outcomes among non-Hispanic Black Americans.

}, keywords = {Dementia, Diagnosis, Disparities, Medicare, race}, issn = {1532-5415}, doi = {10.1111/jgs.18078}, author = {Davis, Matthew A and Lee, Kathryn A and Harris, Melissa and Ha, Jinkyung and Kenneth M. Langa and Bynum, Julie P W and Hoffman, Geoffrey J} } @article {10.3389/fpubh.2021.723925, title = {Examining Rural and Racial Disparities in the Relationship Between Loneliness and Social Technology Use Among Older Adults}, journal = {Frontiers in Public Health}, volume = {9}, year = {2021}, pages = {1280}, abstract = {Loneliness, the subjective negative experience derived from a lack of meaningful companionship, is associated with heightened vulnerability to adverse health outcomes among older adults. Social technology affords an opportunity to cultivate social connectedness and mitigate loneliness. However, research examining potential inequalities in loneliness is limited. This study investigates racial and rural-urban differences in the relationship between social technology use and loneliness in adults aged 50 and older using data from the 2016 wave of the Health and Retirement Study (N = 4,315). Social technology use was operationalized as the self-reported frequency of communication through Skype, Facebook, or other social media with family and friends. Loneliness was assessed using the UCLA Loneliness scale, and rural-urban differences were based on Beale rural-urban continuum codes. Examinations of race focused on differences between Black/African-American and White/Caucasian groups. A path model analysis was performed to assess whether race and rurality moderated the relationship between social technology use and loneliness, adjusting for living arrangements, age, general computer usage. Social engagement and frequency of social contact with family and friends were included as mediators. The primary study results demonstrated that the association between social technology use and loneliness differed by rurality, but not race. Rural older adults who use social technology less frequently experience greater loneliness than urban older adults. This relationship between social technology and loneliness was mediated by social engagement and frequency of social contact. Furthermore, racial and rural-urban differences in social technology use demonstrated that social technology use is less prevalent among rural older adults than urban and suburban-dwelling older adults; no such racial differences were observed. However, Black older adults report greater levels of perceived social negativity in their relationships compared to White older adults. Interventions seeking to address loneliness using social technology should consider rural and racial disparities.}, keywords = {Disparities, Loneliness, rurality, Technology}, issn = {2296-2565}, doi = {10.3389/fpubh.2021.723925}, author = {Byrne, Kaileigh A. and Anaraky, Reza Ghaiumy and Dye, Cheryl and Ross, Lesley A. and Chalil Madathil, Kapil and Knijnenburg, Bart and Levkoff, Sue} } @article {11148, title = {Racial/Ethnic Differences in Mortality in Late Midlife: Have They Narrowed in Recent Years?}, journal = {The Journals of Gerontology: Series B }, volume = {76}, year = {2021}, pages = {1475-1487}, abstract = {

OBJECTIVES: Examine whether racial/ethnic differences in mortality rates have changed in recent years among adults in late midlife, and if so, how.

METHODS: We analyze Health and Retirement Study data on non-Hispanic Whites (Whites), non-Hispanic Blacks (Blacks), and English- and Spanish-speaking Hispanics (Hispanic-English and Hispanic-Spanish), ages 50-64 from two periods: 1998-2004 (P1, n=8920) and 2004-2010 (P2, n=7224). Using survey-generalized linear regression techniques we model death-by-end-of-period as a function of race/ethnicity, and sequentially adjust for a series of period-specific baseline risk factors including demographics, health status, health insurance, health behaviors, and social networks. Regression decomposition techniques are used to assess the contribution of these factors to observed racial/ethnic differences in mortality rates.

RESULTS: The odds ratio for death (ORD) was not statistically different for Blacks (vs. Whites) in P1 but was 33\% higher in P2 (OR=1.33; 95\% CI=1.05-1.69). The adjusted ORD among Hispanic-English (vs. Whites) was not statistically different in both periods. The adjusted ORD among Hispanic-Spanish (vs. Whites) was lower (ORD=0.36; 95\% CI= 0.22-0.59) in P1 but indistinguishable in P2. In P1, 50.1\% of the disparity in mortality rates among Blacks was explained by baseline health status, 53.1\% was explained by financial factors. In P2, 55.8\% of the disparity in mortality rates was explained by health status, 40.0\% by financial factors and 16.2\% by health insurance status.

DISCUSSION: Mortality rates among Blacks and Hispanic-Spanish have risen since the mid-1990s. Hispanic-Spanish, may be losing their advantageous lower risk of mortality, long known as the "Hispanic Paradox."

}, keywords = {Death Rates, Disparities, minorities}, issn = {1758-5368}, doi = {10.1093/geronb/gbaa175}, author = {Doza, Adit and Gail A Jensen and Wassim Tarraf} } @article {11242, title = {Development of Algorithmic Dementia Ascertainment for Racial/Ethnic Disparities Research in the US Health and Retirement Study.}, journal = {Epidemiology}, volume = {31}, year = {2020}, pages = {126-133}, abstract = {

BACKGROUND: Disparities research in dementia is limited by lack of large, diverse, and representative samples with systematic dementia ascertainment. Algorithmic diagnosis of dementia offers a cost-effective alternate approach. Prior work in the nationally representative Health and Retirement Study has demonstrated that existing algorithms are ill-suited for racial/ethnic disparities work given differences in sensitivity and specificity by race/ethnicity.

METHODS: We implemented traditional and machine learning methods to identify an improved algorithm that: (1) had <=5 percentage point difference in sensitivity and specificity across racial/ethnic groups; (2) achieved >=80\% overall accuracy across racial/ethnic groups; and (3) achieved >=75\% sensitivity and >=90\% specificity overall. Final recommendations were based on robustness, accuracy of estimated race/ethnicity-specific prevalence and prevalence ratios compared to those using in-person diagnoses, and ease of use.

RESULTS: We identified six algorithms that met our prespecified criteria. Our three recommended algorithms achieved <=3 percentage point difference in sensitivity and <=5 percentage point difference in specificity across racial/ethnic groups, as well as 77\%-83\% sensitivity, 92\%-94\% specificity, and 90\%-92\% accuracy overall in analyses designed to emulate out-of-sample performance. Pairwise prevalence ratios between non-Hispanic whites, non-Hispanic blacks, and Hispanics estimated by application of these algorithms are within 1\%-10\% of prevalence ratios estimated based on in-person diagnoses.

CONCLUSIONS: We believe these algorithms will be of immense value to dementia researchers interested in racial/ethnic disparities. Our process can be replicated to allow minimally biasing algorithmic classification of dementia for other purposes.

}, keywords = {Algorithms, Alzheimer{\textquoteright}s disease, Dementia, Disparities, Machine learning, Measurement}, issn = {1531-5487}, doi = {10.1097/EDE.0000000000001101}, author = {Kan Z Gianattasio and Ciarleglio, Adam and Melinda C Power} } @article {11272, title = {Nursing Home Use Expectations and Wealth Accumulation Among Older Adults}, number = {WI20-01}, year = {2020}, institution = {Center for Financial Security, University of Wisconsin-Madison}, address = {Madison, WI}, abstract = {Long-term care represents a significant cost to older adults in the US, and nursing home use is an important part of long-term care. It is therefore important to understand how older adults make nursing home-related decisions. This study analyzes the determinants of older adults{\textquoteright} nursing home use expectations, their relationship with actual nursing home use in the future, and the association between nursing home use expectations and older adults{\textquoteright} decisions regarding wealth accumulation. The findings indicate that older adults update their nursing home use expectations rationally and their nursing home use expectations have strong predictive power for actual nursing home use in the future, but these expectations are not statistically significantly associated with wealth accumulation. }, keywords = {Disparities, Nursing home use, Subjective Expectations, wealth accumulation}, url = {https://cfsrdrc.wisc.edu/publications/working-paper/wi20-01}, author = {Padmaja Ayyagari and Wang, Yang} } @article {11308, title = {Racial/ethnic/gender-based Disparities in Health Trajectories among American Older Adults}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {894}, abstract = {Numerous studies have examined racial/ethnic- or gender-based disparities in health. However, few examined health outcomes based on a combination of individuals{\textquoteright} race, ethnicity, and gender. Guided by an intersectionality framework, this study explores racial/ethnic/gender-based differences in older adults{\textquoteright} health trajectories over a ten-year period. Longitudinal data from the Health and Retirement Study (2004-2014) were used (n=16,654). Older adults (65+) were stratified into six groups based on their race, ethnicity, and gender, including (1) Non-Hispanic (NH) White Men; (2) NH White Women; (3) NH Black Men; (4) NH Black Women; (5) Hispanic Men; and (6) Hispanic Women. Growth curve models were used to examine the trajectories of three health indicators over time, including cognitive function, physical function (i.e. the sum of activities of daily living and instrumental activities of daily living), and depressive symptoms. The results indicated that NH White men and women outperformed racial/ethnic minority groups in cognition and physical function trajectories. Females in all racial/ethnic groups had more depressive symptoms but better cognition than their male counterparts. Hispanic women reported the most depressive symptoms. Hispanic women and NH Black women had the poorest physical function. NH Black men/women had the lowest cognition. Study findings highlighted the utility of an intersectionality framework in understanding health disparities in later life. Multiple social identities intersect with each other and generate protective and/or risk effects on cognitive, mental, and physical health status. Multilevel intervention strategies are warranted to close the health equity gap among various marginalized population groups.}, keywords = {Disparities, ethnicity, gender, Health Trajectories, race}, isbn = {2399-5300}, doi = {https://doi.org/10.1093/geroni/igaa057.3295}, author = {Kong, Dexia and Lu, Peiyi and Joan Davitt and Shelley, Mack} } @mastersthesis {11405, title = {Changing minds: A study of cognitive change disparities and their social determinants among older adults in the health and retirement study, 1998{\textendash}2012.}, volume = {Doctor of Philosophy}, year = {2017}, school = {Pennsylvania State University}, address = {State College, PA}, abstract = {Despite the rapidly growing literature on cognitive functioning trajectories, sociologists and social demographers have been largely removed from the research on age-related cognitive change. Indeed, research on cognitive decline tends to be dominated by biological psychologists and cognitive neuroscientists. Given the important insights that the sociological and demographic perspective can provide to understanding cognitive aging processes{\textemdash}particularly with regards to the social determinants of cognitive aging and how the patterns of change vary across social locations (e.g. race, gender, socioeconomic status){\textemdash}it is imperative for a social demographic analysis to be applied when examining cognitive aging. This dissertation aims to describe and explain sociodemographic variations in trajectories of age-related cognitive decline. Using data from the nationally representative longitudinal Health and Retirement Study (HRS) and drawing on the life course perspective, reserve theory, intersectionality theory, and differential exposure/susceptibility perspectives, this study uses an integrated person-centered/variablecentered methodological approach to examine both patterns of cognitive decline across social locations as well as said patterns{\textquoteright} social determinants. Broadly, this study has three main aims. First, this study aims to provide a more nuanced understanding of the various trajectories of agerelated cognitive decline by estimating and examining distinct classes of cognitive aging trajectories using general growth mixture modeling with latent trajectory classes (GGMM-LTC). Further, this study seeks to ascertain whether the cognitive aging disparities follow an age-asleveler, persistent inequality, or cumulative (dis)advantage pattern. Additionally, I examine whether active or passive reserve processes underlie changes in cognitive performance with advancing age. Building on the previous identification of distinct classes of cognitive decline, the second aim of this study is to examine patterns of cognitive aging across social locations by applying intersectionality theory. Lastly, the third aim is to employ differential exposure and differential susceptibility hypotheses to explain racial and gender differences in cognitive aging patterns. Findings addressing the first aim indicate that distinct classes for both episodic memory and mental status exist, and that membership in classes is stratified by race, gender, socioeconomic status, health, and early life adversity. Additionally, support for the age-as leveler, persistent inequality, and cumulative (dis)advantage patterns were found depending on the groups compared and the cognitive domain examined. It was also found that the cognitive reserve process plays out in the mental status domain. Findings related to the second aim of this study indicate that gender and levels of education influence cognitive trajectory class membership for blacks and whites in both episodic memory and mental status domains. More specifically, whites and respondents with higher levels of education are more likely to belong in episodic memory and mental status classes with higher levels of initial functioning. Further, I find evidence for the multiplicative effects of gender and education for episodic memory among whites and for mental status among both whites and blacks thus providing support for the intersectionality perspective. Lastly, findings related to the third aim show that race and gender are both significant predictors of episodic memory and mental status trajectory class membership. Blacks and men are more likely to belong in episodic memory trajectory classes characterized by low initial function with more rapid declines than their white and female counterparts. For mental status, blacks and women are more likely to be in lower initial functioning classes, but are advantaged with regards to rate of decline. Additionally, findings provide little evidence for the notion that early life adversity attenuates the relationship between race and/or gender and cognitive decline trajectory class membership, thereby no support for the differential exposure hypothesis was found. Lastly, lack of statistically significant interactions between both race and gender and early life adversity indicates that there is no support for the differential susceptibility hypothesis. Overall, findings herein show that the social patterning and determinants of cognitive decline in the U.S. are complex, varying with the groups being compared as well as the cognitive domain in question. Moreover, this dissertation provides an argument that researchers in the area of cognitive decline would benefit greatly from an intersectionality approach. This dissertation concludes with the placement of current findings within the existing literature, a detailing of policy implications, a discussion of study limitations, and the outlining of planned future research in the area of cognitive decline and ideas for better cognitive functioning assessment in the population. }, keywords = {Cognition, Disparities}, url = {https://search.proquest.com/openview/fa6ce296a12971a3e2321e8b0bf3a2aa/1?pq-origsite=gscholar\&cbl=18750\&diss=y}, author = {Kyler J. Sherman-Wilkins} }