@article {13744, title = {Wealth Redistribution to Extend Longevity in the US.}, journal = {JAMA Internal Medicine}, year = {Forthcoming}, abstract = {

IMPORTANCE: The US is unique among wealthy countries in its degree of wealth inequality and its poor health outcomes. Wealth is known to be positively associated with longevity, but little is known about whether wealth redistribution might extend longevity.

OBJECTIVE: To examine the association between wealth and longevity and estimate the changes in longevity that could occur with simulated wealth distributions that were perfectly equal, similar to that observed in Japan (among the most equitable of Organisation for Economic Co-operation and Development [OECD] countries), generated by minimum inheritance proposals, and produced by baby bonds proposals.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study analyzed the association between wealth and survival among participants in the Health and Retirement Study (1992-2018), a nationally representative panel study of middle-aged and older (>=50 years) community-dwelling, noninstitutionalized US adults. The data analysis was performed between November 15, 2022, and September 24, 2023.

EXPOSURE: Household wealth on study entry, calculated as the sum of all assets minus the value of debts and classified into deciles.

MAIN OUTCOMES AND MEASURES: Weibull survival models were used to estimate the association between per-person wealth decile and survival, adjusting for age, sex, marital status, household size, and race and ethnicity. Changes in longevity that might occur under alternative wealth distributions were then estimated.

RESULTS: The sample included 35 164 participants (mean [SE] age at study entry, 59.1 [0.1] years; 50.1\% female and 49.9\% male [weighted]). The hazard of death generally decreased with increasing wealth, wherein participants in the highest wealth decile had a hazard ratio of 0.59 for death (95\% CI, 0.53-0.66) compared with those in the lowest decile, corresponding to a 13.5-year difference in survival. A simulated wealth distribution of perfect equality would increase populationwide median longevity by 2.2 years (95\% CI, 2.2-2.3 years), fully closing the mortality gap between the US and the OECD average. A simulated minimum inheritance proposal would increase populationwide median longevity by 1.7 years; a simulated wealth distribution similar to Japan{\textquoteright}s would increase populationwide median longevity by 1.2 years; and a simulated baby bonds proposal would increase populationwide median longevity by 1.0 year.

CONCLUSIONS AND RELEVANCE: These findings suggest that wealth inequality in the US is associated with significant inequities in survival. Wealth redistribution policies may substantially reduce those inequities and increase population longevity.

}, keywords = {health outcomes, Longevity, reduce inequalities, Wealth Inequality}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2023.7975}, author = {Himmelstein, Kathryn E W and Tsai, Alexander C and Venkataramani, Atheendar S} } @article {13397, title = {Association of Social Isolation With Hospitalization and Nursing Home Entry Among Community-Dwelling Older Adults.}, journal = {JAMA Internal Medicine}, volume = {183}, year = {2023}, pages = {955-962}, abstract = {

IMPORTANCE: Social isolation is associated with adverse health outcomes, yet its implications for hospitalization and nursing home entry are not well understood.

OBJECTIVE: To evaluate whether higher levels of social isolation are associated with overnight hospitalization, skilled nursing facility stays, and nursing home placement among a nationally representative sample of community-dwelling older adults after adjusting for key health and social characteristics, including loneliness and depressive symptoms.

DESIGN, SETTING, AND PARTICIPANTS: This observational cohort study included 7 waves of longitudinal panel data from the Health and Retirement Study, with community-dwelling adults aged 65 years or older interviewed between March 1, 2006, and June 30, 2018 (11 517 respondents; 21 294 person-years). Data were analyzed from May 25, 2022, to May 4, 2023.

MAIN OUTCOMES AND MEASURES: Social isolation was measured with a multidomain 6-item scale (range, 0-6, in which a higher score indicates greater isolation). Multivariate logistic regressions were performed on survey-weighted data to produce national estimates for the odds of self-reported hospitalization, skilled nursing facility stays, and nursing home placement over time.

RESULTS: A total of 57\% of this study{\textquoteright}s 11 517 participants were female, 43\% were male, 8.4\% were Black, 6.7\% were Hispanic or Latino, 88.1\% were White, 3.5\% were other ("other" includes American Indian or Alaska Native, Asian or Pacific Islander, and other race, which has no further breakdown available because this variable was obtained directly from the Health and Retirement Study), and 58.2\% were aged 65 to 74 years. Approximately 15\% of community-dwelling older adults in the US experienced social isolation. Higher social isolation scores were significantly associated with increased odds of nursing home placement (odds ratio, 2.01; 95\% CI, 1.21-3.32) and skilled nursing facility stays (odds ratio, 1.16; 95\% CI, 1.06-1.28) during 2 years. With each point increase in an individual{\textquoteright}s social isolation score, the estimated probability of nursing home placement or a skilled nursing facility stay increased by 0.5 and 0.4 percentage points, respectively, during 2 years. Higher levels of social isolation were not associated with 2-year hospitalization rates.

CONCLUSIONS AND RELEVANCE: This cohort study found that social isolation was a significant risk factor for nursing home use among older adults. Efforts to deter or delay nursing home entry should seek to enhance social contact at home or in community settings. The design and assessment of interventions that optimize the social connections of older adults have the potential to improve their health trajectories and outcomes.

}, keywords = {community dwelling, health outcomes, Hospitalization, Nursing homes, social isolation}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2023.3064}, author = {Pomeroy, Mary Louise and Cudjoe, Thomas K M and Cuellar, Alison E and Ihara, Emily S and Ornstein, Katherine A and Bollens-Lund, Evan and Kotwal, Ashwin A and Gimm, Gilbert W} } @article {11995, title = {Prevalence and health outcomes in community-dwelling older adults with comorbid cancer and dementia: A longitudinal analysis.}, journal = {Aging \& Mental Health}, year = {2023}, abstract = {

OBJECTIVES: To examine health outcomes in community-dwelling older adults with: dementia only, cancer only, and comorbid cancer and dementia.

METHODS: Longitudinal analysis was conducted using data from 2010 to 2016 waves of the Health and Retirement Study. Health outcomes included mortality, limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), nursing home utilization, hospital stay, homecare use, self-rated health, and out-of-pocket medical expenditure. Panel regression was used for statistical analysis.

RESULTS: The prevalence of comorbid cancer and dementia ranged from 2.56\% to 2.97\%. Individuals with comorbid cancer and dementia demonstrated a higher likelihood of nursing home utilization and poorer self-rated health but a lower likelihood of hospital stay, homecare use, and out-of-pocket expenditures, compared to the cancer only or dementia only groups. The differences in mortality and ADL and IADL limitations were not statistically significant.

CONCLUSION: Comorbid cancer and dementia predicted longer nursing home utilization and poorer self-rated health. The results help guide care planning for individuals with comorbid cancer and dementia.

}, keywords = {Cancer, comorbid cancer-dementia, Dementia, health outcomes}, issn = {1364-6915}, doi = {10.1080/13607863.2021.2003298}, author = {Parajuli, Jyotsana and Berish, Diane and Jao, Ying-Ling and Liao, Yo-Jen and Johnson, Lee Ann and Walsh, Amanda} } @article {13398, title = {Social isolation linked to higher likelihood of nursing home admission: study}, year = {2023}, publisher = {McKnights }, keywords = {health outcomes, Nursing homes, social isolation}, url = {https://www.mcknights.com/news/social-isolation-linked-to-higher-likelihood-of-nursing-home-admission-study/}, author = {Towhey, Jessica} } @article {13134, title = {Socioeconomic disparities in health outcomes in the United States in the late 2010s: results from four national population-based studies.}, journal = {Arch Public Health}, volume = {81}, year = {2023}, month = {2023 Feb 04}, pages = {15}, abstract = {

BACKGROUND: Despite the importance of monitoring health disparities by multiple socioeconomic categories, there have been no recent updates on the prevalence of general health indicators by socioeconomic categories. The present study aims to update the prevalence estimates of health indicators by education and income categories across three age groups (children, young and~middle-aged adults, and older adults) in the late 2010s by using four nationally representative data sources. We also examine socioeconomic differences in health by race/ethnicity subgroups.

METHODS: Data were obtained from four nationally representative data sources from the U.S.: The National Health Interview Survey (2015-2018); the National Health and Nutrition Examination Survey, NHANES (2017-2020); the Behavioral Risk Factor Surveillance System (2016-2020); and the Health \& Retirement Study (2016). Respondent-rated health and obesity were selected as the health indicators of interest. Socioeconomic factors included percentages of the federal poverty level and years of educational attainment. We conducted logistic regression analyses to calculate adjusted prevalence rates of respondent-rated (or measured, in the case of obesity in NHANES) poor health and obesity by income and education categories after controlling for sociodemographic characteristics. The complex sampling designs were accounted for in all analyses.

RESULTS: Prevalence rates across racial/ethnic groups and age groups demonstrated clear and consistent socioeconomic gradients in respondent-rated poor health, with the highest rates among those in the lowest income and education categories, and decreased rates as income and education levels increased. On the other hand, there were less evident socioeconomic differences in obesity rates across all data sources, racial/ethnic groups, and age groups.

CONCLUSIONS: Our results confirmed earlier, persistent evidence indicating socioeconomic disparities in respondent-rated poor health across all age and race/ethnicity groups by using four nationally representative datasets. In comparison to a decade earlier, socioeconomic disparities in poor health appeared to shrink while they emerged or increased for obesity. The results suggest an urgent need for action to alleviate pervasive health disparities by socioeconomic status. Further research is needed to investigate potentially modifiable factors underlying socioeconomic disparities in health, which may help design targeted health promotion programs.

}, keywords = {health outcomes, socioeconomic disparities}, issn = {0778-7367}, doi = {10.1186/s13690-023-01026-1}, author = {Kim, Yeonwoo and Vazquez, Christian and Cubbin, Catherine} } @article {11877, title = {Association of perceived job security and chronic health conditions with retirement in older UK and US workers.}, journal = {European Journal of Public Health}, volume = {32}, year = {2022}, pages = {52-58}, abstract = {

BACKGROUND: The relationship between job insecurity, chronic health conditions (CHCs) and retirement among older workers are likely to differ between countries that have different labor markets and health and social safety nets. To date, there are no epidemiological studies that have prospectively assessed the role of job insecurity in retirement incidence, while accounting for CHC trajectories in two countries with different welfare systems. We investigated the strength of the association between baseline job insecurity and retirement incidence over an 11-year period while accounting for CHC trajectories, among workers 50-55 years of age at baseline in the UK and USA.

METHODS: We performed Cox proportional hazards regression analysis, using 2006-2016 data from the Health and Retirement Study (US cohort, n = 570) and English Longitudinal Study on Aging (UK cohort n = 1052).

RESULTS: Job insecurity was associated with retirement after adjusting for CHC trajectories (HR = 0.69, 95\% CI = 0.50-0.95) in the UK cohort only. CHC trajectories were associated with retirement in both cohorts; however, this association was attenuated in the US cohort, but remained significant for the medium-increasing trajectory in the UK cohort (HR = 1.41, 95\% CI = 1.01-1.97) after adjustment for all covariates. Full adjustment for relevant covariates attenuated the association between job insecurity and retirement indicating that CHCs, social and health factors are contributing mechanistic factors underpinning retirement incidence.

CONCLUSIONS: The observed differences in the two cohorts may be driven by macro-level factors operating latently, which may affect the work environment, health outcomes and retirement decisions uniquely in different settings.

}, keywords = {attenuation, Chronic disease, community health centers, ELSA, epidemiologic studies, health outcomes, insecurity, labor market, Safety, Sister studies, Social Welfare, Survival Analysis, Workplace}, issn = {1464-360X}, doi = {10.1093/eurpub/ckab170}, author = {Mutambudzi, Miriam and Flowers, Paul and Demou, Evangelia} } @article {11981, title = {Association of Social Support With Functional Outcomes in Older Adults Who Live Alone.}, journal = {JAMA Internal Medicine}, volume = {182}, year = {2022}, pages = {26-32}, abstract = {

Importance: Older adults who live alone are at risk for poor health outcomes. Whether social support mitigates the risk of living alone, particularly when facing a sudden change in health, has not been adequately reported.

Objective: To assess if identifiable support buffers the vulnerability of a health shock while living alone.

Design, Setting, and Participants: In this longitudinal, prospective, nationally representative cohort study from the Health and Retirement Study (enrollment March 2006 to April 2015), 4772 community-dwelling older adults 65 years or older who lived alone in the community and could complete activities of daily living (ADLs) and instrumental ADLs independently were followed up biennially through April 2018. Statistical analysis was completed from May 2020 to March 2021.

Exposures: Identifiable support (ie, can the participant identify a relative/friend who could help with personal care if needed), health shock (ie, hospitalization, new diagnosis of cancer, stroke, heart attack), and interaction (multiplicative and additive) between the 2 exposures.

Main Outcomes and Measures: The primary outcomes were incident ADL dependency, prolonged nursing home stay (>=30 days), and death.

Results: Of 4772 older adults (median [IQR] age, 73 [68-81] years; 3398 [71\%] women) who lived alone, at baseline, 1813 (38\%) could not identify support, and 3013 (63\%) experienced a health shock during the study. Support was associated with a lower risk of a prolonged nursing home stay at 2 years (predicted probability, 6.7\% vs 5.2\%; P = .002). Absent a health shock, support was not associated with a prolonged nursing home stay (predicted probability over 2 years, 1.9\% vs 1.4\%; P = .21). However, in the presence of a health shock, support was associated with a lower risk of a prolonged nursing home stay (predicted probability over 2 years, 14.2\% vs 10.9\%; P = .002). Support was not associated with incident ADL dependence or death.

Conclusions and Relevance: In this longitudinal cohort study among older adults who live alone, identifiable support was associated with a lower risk of a prolonged nursing home stay in the setting of a health shock.

}, keywords = {health outcomes, Social Support}, issn = {2168-6114}, doi = {10.1001/jamainternmed.2021.6588}, author = {Sachin J Shah and Margaret C Fang and Wannier, S Rae and Michael A Steinman and Kenneth E Covinsky} } @mastersthesis {12855, title = {Dimensions of Social Isolation and Adverse Health Outcomes among Older Men and Women in the United States: How Aging, Living Alone, and Obesity Contribute to Mortality}, year = {2022}, school = {University of Massachusetts Amherst}, address = {Amherst, MA}, abstract = {This dissertation examines the interaction of a series of potential social and biological mechanisms that may affect inequalities in mortality among those 65 or older. The mechanisms are social isolation and its relationships with obesity and diabetes. Although many prior studies have confirmed social isolation as a risk factor for adverse health outcomes such as obesity, diabetes, and even premature death, how and why social isolation works to generate adverse health outcomes remains mostly unknown. To extend the scholarship on social isolation and health, each chapter of this dissertation tests distinctive aspects of social isolation: living alone, rurality, and retirement, respectively, while using various datasets from the Health and Retirement Study. First, this dissertation finds that older women{\textquoteright}s living alone status is related to a lower likelihood of sarcopenic obesity, whereas their widowhood status showed a higher possibility of sarcopenic obesity. Second, while the rural-urban classification complicates results, older men experiencing severe food insecurity, accounting for rural-urban distinctions, tended to have a greater likelihood of obesity than not being obese. Last, older adults who were partly retired or had a pension had a lower mortality risk. However, their significance disappeared after adjusting for confounders. Yet, in-person contact emerged to be associated with a decreased mortality risk. The dissertation contributes three novel ideas for scholars with expertise in social determinants of health. First, it bears keeping in mind that although a composite construct such as social isolation can be effectively used to examine health outcomes, the relationship between each component of the variable and outcomes should also be carefully examined. Second, this thesis constructed a geographic metabolic risk partition measure in order to establish high-metabolic-risk states vs. low-risk states. This measure reflects the reality that the prevalence of obesity and diabetes is deeply rooted in an environmental context such as a state. Third, clinical research already focuses on sarcopenic obesity, but social factors for the disease are rarely studied. Since this dissertation found younger cohorts{\textquoteright} greater likelihood of sarcopenic obesity among older Americans, social scientists should pursue new frontiers in research focused on the social aspects of sarcopenic obesity.}, keywords = {health outcomes, Living Alone, Mortality, Obesity, social isolation}, doi = {10.7275/31020751}, author = {Bae, Youngjoon} } @article {12252, title = {Exploring Rural-Urban Differences in Polygenic Associations for Health among Older Adults in the United States}, journal = {Journal of Rural Social Sciences}, volume = {37}, year = {2022}, pages = {art 4}, abstract = {A complex combination of genes and environment influence health and, as a result, both genes and environment can play a role in shaping health disparities. We consider distinctions in these influences across rural and urban settings, expanding upon work that shows lower genetic associations in rural compared to urban places by studying an older age group and examining more than the typical outcomes of alcohol/substance abuse. Using a sample of 14,994 adults from the 1992 through 2016 waves of the Health and Retirement Study, our results suggest genetic associations for BMI and heart conditions are significantly lower in rural compared to urban settings. We do not find evidence in support of this association for depression and smoking. In sum, the results suggest the gene-environment interaction may play a role in the well-documented disparities across rural and urban places within the United States, further highlighting the importance of the social, economic, and built environments for individual health.}, keywords = {Gene-Environment Interaction, Health Disparities, health outcomes, rural-urban}, url = {https://egrove.olemiss.edu/cgi/viewcontent.cgi?article=1499\&context=jrss}, author = {Davidson, Trent and Boardman, Jason D and Hunter, Lori M.} } @article {12707, title = {Genome-wide meta-analyses reveal novel loci for verbal short-term memory and learning.}, journal = {Molecular Psychiatry}, year = {2022}, abstract = {

Understanding the genomic basis of memory processes may help in combating neurodegenerative disorders. Hence, we examined the associations of common genetic variants with verbal short-term memory and verbal learning in adults without dementia or stroke (N = 53,637). We identified novel loci in the intronic region of CDH18, and at 13q21 and 3p21.1, as well as an expected signal in the APOE/APOC1/TOMM40 region. These results replicated in an independent sample. Functional and bioinformatic analyses supported many of these loci and further implicated POC1. We showed that polygenic score for verbal learning associated with brain activation in right parieto-occipital region during working memory task. Finally, we showed genetic correlations of these memory traits with several neurocognitive and health outcomes. Our findings suggest a role of several genomic loci in verbal memory processes.

}, keywords = {Genome, health outcomes, Memory, neurocognitive outcomes, polygenic score, Verbal Learning}, issn = {1476-5578}, doi = {10.1038/s41380-022-01710-8}, author = {Lahti, Jari and Tuominen, Samuli and Yang, Qiong and Pergola, Giulio and Ahmad, Shahzad and Amin, Najaf and Armstrong, Nicola J and Beiser, Alexa and Bey, Katharina and Bis, Joshua C and Boerwinkle, Eric and Bressler, Jan and Campbell, Archie and Campbell, Harry and Chen, Qiang and Corley, Janie and Cox, Simon R and Davies, Gail and De Jager, Philip L and Derks, Eske M and Jessica Faul and Fitzpatrick, Annette L and Fohner, Alison E and Ford, Ian and Fornage, Myriam and Gerring, Zachary and Grabe, Hans J and Grodstein, Francine and Gudnason, Vilmundur and Simonsick, Eleanor and Holliday, Elizabeth G and Joshi, Peter K and Kajantie, Eero and Kaprio, Jaakko and Karell, Pauliina and Kleineidam, Luca and Knol, Maria J and Kochan, Nicole A and Kwok, John B and Leber, Markus and Lam, Max and Lee, Teresa and Li, Shuo and Loukola, Anu and Luck, Tobias and Marioni, Riccardo E and Mather, Karen A and Medland, Sarah and Mirza, Saira S and Nalls, Mike A and Nho, Kwangsik and O{\textquoteright}Donnell, Adrienne and Oldmeadow, Christopher and Painter, Jodie and Pattie, Alison and Reppermund, Simone and Risacher, Shannon L and Rose, Richard J and Sadashivaiah, Vijay and Scholz, Markus and Satizabal, Claudia L and Schofield, Peter W and Schraut, Katharina E and Scott, Rodney J and Simino, Jeannette and Smith, Albert V and Smith, Jennifer A and Stott, David J and Surakka, Ida and Teumer, Alexander and Thalamuthu, Anbupalam and Trompet, Stella and Turner, Stephen T and van der Lee, Sven J and Villringer, Arno and V{\"o}lker, Uwe and Wilson, Robert S and Wittfeld, Katharina and Vuoksimaa, Eero and Xia, Rui and Yaffe, Kristine and Yu, Lei and Zare, Habil and Zhao, Wei and Ames, David and Attia, John and Bennett, David A and Brodaty, Henry and Chasman, Daniel I and Goldman, Aaron L and Hayward, Caroline and Ikram, M Arfan and Jukema, J Wouter and Sharon L R Kardia and Lencz, Todd and Loeffler, Markus and Mattay, Venkata S and Palotie, Aarno and Psaty, Bruce M and Ramirez, Alfredo and Ridker, Paul M and Riedel-Heller, Steffi G and Sachdev, Perminder S and Saykin, Andrew J and Scherer, Martin and Schofield, Peter R and Sidney, Stephen and Starr, John M and Trollor, Julian and Ulrich, William and Wagner, Michael and David R Weir and Wilson, James F and Wright, Margaret J and Weinberger, Daniel R and Debette, St{\'e}phanie and Eriksson, Johan G and Mosley, Thomas H and Launer, Lenore J and van Duijn, Cornelia M and Deary, Ian J and Seshadri, Sudha and R{\"a}ikk{\"o}nen, Katri} } @article {12166, title = {Higher aging satisfaction improves subsequent health outcomes}, year = {2022}, publisher = {Healio}, abstract = {Adults with higher aging satisfaction were more likely to have improved health and well-being later in life, according to findings published in JAMA Network Open. }, keywords = {Aging, health outcomes, Satisfaction}, url = {https://www.healio.com/news/primary-care/20220216/higher-aging-satisfaction-improves-subsequent-health-outcomes}, author = {Marabito, Maria} } @mastersthesis {12520, title = {Perceived Discrimination and Health Outcomes in Older Adults}, volume = {Ph.D.}, year = {2022}, school = {University of Massachusetts, Boston}, address = {Boston, MA}, keywords = {Aging, Discrimination, health outcomes, Healthcare Disparities}, url = {https://www.proquest.com/dissertations-theses/perceived-discrimination-health-outcomes-older/docview/2681897382/se-2?accountid=14667}, author = {Hendricksen, Meghan} } @mastersthesis {11859, title = {ESSAYS ON MEDICARE PART D MARKET: SOURCES OF WELFARE EFFECTS AND MERGER AND ACQUISITION EFFECTS}, volume = {Ph.D.}, year = {2021}, school = {State University of New York at Albany}, address = {Albany, NY}, abstract = {This dissertation contains three essays on the Medicare Part D market in the United States. Three chapters account the benefit of Medicare Part D, analyze how merger and acquisition affect insurance plan{\textquoteright}s characteristics and how merger and acquisition affect senior{\textquoteright}s health outcomes. The first chapter studies the benefits of Medicare Part D. The Medicare prescription drug program (Part D) launched in 2006. Since then, the stand-alone prescription drug plans (PDPs) available to consumers and their plan characteristics have been evolving. This paper examines how those evolutions affect consumer surplus of Medicare beneficiaries. We estimate a structural demand model of stand-alone PDPs for Medicare beneficiaries using plan level data across 34 markets defined by Centers for Medicare and Medicaid Services (CMS) from 2008 to 2017. Encouragingly, consumer surplus increases over time because there are more enhanced plans available in the market over time despite the total number of plans available reduces over time. Nonetheless, such effect of consumer surplus is unevenly distribution across markets because the evolutions of plan availability and characteristics vary across markets. The second chapter examines the effects of mergers and acquisitions (M\&A) on Part D prescription drug plans(PDPs). The Medicare prescription drug program (Part D) launched in 2006. Since then, there has been a series of M\&A among the parent companies providing the PDPs, which concentrates the Medicare Part D market. This paper applies a differences-in-differences model to a plan-level dataset from 2007 to 2019 to estimate the effects of M\&A on plan{\textquoteright}s premium, characteristics, and market shares. We find that, on average, those M\&A increases premium and deteriorates plan quality but increases market share. Such effects are stronger in the Medicare region that the merging insurers are serving together and in the mergers among publicly traded (potentially larger) insurers but less in insurers are consolidating their plans. The chapter 3 studies the effects of M\&A on individual{\textquoteright}s health outcomes. Given the previous chapter reports that M\&A among the parent companies providing the PDPs increases premium and deteriorates plan quality, especially in the Medicare region that the merging insurers are serving together. This chapter matches the individual-level data from the 2008-2018 waves of RAND Health and Retirement Study (HRS) and the M\&A and plan information from CMS Landscape, and examine the effects of those M\&As on seniors{\textquoteright} Part D participation, out-of-pocket costs and prescription drug usage. We find that M\&As increase the out-of-pocket (OOP) prescription drug costs for enrollees and reduces their drug usage. Our results are consistent with elderly shifts their plans with poorer coverage after the M\&As and results in those poorer outcomes.}, keywords = {health outcomes, Medicare Part D, Out-of-pocket medical expenses, prescription drugs}, url = {https://www.proquest.com/docview/2569681798?pq-origsite=gscholar\&fromopenview=true}, author = {Wang, Yichuan} } @article {11989, title = {How Does Debt Shape Health Outcomes for Older Americans?}, number = {WP$\#$2021-17}, year = {2021}, institution = {Center for Retirement Research at Boston College}, address = {Newton, MA}, abstract = {This study explores the association between debt burdens and health at older ages. It examines a range of physical and mental health measures and assesses how they may be shaped by the debt held by older adults. It compares health outcomes for older adults with and without debt. It also explores whether the amount or type of debt modifies the debt-health nexus. To address the likely endogeneity of debt and health, the study employs marginal structural models, developed specifically as an identification strategy in the presence of possible endogeneity, alongside population-averaged models that allow us to compare outcomes for populations with and without debt without having to rely on unverifiable assumptions regarding the underlying population distribution, as is the case with random- and fixed-effects models. Data for this study come primarily from the Health and Retirement Study, and the sample is limited to respondents ages 55 and older from the 1998 through 2016 survey waves.}, keywords = {Debt, health outcomes, Mental Health, Physical Health}, url = {https://crr.bc.edu/working-papers/how-does-debt-shape-health-outcomes-for-older-americans/}, author = {Mudrazija, Stipica and Barbara A Butrica} } @mastersthesis {11863, title = {The Role of Self-Efficacy in the Variation of Health Outcomes Late in Life}, volume = {M.S.}, year = {2021}, school = {University of Michigan - Dearborn}, address = {Dearborn, MI}, abstract = {As the population of the United States ages, variation in late-life health and wellbeing outcomes have become an increasingly popular and necessary area of scientific exploration. Previous research has identified ageism (Levy et al., 2000) and perceived age discrimination (Han \& Richardson, 2015; Marquet et al., 2019) as factors that negatively impact outcomes for older adults. Further, as conceptualized through the Stereotype Embodiment Theory (Levy, 2009), self-perceptions of aging have been found to mediate the influence of perceived age discrimination on health outcomes. Individuals from stigmatized groups have a physiological reaction (i.e., a stress response) to negative age stereotypes (Levy et al., 2000) and other forms of discrimination (Lui \& Quezada, 2019). Therefore, analyzing the Stereotype Embodiment Theory and Transactional Model of Stress (Lazarus \& Folkman, 1987) in combination allows one to consider the variation of aging outcomes as subject to individual factors involved in stress appraisal and coping. The current study utilized public data from 676 older adults who participated in two waves of the Health and Retirement Study (2012; 2016). First, conditional process analysis was employed to confirm self-perceptions of aging as a mediator between perceived age discrimination and outcomes. Next, the potential protective effects of self-efficacy in the stress appraisal process were explored. Results confirmed the indirect effect of perceived age discrimination on health outcomes and life satisfaction through self-perceptions of aging. However, the analysis did not provide evidence for self-efficacy{\textquoteright}s moderating effect on the relationship between perceived age discrimination and self-perceptions of aging. This study provides additional support for the Stereotype Embodiment Theory and offers individual differences in stress appraisal as an explanation for variation in late-life wellness. }, keywords = {Ageism, health outcomes, Life Satisfaction, perceived age discrimination, Self-efficacy}, url = {https://deepblue.lib.umich.edu/bitstream/handle/2027.42/169509/Bookman\%2C\%20Lindsey\%20-\%20The\%20Role\%20of\%20Self-Efficacy\%20in\%20the\%20Variation\%20of\%20Health\%20Outcomes\%20Later\%20in\%20Life.pdf?sequence=3}, author = {Bookman, Lindsey} } @article {11179, title = {A decade of experience for high-needs beneficiaries under Medicare Advantage.}, journal = {Healthcare (Amsterdam)}, volume = {8}, year = {2020}, abstract = {

OBJECTIVE: To describe the association between longitudinal enrollment in Medicare Advantage (MA) and utilization, access, quality of care, and health outcomes for beneficiaries with complex health needs.

DATA SOURCES/STUDY SETTING: Beneficiary characteristics, enrollment, and outcomes data from the 2004-2016 waves of the Health and Retirement Study (HRS).

STUDY DESIGN: Using the HRS panel structure, we identified beneficiaries consistently reporting high needs as well as enrollment in MA versus traditional Medicare (TM). We first evaluated a robust set of beneficiary characteristics to identify those that distinguish beneficiaries who consistently enrolled in MA versus TM. We then described adjusted differences in outcomes between high-needs beneficiaries who consistently enrolled in MA versus TM.

PRINCIPAL FINDINGS: Among high-needs beneficiaries, there was a modest amount of favorable selection into MA based on health. Controlling for several characteristics, MA enrollees used less care (with a 6.6 percentage point (pp) lower probability of hospitalization, 4.7 fewer physician visits, and a 5.1 pp lower probability of using home health care), had a 4.1 pp greater probability of being unable to afford their care, and had a 5.7 pp lower probability of reporting that they were very satisfied with their care. Compared to associations between MA and outcomes for high-needs beneficiaries, for non-high-needs beneficiaries MA enrollment was associated with smaller decreases in utilization and no statistically significant difference in the inability to afford care.

CONCLUSIONS: Our descriptive findings raise the possibility that high-needs beneficiaries may experience unique challenges in MA compared to their non-high-needs counterparts.

}, keywords = {Access, health outcomes, High-needs beneficiaries, Medicare advantage, Quality of care}, issn = {2213-0772}, doi = {10.1016/j.hjdsi.2020.100490}, author = {Levinson, Zachary and Adler-Milstein, Julia} } @article {11304, title = {Intersectional Discrimination Attributions and Health Outcome among American Older Adults}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {871}, abstract = {Discrimination has been consistently documented to relate to adverse health outcomes. However, most existing research focused on a single discrimination attribution (e.g. ageism). Few studies considered multifaceted discrimination attributions. Guided by an intersectionality framework, this study examined intersectional discrimination attributions and their associations with health outcomes. Older respondents (aged \>50) from the Health and Retirement Study in 2014-2015 were included in the analysis (n=6,286). Their experiences and self-perceived reasons (age, gender, sexual orientation, race, national origin, religion, financial status, weight, physical appearance, disability, and others) for everyday discrimination were examined. Latent class analysis was employed to ascertain the profiles of subgroups characterized by their intersectional discrimination attributions. Regression models examined the correlates of the class memberships and the associations with health outcomes. Six classes were identified: class 1 (54.52\% of the sample) had no/minimal discrimination experience; Class 2 (21.89\%) experienced primarily ageism; class 3 (8.81\%) reported discrimination based on age/gender/national origin/race; class 4 (7.99\%) attributed discrimination to financial/other reasons; class 5 (5.87\%) experienced discrimination based on age/weight/physical appearance/disability; and class 6 (0.92\%) perceived discrimination from almost every aspect. Intersectional discrimination attributions were associated with poorer self-rated health, and greater levels of depressive symptoms and loneliness. The associations between intersectional discrimination and cognition were not statistically significant. This study found multiple marginalized identities co-occur and compound to contribute to perceived everyday discrimination among American older adults. Those experiencing discrimination due to multiple reasons warrant particular attention. Results underscore the utility of an intersectional approach in understanding discrimination in later life.}, keywords = {health outcomes, intersectional discrimination}, isbn = {2399-5300}, doi = {https://doi.org/10.1093/geroni/igaa057.3222}, author = {Lu, Peiyi and Kong, Dexia and Shelley, Mack and Joan Davitt} } @mastersthesis {10340, title = {Essays on Health, Healthcare, Job Insecurity and Health Outcomes}, volume = {PhD}, year = {2019}, note = {Copyright - Database copyright ProQuest LLC; ProQuest does not claim copyright in the individual underlying works; Last updated - 2019-07-24}, pages = {140}, school = {University of South Florida}, type = {phd}, abstract = {This doctoral dissertation proposal is comprised of three separate chapters, all of which uses the nationally representative uniform survey Health and Retirement Survey (HRS) to examine the relationship between health, insurance, health care and health outcomes. Below, the brief introduction for each section is provided: Chapter I: Medicare Part D and Patients{\textquoteright} Well-being. Chapter II: Parent{\textquoteright}s Health Insurance and Informal Care. Chapter III: Job Insecurity and Health (with Dr. Ayyagari) In chapter I, I explore how Medicare Part D (MD) affects the well-being of the severely sick patients both in the short- and in the long- term. I employ difference-in-difference (DD) alongside the instrumental variable (IV) model. The estimated results imply MD significantly improves mental health and increases regular drug utilization for the elderly. However, it neither systematically improves out-of-pocket payment (OOP) nor improves mortality across all waves. This suggests that MD provides an efficient mechanism to improve mental health and drug utilization, but might not necessarily enhance survival rate and financial burden for vulnerable patients. Chapter II investigates the relationship between informal care provided by the children and the take-up of health insurance by the near-elderly and elderly parents, and how the correlation is influenced by parent{\textquoteright}s Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The results indicate that when the endogeneity is controlled for, in-formal care systematically crowds out the take-up of private long-term care (LTC) insurance whereas "crowds in" the take-up of the total plan including supplement insurance plans (TSP). Nevertheless, the degree of both crowding-out and "crowding-in" effect is reduced when the severity of ADLs/IADLs disability level grows. Our study reflects (a) the strong demand for TSP and more additional health coverage within household budget line (b) and the potential gap between healthcare demands by the parents and the informal care provided by the children and the potential gap between the healthcare demands by the parents and the formal care covered by the insurance. Our estimates are robust to alternative measures of informal care. The final chapter III examines the causal effect of subjective job insecurity on health, using pooled ordinary least squares (OLS), fixed-effects (FE) and instrumental variable (IV) specifications. The estimate implies that the negative impact of job insecurity is more pronounced for certain outcomes such as mental health and the emergence of new health conditions. Job insecurity provides a powerful prediction on subsequent job displacement and real income loss. Sub-population such as low-employability/better-educated individuals or males responds more to job insecurity than their counterparts.}, keywords = {0493:Aging, 0501:Economics, Aging, Economics, Health and environmental sciences, health outcomes, Healthcare, Job insecurity, Social Sciences}, isbn = {9781392227893}, url = {https://search.proquest.com/docview/2246502915?pq-origsite=gscholar}, author = {Nakamoto,Ichiro} } @article {10232, title = {Retirement and Health Investment Behaviors: An International Comparison}, number = {96133}, year = {2019}, month = {09/2019}, institution = {Munich Personal RePEc Archive Paper}, address = {Munich, Germany}, abstract = {This study aims to better understand the effects of retirement on health outcomes, which is of great interest worldwide, by examining the effects of retirement on health investment behaviors. To this end, we conducted a large-scale international comparison of the changes in health investment behaviors after retirement among the populations of seven developed countries using Global Aging Data, exploiting differences in the financial incentives in the pension systems of each country as our identification strategy. The results show that while elderly change their health investment behaviors in some way after retirement, the patterns of the changes in many health investment behaviors differ across each country. Further, a review of the literature and our results suggest that health investment behaviors are not necessarily determinants of the effects of retirement on health. }, keywords = {aging population, global aging data, health investment behaviors, health outcomes, Heterogeneity, Retirement}, url = {https://mpra.ub.uni-muenchen.de/96133/}, author = {Motegi, Hiroyuki and Nishimura, Yoshinori and Oikawa, Masato} } @mastersthesis {10269, title = {Muscle Weakness in Older Americans: Examining the Measurement, Health Outcomes and Life Course Determinants.}, volume = {PhD}, year = {2018}, month = {10/2018}, pages = {170}, school = {University of Michigan}, address = {Ann Arbor, MI}, abstract = {Muscle weakness, as measured by hand grip strength, has been shown to be an important indicator of future disability, chronic disease status and early mortality. While muscle weakness is considered an important prognostic indicator, how best to measure weakness, the long term health outcomes associated with muscle weakness across different sub-populations and the life course determinants remain poorly understood. Indeed, there is little agreement on how best to measure muscle weakness across different groups and how to screen for muscle weakness in order to prevent disability and premature mortality. We begin by first deriving cutpoints for muscle weakness in a nationally representative sample of older adults from the Health and Retirement Study. After using Classification and Regression Tree (CART) models to identify cutpoints, we found that fifty-five percent of men (max grip strength < 39kg) and 47\% of women (< 22kg) were classified as weak. Higher cutpoints were identified for Black males (< 40kg) and females (< 31kg), and the prevalence of weakness (57\% and 88\%, respectively), was higher compared to Whites. As an extension to these results, we examine the validity of these cutpoints in a longitudinal setting to determine whether muscle weakness is associated with disability dynamics and premature mortality. We found that clinical muscle weakness, as identified by sex/race specific population-derived cutpoints from Aim 1, is strongly associated with the onset, progression and persistence of physical disability status. The odds of experiencing an onset of ADL disability were 54\% higher among weak individuals compared those who were not weak at baseline. We also found that weak individuals had a steeper decline in their survival trajectory, compared to non-weak individuals. Specifically, weak individuals were over 50\% more likely to die earlier than non-weak individuals. Lastly, the third aim of this dissertation seeks to quantify and understand whether experiencing stressful and traumatic events across the life course influences trajectories of grip strength in later life. We found that life course trauma and stress experienced during emerging/early adulthood was associated with both mean grip strength at age 50 and trajectories of grip strength over time. Among Black men, stress and trauma experienced during emerging/early adulthood was not only related to higher mean grip strength at age 50, but also associated with steeper declines as individuals aged over time compare to White men. Among Black women, traumatic events during emerging/early adulthood were associated with lower mean grip strength at age 50. Taken together, the results of this dissertation chart new territory in its overall goal to improve the measurement of muscle health across the diverse, older adult population and in identifying those most at risk for future disability and premature mortality. This dissertation also demonstrates the importance of investigating how life course social exposures drive differential vulnerability to muscle weakness among older adults. The results of this dissertation can be used to inform clinical practice in screening adults for muscle weakness while also seeking to shift the distribution of muscle weakness at the population level in order to intervene among those who are most vulnerable.}, keywords = {health outcomes, Muscle Weakness, Older Adults, social epidemiology}, url = {https://deepblue.lib.umich.edu/handle/2027.42/145837}, author = {Kate A Duchowny} }