TY - JOUR T1 - Physical Activity as a Mediator between Race/Ethnicity and Changes in Multimorbidity. JF - The Journals of Gerontology, Series B Y1 - 2022 A1 - Jason T Newsom A1 - Denning, Emily C A1 - Elman, Miriam R A1 - Anda Botoseneanu A1 - Heather G. Allore A1 - Corey L Nagel A1 - David A Dorr A1 - Ana R Quiñones KW - Chronic illness KW - Disparities KW - Exercise AB -

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.

VL - 77 IS - 8 ER - TY - JOUR T1 - Racial and Ethnic Differences in Multimorbidity Changes Over Time. JF - Medical Care Y1 - 2021 A1 - Ana R Quiñones A1 - Jason T Newsom A1 - Elman, Miriam R A1 - Markwardt, Sheila A1 - Corey L Nagel A1 - David A Dorr A1 - Heather G. Allore A1 - Anda Botoseneanu KW - multimorbidity KW - race and ethnicity AB -

BACKGROUND: Our understanding of how multimorbidity progresses and changes is nascent.

OBJECTIVES: Assess multimorbidity changes among racially/ethnically diverse middle-aged and older adults.

DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study using latent class analysis to identify multimorbidity combinations over 16 years, and multinomial logistic models to assess change relative to baseline class membership. Health and Retirement Study respondents (age 51 y and above) in 1998 and followed through 2014 (N=17,297).

MEASURES: Multimorbidity latent classes of: hypertension, heart disease, lung disease, diabetes, cancer, arthritis, stroke, high depressive symptoms.

RESULTS: Three latent classes were identified in 1998: minimal disease (45.8% of participants), cardiovascular-musculoskeletal (34.6%), cardiovascular-musculoskeletal-mental (19.6%); and 3 in 2014: cardiovascular-musculoskeletal (13%), cardiovascular-musculoskeletal-metabolic (12%), multisystem multimorbidity (15%). Remaining participants were deceased (48%) or lost to follow-up (12%) by 2014. Compared with minimal disease, individuals in cardiovascular-musculoskeletal in 1998 were more likely to be in multisystem multimorbidity in 2014 [odds ratio (OR)=1.78, P<0.001], and individuals in cardiovascular-musculoskeletal-mental in 1998 were more likely to be deceased (OR=2.45, P<0.001) or lost to follow-up (OR=3.08, P<0.001). Hispanic and Black Americans were more likely than White Americans to be in multisystem multimorbidity in 2014 (OR=1.67, P=0.042; OR=2.60, P<0.001, respectively). Black compared with White Americans were more likely to be deceased (OR=1.62, P=0.01) or lost to follow-up (OR=2.11, P<0.001) by 2014.

CONCLUSIONS AND RELEVANCE: Racial/ethnic older adults are more likely to accumulate morbidity and die compared with White peers, and should be the focus of targeted and enhanced efforts to prevent and/or delay progression to more complex multimorbidity patterns.

VL - 59 IS - 5 ER - TY - JOUR T1 - Annual Wellness Visits and Influenza Vaccinations among Older Adults in the US. JF - Journal of Primary Care & Community Health Y1 - 2020 A1 - Jørgensen, Terese Sara Høj A1 - Heather G. Allore A1 - Elman, Miriam R A1 - Corey L Nagel A1 - Zhang, Mengran A1 - Markwardt, Sheila A1 - Ana R Quiñones KW - annual wellness visits KW - influenza vaccinations KW - machine learning methods KW - preventive healthcare utilization AB -

OBJECTIVES: Investigate whether combinations of sociodemographic factors, chronic conditions, and other health indicators pose barriers for older adults to access Annual Wellness Visits (AWVs) and influenza vaccinations.

METHODS: Data on 4999 individuals aged ≥65 years from the 2012 wave of the Health and Retirement Study linked with Medicare claims were analyzed. Conditional Inference Tree (CIT) and Random Forest (CIRF) analyses identified the most important predictors of AWVs and influenza vaccinations. Multivariable logistic regression (MLR) was used to quantify the associations.

RESULTS: Two-year uptake was 22.8% for AWVs and 65.9% for influenza vaccinations. For AWVs, geographical region and wealth emerged as the most important predictors. For influenza vaccinations, number of somatic conditions, race/ethnicity, education, and wealth were the most important predictors.

CONCLUSIONS: The importance of geographic region for AWV utilization suggests that this service was unequally adopted. Non-Hispanic black participants and/or those with functional limitations were less likely to receive influenza vaccination.

VL - 11 ER - TY - JOUR T1 - Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults. JF - PLoS One Y1 - 2019 A1 - Ana R Quiñones A1 - Anda Botoseneanu A1 - Markwardt, Sheila A1 - Corey L Nagel A1 - Jason T Newsom A1 - David A Dorr A1 - Heather G. Allore KW - Chronic conditions KW - Comorbidity KW - Racial/ethnic differences AB -

BACKGROUND: Multimorbidity-having two or more coexisting chronic conditions-is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies differences in rates of chronic disease accumulation and multimorbidity development among non-Hispanic white, non-Hispanic black, and Hispanic study participants starting in middle-age and followed up to 16 years.

METHODS AND FINDINGS: We analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly-available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic disease burden among 8,872 non-Hispanic black, non-Hispanic white, and Hispanic participants who were 51-55 years of age at their first interview any time during the study period (1998-2014) and all subsequent follow-up observations until 2014. Multimorbidity was defined as having two or more of seven somatic chronic diseases: arthritis, cancer, heart disease (myocardial infarction, coronary heart disease, angina, congestive heart failure, or other heart problems), diabetes, hypertension, lung disease, and stroke. We used negative binomial generalized estimating equation models to assess the trajectories of multimorbidity burden over time for non-Hispanic black, non-Hispanic white, and Hispanic participants. In covariate-adjusted models non-Hispanic black respondents had initial chronic disease counts that were 28% higher than non-Hispanic white respondents (IRR 1.279, 95% CI 1.201, 1.361), while Hispanic respondents had initial chronic disease counts that were 15% lower than non-Hispanic white respondents (IRR 0.852, 95% CI 0.775, 0.938). Non-Hispanic black respondents had rates of chronic disease accumulation that were 1.1% slower than non-Hispanic whites (IRR 0.989, 95% CI 0.981, 0.998) and Hispanic respondents had rates of chronic disease accumulation that were 1.5% faster than non-Hispanic white respondents (IRR 1.015, 95% CI 1.002, 1.028). Using marginal effects commands, this translates to predicted values of chronic disease for white respondents who begin the study period with 0.98 chronic diseases and end with 2.8 chronic diseases; black respondents who begin the study period with 1.3 chronic diseases and end with 3.3 chronic diseases; and Hispanic respondents who begin the study period with 0.84 chronic diseases and end with 2.7 chronic diseases.

CONCLUSIONS: Middle-aged non-Hispanic black adults start at a higher level of chronic disease burden and develop multimorbidity at an earlier age, on average, than their non-Hispanic white counterparts. Hispanics, on the other hand, accumulate chronic disease at a faster rate relative to non-Hispanic white adults. Our findings have important implications for improving primary and secondary chronic disease prevention efforts among non-Hispanic black and Hispanic Americans to stave off greater multimorbidity-related health impacts.

VL - 14 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/31206556?dopt=Abstract ER - TY - JOUR T1 - TRACKING CHANGES IN MULTIMORBIDITY AMONG RACIALLY AND ETHNICALLY DIVERSE POPULATIONS JF - Innovation in Aging Y1 - 2019 A1 - Ana R Quiñones A1 - Anda Botoseneanu A1 - Markwardt, Sheila A1 - Corey L Nagel A1 - Jason T Newsom A1 - David A Dorr A1 - Heather G. Allore KW - multimorbidity KW - race-ethnicity KW - Racial and ethnic differences AB - Multimorbidity is widely recognized as having adverse effects on health and wellbeing above and beyond the risk attributable to individual chronic disease. Much of what is known about multimorbidity rests on research that has largely focused on one point-in-time, or from a static perspective, with little consideration to issues involved in assessing longitudinal changes in multimorbidity. In addition, less focus has been placed on assessing racial and ethnic variations in longitudinal changes of multimorbidity. Addressing this knowledge gap, we highlight important issues and considerations in addressing multimorbidity research from a longitudinal perspective and present findings from longitudinal models that examine differences in the rate of chronic disease accumulation and multimorbidity onset between non-Hispanic white (white), non-Hispanic black (black), and Hispanic study participants in the Health and Retirement Study starting in middle-age and followed for up to 16 years. VL - 3 SN - 2399-5300 IS - Suppl 1 ER - TY - JOUR T1 - Socioeconomic stratification and multidimensional health trajectories: evidence of convergence in later old age. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2015 A1 - Xiao Xu A1 - Jersey Liang A1 - Joan M. Bennett A1 - Anda Botoseneanu A1 - Heather G. Allore KW - Aged KW - Aged, 80 and over KW - Aging KW - Cognition Disorders KW - Disabled Persons KW - Educational Status KW - Female KW - Health Status KW - Humans KW - Male KW - Social Class KW - United States AB -

OBJECTIVES: This research sought to examine socioeconomic stratification in the joint trajectories of physical, emotional, and cognitive functioning among older Americans and how it differs by age groups.

METHODS: We used data from a nationally representative sample of 9,237 Americans age 65 or older from the Health and Retirement Study, who were observed biennially from 1998 to 2010. Joint trajectories of physical, emotional, and cognitive functioning were characterized using a group-based mixture model. We then applied multinomial logistic regression analysis to evaluate their linkages with socioeconomic status and how the linkages differ by age groups.

RESULTS: We identified four distinct patterns of joint changes in physical, emotional, and cognitive functioning over time. Accounting for 29.3%, 23.5%, 24.5%, and 22.6% of the older Americans, respectively, these trajectory patterns characterized groups of individuals experiencing minimal to severe levels of impairment and deterioration. Lower education, income, and net worth were associated with trajectories featuring greater impairment or more rapid deterioration in these functional dimensions. Disparities based on education, however, attenuated in later old age, whereas health benefits associated with higher income and higher net worth persisted into advanced age.

DISCUSSION: Distinct patterns of joint trajectories of physical, emotional, and cognitive functioning exist in old age. There were significant socioeconomic differences in the joint trajectories, with education-based inequality in health converging in later old age. Further research identifying strategies to alleviate the disproportionate burden of poor multidimensional health trajectories in lower socioeconomic groups is important.

PB - 70 VL - 70 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2014/08/25/geronb.gbu095.abstract IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25161216?dopt=Abstract U2 - PMC4462671 U4 - Socioeconomic status/Joint trajectories/Elderly/Disability/Disability/Depression/Cognition. ER -