TY - JOUR T1 - Epigenetic-based age acceleration in a representative sample of older Americans: Associations with aging-related morbidity and mortality. JF - PNAS Y1 - 2023 A1 - Jessica Faul A1 - Jung K Kim A1 - Levine, Morgan E A1 - Bharat Thyagarajan A1 - David R Weir A1 - Eileen M. Crimmins KW - Acceleration KW - Aging KW - Biomarkers KW - Cross-Sectional Studies KW - DNA Methylation KW - Epigenesis KW - genetic AB -

Biomarkers developed from DNA methylation (DNAm) data are of growing interest as predictors of health outcomes and mortality in older populations. However, it is unknown how epigenetic aging fits within the context of known socioeconomic and behavioral associations with aging-related health outcomes in a large, population-based, and diverse sample. This study uses data from a representative, panel study of US older adults to examine the relationship between DNAm-based age acceleration measures in the prediction of cross-sectional and longitudinal health outcomes and mortality. We examine whether recent improvements to these scores, using principal component (PC)-based measures designed to remove some of the technical noise and unreliability in measurement, improve the predictive capability of these measures. We also examine how well DNAm-based measures perform against well-known predictors of health outcomes such as demographics, SES, and health behaviors. In our sample, age acceleration calculated using "second and third generation clocks," PhenoAge, GrimAge, and DunedinPACE, is consistently a significant predictor of health outcomes including cross-sectional cognitive dysfunction, functional limitations and chronic conditions assessed 2 y after DNAm measurement, and 4-y mortality. PC-based epigenetic age acceleration measures do not significantly change the relationship of DNAm-based age acceleration measures to health outcomes or mortality compared to earlier versions of these measures. While the usefulness of DNAm-based age acceleration as a predictor of later life health outcomes is quite clear, other factors such as demographics, SES, mental health, and health behaviors remain equally, if not more robust, predictors of later life outcomes.

VL - 120 IS - 9 ER - TY - JOUR T1 - Racial/Ethnic Differences in Biological Aging and Their Life Course Socioeconomic Determinants: The 2016 Health and Retirement Study. JF - Journal of Aging and Health Y1 - 2023 A1 - Farina, Mateo P A1 - Jung K Kim A1 - Eileen M. Crimmins KW - accelerated biological aging KW - racial/ethnic disparities AB -

This study examined differences in accelerated biological aging among non-Hispanic Blacks, Hispanics, and non-Hispanic Whites in the United States and assessed whether including life course socioeconomic conditions attenuated observed racial/ethnic differences. Data came from the Venous Blood Collection Subsample of the Health and Retirement Study. We used a comprehensive summary measure of biological age (BA-22). We determined whether key lifetime socioeconomic conditions contributed to racial/ethnic differences in biological aging. Findings indicated that non-Hispanic Blacks and Hispanics have accelerated aging, and non-Hispanic Whites have decelerated aging. Racial/ethnic differences were strongly tied to educational attainment. We also observed a significant difference by birthplace for Hispanics. US-born Hispanics had accelerated biological aging, whereas foreign-born Hispanics did not. In age-stratified analyses, these racial/ethnic differences were found for adults aged 56-74, but not for adults aged 75+. These findings provide insight into biological differences underlying racial/ethnic disparities in health.

ER - TY - JOUR T1 - Accelerated epigenetic aging mediates link between adverse childhood experiences and depressive symptoms in older adults: Results from the Health and Retirement Study. JF - SSM Population Health Y1 - 2022 A1 - Klopack, Eric T A1 - Eileen M. Crimmins A1 - Cole, Steve W A1 - Seeman, Teresa E A1 - Carroll, Judith E KW - ACEs KW - Adverse childhood events KW - Ageing KW - depression KW - Epigenetic aging AB -

Adverse childhood experiences (ACEs) increase risk for depression at subsequent ages and have been linked to accelerated biological aging. We hypothesize that accelerated epigenetic aging may partially mediate the link between ACEs and depression. This study examines 3 three second-generation epigenetic aging measures (viz., GrimAge, PhenoAge, and DunedinPoAm38) as mediators of the link between ACEs and depressive symptoms in older adulthood. We utilize structural equation modeling to assess mediation in the Health and Retirement Study (N = 2672). Experiencing ACEs is significantly associated with an older GrimAge and a faster pace of aging via the DunedinPoAm38. Having an older GrimAge and faster DunedinPoAm38 pace of aging were also significantly associated with more depressive symptoms. PhenoAge was not significantly associated with depressive symptoms and was only associated with experiencing three ACEs. These associations were reduced by socioeconomic and lifestyle factors, including obesity and substance use. GrimAge explained between 9 and 14% of the association between ACEs and adult depressive symptoms, and DunedinPoAm38 explained between 2 and 7% of the association between ACEs and adult depressive symptoms. Findings indicate accelerated aging, as measured by GrimAge and DunedinPoAm38, is associated with ACEs and with depressive symptoms in older Americans. Findings also show these epigenetic aging measures mediate a portion of the association between ACEs and adult depressive symptoms. Epigenetic aging may represent a physiological mechanism underlying the link between early life adversity and adult depression. Weight maintenance and substance use are potentially important areas for intervention.

VL - 17 ER - TY - JOUR T1 - Age-related differences in T cell subsets in a nationally representative sample of people over age 55: Findings from the Health and Retirement Study. JF - The Journals of Gerontology, Series A Y1 - 2022 A1 - Bharat Thyagarajan A1 - Jessica Faul A1 - Vivek, Sithara A1 - Jung K Kim A1 - Nikolich-Žugich, Janko A1 - David R Weir A1 - Eileen M. Crimmins KW - Aging KW - CMV Seropositivity AB -

Though T cell immunosenescence is a major risk factor for age-related diseases, susceptibility to infections, and responses to vaccines, differences in T cells subset counts and representation by age and sex have not been determined for a large sample representative of the national population of the US. We evaluated the counts of T cell subsets including total, CD4+ and CD8+ T cells, and their naïve (Tn), effector memory (Tem) and effector subsets, in the context of age, sex and exposure to cytomegalovirus (CMV) infection among 8,848 Health and Retirement Study (HRS) participants, a nationally representative study of adults over 55 years. Total T cells (CD3+) and CD4+ cells declined markedly with age; CD8+ T cells declined somewhat less. While CD4+ T cell declines with age occurred for both CMV seropositive and CMV seronegative groups, total T cells and CD8+ cells were both substantially higher among the CMV seropositive group. Numbers of Tn CD4+ and CD8+ cells were strongly and inversely related to age, were better conserved among women, and were independent of CMV seropositivity. By contrast, accumulation of the CD8+ and CD4+ Tem and effector subsets was CMV-associated. This is the first study to provide counts of T cell subsets by age and sex in a national sample of older US adults over the age of 55 years. Understanding T cell changes with age and sex is an important first step in determining strategies to reduce its impact on age-related diseases and susceptibility to infection.

VL - 77 IS - 5 ER - TY - JOUR T1 - A computational solution for bolstering reliability of epigenetic clocks: implications for clinical trials and longitudinal tracking JF - Nature Aging Y1 - 2022 A1 - Higgins-Chen, Albert T. A1 - Thrush, Kyra L. A1 - Wang, Yunzhang A1 - Minteer, Christopher J. A1 - Kuo, Pei-Lun A1 - Wang, Meng A1 - Niimi, Peter A1 - Sturm, Gabriel A1 - Lin, Jue A1 - Ann Zenobia Moore A1 - Bandinelli, Stefania A1 - Vinkers, Christiaan H. A1 - Vermetten, Eric A1 - Rutten, Bart P. F. A1 - Geuze, Elbert A1 - Okhuijsen-Pfeifer, Cynthia A1 - van der Horst, Marte A1 - Schreiter, Stefanie A1 - Gutwinski, Stefan A1 - Luykx, Jurjen J. A1 - Picard, Martin A1 - Ferrucci, Luigi A1 - Eileen M. Crimmins A1 - Boks, Marco P. A1 - Hägg, Sara A1 - Hu-Seliger, Tina T. A1 - Morgan E. Levine KW - Aging KW - Bioinformatics KW - computational models KW - DNA Methylation KW - predictive markers AB - Epigenetic clocks are widely used aging biomarkers calculated from DNA methylation data, but this data can be surprisingly unreliable. Here we show that technical noise produces deviations up to 9 years between replicates for six prominent epigenetic clocks, limiting their utility. We present a computational solution to bolster reliability, calculating principal components (PCs) from CpG-level data as input for biological age prediction. Our retrained PC versions of six clocks show agreement between most replicates within 1.5 years, improved detection of clock associations and intervention effects, and reliable longitudinal trajectories in vivo and in vitro. This method entails only one additional step compared to traditional clocks, requires no replicates or previous knowledge of CpG reliabilities for training, and can be applied to any existing or future epigenetic biomarker. The high reliability of PC-based clocks is critical for applications to personalized medicine, longitudinal tracking, in vitro studies and clinical trials of aging interventions. VL - 2 ER - TY - JOUR T1 - Cross sectional association between cytomegalovirus seropositivity, inflammation and cognitive impairment in elderly cancer survivors. JF - Cancer Causes & Control Y1 - 2022 A1 - Vivek, Sithara A1 - Heather Hammond Nelson A1 - Anna Prizment A1 - Jessica Faul A1 - Eileen M. Crimmins A1 - Bharat Thyagarajan KW - Cancer survivor KW - CMV Seropositivity KW - Dementia KW - Inflammation AB -

PURPOSE: The higher prevalence of cognitive impairment/ dementia among cancer survivors is likely multifactorial. Since both exposures to cytomegalovirus (CMV) and inflammation are common among elderly cancer survivors, we evaluated their contribution towards dementia.

METHODS: Data from 1387 cancer survivors and 7004 participants without cancer in the 2016 wave of the Health and Retirement Study (HRS) was used in this study. Two inflammatory biomarkers, C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR), were used to create an inflammation score. We used survey logistic regression adjusted for survey design parameters.

RESULTS: CMV seropositivity was not associated with cognitive impairment among cancer survivors (p = 0.2). In addition, inflammation was associated with elevated odds of cognitive impairment (OR = 2.2, 95% CI [1.2, 4.2]). Cancer survivors who were both CMV seropositive and had increased inflammation had the highest odds of cognitive impairment compared to those who were CMV seronegative and had low inflammation (OR = 3.8, 95% CI [1.5, 9.4]). The stratified analysis among cancer survivors showed this association was seen only among cancer survivors in whom the cancer was diagnosed within three years of measurement of inflammation score and CMV serostatus (OR = 18.5; 95% CI [6.1, 56.1]).

CONCLUSION: The CMV seropositivity and high inflammation was associated with higher cognitive impairment among cancer survivors. The stronger associations seen among cancer survivors diagnosed within the last three years suggest that strategies to reduce CMV activation and inflammation during or immediately after cancer treatment may be important in reducing the prevalence of cognitive impairment/ dementia among cancer survivors.

VL - 33 IS - 1 ER - TY - JOUR T1 - Do Early-Life Social, Behavioral, and Health Exposures Increase Later-Life Arthritis Incidence? JF - Research on Aging Y1 - 2022 A1 - Blakelee R Kemp A1 - Kenneth F Ferraro A1 - Patricia M Morton A1 - Thomas, Patricia A A1 - Sarah A Mustillo A1 - Eileen M. Crimmins KW - Adverse Childhood Experiences KW - Body Mass Index KW - Cumulative inequality theory KW - Osteoarthritis KW - rheumatoid arthritis AB -

OBJECTIVES: This study investigates direct and indirect influences of childhood social, behavioral, and health exposures on later-life osteoarthritis and rheumatoid arthritis development.

METHODS: Drawing from cumulative inequality theory and six waves of the Health and Retirement Study (2004-2014), we estimate structural equation modeling-based discrete-time survival analysis of the association between six childhood exposure domains and both osteoarthritis and rheumatoid arthritis incidence for men ( = 2720) and women ( = 2974). Using the delta method to test for mediation, we examine indirect effects via selected health-related risks and resources.

RESULTS: Risky adolescent behavior is associated with rheumatoid arthritis incidence for women (h.O.R. = 1.883, 95% C.I. [1.016, 3.490]), whereas several types of childhood exposures are associated with later-life osteoarthritis development for both men and women. Experiencing two or more childhood socioeconomic disadvantages is indirectly associated with osteoarthritis (men: coef. = 0.024, 95% C.I. [0.003, 0.045]; women: coef. = 0.111, 95% C.I. [0.071, 0.150]) and rheumatoid arthritis (men: coef. = 0.037, 95% C.I. [0.000, 0.074]; women: coef. = 0.097, 95% C.I. [0.035, 0.159]) development through adult body mass index.

DISCUSSION: Findings highlight the importance of childhood contexts in understanding the development of later-life osteoarthritis and rheumatoid arthritis.

VL - 44 IS - 7-8 ER - TY - JOUR T1 - Evaluation of T-cell aging-related immune phenotypes in the context of biological aging and multimorbidity in the Health and Retirement Study. JF - Immunity & Ageing Y1 - 2022 A1 - Ramasubramanian, Ramya A1 - Meier, Helen C S A1 - Vivek, Sithara A1 - Klopack, Eric A1 - Eileen M. Crimmins A1 - Jessica Faul A1 - Nikolich-Žugich, Janko A1 - Bharat Thyagarajan KW - Adaptive immunity KW - biological aging KW - immune aging KW - multimorbidity AB -

BACKGROUND: Cellular changes in adaptive immune system accompany the process of aging and contribute to an aging-related immune phenotype (ARIP) characterized by decrease in naïve T-cells (T) and increase in memory T-cells (T). A population-representative marker of ARIP and its associations with biological aging and age-related chronic conditions have not been studied previously.

METHODS: We developed two ARIP indicators based on well understood age-related changes in T cell distribution: T/(T (Central Memory) + T (Effector Memory) + T (Effector)) (referred as T/T) in CD4 + and CD8 + T-cells. We compared them with existing ARIP measures including CD4/CD8 ratio and CD8 + TN cells by evaluating associations with chronological age and the Klemera Doubal measure of biological age (measured in years) using linear regression, multimorbidity using multinomial logistic regression and two-year mortality using logistic regression.

RESULTS: CD8 + T and CD8 + T/T had the strongest inverse association with chronological age (beta estimates: -3.41 and -3.61 respectively; p-value < 0.0001) after adjustment for sex, race/ethnicity and CMV status. CD4 + T/T and CD4 + T had the strongest inverse association with biological age (β = -0.23; p = 0.003 and β = -0.24; p = 0.004 respectively) after adjustment for age, sex, race/ethnicity and CMV serostatus. CD4/CD8 ratio was not associated with chronological age or biological age. CD4 + T/T and CD4 + T was inversely associated with multimorbidity. For CD4 + T/T, people with 2 chronic conditions had an odds ratio of for 0.74 (95%CI: 0.63-0.86 p = 0.0003) compared to those without any chronic conditions while those with 3 chronic conditions had an odds ratio of 0.75 (95% CI: 0.63-0.90; p = 0.003) after adjustment for age, sex, race/ethnicity, CMV serostatus, smoking, and BMI. The results for the CD4 + T subset were very similar to the associations seen with the CD4 + T/T. CD4 + T/T and CD4 + T were both associated with two-year mortality (OR = 0.80 (95% CI: 0.67-0.95; p = 0.01) and 0.81 (0.70-0.94; p = 0.01), respectively).

CONCLUSION: CD4 + T/T and CD4 + T had a stronger association with biological age, age-related morbidity and mortality compared to other ARIP measures. Future longitudinal studies are needed to evaluate the utility of the CD4 + subsets in predicting the risk of aging-related outcomes.

VL - 19 IS - 1 ER - TY - JOUR T1 - Food insecurity, food environments, and disparities in diet quality and obesity in a nationally representative sample of community-dwelling older Americans. JF - Preventive Medicine Reports Y1 - 2022 A1 - Choi, Yeon Jin A1 - Eileen M. Crimmins A1 - Jennifer A Ailshire KW - diet quality KW - Food access KW - Healthy Eating Index KW - Obesity risk KW - Social and environmental factors AB -

Food insecurity, reflecting a household's low ability to purchase healthy food, is a public health concern that is associated with poor diet and obesity. Poor food environments, characterized as a neighborhood with low access to healthy, affordable food, may amplify the negative impact of food insecurity on diet and obesity. This study aims to investigate whether food insecurity and food environments are jointly associated with an increased risk of poor diet quality and obesity. We used data from a nationally representative sample of community-dwelling older adults in the Health and Retirement Study Health Care and Nutrition Survey and the National Neighborhood Data Archive to investigate the role of household and neighborhood characteristics on diet and obesity. Weighted regression models were estimated to examine the relationship between food insecurity and food environments as well as their interaction with diet quality and obesity. Food insecure respondents had lower Healthy Eating Index scores and were more likely to be obese than food secure respondents. Living in a poor food environment was associated with lower Healthy Eating Index scores, but not with obesity. We did not find any interaction between food insecurity and food environment in determining either healthy eating or obesity. Reducing food insecurity and increasing access to healthy food environments may encourage healthier eating among older adults, while alleviating food-related hardship may also reduce their obesity risk.

VL - 29 ER - TY - JOUR T1 - Genetic variation in ALDH4A1 is associated with muscle health over the lifespan and across species. JF - Elife Y1 - 2022 A1 - Villa, Osvaldo A1 - Stuhr, Nicole L A1 - Yen, Chia-An A1 - Eileen M. Crimmins A1 - Arpawong, Thalida Em A1 - Curran, Sean P KW - C. elegans KW - evolutionary biology KW - Genetics KW - Genomics AB -

The influence of genetic variation on the aging process, including the incidence and severity of age-related diseases, is complex. Here we define the evolutionarily conserved mitochondrial enzyme ALH-6/ALDH4A1 as a predictive biomarker for age-related changes in muscle health by combining genetics and a gene-wide association scanning (GeneWAS) from older human participants of the US Health and Retirement Study (HRS). In a screen for mutations that activate oxidative stress responses, specifically in the muscle of , we identified 96 independent genetic mutants harboring loss-of-function alleles of , exclusively. Each of these genetic mutations mapped to the ALH-6 polypeptide and led to the age-dependent loss of muscle health. Intriguingly, genetic variants in show associations with age-related muscle-related function in humans. Taken together, our work uncovers mitochondrial as a critical component to impact normal muscle aging across species and a predictive biomarker for muscle health over the lifespan.

VL - 11 ER - TY - JOUR T1 - Genetic variation in ALDH4A1 predicts muscle health over the lifespan and across species JF - Elife Y1 - 2022 A1 - Villa, Osvaldo A1 - Stuhr, Nicole L. A1 - Yen, Chia-An A1 - Eileen M. Crimmins A1 - Thalida E. Arpawong A1 - Curran, Sean P. KW - Genetic Variation KW - muscle health AB - Environmental stress can negatively impact organismal aging, however, the long-term impact of endogenously derived reactive oxygen species from normal cellular metabolism remains less clear. Here we define the evolutionarily conserved mitochondrial enzyme ALH-6/ALDH4A1 as a biomarker for age-related changes in muscle health by combining C. elegans genetics and a gene-wide association study (GeneWAS) from aged human participants of the US Health and Retirement Study (HRS)1–4. In a screen for mutations that activate SKN-1-dependent oxidative stress responses in the muscle of C. elegans5–7, we identified 96 independent genetic mutants harboring loss-of-function alleles of alh-6, exclusively. These genetic mutations map across the ALH-6 polypeptide, which lead to age-dependent loss of muscle health. Intriguingly, genetic variants in ALDH4A1 differentially impact age-related muscle function in humans. Taken together, our work uncovers mitochondrial alh-6/ALDH4A1 as a critical component of normal muscle aging across species and a predictive biomarker for muscle health over the lifespan.Competing Interest StatementThe authors have declared no competing interest. VL - 11 IS - e74308 ER - TY - JOUR T1 - Lifetime exposure to smoking, epigenetic aging, and morbidity and mortality in older adults. JF - Clinical Epigenetics Y1 - 2022 A1 - Klopack, Eric T A1 - Carroll, Judith E A1 - Cole, Steve W A1 - Seeman, Teresa E A1 - Eileen M. Crimmins KW - DNA Methylation KW - Epigenesis KW - genetic KW - Morbidity KW - Smoking KW - Tobacco KW - Venous Blood Study AB -

BACKGROUND: Cigarette smoke is a major public health concern. Epigenetic aging may be an important pathway by which exposure to cigarette smoke affects health. However, little is known about how exposure to smoke at different life stages affects epigenetic aging, especially in older adults. This study examines how three epigenetic aging measures (GrimAge, PhenoAge, and DunedinPoAm38) are associated with parental smoking, smoking in youth, and smoking in adulthood, and whether these epigenetic aging measures mediate the link between smoke exposure and morbidity and mortality. This study utilizes data from the Health and Retirement Study (HRS) Venous Blood Study (VBS), a nationally representative sample of US adults over 50 years old collected in 2016. 2978 participants with data on exposure to smoking, morbidity, and mortality were included.

RESULTS: GrimAge is significantly increased by having two smoking parents, smoking in youth, and cigarette pack years in adulthood. PhenoAge and DunedinPoAm38 are associated with pack years. All three mediate some of the effect of pack years on cancer, high blood pressure, heart disease, and mortality and GrimAge and DunedinPoAm38 mediate this association on lung disease.

CONCLUSIONS: Results suggest epigenetic aging is one biological mechanism linking lifetime exposure to smoking with development of disease and earlier death in later life. Interventions aimed at reducing smoking in adulthood may be effective at weakening this association.

VL - 14 IS - 1 ER - TY - JOUR T1 - Links between inflammation and immune functioning with cognitive status among older Americans in the Health and Retirement Study. JF - Brain, Behavior, & Immunity - Health Y1 - 2022 A1 - Farina, Mateo P A1 - Jung K Kim A1 - Hayward, Mark D A1 - Eileen M. Crimmins KW - Biomarkers KW - Dementia KW - immune functioning KW - Inflammation AB -

Elevated inflammation and poor immune functioning are tied to worse cognitive health. Both processes are fundamental to aging and are strongly implicated in the development of age-related health outcomes, including cognitive status. However, results from prior studies evaluating links between indicators of inflammation and immune function and cognitive impairment have been inconsistent due to biomarker selection, sample selection, and cognitive outcome. Using the Health and Retirement Study (HRS), a nationally representative study of older adults in the United States, we assessed how indicators of inflammation (neutrophil-lymphocyte ratio (NLR), albumin, CRP, IL6, IL10, IL-1Ra, sTNFR1, and TGFβ1) and immune functioning (CMV, CD4 T/T and CD8 T/T) are associated with cognitive status. First, to examine the association between each biomarker and cognitive status, we tested whether markers of inflammation and immune functioning varied across cognitive status categories. We found that dementia and cognitive impairment without dementia (CIND) were associated with elevated inflammation and poorer immune functioning across biomarkers except for CD4 T/T. Next, we estimated multinomial logistic regression models to assess which biomarkers would continue to be associated with dementia and CIND, net of each other. In these models, albumin, cytokines, CMV, CD4 T/T and CD8 T/T are associated with cognitive status. Because poor immune functioning and increased inflammation are associated with cognitive impairment, improving immune functioning and reducing inflammation may provide a mechanism for reducing ADRD risk in the population.

VL - 26 ER - TY - JOUR T1 - Mortality and morbidity in ageing men: Biology, Lifestyle and Environment. JF - Reviews in Endocrine and Metabolic Disorders Y1 - 2022 A1 - Zhao, Erfei A1 - Eileen M. Crimmins KW - Cholesterol KW - Diabetes KW - Epigenetic aging KW - gender KW - Heart disease KW - Hypertension KW - Life Expectancy KW - sex KW - Stroke AB -

Males live shorter lives than women in all countries. The universality of shorter male life expectancy is a 21st Century phenomena. It occurs with the decline in infectious diseases and the rise in cardiovascular diseases accounting for mortality. Male/female differences in morbidity are not as succinctly characterized. Men have a higher prevalence of lethal diseases, which is linked to their lower life expectancy. Women have more non-lethal conditions such as depression and arthritis; which may also be linked in part to longer survival. Men have better physical functioning and less disability which is partly explained by gender differences in diseases and also by their greater strength, size, and stamina. Gender differences in risk factors for disease have changed over time with the prevalence and treatment of risk as well as differential behavior by gender. Examination of what are seen as basic molecular and cellular measures related to aging indicates men age faster than women; however, even these basic biological measures result from a combination of biology, behavior, and social factors.

VL - 23 IS - 6 ER - TY - JOUR T1 - The role of cohabitation on adaptive and innate immune cell profiles in the Health and Retirement Study JF - American Journal of Clinical Pathology Y1 - 2022 A1 - Ramasubramanian, Ramya A1 - Meier, Helen A1 - Eileen M. Crimmins A1 - Jessica Faul A1 - Bharat Thyagarajan KW - adaptive immune cells KW - Cohabitation KW - Households AB - Immune cells distribution is shaped by numerous factors including environmental factors, age, and genetics. Cohabitation has been associated with similar microbiomes, possibly due to dietary patterns and exposure to similar pathogens but has not been studied in the context of adaptive and innate immune systems previously. We used immunophenotyping data of 2283 households with participants living in the same household and compared it to 2283 randomly generated pairs of participants from the Health and Retirement study. The adaptive immune cells (subsets of T-cells and B-cells), and innate immune cells (monocytes, natural killer cells, and neutrophils) were compressed to two coordinates using multidimensional scaling. The Euclidean distances between participants in the same household were compared to the distances between the random pairs of participants using two sample independent t-tests. The mean distances of the immune coordinate points for adaptive immune cells between participants in the same household were lower than the randomly paired participants (p-value < 0.0001) and the variability of intra-household distances was lower than the random pairs (IQR: 7.18 vs 8.99). For the innate immune cells, the mean distances between participants in the same household were slightly lower than the randomly paired participants (p-value = 0.03) but the variability of the intra-household distances was higher than the random pairs (IQR: 4.08 vs 3.65). Variability in the adaptive immune system among participants living in the same household were substantially lower indicating the influence of shared environmental conditions in determining the adaptive immune profiles. VL - 158 ER - TY - JOUR T1 - Social stressors associated with age-related T lymphocyte percentages in older US adults: Evidence from the US Health and Retirement Study. JF - Proceedings of the National Academy of Sciences Y1 - 2022 A1 - Klopack, Eric T A1 - Eileen M. Crimmins A1 - Cole, Steve W A1 - Seeman, Teresa E A1 - Carroll, Judith E KW - Aging KW - Immunosenescence KW - socioeconomic status KW - Stress AB -

Exposure to stress is a risk factor for poor health and accelerated aging. Immune aging, including declines in naïve and increases in terminally differentiated T cells, plays a role in immune health and tissue specific aging, and may contribute to elevated risk for poor health among those who experience high psychosocial stress. Past data have been limited in estimating the contribution of life stress to the development of accelerated immune aging and investigating mediators such as lifestyle and cytomegalovirus (CMV) infection. This study utilizes a national sample of 5,744 US adults over age 50 to assess the relationship of social stress (viz., everyday discrimination, stressful life events, lifetime discrimination, life trauma, and chronic stress) with flow cytometric estimates of immune aging, including naïve and terminally differentiated T cell percentages and the ratio of CD4 to CD8 cells. Experiencing life trauma and chronic stress was related to a lower percentage of CD4 naïve cells. Discrimination and chronic stress were each associated with a greater percentage of terminally differentiated CD4 cells. Stressful life events, high lifetime discrimination, and life trauma were related to a lower percentage of CD8 naïve cells. Stressful life events, high lifetime discrimination, and chronic stress were associated with a higher percentage of terminally differentiated CD8 cells. High lifetime discrimination and chronic stress were related to a lower CD4:CD8 ratio. Lifestyle factors and CMV seropositivity partially reduced these effects. Results identify psychosocial stress as a contributor to accelerating immune aging by decreasing naïve and increasing terminally differentiated T cells.

VL - 119 IS - 25 ER - TY - JOUR T1 - Trends in Dementia Prevalence, Incidence, and Mortality in the United States (2000-2016). JF - Journal of Aging and Health Y1 - 2022 A1 - Mateo P Farina A1 - Yuan S Zhang A1 - Jung K Kim A1 - Mark D Hayward A1 - Eileen M. Crimmins KW - dementia incidence KW - educational composition AB -

The prevalence of dementia has declined in the United States; how this parallels to changes in incidence and mortality, and how improvements in educational attainment may have influences these trends, is not known. Using the Health and Retirement Study (2000-2016), we estimated logistic regression models to examine trends in dementia prevalence and incidence, and mortality for those with and without dementia. The relative decline was about 2.4% per year for dementia prevalence and 1.9% for dementia incidence. Mortality declined similarly for those with and without dementia. Improved educational attainment accounted for decline in incidence, some of the decline in prevalence, and had a negligible role in mortality. The declines in dementia incidence provide evidence that dementia prevalence should continue to decline in the near future. These declines are most likely largely driven by continued improvements in older adult education.

VL - 34 IS - 1 ER - TY - JOUR T1 - Association of GrimAge DNA methylation components and 2-year mortality in the Health and Retirement Study JF - Innovation in Aging Y1 - 2021 A1 - Meier, Helen A1 - Colter Mitchell A1 - Eileen M. Crimmins A1 - Bharat Thyagarajan A1 - Jessica Faul KW - 2-year mortality KW - DNA Methylation KW - GrimAge AB - DNA methylation (DNAm) patterns related to age and aging phenotypes (i.e., epigenetic clocks) are of growing interest as indicators of biological age and risk of negative health outcomes. We investigated associations between the components of GrimAge, an epigenetic clock estimated from DNAm patterns for seven blood protein levels and smoking pack years, and 2-year mortality in the Health and Retirement Study (HRS) to determine if any of the DNAm subcomponents were driving observed associations. A representative subsample of individuals who participated in the HRS 2016 Venus Blood Study were included in this analysis (N=3430). DNAm was measured with the Infinium Methylation EPIC BeadChip. Deaths that occurred between 2016 and 2018 contributed to 2-year mortality estimates (N=159, 4.5% of the sample). Weighted logistic regression estimated the association first between GrimAge and 2-year mortality and second between the DNAm subcomponents and 2-year mortality. All models were adjusted for age, sex, race/ethnicity, education, current smoking status, smoking pack years and cell composition of the biological sample. The average GrimAge for participants with and without 2-year mortality was 77 years 68 years respectively. A one-year increase in GrimAge was associated with 17% higher odds of 2-year mortality (95% CI: 1.16, 1.17). Two of the seven DNAm blood protein subcomponents of GrimAge (TIMP metallopeptidase inhibitor 1, adrenomedullin) and DNAm smoking pack years were associated with 2-year mortality and DNAm smoking pack years appeared to drive the overall GrimAge association with 2-year mortality. GrimAge was a better predictor of 2-year mortality than the DNAm subcomponents individually. VL - 5 IS - Suppl _1 ER - TY - JOUR T1 - Associations of Age, Sex, Race/Ethnicity and Education with 13 Epigenetic Clocks in a Nationally Representative US Sample: The Health and Retirement Study. JF - The Journals of Gerontology: Series A Y1 - 2021 A1 - Eileen M. Crimmins A1 - Bharat Thyagarajan A1 - Morgan E. Levine A1 - David R Weir A1 - Jessica Faul KW - DNA Methylation KW - DunedinPoAm38 KW - Epigenetic Age KW - GrimAge KW - PhenoAgeAcceleration AB -

BACKGROUND: Many DNA methylation based indicators have been developed as summary measures of epigenetic aging. We examine the associations between 13 epigenetic clocks, including 4 second generation clocks, as well as the links of the clocks to social, demographic and behavioral factors known to be related to health outcomes: sex, race/ethnicity, socioeconomic status, obesity and lifetime smoking pack years.

METHODS: The Health and Retirement Study is the data source which is a nationally representative sample of Americans over age 50. Assessment of DNA methylation was based on the EPIC chip and epigenetic clocks were developed based on existing literature.

RESULTS: The clocks vary in the strength of their relationships with age, with each other and with independent variables. Second generation clocks trained on health related characteristics tend to relate more strongly to the sociodemographic and health behaviors known to be associated with health outcomes in this age group.

CONCLUSIONS: Users of this publicly available data set should be aware that epigenetic clocks vary in their relationships to age and to variables known to be related to the process of health change with age.

VL - 76 IS - 6 ER - TY - JOUR T1 - Cardiometabolic Risk Trajectory among Older Americans: Findings from the Health and Retirement Study. JF - The Journals of Gerontology, Series A Y1 - 2021 A1 - Wu, Qiao A1 - Jennifer A Ailshire A1 - Jung K Kim A1 - Eileen M. Crimmins KW - cardiovascular KW - Change with age KW - Medication KW - Metabolism AB -

BACKGROUND: Cardiometabolic risk (CMR) is a key indicator of physiological decline with age; but age-related declines in a nationally representative older U.S. population have not been previously examined.

METHODS: We examined the trajectory of cardiometabolic risk (CMR) over 8 years of aging, from 2006/2008 to 2014/2016, among 3,528 people over age 50 in the Health and Retirement Study. We used growth curve models to examine change in total CMR as well as in individual cardiometabolic biomarkers to understand how baseline differences and rates of change vary across sociodemographic characteristics, by smoking status, and medication use.

RESULTS: Total CMR did not change among respondents who survived over 8 years. Despite significant differences in CMR across demographic and education groups at baseline, the pace of change with age did not differ by these characteristics. Among individual biomarkers, risk levels of diastolic blood pressure, resting heart rate, and total cholesterol decreased over 8 years while glycosylated hemoglobin, waist circumference, and pulse pressure increased over that time. Both the statistical significance levels and the magnitudes of the reduction over time with age in diastolic blood pressure, resting heart rate, and total cholesterol in models adjusted for age, race/ethnicity, gender, smoking, and education were reduced after controlling for blood pressure and cholesterol medication.

CONCLUSIONS: The relatively constant total CMR level over 8 years occurred because some indicators improved with age while some deteriorated in this period. Medication use contributed to the improvement in blood pressure, resting heart rate, and total cholesterol.

VL - 76 IS - 12 ER - TY - JOUR T1 - Epigenome Wide Associations of Smoking Behavior in the Health and Retirement Study JF - Innovation in Aging Y1 - 2021 A1 - Fisher, Jonah A1 - Meier, Helen A1 - Jessica Faul A1 - Colter Mitchell A1 - Eileen M. Crimmins A1 - Bharat Thyagarajan KW - DNA Methylation KW - epigenome-wide association studies KW - Smoking AB - DNA methylation (DNAm) is an increasingly popular biomarker of health and aging outcomes. Smoking behaviors have a significant and well documented correlation with methylation signatures within the epigenome and are important confounding variables to account for in epigenome-wide association studies (EWAS). However, the common classification of individuals as ‘current’, ‘former’, and ‘never’ smokers may miss crucial DNAm patterns associated with other smoking behaviors such as duration, intensity, and frequency of cigarette smoking, resulting in an underestimation of the contribution of smoking behaviors to DNAm and potentially biasing EWAS results. We investigated associations between multiple smoking behavioral phenotypes (smoking pack years, smoking duration, smoking start age, and smoking end age) and single site DNAm using linear regressions adjusting for age, sex, race/ethnicity, education, and cell-type proportions in a subsample of individuals who participated in the HRS 2016 Venous Blood Study (N=1,775). DNAm was measured using the Infinium Methylation EPIC BeadChip. All 4 phenotypes had significant associations (FDR < 0.05) with many methylation sites (packyears=6859, smoking duration=6572, start age=11374, quit age=773). There was not much overlap in DNAm sites between the full set of models with only 6 overlapping between all 4. However, the phenotypes packyears and smoking duration showed large overlap (N=3782). Results suggest additional smoking phenotypes beyond current/former/never smoker classification should be included in EWAS analyses to appropriately account for the influence of smoking behaviors on DNAm. VL - 5 IS - Suppl _1 ER - TY - JOUR T1 - Food and Nutrient Intake and Diet Quality among Older Americans JF - Public Health Nutrition Y1 - 2021 A1 - Choi, Yeon Jin A1 - Eileen M. Crimmins A1 - Jung K Kim A1 - Jennifer A Ailshire KW - diet quality KW - food KW - Nutrients AB - A suboptimal diet and nutritional deficiencies can have important influences on health with significant impact among older adults. This study aims to assess the presence of suboptimal dietary intake among older Americans and identify risk and protective factors influencing diet quality. For this study, data from a nationally representative sample of 5,614 community-dwelling older adults over age 54 in the Health and Retirement Study – Health Care and Nutrition Survey were used. Descriptive analyses were conducted to assess average intake of 17 food groups and nutrients and the percentage of respondents who consumed an optimal amount of food and nutrients. Differences in diet quality by sociodemographic, psychosocial, environmental, and geographic factors were assessed using chi-square and OLS regression was used to identify risk and protective factors for good quality diet. Overall, only 10.7% of respondents had a good quality diet (HEI score 81 and above); the majority had diets considered poor or needing improvement. Less than 50% of respondents met dietary guidelines and nutritional goals for most individual food groups and nutrients. Respondents with low socioeconomic status, fewer psychosocial resources, and those who had limited access to healthy food outlets were more likely to have a diet of suboptimal quality. Efforts to remove identified barriers that put older adults at risk for poor nutrition and to provide resources that increase access to healthy food should be made to encourage healthy eating and enhance diet quality. VL - 24 IS - 7 ER - TY - JOUR T1 - Housing and cardiometabolic risk among older renters and homeowners JF - Housing Studies Y1 - 2021 A1 - Mawhorter, Sarah A1 - Eileen M. Crimmins A1 - Jennifer A Ailshire KW - cardiometabolic risk KW - health KW - Homeownership KW - housing affordability KW - housing conditions AB - Scholars consistently find that renters have poorer health outcomes when compared with homeowners. Health disparities between renters and homeowners likely widen over the life course, yet few studies have examined this link among older adults, and the connection is not fully understood. Homeowners’ relative socio-economic advantage may explain their better health; renters also more commonly experience adverse housing conditions and financial challenges, both of which can harm health. In this paper, we analyse the extent to which socio-economic advantage, housing conditions, and financial strain explain the relationship between homeownership and health among adults over age 50, using Health and Retirement Study 2010/2012 data to assess cardiometabolic risk (CMR) levels using biomarkers for inflammation, cardiovascular health, and metabolic function. We find that people living with poor housing conditions and financial strain have higher CMR levels, even taking socio-economic advantage into account. This analysis sheds light on the housing-related health challenges of older adults, especially older renters. SN - 0267-3037 ER - TY - JOUR T1 - The Importance of Improving Educational Attainment for Dementia Prevalence Trends from 2000-2014, among Older non-Hispanic Black and White Americans. JF - The Journals of Gerontology, Series B Y1 - 2021 A1 - Mark D Hayward A1 - Mateo P Farina A1 - Yuan S Zhang A1 - Jung K Kim A1 - Eileen M. Crimmins KW - Cognitive health KW - Educational attainment AB -

OBJECTIVES: While a number of studies have documented a notable decline in age-standardized prevalence in dementia in the U.S. population, relatively little is known about how dementia has declined for specific age and race groups, and the importance of changing educational attainment on the downward trend. We assess 1) how the trends in dementia prevalence may have differed across age and race groups and 2) the role of changing educational attainment in understanding these trends.

METHOD: This paper estimates a series of logistic regression models using data from the Health and Retirement Study (2000-2014) to assess the relative annual decline in dementia prevalence and the importance of improving educational attainment for non-Hispanic Whites and non-Hispanic Blacks.

RESULTS: Consistent with other studies, we found significant declines in dementia for non-Hispanic Blacks and non-Hispanic Whites across this period. Nonetheless, these declines were not uniform across age and race groups. Non-Hispanic Blacks aged 65-74 had the steepest decline in this period. We also found that improved educational attainment in the population was fundamentally important in understanding declining dementia prevalence in the United States.

DISCUSSION: This study shows the importance of improvement in educational attainment in the early part of the 20 th century to understand the downward trend in dementia prevalence in the United States from 2000 to 2014.

VL - 76 IS - 9 ER - TY - JOUR T1 - Neighborhood Characteristics and Accelerated Aging: Evidence From the Health and Retirement Study JF - Innovation in Aging Y1 - 2021 A1 - Lee, Haena A1 - Jennifer A Ailshire A1 - Eileen M. Crimmins KW - accelerated aging KW - Neighborhood characteristics KW - Venous Blood Study AB - An individual’s rate of aging directly impacts one’s functioning, morbidity and mortality. Identifying factors related to accelerated or delayed aging may provide important information for potential areas of intervention. While race/ethnicity, socioeconomic status and behavior characteristics have been linked to biological aging, it is unclear whether neighborhood characteristics are associated with one’s rate of aging. We use a novel aging measure, Expanded Biological Age, from the 2016 Health and Retirement Study Venous Blood Study (HRS-VBS) to investigate whether individuals living with unfavorable neighborhood conditions are experiencing accelerated aging compared to those living in more favorable conditions. We constructed a summary measure of expanded biological age using 22 novel biomarkers in the HRS-VBS; we then regressed the summary measure on age and used the residuals as indicators of accelerated or delayed aging. We measured neighborhood physical disorder, presence of green space, and perceived social cohesion using the 2016 HRS Interviewer Observation data and Self-Administered Questionnaire. We find that individuals living with higher levels of neighborhood physical disorder appeared 1.05 years older biologically than the average for those of the same chronological age. Individuals living near green space including parks were 1.5 years younger biologically than expected based on their chronological age though this association was marginally significant. We did not find an association between neighborhood social cohesion and accelerated aging. This implies that living with severe neighborhood disorder, characterized by presence of disrepair, trash/litter, and abandoned structures, and living near green space, play an important role in who lives longer. VL - 5 IS - Suppl 1 ER - TY - JOUR T1 - Quest for a summary measure of biological age: The Health and Retirement Study. JF - Geroscience Y1 - 2021 A1 - Eileen M. Crimmins A1 - Bharat Thyagarajan A1 - Jung K Kim A1 - David R Weir A1 - Jessica Faul KW - Biological age KW - Biomarkers KW - Phenotypic age KW - TAME markers AB -

Measures of biological age and its components have been shown to provide important information about individual health and prospective change in health as there is clear value in being able to assess whether someone is experiencing accelerated or decelerated aging. However, how to best assess biological age remains a question. We compare prediction of health outcomes using existing summary measures of biological age with a measure created by adding novel biomarkers related to aging to measures based on more conventional clinical chemistry and exam measures. We also compare the explanatory power of summary biological age measures compared to the individual biomarkers used to construct the measures. To accomplish this, we examine how well biological age, phenotypic age, and expanded biological age and five sets of individual biomarkers explain variability in four major health outcomes linked to aging in a large, nationally representative cohort of older Americans. We conclude that different summary measures of accelerated aging do better at explaining different health outcomes, and that chronological age has greater explanatory power for both cognitive dysfunction and mortality than the summary measures. In addition, we find that there is reduction in the variance explained in health outcomes when indicators are combined into summary measures, and that combining clinical indicators with more novel markers related to aging does best at explaining health outcomes. Finally, it is hard to define a set of assays that parsimoniously explains the greatest amount of variance across the range of health outcomes studied here. All of the individual markers considered were related to at least one of the health outcomes.

VL - 43 IS - 1 ER - TY - JOUR T1 - Sex, Race, and Age Differences in Prevalence of Dementia in Medicare Claims and Survey Data JF - The Journals of Gerontology: Series B Y1 - 2021 A1 - Zhu, Yingying A1 - Chen, Yi A1 - Eileen M. Crimmins A1 - Julie M Zissimopoulos KW - cognitive tests KW - diagnosis codes KW - neuropsychological assessment KW - racial/ethnic minorities KW - Trends AB - This study provides the first comparison of trends in dementia prevalence in the US population using three different dementia ascertainments/data sources: neuropsychological assessment, cognitive tests, and diagnosis codes from Medicare claims.We used data from the nationally representative Health and Retirement Study and Aging, Demographics and Memory Study, and a 20% random sample of Medicare beneficiaries. We compared dementia prevalence across the three sources by race, gender, and age. We estimated trends in dementia prevalence from 2006 to 2013 based on cognitive tests and diagnosis codes utilizing logistic regression.Dementia prevalence among older adults aged 70 and above in 2004 was 16.6% (neuropsychological assessment), 15.8% (cognitive tests), and 12.2% (diagnosis codes). The difference between dementia prevalence based on cognitive tests and diagnosis codes diminished in 2012 (12.4% and 12.9% respectively), driven by decreasing rates of cognitive test-based and increasing diagnosis codes-based dementia prevalence. This difference in dementia prevalence between the two sources by sex and for age groups 75 to 79 and 90 and above vanished over time. However, there remained substantial differences across measures in dementia prevalence among blacks and Hispanics (10.9 and 9.8 percentage points respectively) in 2012.Our results imply that ascertainment of dementia through diagnosis may be improving over time, but gaps across measures among racial/ethnic minorities highlight the need for improved measurement of dementia prevalence in these populations. VL - 76 SN - 1079-5014 IS - 3 ER - TY - CHAP T1 - Trends in morbidity, healthy life expectancy, and the compression of morbidity T2 - Handbook of the Biology of Aging (Ninth Edition)Handbooks of Aging Y1 - 2021 A1 - Eileen M. Crimmins A1 - Yuan S Zhang A1 - Jung K Kim A1 - Morgan E. Levine ED - Musi, Nicolas ED - Hornsby, Peter J. KW - compression of morbidity KW - health trends KW - Healthy life expectancy KW - Morbidity AB - This chapter lays out the dimensions of morbidity and the processes linking morbidity and mortality. It provides evidence of recent trends in morbidity of the older American population: decline in some types of disability but not others, disease, and physiological dysregulation among the older American population. In addition, the chapter uses data from two recent cohorts to look at survival without disease and the age at onset of diseases. We have generally seen an increase in the prevalence and time with disease; but disease appears less disabling now than in the past. In addition, the onset of myocardial infarction appears to have been delayed by the recent control of biological risk. Most of the evidence does not support the idea that we have experienced a recent compression of morbidity; it does support some delay and retarding of progression of the morbidity process. JF - Handbook of the Biology of Aging (Ninth Edition)Handbooks of Aging PB - Academic Press SN - 978-0-12-815962-0 ER - TY - JOUR T1 - Age-Related Vulnerability to Coronavirus Disease 2019 (COVID-19): Biological, Contextual, and Policy-Related Factors. JF - Public Policy and Aging Report Y1 - 2020 A1 - Eileen M. Crimmins KW - COVID-19 KW - Immunosenescence KW - Mortality KW - Nursing homes AB - The detailed facts surrounding the coronavirus disease 2019 (COVID-19) pandemic are still evolving; however, one of the most shocking aspects of the COVID-19 pandemic is how lethal this condition is for the older population (Dowd et al., 2020). The risk for death and severe illness with COVID-19 is best predicted by age. The likelihood of death increases exponentially with age among those who contract the virus in all countries where this has been examined (Figure 1). Figure 1 shows the percent of confirmed cases ending in mortality, by age, for five countries near the beginning of June. In every country, the percent dying increases sharply after age 50, and the highest rates occur among the oldest persons. The age pattern is clear across the countries even though the mortality levels are quite different; the United States has had a much greater number of cases and deaths than the other countries in this figure, but the mortality level was higher in Italy. This difference in levels could be influenced by the proportion of diagnosed cases, which depends on testing, treatment of cases, and whether COVID-19 deaths include only those confirmed with a diagnostic test or include both confirmed and probable deaths (Sung & Kaplan, 2020). Even with these differences, the pattern of an exponential increase in death with age is clear. VL - 30 IS - 4 ER - TY - JOUR T1 - Blood Pressure and Mortality: Joint Effect of Blood Pressure Measures JF - Journal of Clinical Cardiology and Cardiovascular Therapy Y1 - 2020 A1 - Jung K Kim A1 - Eileen M. Crimmins KW - diastolic blood pressure KW - Mortality KW - pulse pressure KW - Systolic blood pressure AB - We examine how combinations of systolic and diastolic blood pressure levels and pulse pressure levels predicted mortality risk. Respondents are those aged over 50 from the Health and Retirement Study (N=10,366) who provided blood pressure measures in 2006/2008. Systolic and diastolic blood pressures were measured three times; and we averaged the three readings. Pulse pressure was calculated as systolic minus diastolic blood pressure. Seven combinations of systolic and diastolic blood pressure (low/normal/high of each) and three levels of pulse pressure (low/normal/high) were used to categorize blood pressure. Over 1 to 10 years of follow-up (average follow-up time of 7.8 years), 2,820 respondents died after blood pressure measurement in 2006/2008. Potential covariates including age, gender, education, BMI, total cholesterol, HbA1c, antihypertensive medication intake and lifetime-smoking pack years were adjusted in Cox proportional hazard models and survival curves. The blood pressure subgroup with low systolic blood pressure (<90 mmHg) and low diastolic blood pressure (< 60 mmHg) had the highest relative risk of mortality (HR=2.34, 95% CI: 1.45-3.80), followed by those with normal systolic blood pressure but low diastolic blood pressure (HR=1.45, 95% CI: 1.17-1.81) among those with cardiovascular conditions at baseline. For those without cardiovascular conditions at baseline, low blood pressure, either systolic or diastolic, was not related to mortality. Those with high levels of both systolic and diastolic blood pressure had a higher risk of mortality than those with both blood pressures normal but no other subgroups with low blood pressure differed from normal/normal in predicting mortality. Pulse pressure did not predict mortality. How high and low blood pressures are related to mortality needs to be examined by jointly looking at systolic and diastolic blood pressure. VL - 2 IS - 1.1009 ER - TY - JOUR T1 - Cardiometabolic Risk and Biomarker Trajectories Among Older Adults: Findings From the Health and Retirement Study JF - Innovation in Aging Y1 - 2020 A1 - Wu, Qiao A1 - Eileen M. Crimmins A1 - Jennifer A Ailshire A1 - Jung K Kim A1 - Zhao, Erfei KW - biomarker trajectories KW - cardiometabolic risk AB - The deterioration of the cardiovascular system is a process associated with aging. Most of the prior works have examined changes in cardiometabolic risk (CMR) while aging at the population level using cross-sectional data, but we study within-person changes for total CMR and separate risk factors, including pulse pressure, resting heart rate, C-reactive protein, glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol, total cholesterol, waist circumference, and obesity. We examine 8-year changes (from 2006 to 2014) among respondents from the Health and Retirement Study biomarker sample (n=19,776). We use growth curve models to identify differences at baseline and the changes while aging, by age, gender, race/ethnicity, and education. Blacks, the old-old, the less educated, and current smokers have higher baseline CMR. The total CMR increases while people age over 8 years. HbA1c, waist circumference, and pulse pressure increase significantly with age. A reduction in total cholesterol can be observed and is likely due to medication. The CMR increase is no longer significant after accounting for socioeconomic status. The next step of this study is to focus on the disparity of risk distribution, in order to identify the individuals that are most in need of specific care and support. VL - 4 SN - 2399-5300 IS - Supplement_1 ER - TY - JOUR T1 - Cognitive Function and Cardiometabolic-Inflammatory Risk Factors Among Older Indians and Americans. JF - Journal of the American Geriatrics Society Y1 - 2020 A1 - Hu, Peifeng A1 - Jinkook Lee A1 - Beaumaster, Sidney A1 - Jung K Kim A1 - Dey, Sharmistha A1 - David R Weir A1 - Eileen M. Crimmins KW - cardiometabolic risk KW - Cognition KW - HCAP KW - LASI-DAD AB -

OBJECTIVES: To investigate how cardiometabolic-inflammatory risk factors are related to cognition among older adults in India and the United States.

DESIGN: The Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD) and the Harmonized Cognitive Assessment Protocol of the Health and Retirement Study (HRS-HCAP) in the United States conducted an in-depth assessment of cognition, using protocols designed for international comparison.

SETTING: Cognitive tests were conducted in hospital or household settings in India and in household settings in the United States.

PARTICIPANTS: Respondents aged 60 years and older from LASI-DAD (N = 1,865) and respondents aged 65 years and older from HRS-HCAP (N = 2,111) who provided venous blood specimen.

MEASUREMENTS: We used total composite scores from the common cognitive tests administered. Cardiovascular risk was indicated by systolic and diastolic blood pressure, pulse rate, pro-B-type natriuretic peptide (proBNP), and homocysteine. Metabolic risk was measured by body mass index, glycosylated hemoglobin (HbA1c), high-density lipoprotein cholesterol, and lipoprotein (a) (only in India). Inflammatory risk was indicted by white blood cell count, C-reactive protein, albumin, and uric acid (only in India).

RESULTS: The distribution of both total cognition scores and of cardiometabolic risk factors differed significantly between India and the United States. In both countries, lower cognition was associated with older age, lower education, elevated homocysteine, elevated proBNP, and lower albumin levels. The associations between HbA1c levels and cognitive measures were statistically significant in both countries, but in the opposite direction, with a coefficient of 1.5 (P < .001) in India and -2.4 (P < .001) in the United States for one percentage increase in absolute HbA1c value.

CONCLUSION: Cardiometabolic-inflammatory biomarkers are associated with cognitive functional levels in each country, but the relationships may vary across countries. J Am Geriatr Soc 68:S36-S44, 2020.

VL - 68 IS - Suppl 3 ER - TY - JOUR T1 - Diet Quality and Biological Risk in a National Sample of Older Americans JF - Innovation in Aging Y1 - 2020 A1 - Choi, Yeon Jin A1 - Jennifer A Ailshire A1 - Jung K Kim A1 - Eileen M. Crimmins KW - biological risk KW - diet quality AB - Biomarkers are sensitive to current health status and capture aspects of health that may precede the development of disease and other health problems. Using comprehensive measures of biological risk, this study aims to investigate the relationship between intake of individual dietary components, overall diet quality, and biological dysregulation. For the analysis, we used nutrition and biomarker data from 3,641 older adults (over age 50) in the Health and Retirement Study. Eleven out of 13 individual dietary components were associated with lower biological risk. After controlling for SES, health behaviors, and access to health care, a high intake of fruits, greens and beans, whole grains, seafood and plant proteins, and fatty acids and a low intake of sodium and saturated fat were still associated with lower biological risk. Respondents with poor/suboptimal quality diet had higher biological risk than those with good quality diet. After controlling for SES, health behaviors, and access to health care, respondents with poor/suboptimal quality diet continued to exhibit higher biological risk than those with good quality diet, though the differences in biological risk were reduced. Findings from this study emphasize the importance of healthy eating in improving health of older adults. Encouraging intake of fruits, greens and beans, whole grains, seafood and plant proteins, and fatty acids, while limiting consumption of sodium and saturated fat would improve overall diet quality and contribute to the prevention of chronic diseases and morbidity. VL - 4 SN - 2399-5300 IS - Suppl 1 ER - TY - JOUR T1 - Dried blood spots: Effects of less than optimal collection, shipping time, heat, and humidity JF - American Journal of Human Biology Y1 - 2020 A1 - Eileen M. Crimmins A1 - Yuan S Zhang A1 - Jung K Kim A1 - Frochen, Stephen A1 - Kang, Hyewon A1 - Shim, Hyunju A1 - Jennifer A Ailshire A1 - Potter, Alan A1 - Cofferen, Jake A1 - Jessica Faul KW - Dried Blood Spot Testing AB - Abstract Objectives This study investigates how factors related to collection, storage, transport time, and environmental conditions affect the quality and accuracy of analyses of dried blood spot (DBS) samples. Methods Data come from the 2016 Health and Retirement Study (HRS) DBS laboratory reports and the HRS merged with the National Climatic Data Center (NCDC) Global Historical Climate Network Daily (NCDC GHCN-Daily) and the NCDC Local Climatological Data, by zip code. We ran regression models to examine the associations between assay values based on DBS for five analytes (total cholesterol, high-density lipoprotein (HDL) cholesterol, glycosylated hemoglobin (HbA1c), C-reactive protein (CRP), and cystatin C) and the characteristics of DBS cards and drops, shipping time, and temperature, and humidity at the time of collection. Results We found cholesterol measures to be sensitive to many factors including small spots, shipping time, high temperature and humidity. Small spots in DBS cards are related to lower values across all analytes. Longer DBS transit time before freezing is associated with lower values of total and HDL cholesterol and cystatin C. Results were similar whether or not venous blood sample values were included in equations. Conclusions Small spots, long shipping time, and exposure to high temperature and humidity need to be avoided if possible. Quality of spots and cards and information on shipping time and conditions should be coded with the data to make adjustments in values when necessary. The different results across analytes indicate that results cannot be generalized to all DBS assays. VL - 32 IS - 5 ER - TY - JOUR T1 - Estimates of the Association of Dementia With US Mortality Levels Using Linked Survey and Mortality Records JF - JAMA Neurology Y1 - 2020 A1 - Andrew C. Stokes A1 - Weiss, Jordan A1 - Lundberg, Dielle J. A1 - Xie, Wubin A1 - Jung K Kim A1 - Samuel H. Preston A1 - Eileen M. Crimmins KW - Dementia KW - Mortality AB - Vital statistics are the primary source of data used to understand the mortality burden of dementia in the US, despite evidence that dementia is underreported on death certificates. Alternative estimates, drawing on population-based samples, are needed.To estimate the percentage of deaths attributable to dementia in the US.A prospective cohort study of the Health and Retirement Study of noninstitutionalized US individuals with baseline exposure assessment in 2000 and follow-up through 2009 was conducted. Data were analyzed from November 2018 to May 2020. The sample was drawn from 7489 adults aged 70 to 99 years interviewed directly or by proxy. Ninety participants with missing covariates or sample weights and 57 participants lost to follow-up were excluded. The final analytic sample included 7342 adults.Dementia and cognitive impairment without dementia (CIND) were identified at baseline using Health and Retirement Study self- or proxy-reported cognitive measures and the validated Langa-Weir score cutoff.Hazard ratios relating dementia and CIND status to all-cause mortality were estimated using Cox proportional hazards regression models, accounting for covariates, and were used to calculate population-attributable fractions. Results were compared with information on cause of death from death certificates.Of the 7342 total sample, 4348 participants (60.3%) were women. At baseline, 4533 individuals (64.0%) were between ages 70 and 79 years, 2393 individuals (31.0%) were between 80 and 89 years, and 416 individuals (5.0%) were between 90 and 99 years; percentages were weighted. The percentage of deaths attributable to dementia was 13.6% (95% CI, 12.2%-15.0%) between 2000 and 2009. The mortality burden of dementia was significantly higher among non-Hispanic Black participants (24.7%; 95% CI, 17.3-31.4) than non-Hispanic White participants (12.2%; 95% CI, 10.7-13.6) and among adults with less than a high school education (16.2%; 95% CI, 13.2%-19.0%) compared with those with a college education (9.8%; 95% CI, 7.0%-12.5%). Underlying cause of death recorded on death certificates (5.0%; 95% CI, 4.3%-5.8%) underestimated the contribution of dementia to US mortality by a factor of 2.7. Incorporating deaths attributable to CIND revealed an even greater underestimation.The findings of this study suggest that the mortality burden associated with dementia is underestimated using vital statistics, especially when considering CIND in addition to dementia. VL - 77 SN - 2168-6149 IS - 12 ER - TY - JOUR T1 - Female vulnerability to the effects of smoking on health outcomes in older people JF - PloS one Y1 - 2020 A1 - Haghani, Amin A1 - Thalida E. Arpawong A1 - Jung K Kim A1 - Lewinger, Juan Pablo A1 - Caleb E Finch A1 - Eileen M. Crimmins KW - Cardiovascular disease KW - Smoking KW - Women's Health AB - Cigarette smoking is among the leading risk factors for mortality and morbidity. While men have a higher smoking prevalence, mechanistic experiments suggest that women are at higher risk for health problems due to smoking. Moreover, the comparison of smoking effects on multiple conditions and mortality for men and women has not yet been done in a population-based group with race/ethnic diversity. We used proportional hazards models and restricted mean survival time to assess differences in smoking effects by sex for multiple health outcomes using data from the U.S. Health and Retirement Study (HRS), a population-representative cohort of individuals aged 50+ (n = 22,708, 1992-2014). Men had experienced more smoking pack-years than women (22.0 vs 15.6 average pack-years). Age of death, onset of lung disorders, heart disease, stroke, and cancer showed dose-dependent effects of smoking for both sexes. Among heavy smokers (>28 pack-years) women had higher risk of earlier age of death (HR = 1.3, 95%CI:1.03-1.65) and stroke (HR = 1.37, 95%CI:1.02-1.83). Risk of cancer and heart disease did not differ by sex for smokers. Women had earlier age of onset for lung disorders (HR = 2.83, 95%CI:1.74-4.6), but men risk due to smoking were higher (Smoking-Sex interaction P<0.02) than women. Passive smoke exposure increased risk of earlier heart disease (HR = 1.33, 95%CI:1.07-1.65) and stroke (HR:1.54, 95%CI:1.07-2.22) for non-smokers, mainly in men. Smoking cessation after 15 years partially attenuated the deleterious smoking effects for all health outcomes. In sum, our results suggest that women are more vulnerable to ever smoking for earlier death and risk of stroke, but less vulnerable for lung disorders. From an epidemiological perspective, sex differences in smoking effects are important considerations that could underlie sex differences in health outcomes. These findings also encourage future mechanistic experiments to resolve potential mechanisms of sex-specific cigarette smoke toxicity. VL - 15 SN - 1932-6203 UR - https://pubmed.ncbi.nlm.nih.gov/32497122 IS - 6 U1 - 32497122[pmid] U4 - PONE-D-20-03538[PII] JO - PLoS One ER - TY - JOUR T1 - Living alone, social networks in neighbourhoods, and daily fruit and vegetable consumption among middle-aged and older adults in the USA JF - Public Health Nutrition Y1 - 2020 A1 - Choi, Yeon Jin A1 - Jennifer A Ailshire A1 - Eileen M. Crimmins KW - Dietary intake KW - Fruit and vegetable consumption KW - Healthy diet KW - Living arrangements KW - Social networks AB - Objective: A social network is a valuable resource in later life. Therefore, the current study aims to investigate whether social networks within homes and neighbourhoods are associated with older adults’ daily fruit and vegetable consumption. Design: Cross-sectional secondary data analysis. Setting: USA. Participants: A nationally representative sample of 6865 community-dwelling older adults over age 53 in the Health and Retirement Study – Health Care and Nutrition Survey. Results: Older adults who lived alone with no children or friends nearby had the lowest fruit and vegetable consumption. However, the daily fruit and vegetable consumption of respondents who lived alone and had children or friends nearby or those who lived with someone and had no children or friends nearby was not statistically different from those who lived with someone and had children or friends nearby. This suggests that having a social network either at home or in the neighbourhood complements the absence of living with someone or having children or friends nearby and attenuates the negative association between limited social networks and daily fruit and vegetable consumption. A greater decrease in the number of fruits and vegetables consumed was observed among men when they lived alone with no children or friends nearby. Conclusions: Special attention should be given to older adults with limited social networks, especially older adults living alone with no children or friends nearby. Provision of help with grocery shopping and meal preparation as well as social support networks and more opportunities that can improve social engagement appear to be necessary. VL - 23 IS - 18 ER - TY - CHAP T1 - Microsimulation of Health Expectancies, Life Course Health, and Health Policy Outcomes T2 - International Handbooks of Population: International Handbook of Health Expectancies Y1 - 2020 A1 - Laditka, Sarah B. A1 - Laditka, James N. A1 - Jagger, Carol ED - Jagger, Carol ED - Eileen M. Crimmins ED - Saito, Yasuhiko ED - De Carvalho Yokota, Renata Tiene ED - Van Oyen, Herman ED - Robine, Jean-Marie KW - Active life expectancy KW - Forecasting KW - Health expectancy KW - health policy KW - Population Health AB - Active life expectancy measures life expectancy and the proportions of remaining life with and without disease or disability. Microsimulation, a useful tool for life course research, estimates active life expectancy by simulating individual lifetime health biographies, where the individual's status in one or more outcomes is known for each measured unit of life. In this chapter we describe how researchers use microsimulation to study active life expectancy, focusing on research of the past 20 years. We summarize the microsimulation process. We describe how researchers model current and future population health, calculate new active life expectancy measures, and forecast effects of policy change. We illustrate the application of microsimulation to active life expectancy research with a study of interval need, a measure of need for health care and other services focused on resource use. We describe strengths of microsimulation, considerations regarding its use, and directions for future research. JF - International Handbooks of Population: International Handbook of Health Expectancies PB - Springer International Publishing CY - Basel VL - 9 SN - 978-3-030-37668-0 ER - TY - JOUR T1 - Racial and educational disparities in cognitive life expectancies. JF - The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences Y1 - 2020 A1 - Mateo P Farina A1 - Mark D Hayward A1 - Eileen M. Crimmins A1 - Jung K Kim KW - Cognition & Reasoning KW - Mortality KW - Racial/ethnic differences AB -

OBJECTIVES: We estimate life expectancy with and without dementia for Americans 65 years and older by education and race to examine how these stratification systems combine to shape disparities in later-life cognitive health.

METHOD: Based on the Health and Retirement Study (2000-2014), we use a multivariate, incidence-based life table approach to estimate life expectancy by cognitive health status for race-education groups. The models also simulate group differences in the prevalence of dementia implied by these rates.

RESULTS: The life table results document notable race-education differences in dementia and dementia-free life expectancy, as well as stark differences in implied dementia prevalence. At each education level, blacks can expect to live more years with dementia and they have significantly higher rates of dementia prevalence. This distribution of disparities in the older population is anchored by two groups -- blacks without a high school diploma and whites with some college or more.

DISCUSSION: Dementia experience and dementia burden differ dramatically along race-education lines. Race and education combine to exaggerate disparities and they both have enduring effects. Future research should explicitly consider how race and education combine to influence dementia in the older American population.

VL - 75 IS - 7 ER - TY - JOUR T1 - Social hallmarks of aging: Suggestions for geroscience research JF - Ageing Research Reviews Y1 - 2020 A1 - Eileen M. Crimmins KW - Biological age – chronological age KW - Hallmarks of aging KW - Social determinants of aging AB - This paper focuses on the idea that there are clear social hallmarks of aging including low lifetime socioeconomic status, adversity in childhood and adulthood, being a member of a minority group, adverse health behaviors, and adverse psychological states. The “Social Hallmarks of Aging” are analogous to the “Geroscience Hallmarks of Aging” in reflecting a set of underlying and interrelated social causes of multiple agerelated health outcomes. This paper presents empirical work incorporating the social hallmarks of aging with indicators of multiple biological hallmarks of aging as well downstream biology in explaining a range of health outcomes in order to show the relative strength of the associations of social and biological measures with important health outcomes. Social factors are strongly related to physical and cognitive functioning and multimorbidity in this older population and this remains true when the significant number of biological measures are controlled. This can be interpreted to mean that a significant amount of social variance in age-related health outcomes is not explained by these measures of biology. Indicators of the geroscience hallmarks of aging only relate modestly to the variability in human health outcomes. Attention to the social hallmarks related to human aging can usefully be incorporated into work on the biological hallmarks of aging to make greater progress in understanding human aging. VL - 63 SN - 1568-1637 ER - TY - JOUR T1 - Validation of a hybrid approach to standardize immunophenotyping analysis in large population studies: The Health and Retirement Study JF - Scientific Reports Y1 - 2020 A1 - Hunter-Schlichting, DeVon A1 - Lane, John A1 - Cole, Benjamin A1 - Flaten, Zachary A1 - Barcelo, Helene A1 - Ramasubramanian, Ramya A1 - Cassidy, Erin A1 - Jessica Faul A1 - Eileen M. Crimmins A1 - Pankratz, Nathan A1 - Bharat Thyagarajan KW - Bioinformatics KW - high-throughput screening AB - Traditional manual gating strategies are often time-intensive, place a high burden on the analyzer, and are susceptible to bias between analyzers. Several automated gating methods have shown to exceed performance of manual gating for a limited number of cell subsets. However, many of the automated algorithms still require significant manual interventions or have yet to demonstrate their utility in large datasets. Therefore, we developed an approach that utilizes a previously published automated algorithm (OpenCyto framework) with a manually created hierarchically cell gating template implemented, along with a custom developed visualization software (FlowAnnotator) to rapidly and efficiently analyze immunophenotyping data in large population studies. This approach allows pre-defining populations that can be analyzed solely by automated analysis and incorporating manual refinement for smaller downstream populations. We validated this method with traditional manual gating strategies for 24 subsets of T cells, B cells, NK cells, monocytes and dendritic cells in 931 participants from the Health and Retirement Study (HRS). Our results show a high degree of correlation (r ≥ 0.80) for 18 (78%) of the 24 cell subsets. For the remaining subsets, the correlation was low (<0.80) primarily because of the low numbers of events recorded in these subsets. The mean difference in the absolute counts between the hybrid method and manual gating strategy of these cell subsets showed results that were very similar to the traditional manual gating method. We describe a practical method for standardization of immunophenotyping methods in large scale population studies that provides a rapid, accurate and reproducible alternative to labor intensive manual gating strategies. VL - 10 SN - 2045-2322 IS - 1 ER - TY - JOUR T1 - Analysis of dementia in the US population using Medicare claims: Insights from linked survey and administrative claims data. JF - Alzheimers Dement (N Y) Y1 - 2019 A1 - Chen, Yi A1 - Tysinger, Bryan A1 - Eileen M. Crimmins A1 - Julie M Zissimopoulos KW - Cognitive Ability KW - Dementia KW - Education KW - Medicare claims KW - Medicare linkage KW - Racial/ethnic differences AB -

Introduction: Medicare claims data may be a rich data source for tracking population dementia rates. Insufficient understanding of completeness of diagnosis, and for whom, limits their use.

Methods: We analyzed agreement in prevalent and incident dementia based on cognitive assessment from the Health and Retirement Study for persons with linked Medicare claims from 2000 to 2008 (N = 10,450 persons). Multinomial logistic regression identified sociodemographic factors associated with disagreement.

Results: Survey-based cognitive tests and claims-based dementia diagnosis yielded equal prevalence estimates, yet only half were identified by both measures. Race and education were associated with disagreement. Eighty-five percent of respondents with incident dementia measured by cognitive decline received a diagnosis or died within the study period, with lower odds among blacks and Hispanics than among whites.

Discussions: Claims data are valuable for tracking dementia in the US population and improve over time. Delayed diagnosis may underestimate rates within black and Hispanic populations.

VL - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/31198838?dopt=Abstract ER - TY - JOUR T1 - ASSOCIATIONS OF GENETICS AND LIFE COURSE CIRCUMSTANCES WITH A NOVEL AGING MEASURE THAT CAPTURES MORTALITY RISK JF - Innovation in Aging Y1 - 2019 A1 - Liu, Zuyun A1 - Chen, Xi A1 - Thomas M Gill A1 - Ma, Chao A1 - Eileen M. Crimmins A1 - Morgan E. Levine KW - Genetics KW - Mortality KW - mortality risk AB - We aimed to evaluate associations between a comprehensive set of factors, including genetics and childhood and adulthood circumstances, and a novel aging measure, Phenotypic Age (PhenoAge), which has been shown to capture mortality and morbidity risk in the U.S. population. Using data from 2339 adults (aged 51+) from the U.S. Health and Retirement Study, we found that together all 11 study domains (4 childhood and adulthood circumstances domains, 5 polygenic scores [PGSs] domains, and 1 demographics, and 1 behaviors domains) accounted for about 30\% of variance in PhenoAge after accounting for chronological age. Among the 4 circumstances domains, adulthood adversity was the largest contributor (9\%), while adulthood socioeconomic status (SES), childhood adversity, and childhood SES accounted for 2.8\%, 2.1\%, 0.7\%, respectively. All PGSs contributed 3.8\% of variance in PhenoAge (after accounting for chronological age). Further, using Hierarchical Clustering, we identified 6 distinct subpopulations/clusters based on the 4 circumstances domains, and 3 subpopulations/clusters of them that appear to represent disadvantaged circumstances were associated with higher PhenoAge. Finally, there was a significant gene-by-environment interaction between a previously validated PGS for coronary artery disease and the most apparently disadvantaged subpopulation/cluster, suggesting a multiplicative effect of adverse life course circumstances coupled with genetic risk on phenotypic aging. We concluded that socioenvironmental circumstances during childhood and adulthood account for a sizable proportion of differences in phenotypic aging among U.S. older adults. The disadvantaged subpopulations exhibited accelerated aging and the detrimental effects may be further exacerbated among persons with genetic predisposition to coronary artery disease. VL - 3 UR - https://doi.org/10.1093/geroni/igz038.1177 ER - TY - JOUR T1 - Associations of genetics, behaviors, and life course circumstances with a novel aging and healthspan measure: Evidence from the Health and Retirement Study. JF - PLoS Medicine Y1 - 2019 A1 - Liu, Zuyun A1 - Chen, Xi A1 - Thomas M Gill A1 - Ma, Chao A1 - Eileen M. Crimmins A1 - Morgan E. Levine KW - Genetics KW - Health Behavior KW - Life trajectories AB -

BACKGROUND: An individual's rate of aging directly influences his/her susceptibility to morbidity and mortality. Thus, quantifying aging and disentangling how various factors coalesce to produce between-person differences in the rate of aging, have important implications for potential interventions. We recently developed and validated a novel multi-system-based aging measure, Phenotypic Age (PhenoAge), which has been shown to capture mortality and morbidity risk in the full US population and diverse subpopulations. The aim of this study was to evaluate associations between PhenoAge and a comprehensive set of factors, including genetic scores, childhood and adulthood circumstances, and health behaviors, to determine the relative contributions of these factors to variance in this aging measure.

METHODS AND FINDINGS: Based on data from 2,339 adults (aged 51+ years, mean age 69.4 years, 56% female, and 93.9% non-Hispanic white) from the US Health and Retirement Study, we calculated PhenoAge and evaluated the multivariable associations for a comprehensive set of factors using 2 innovative approaches-Shapley value decomposition (the Shapley approach hereafter) and hierarchical clustering. The Shapley approach revealed that together all 11 study domains (4 childhood and adulthood circumstances domains, 5 polygenic score [PGS] domains, and 1 behavior domain, and 1 demographic domain) accounted for 29.2% (bootstrap standard error = 0.003) of variance in PhenoAge after adjustment for chronological age. Behaviors exhibited the greatest contribution to PhenoAge (9.2%), closely followed by adulthood adversity, which was suggested to contribute 9.0% of the variance in PhenoAge. Collectively, the PGSs contributed 3.8% of the variance in PhenoAge (after accounting for chronological age). Next, using hierarchical clustering, we identified 6 distinct subpopulations based on the 4 childhood and adulthood circumstances domains. Two of these subpopulations stood out as disadvantaged, exhibiting significantly higher PhenoAges on average. Finally, we observed a significant gene-by-environment interaction between a previously validated PGS for coronary artery disease and the seemingly most disadvantaged subpopulation, suggesting a multiplicative effect of adverse life course circumstances coupled with genetic risk on phenotypic aging. The main limitations of this study were the retrospective nature of self-reported circumstances, leading to possible recall biases, and the unrepresentative racial/ethnic makeup of the population.

CONCLUSIONS: In a sample of US older adults, genetic, behavioral, and socioenvironmental circumstances during childhood and adulthood account for about 30% of differences in phenotypic aging. Our results also suggest that the detrimental effects of disadvantaged life course circumstances for health and aging may be further exacerbated among persons with genetic predisposition to coronary artery disease. Finally, our finding that behaviors had the largest contribution to PhenoAge highlights a potential policy target. Nevertheless, further validation of these findings and identification of causal links are greatly needed.

VL - 16 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/31211779?dopt=Abstract ER - TY - JOUR T1 - Change in cardiometabolic risk among blacks, whites and Hispanics: findings from the Health and Retirement Study JF - The Journals of Gerontology: Series A Y1 - 2019 A1 - Uchechi A Mitchell A1 - Jennifer A Ailshire A1 - Eileen M. Crimmins KW - Biomarkers KW - C-reactive protein KW - Cardiovascular health KW - Racial/ethnic differences KW - Risk Factors AB - Background Blacks experience greater multi-system physiological dysregulation, or cumulative biological risk, which is associated with poor cardiometabolic health and mortality. In this study, we assess race differences in change in risk over four years among older whites, blacks and Hispanics. Method We examined race differences in 4-year change in individual biomarkers and a cumulative measure of risk—cardiometabolic risk (CMR)—using data for each respondent from two waves of the Health and Retirement Study’s biomarker assessment (n=5,512). CMR is a count of high-risk cardiovascular and metabolic biomarkers. We estimated mean CMR at baseline and follow-up by race/ethnicity, and used logistic regression to determine whether race differences exist in 4-year transitions between high- and low-risk states for individual biomarkers. Results Blacks had higher baseline CMR than whites and Hispanics and experienced an increase in risk over four years; conversely, CMR decreased among whites and Hispanics. Blacks were more likely to develop high-risk pulse pressure and high-risk hemoglobin A1c, which contributed to increases in CMR. Whites and Hispanics were more likely to become low-risk on C-reactive protein and HDL cholesterol which contributed to declines in CMR. Race differences in transitions between risk states remained after controlling for social, behavioral and health care related factors. However, the racial patterning of these differences was influenced by disease diagnosis and medication use. Conclusions We show that the cardiometabolic health of older blacks worsens as they age both absolutely and relative to that of whites and Hispanics because of poor blood pressure control and diabetes prevention. VL - 74 UR - https://academic.oup.com/biomedgerontology/advance-article/doi/10.1093/gerona/gly026/4857183http://academic.oup.com/biomedgerontology/advance-article-pdf/doi/10.1093/gerona/gly026/23921802/gly026.pdf IS - 2 ER - TY - JOUR T1 - Changing Disease Prevalence, Incidence, and Mortality Among Older Cohorts: The Health and Retirement Study JF - The Journals of Gerontology: Series A Y1 - 2019 A1 - Eileen M. Crimmins A1 - Yuan S Zhang A1 - Jung K Kim A1 - Morgan E. Levine KW - disease incidence KW - disease prevalence KW - Mortality AB - This article investigates changes in disease prevalence, incidence, and mortality among four cohorts of older persons in the Health and Retirement Study.We examine two cohorts initially aged 51 to 61, whom we call younger cohorts, and two older cohorts aged 70 to 80 at the start of observation. Each of the paired cohorts was born about 10 years apart. We follow the cohorts for approximately 10 years.The prevalence of cancer, stroke, and diabetes increased in later-born cohorts; while the prevalence of myocardial infarction decreased markedly in both later-born cohorts. The incidence of heart disease, myocardial infarction, and stroke decreased among those in the later-born older cohort; while only the incidence of myocardial infarction decreased in the later-born younger cohort. On the other hand, diabetes incidence increased among those in both later-born cohorts. Death rates among those with heart disease, cancer, and diabetes decreased in the later-born cohorts. The declining incidence of three cardiovascular conditions among those who are over age 70 reflects improving population health and has resulted in stemming the increase in prevalence of people with heart disease and stroke.While these results provide some important signs of improving population health, especially among those over 70; trends for those less than 70 in the United States are not as positive. VL - 74 UR - https://doi.org/10.1093/gerona/glz075 ER - TY - JOUR T1 - Changing impact of obesity on active life expectancy of older Americans. JF - Journals of Gerontology Series A: Biological Sciences & Medical Sciences Y1 - 2019 A1 - Yuan S Zhang A1 - Saito, Yasuhiko A1 - Eileen M. Crimmins KW - Health Trajectories KW - Longevity KW - Obesity AB -

BACKGROUND: The rise in the number and earlier age of onset of obese persons has raised critical concerns about consequences of obesity; however, recent evidence suggests that the impact of obesity on health outcomes may have changed. This study aims to assess the change of the impact of obesity on active life expectancy among Americans 70 years and older over almost two decades, 1993-1998 to 2010-2014.

METHODS: For each period, we use three waves of data from the Health and Retirement Study to estimate age-specific transition probabilities between health states. The average number of years active and disabled are calculated with Interpolated Markov Chain software based on estimated transition probabilities.

RESULTS: Overall obesity and severe obesity increased markedly over time yet active life expectancy expanded for all individuals and the increases are greater among the obese and women. Increases in total and active life expectancy occurred because of the changing association of obesity with disability and mortality.

CONCLUSION: Individuals at age 70 in the later period in each weight group could expect to live a smaller proportion of remaining life with ADL disability than those in the earlier period. High levels of obesity continue to have significant adverse effects on the quality of life. The increasing prevalence of severe obesity and the growing number of older persons may result in substantial additional health care needs and costs. Continued effort to improve cardiovascular health is required to control the burden of obesity in later life in an era of rising obesity.

U1 - http://www.ncbi.nlm.nih.gov/pubmed/31120111?dopt=Abstract ER - TY - JOUR T1 - Cognitive Performance Among Older Persons in Japan and the United States JF - Journal of the American Geriatrics Society Y1 - 2019 A1 - Saito, Yasuhiko A1 - Jung K Kim A1 - Davarian, Shieva A1 - Hagedorn, Aaron A1 - Eileen M. Crimmins KW - cognitive performance KW - Education KW - Japan KW - Nihon University Japanese Longitudinal Study of Aging KW - United States AB - OBJECTIVE To compare cognitive performance among Japanese and American persons, aged 68 years and older, using two nationally representative studies and to examine whether differences can be explained by differences in the distribution of risk factors or in their association with cognitive performance. DESIGN Nationally representative studies with harmonized collection of data on cognitive functioning. SETTING Nihon University Japanese Longitudinal Study of Aging and the US Health and Retirement Study. PARTICIPANTS A total of 1953 Japanese adults and 2959 US adults, aged 68 years or older. MEASUREMENTS Episodic memory and arithmetic working memory are measured using immediate and delayed word recall and serial 7s. RESULTS Americans have higher scores on episodic memory than Japanese people (0.72 points on a 20-point scale); however, when education is controlled, American and Japanese people did not differ. Level of working memory was higher in Japan (0.36 on a 5-point scale) than in the United States, and the effect of education on working memory was stronger among Americans than Japanese people. There are no differences over the age of 85 years. CONCLUSION Even with large differences in educational attainment and a strong effect of education on cognitive functioning, the overall differences in cognitive functioning between the United States and Japan are modest. Differences in health appear to have little effect on national differences in cognition. UR - https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.16163 ER - TY - JOUR T1 - Cohort Trends in the Gender Distribution of Household Tasks in the United States and the Implications for Understanding Disability JF - Journal of Aging and Health Y1 - 2019 A1 - Connor M Sheehan A1 - Benjamin W Domingue A1 - Eileen M. Crimmins KW - Cohort Studies KW - Disabilities KW - Gender Differences KW - Household KW - Women and Minorities AB - Objectives: Measures of disability depend on health and social roles in a given environment. Yet, social roles can change over time as they have by gender. We document how engagement in Instrumental Activities of Daily Living (IADLs) is shifting by gender and birth cohort among older adults, and the challenges these shifts can create for population-level estimates of disability. Method: We used the Health and Retirement Study (N = 25,047) and multinomial logistic regression models with an interaction term between gender and birth cohort to predict limitation and nonperformance relative to no difficulty conducting IADLs. Results: Nonperformance of IADLs have significantly decreased among younger cohorts. Women in younger cohorts were more likely to use a map, whereas men in younger cohorts were more likely to prepare meals and shop. Discussion: Failing to account for gender and cohort changes in IADL, performance may lead to systematic bias in estimates of population-level disability. JO - J Aging Health ER - TY - JOUR T1 - COMBINED EFFECT OF CMV SEROPOSITIVITY AND SYSTEMIC INFLAMMATION ON DEMENTIA PREVALENCE IN CANCER SURVIVORS JF - Innovation in Aging Y1 - 2019 A1 - Vivek, Sithara A1 - Bharat Thyagarajan A1 - Heather Hammond Nelson A1 - Anna Prizment A1 - Eileen M. Crimmins A1 - Jessica Faul KW - Cancer KW - cnv KW - Dementia KW - Inflammation KW - seropositivity AB - Though cancer patients treated with multi-modal therapies demonstrate higher levels of systemic inflammation, which is associated with dementia, cancer survivors have not shown a consistent association with dementia. Since several studies reported an independent association between cytomegalovirus (CMV) infection, inflammation and dementia in non-cancer populations, we have evaluated whether CMV infection and systemic inflammation were associated with increased prevalence of dementia in cancer survivors in Health and Retirement Study (HRS). We evaluated prevalence of dementia (using score ≤7 on the 27-point scale) among 1607 cancer survivors, in whom we measured CMV seropositivity and two biomarkers of systemic inflammation: C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR). The prevalence of CMV seropositivity was 68.26\% (n=1097), while prevalence of increased systemic inflammation [CRP \>5mg/L and NLR \>4] was 4.23\% (n=68). Using survey logistic regression, adjusted for age, race, gender, BMI (Body Mass Index) and sampling design, cancer survivors who were both CMV seropositive and had increased systemic inflammation had the highest odds of dementia compared to those who were CMV seronegative and had low levels of systemic inflammation (OR=6.59; 95\% CI [2.81, 15.44]; p\<.0001). Cancer survivors who were CMV seropositive without evidence of systemic inflammation had a lower but increased odds of dementia (OR=2.02; 95\% CI [1.17, 3.47]; p=0.01). Odds of dementia among those who were CMV seronegative with elevated systemic inflammation was not significant (p=0.09). Our study demonstrates a possible role for ongoing CMV induced inflammation in determining dementia prevalence among cancer survivors that needs further confirmation. VL - 3 ER - TY - JOUR T1 - CROSS-COUNTRY COMPARISON OF INTERNET USE AND DEPRESSION BY GENDER: THE ROLE OF INTERGENERATIONAL FACTORS JF - Innovation in Aging Y1 - 2019 A1 - Shim, Hyunju A1 - Jennifer A Ailshire A1 - Eileen M. Crimmins KW - depression KW - gender KW - Intergenerational ties KW - International AB - Technology may offer one approach to reducing depression as it provides medium to maintain connections (Cotton et al., 2014). Yet, depression, internet use, gender roles, and expectation of intergenerational interaction all differ across countries. Using nationally representative data from the U.S (Health and Retirement Study: HRS) and South Korea (Living Profiles of Older People Survey: LPOPS), the study examines 1) association between internet use and depressive symptoms by gender in two countries; 2) and whether intergenerational factors moderated this association. In the U.S., more than half of men and women aged 65+ used the internet, while approximately 30% of women and 47% of men used the internet in Korea. Using the internet was associated with lower depression for those living far from the closest child for women in the U.S., and for men in Korea. The findings indicate that the association of internet use on depressive symptoms can be influenced by intergenerational factors that may differentially affect men and women depending on the sociohistorical contexts. VL - 3 SN - 2399-5300 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6840073/ IS - Suppl 1 JO - Innov Aging ER - TY - JOUR T1 - Differential vulnerability to neighbourhood disorder: a gene×environment interaction study JF - Journal of Epidemiology and Community Health Y1 - 2019 A1 - Jennifer W Robinette A1 - Jason D Boardman A1 - Eileen M. Crimmins KW - Diabetes KW - Genetics KW - Neighborhoods AB - Background: Type 2 diabetes (T2D) is preventable, it is increasing in prevalence and it is a major risk factor for morbidity and mortality. Importantly, residents of neighbourhoods with high levels of disorder are more likely to develop T2D than those living in less disordered neighbourhoods and neighbourhood disorder may exacerbate genetic risk for T2D. Method: We use genetic, self-reported neighbourhood, and health data from the Health and Retirement Study. We conducted weighted logistic regression analyses in which neighbourhood disorder, polygenic scores for T2D and their interaction predicted T2D. Results: Greater perceptions of neighbourhood disorder (OR=1.11, p<0.001) and higher polygenic scores for T2D (OR=1.42, p<0.001) were each significantly and independently associated with an increased risk of T2D. Furthermore, living in a neighbourhood perceived as having high levels of disorder exacerbated genetic risk for T2D (OR=1.10, p=0.001). This significant gene×environment interaction was observed after adjusting for years of schooling, age, gender, levels of physical activity and obesity. Conclusion: Findings in the present study suggested that minimising people's exposure to vandalism, vacant buildings, trash and circumstances viewed by residents as unsafe may reduce the burden of this prevalent chronic health condition, particularly for subgroups of the population who carry genetic liability for T2D. VL - 73 UR - http://jech.bmj.com/lookup/doi/10.1136/jech-2018-211373https://syndication.highwire.org/content/doi/10.1136/jech-2018-211373 IS - 5 JO - J Epidemiol Community Health ER - TY - JOUR T1 - Differential vulnerability to neighbourhood disorder: a gene×environment interaction study JF - Journal of Epidemiology & Community Health Y1 - 2019 A1 - Jennifer W Robinette A1 - Jason D Boardman A1 - Eileen M. Crimmins KW - Diabetes KW - Genetics KW - neighborhood AB - Background Type 2 diabetes (T2D) is preventable, it is increasing in prevalence and it is a major risk factor for morbidity and mortality. Importantly, residents of neighbourhoods with high levels of disorder are more likely to develop T2D than those living in less disordered neighbourhoods and neighbourhood disorder may exacerbate genetic risk for T2D.Method We use genetic, self-reported neighbourhood, and health data from the Health and Retirement Study. We conducted weighted logistic regression analyses in which neighbourhood disorder, polygenic scores for T2D and their interaction predicted T2D.Results Greater perceptions of neighbourhood disorder (OR=1.11, p<0.001) and higher polygenic scores for T2D (OR=1.42, p<0.001) were each significantly and independently associated with an increased risk of T2D. Furthermore, living in a neighbourhood perceived as having high levels of disorder exacerbated genetic risk for T2D (OR=1.10 VL - 73 UR - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935762/ IS - 5 ER - TY - JOUR T1 - How Does Subjective Age Get “Under the Skin”? The Association Between Biomarkers and Feeling Older or Younger Than One’s Age: The Health and Retirement Study JF - Innovation in Aging Y1 - 2019 A1 - Bharat Thyagarajan A1 - Shippee, Nathan A1 - Parsons, Helen A1 - Vivek, Sithara A1 - Eileen M. Crimmins A1 - Jessica Faul A1 - Shippee, Tetyana KW - Age discrepancy score KW - Biological domains KW - Physiological aging AB - Though subjective age is a well-recognized risk factor for several chronic diseases, the biological basis for these associations remains poorly understood.We used new comprehensive biomarker data from the 2016 wave of the nationally representative Health and Retirement Study (HRS) to evaluate the association between biomarker levels and self-reported subjective age in a subset of 3,740 HRS participants who provided a blood sample. We measured biomarkers in seven biological domains associated with aging: inflammation, glycemia, lipids, liver function, endocrine function, renal function, and cardiac function. The primary outcome was the age discrepancy score (subjective age − chronological age) categorized as those who felt younger, older, or the same as their chronological age (reference group). Analyses adjusted for comprehensive psychosocial factors (chronic stress index, depression score), demographic factors (race, sex, body mass index, marital status, physical activity), and prevalence of chronic health conditions (comorbidity index).The prevalence of clinically relevant reduced levels of albumin concentrations was lower in those who felt younger (8.8\% vs. 16.0\%; p = .006) and higher in those who felt older (20.4\% vs. 16.0\%; p = .03) when compared with the reference category. The prevalence of clinically significant elevation in liver enzymes such as alanine aminotransferase was also significantly lower among those who felt younger (7.1\% vs. 8.6\%; p = .04) when compared with the reference category. Prevalence of clinically elevated levels in cystatin C was also lower among those who felt younger when compared with the reference category (50.0\% vs. 59.1\%; p = .04). There was no association between lipids, glucose, or C-reactive protein (inflammatory marker) and subjective age categories.These results suggest that people who feel younger may have favorable biomarker profiles and as a result may have lower prevalence of age-related diseases when compared with those who feel older or those who feel the same as their chronological age. VL - 3 IS - 4 ER - TY - JOUR T1 - Perceived neighborhood social cohesion and cardiometabolic risk: a gene x environment study JF - BIODEMOGRAPHY AND SOCIAL BIOLOGY Y1 - 2019 A1 - Jennifer W Robinette A1 - Jason D Boardman A1 - Eileen M. Crimmins KW - BODY-MASS INDEX; BLOOD-PRESSURE; OBESITY; DETERMINANTS; PREDICTION; AB - People living in socially cohesive neighborhoods generally have better health. We extend this research by evaluating the hypothesis that perceived neighborhood cohesion may influence health by attenuating genetic liability for cardiometabolic risk factors. Using data from the Health and Retirement Study (n = 6615; mean age 69.7), we conducted a gene x environment interaction study hypothesizing that perceived neighborhood cohesion would attenuate the link between polygenic scores for waist-to-hip ratio (WHR) and body mass index and a measure of multisystem cardiometabolic risk (systolic and diastolic blood pressure, heart rate, A1c, C-reactive protein, and total and high-density lipoprotein cholesterol). In support of the hypothesis, results indicated that among people perceiving low neighborhood cohesion, higher WHR polygenic scores were associated with greater cardiometabolic risk. In contrast, the genetic-cardiometabolic risk link was much attenuated among those living in neighborhoods perceived as socially cohesive. Our results support community-level interventions to enhance the social cohesiveness of individuals' neighborhoods which may provide health benefits by reducing the risks associated with known genetic risk factors. VL - 65 IS - 1 ER - TY - JOUR T1 - Cross-Country Comparisons of Disability and Morbidity: Evidence from the Gateway to Global Aging Data JF - The Journals of Gerontology: Series A Y1 - 2018 A1 - Jinkook Lee A1 - Drystan F. Phillips A1 - Wilkens, Jenny A1 - Chien, Sandy A1 - Lin, Yu-Chen A1 - Marco Angrisani A1 - Eileen M. Crimmins KW - Cross-National KW - Disabilities KW - Disease KW - Gateway to Global Aging AB - Background International comparisons of disease prevalence have been useful in understanding what proportion of disease might be preventable and in informing potential policy interventions in different cultural and economic contexts. Using newly available, harmonized data from 20 countries, we compare disability and morbidity of older adults between the ages of 55 and 74. Methods The Gateway to Global Aging Data, a data and information portal, provides access to easy-to-use individual-level longitudinal data from 10 surveys covering over 30 countries. Exploiting harmonized measures available from the Gateway, we descriptively examine how disability and morbidity differ across countries. Results Significant cross-country differences are observed for several health indicators. Comparing countries with the highest and lowest prevalence rates, we observe that hypertension rates vary twofold and stroke rates vary threefold, while disability and arthritis rates vary more than fivefold. Among women, higher gross domestic product and life expectancy are related to lower diabetes, heart disease, and better functioning. Among men, national indicators of economic conditions are not significantly associated with reported disease prevalence. Conclusions We document substantial heterogeneity in disability and morbidity across countries, separately for men and women and after controlling for population age composition and education. Rich data from various surveys across the world offers remarkable opportunities for cross-country analyses, calling for further investigation of what drives observed differences. The Gateway to Global Aging Data provides easy-to-use harmonized data files and tools to facilitate this type of research. VL - 73 UR - http://academic.oup.com/biomedgerontology/advance-article/doi/10.1093/gerona/glx224/4683782http://academic.oup.com/biomedgerontology/advance-article-pdf/doi/10.1093/gerona/glx224/22474170/glx224.pdf IS - 11 ER - TY - JOUR T1 - Education and Psychosocial Functioning Among Older Adults: 4-Year Change in Sense of Control and Hopelessness. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2018 A1 - Uchechi A Mitchell A1 - Jennifer A Ailshire A1 - Lauren L Brown A1 - Morgan E. Levine A1 - Eileen M. Crimmins KW - Activities of Daily Living KW - Aged KW - Educational Status KW - Female KW - Humans KW - Internal-External Control KW - Male KW - Middle Aged KW - Psychology KW - Sadness KW - Social participation KW - Social Support AB -

OBJECTIVES: This study investigates education differences in levels and change in sense of control and hopelessness among older adults.

METHOD: We used data from the Health and Retirement Study, an ongoing biennial survey of a nationally representative sample of older Americans, to examine education differences in sense of control (e.g., mastery and perceived constraints) and hopelessness. Our sample included 8,495 adults aged 52 and older who were interviewed in 2006/2008 and 2010/2012. We assessed separate models for change in sense of control and hopelessness, accounting for recent changes in social circumstances and health status.

RESULTS: Low mastery, perceived constraints, and hopelessness were highest among individuals with less than a high school education. Over a 4-year period, this group experienced the greatest declines in psychosocial functioning, as indicated by greater increases in low mastery, perceived constraints, and hopelessness. Education differences existed net of recent negative experiences, specifically the loss of intimate social relationships and social support and increases in disease and disability.

DISCUSSION: These findings highlight the importance of education for sense of control and hopelessness in older adulthood and demonstrate the cumulative advantage of higher levels of education for psychosocial functioning.

VL - 73 UR - http://psychsocgerontology.oxfordjournals.org/content/early/2016/03/23/geronb.gbw031.abstract IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27013537?dopt=Abstract U4 - Health and Retirement Study/Longitudinal analysis/Mastery/Perceived constraints ER - TY - JOUR T1 - Educational Differences in the Prevalence of Dementia and Life Expectancy with Dementia: Changes from 2000 to 2010. JF - Journals of Gerontology Series B: Psychological Sciences & Social Sciences Y1 - 2018 A1 - Eileen M. Crimmins A1 - Saito, Yasuhiko A1 - Jung K Kim A1 - Yuan S Zhang A1 - Sasson, Isaac A1 - Mark D Hayward KW - Dementia KW - Education KW - Mortality AB -

Objectives: This article provides the first estimates of educational differences in age-specific prevalence, and changes in prevalence over time, of dementia by education levels in the United States. It also provides information on life expectancy, and changes in life expectancy, with dementia and cognitively healthy life for educational groups.

Method: Data on cognition from the 2000 and 2010 Health and Retirement Study are used to classify respondents as having dementia, cognitive impairment without dementia (CIND), or being cognitively intact. Vital statistics data are used to estimate life tables for education groups and the Sullivan method is used to estimate life expectancy by cognitive state.

Results: People with more education have lower prevalence of dementia, more years of cognitively healthy life, and fewer years with dementia. Years spent in good cognition increased for most sex-education groups and, conversely, years spent with dementia decreased for some. Mortality reduction was the most important factor in increasing cognitively healthy life. Change in the distribution of educational attainment has played a major role in the reduction of life with dementia in the overall population.

Discussion: Differences in the burden of cognitive loss by education point to the significant cost of low social status both to individuals and to society.

VL - 73 IS - suppl_1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/29669097?dopt=Abstract ER - TY - JOUR T1 - Effect of delayed cell processing and cryopreservation on immunophenotyping in multicenter population studies. JF - Journal of Immunological Methods Y1 - 2018 A1 - Bharat Thyagarajan A1 - Barcelo, Helene A1 - Eileen M. Crimmins A1 - David R Weir A1 - Minnerath, Sharon A1 - Vivek, Sithara A1 - Jessica Faul KW - Cell Separation KW - Cryopreservation KW - Immunophenotyping KW - Leukocytes KW - Time Factors AB -

Variability induced by delayed cell processing and cell cryopreservation presents unique challenges for immunophenotyping in large population studies. We conducted a pilot study to evaluate the effect of delayed cell processing and cryopreservation on cell percentages obtained by immunophenotyping. We collected blood from 20 volunteers and compared the effect of (a) delayed cell processing up to 72 h (b) cryopreservation and (c) the combined effect of delayed cell processing and cryopreservation on immunophenotyping of 31 cell subsets that included several subsets of T, B, Natural Killer (NK) cells, monocytes and dendritic cells using both whole blood collected in EDTA tubes and peripheral blood mononuclear cells collected in CPT tubes. We found the delayed cell processing up to 72 h or cryopreservation alone did not significantly affect the percentages T cells, dendritic cells or monocytes but significantly increased the percentage of B cells and NK cells (p for trend ≤0.01) but. However combination of delayed cell processing up to 72 h and cryopreservation significantly increased the percentage of T cells as compared to cells processed immediately (p for trend <0.0001) while a delayed cell processing followed by cryopreservation decreased the percentage of NK cells (p for trend <0.0001). Total B-cells increased significantly with a 24-48 h delay in cell processing and cryopreservation but not at 72 h. The percentages of monocytes and dendritic cells remained unaffected by the combination of delayed cell processing and cryopreservation. These findings suggest that immunophenotyping of several immune cell subsets can be successfully implemented in large population studies as long as blood is processed within 48 h of biospecimen collection though some cell subsets may be more susceptible to a combination of delayed cell processing and cryopreservation.

VL - 463 ER - TY - JOUR T1 - The Health and Retirement Study: Analysis of Associations Between Use of the Internet for Health Information and Use of Health Services at Multiple Time Points JF - Journal of Medical Internet Research Y1 - 2018 A1 - Shim, Hyunju A1 - Jennifer A Ailshire A1 - Elizabeth Zelinski A1 - Eileen M. Crimmins KW - Accessibility KW - Health Behavior KW - Internet usage KW - Survey Methodology AB - Background: The use of the internet for health information among older people is receiving increasing attention, but how it is associated with chronic health conditions and health service use at concurrent and subsequent time points using nationally representative data is less known. Objective: This study aimed to determine whether the use of the internet for health information is associated with health service utilization and whether the association is affected by specific health conditions. Methods: The study used data collected in a technology module from a nationally representative sample of community-dwelling older Americans aged 52 years and above from the 2012 Health and Retirement Study (HRS; N=991). Negative binomial regressions were used to examine the association between use of Web-based health information and the reported health service uses in 2012 and 2014. Analyses included additional covariates adjusting for predisposing, enabling, and need factors. Interactions between the use of the internet for health information and chronic health conditions were also tested. Results: A total of 48.0% (476/991) of Americans aged 52 years and above reported using Web-based health information. The use of Web-based health information was positively associated with the concurrent reports of doctor visits, but not over 2 years. However, an interaction of using Web-based health information with diabetes showed that users had significantly fewer doctor visits compared with nonusers with diabetes at both times. Conclusions: The use of the internet for health information was associated with higher health service use at the concurrent time, but not at the subsequent time. The interaction between the use of the internet for health information and diabetes was significant at both time points, which suggests that health-related internet use may be associated with fewer doctor visits for certain chronic health conditions. Results provide some insight into how Web-based health information may provide an alternative health care resource for managing chronic conditions. VL - 20 UR - http://www.jmir.org/2018/5/e200/ IS - 5 JO - J Med Internet Res ER - TY - JOUR T1 - The Impact of Changes in Population Health and Mortality on Future Prevalence of Alzheimer’s Disease and Other Dementias in the United States JF - The Journals of Gerontology: Series B Y1 - 2018 A1 - Julie M Zissimopoulos A1 - Tysinger, Bryan A1 - Patricia A St Clair A1 - Eileen M. Crimmins KW - Alzheimer's disease KW - Dementia KW - Mortality KW - Population Health AB - Objectives We assessed potential benefits for older Americans of reducing risk factors associated with dementia. Methods A dynamic simulation model tracked a national cohort of persons 51 and 52 years of age to project dementia onset and mortality in risk reduction scenarios for diabetes, hypertension, and dementia. Results We found reducing incidence of diabetes by 50% did not reduce number of years a person ages 51 or 52 lived with dementia and increased the population ages 65 and older in 2040 with dementia by about 115,000. Eliminating hypertension at middle and older ages increased life expectancy conditional on survival to age 65 by almost 1 year, however, it increased years living with dementia. Innovation in treatments that delay onset of dementia by 2 years increased longevity, reduced years with dementia, and decreased the population ages 65 and older in 2040 with dementia by 2.2 million. Conclusions Prevention of chronic disease may generate health and longevity benefits but does not reduce burden of dementia. A focus on treatments that provide even short delays in onset of dementia can have immediate impacts on longevity and quality of life and reduce the number of Americans with dementia over the next decades. VL - 73 UR - https://academic.oup.com/psychsocgerontology/article/73/suppl_1/S38/4971567http://academic.oup.com/psychsocgerontology/article-pdf/73/suppl_1/S38/24626796/gbx147.pdf IS - suppl_1 ER - TY - JOUR T1 - A Practical Cryopreservation and Staining Protocol for Immunophenotyping in Population Studies. JF - Current Protocols in Cytometry Y1 - 2018 A1 - Barcelo, Helene A1 - Jessica Faul A1 - Eileen M. Crimmins A1 - Bharat Thyagarajan KW - Cryopreservation KW - Quality control KW - Survey Methodology AB - Large population-based cohort studies, through their prospective collection of a broad range of health information, represent an invaluable resource for novel insights into the pathogenesis of human diseases. Collection and cryopreservation of viable cells from blood samples is becoming increasingly common in large cohorts as these cells are a valuable resource for immunophenotyping and functional studies. The cryopreservation of peripheral blood mononuclear cells (PBMCs), thawing, and immunophenotyping protocols used to immunophenotype 9938 participants in the Health and Retirement Study (HRS) are described. The extensive quality control involved in a large-scale immunophenotyping epidemiological study is also outlined. The existing literature on the effect of cryopreservation on various immune cell subsets including T, B, NK cells, monocytes, and dendritic cells is provided. © 2018 by John Wiley & Sons, Inc. VL - 84 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/30040214?dopt=Abstract ER - TY - JOUR T1 - Predictors and implications of accelerated cognitive aging JF - Biodemography and Social Biology Y1 - 2018 A1 - Morgan E. Levine A1 - Harrati, Amal A1 - Eileen M. Crimmins KW - BMI KW - Cognition & Reasoning KW - Risk Factors KW - Socioeconomic factors AB - Aging is a major risk factor for both normal and pathological cognitive decline. However, individuals vary in their rate of age-related decline. We developed an easily interpretable composite measure of cognitive age, and related both the level of cognitive age and cognitive slope to sociodemographic, genetic, and disease indicators and examined its prediction of dementia transition. Using a sample of 19,594 participants from the Health and Retirement Study, cognitive age was derived from a set of performance tests administered at each wave. Our findings reveal different conclusions as they relate to levels versus slopes of cognitive age, with more pronounced differences by sex and race/ethnicity for absolute levels of cognitive decline rather than for rates of declines. We also find that both level and slope of cognitive age are inversely related to education, as well as increased for persons with APOE ?4 and/or diabetes. Finally, results show that the slope in cognitive age predicts subsequent dementia among non-demented older adults. Overall, our study suggests that this measure is applicable to cross-sectional and longitudinal studies on cognitive aging, decline, and dementia with the goal of better understanding individual differences in cognitive decline. VL - 64 UR - https://www.tandfonline.com/doi/full/10.1080/19485565.2018.1552513https://www.tandfonline.com/doi/pdf/10.1080/19485565.2018.1552513 IS - 2 JO - Biodemography and Social Biology ER - TY - CHAP T1 - Ageing in North America: Canada and the United States T2 - Oxford Textbook of Geriatric Medicine Y1 - 2017 A1 - Eileen M. Crimmins A1 - Hiram Beltrán-Sánchez A1 - Lauren L Brown A1 - Yon, Yongjie A1 - Michel, Jean-Pierre A1 - Beattie, B. Lynn A1 - Martin, Finbarr C. A1 - Jeremy D Walston KW - Aging KW - Cross-National JF - Oxford Textbook of Geriatric Medicine PB - Oxford University Press CY - Cary, NC SN - 978-0198701590 ER - TY - JOUR T1 - Clinical Trials Targeting Aging and Age-Related Multimorbidity JF - The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Y1 - 2017 A1 - Mark A. Espeland A1 - Eileen M. Crimmins A1 - Brandon R. Grossardt A1 - Jill P. Crandall A1 - Jonathan A. L. Gelfond A1 - Tamara B Harris A1 - Stephen B Kritchevsky A1 - JoAnn E Manson A1 - Jennifer G Robinson A1 - Walter A Rocca A1 - Temprosa, Marinella A1 - Thomas, Fridtjof A1 - Robert B Wallace A1 - Barzilai, Nir KW - Chronic disease KW - Clinical trials KW - Older Adults AB - Background: There is growing interest in identifying interventions that may increase health span by targeting biological processes underlying aging. The design of efficient and rigorous clinical trials to assess these interventions requires careful consideration of eligibility criteria, outcomes, sample size, and monitoring plans. Methods: Experienced geriatrics researchers and clinical trialists collaborated to provide advice on clinical trial design. Results: Outcomes based on the accumulation and incidence of age-related chronic diseases are attractive for clinical trials targeting aging. Accumulation and incidence rates of multimorbidity outcomes were developed by selecting at-risk subsets of individuals from three large cohort studies of older individuals. These provide representative benchmark data for decisions on eligibility, duration, and assessment protocols. Monitoring rules should be sensitive to targeting aging-related, rather than disease-specific, outcomes. Conclusions: Clinical trials targeting aging are feasible, but require careful design consideration and monitoring rules. VL - 72 UR - https://academic.oup.com/biomedgerontology/article-lookup/doi/10.1093/gerona/glw220https://academic.oup.com/biomedgerontology/article/2328606/Clinical-Trials-Targeting-Aging-and-AgeRelated IS - 3 JO - GERONA ER - TY - JOUR T1 - A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012. JF - JAMA Intern Med Y1 - 2017 A1 - Kenneth M. Langa A1 - Eric B Larson A1 - Eileen M. Crimmins A1 - Jessica Faul A1 - Deborah A Levine A1 - Mohammed U Kabeto A1 - David R Weir KW - Aged KW - Dementia KW - Female KW - Humans KW - Male KW - Prevalence KW - Risk Factors KW - United States AB -

Importance: The aging of the US population is expected to lead to a large increase in the number of adults with dementia, but some recent studies in the United States and other high-income countries suggest that the age-specific risk of dementia may have declined over the past 25 years. Clarifying current and future population trends in dementia prevalence and risk has important implications for patients, families, and government programs.

Objective: To compare the prevalence of dementia in the United States in 2000 and 2012.

Design, Setting, and Participants: We used data from the Health and Retirement Study (HRS), a nationally representative, population-based longitudinal survey of individuals in the United States 65 years or older from the 2000 (n = 10 546) and 2012 (n = 10 511) waves of the HRS.

Main Outcomes and Measures: Dementia was identified in each year using HRS cognitive measures and validated methods for classifying self-respondents, as well as those represented by a proxy. Logistic regression was used to identify socioeconomic and health variables associated with change in dementia prevalence between 2000 and 2012.

Results: The study cohorts had an average age of 75.0 years (95% CI, 74.8-75.2 years) in 2000 and 74.8 years (95% CI, 74.5-75.1 years) in 2012 (P = .24); 58.4% (95% CI, 57.3%-59.4%) of the 2000 cohort was female compared with 56.3% (95% CI, 55.5%-57.0%) of the 2012 cohort (P < .001). Dementia prevalence among those 65 years or older decreased from 11.6% (95% CI, 10.7%-12.7%) in 2000 to 8.8% (95% CI, 8.2%-9.4%) (8.6% with age- and sex-standardization) in 2012 (P < .001). More years of education was associated with a lower risk for dementia, and average years of education increased significantly (from 11.8 years [95% CI, 11.6-11.9 years] to 12.7 years [95% CI, 12.6-12.9 years]; P < .001) between 2000 and 2012. The decline in dementia prevalence occurred even though there was a significant age- and sex-adjusted increase between years in the cardiovascular risk profile (eg, prevalence of hypertension, diabetes, and obesity) among older US adults.

Conclusions and Relevance: The prevalence of dementia in the United States declined significantly between 2000 and 2012. An increase in educational attainment was associated with some of the decline in dementia prevalence, but the full set of social, behavioral, and medical factors contributing to the decline is still uncertain. Continued monitoring of trends in dementia incidence and prevalence will be important for better gauging the full future societal impact of dementia as the number of older adults increases in the decades ahead.

VL - 177 UR - http://archinte.jamanetwork.com/article.aspx?doi=10.1001/jamainternmed.2016.6807http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2587084 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27893041?dopt=Abstract JO - JAMA Intern Med ER - TY - JOUR T1 - Contemporaneous Social Environment and the Architecture of Late-Life Gene Expression Profiles. JF - American Journal of Epidemiology Y1 - 2017 A1 - Morgan E. Levine A1 - Eileen M. Crimmins A1 - David R Weir A1 - Steven W. Cole KW - Genetics KW - Socioeconomic factors AB - Environmental or social challenges can stimulate a cascade of coordinated physiological changes in stress response systems. Unfortunately, chronic activation of these adaptations under conditions such as low socioeconomic status (SES) can have negative consequences for long-term health. While there is substantial evidence tying low SES to increased disease risk and reduced life expectancy, the underlying biology remains poorly understood. Using pilot data on 120 older adults from the Health and Retirement Study (United States, 2002-2010), we examined the associations between SES and gene expression levels in adulthood, with particular focus on a gene expression program known as the conserved transcriptional response to adversity. We also used a bioinformatics-based approach to assess the activity of specific gene regulation pathways involved in inflammation, antiviral responses, and stress-related neuroendocrine signaling. We found that low SES was related to increased expression of conserved transcriptional response to adversity genes and distinct patterns of proinflammatory, antiviral, and stress signaling (e.g., sympathetic nervous system and hypothalamic-pituitary-adrenal axis) transcription factor activation. VL - 186 IS - 5 U1 - http://www.ncbi.nlm.nih.gov/pubmed/28911009?dopt=Abstract ER - TY - RPRT T1 - Documentation of Blood-Based Biomarkers in the 2014 Health and Retirement Study Y1 - 2017 A1 - Eileen M. Crimmins A1 - Jessica Faul A1 - Jung K Kim A1 - David R Weir PB - Survey Research Center, Institute for Social Research, University of Michigan CY - Ann Arbor, MI ER - TY - JOUR T1 - Genetic architecture of epigenetic and neuronal ageing rates in human brain regions JF - Nature Communications Y1 - 2017 A1 - Lu, Ake T A1 - Hannon, Eilis A1 - Morgan E. Levine A1 - Eileen M. Crimmins A1 - Lunnon, Katie A1 - Mill, Jonathan A1 - Daniel H. Geschwind A1 - Horvath, Steve KW - Genetics AB - Identifying genes regulating the pace of epigenetic ageing represents a new frontier in genome-wide association studies (GWASs). Here using 1,796 brain samples from 1,163 individuals, we carry out a GWAS of two DNA methylation-based biomarkers of brain age: the epigenetic ageing rate and estimated proportion of neurons. Locus 17q11.2 is significantly associated (P=4.5 × 10 -9 ) with the ageing rate across five brain regions and harbours a cis-expression quantitative trait locus for EFCAB5 (P=3.4 × 10-20 ). Locus 1p36.12 is significantly associated (P=2.2 × 10-8 ) with epigenetic ageing of the prefrontal cortex, independent of the proportion of neurons. Our GWAS of the proportion of neurons identified two genome-wide significant loci (10q26 and 12p13.31) and resulted in a gene set that overlaps significantly with sets found by GWAS of age-related macular degeneration (P=1.4 × 10 -12 ), ulcerative colitis (P<1.0 × 10-20 ), type 2 diabetes (P=2.8 × 10-13 ), hip/waist circumference in men (P=1.1 × 10-9 ), schizophrenia (P=1.6 × 10-9 ), cognitive decline (P=5.3 × 10-4 ) and Parkinson's disease (P=8.6 × 10-3 ). VL - 8 UR - http://www.nature.com/doifinder/10.1038/ncomms15353http://www.nature.com/doifinder/10.1038/ncomms15353 JO - Nat Comms ER - TY - RPRT T1 - Venous Blood Collection and Assay Protocol in the 2016 Health and Retirement Study Y1 - 2017 A1 - Eileen M. Crimmins A1 - Jessica Faul A1 - Bharat Thyagarajan A1 - David R Weir PB - Survey Research Center, Institute for Social Research, University of Michigan CY - Ann Arbor, Michigan ER - TY - JOUR T1 - Change in Cognitively Healthy and Cognitively Impaired Life Expectancy in the United States: 2000-2010. JF - SSM Popul Health Y1 - 2016 A1 - Eileen M. Crimmins A1 - Saito, Yasuhiko A1 - Jung K Kim AB -

OBJECTIVE: To determine how cognitively healthy and cognitively impaired life expectancy have changed from 2000 to 2010 among American men and women 65 years of age and over.

METHODS: The prevalence of dementia, cognitive impairment without dementia (CIND), and normal cognition is determined from the nationally representative data from the U.S. Health and Retirement Study (HRS). Mortality rates are from U.S. Decennial Life Table for 2000 and the U.S. annual life table for 2010. Life expectancy by cognitive status is estimated using the Sullivan method.

RESULTS: Most of the increase in life expectancy has been concentrated in cognitively healthy years in this 10 year period. The increase in expected years cognitively intact at age 65, which exceeded that in total life expectancy, was 1.8 for men and 1.6 for women.

CONCLUSION: This study provides evidence suggesting that there has been a compression of cognitive morbidity.

VL - 2 UR - http://linkinghub.elsevier.com/retrieve/pii/S2352827316301148http://api.elsevier.com/content/article/PII:S2352827316301148?httpAccept=text/plainhttp://api.elsevier.com/content/article/PII:S2352827316301148?httpAccept=text/xml U1 - http://www.ncbi.nlm.nih.gov/pubmed/27917398?dopt=Abstract JO - SSM - Population Health ER - TY - JOUR T1 - The effect of job loss on health: Evidence from biomarkers JF - Labour Economics Y1 - 2016 A1 - Pierre-Carl Michaud A1 - Eileen M. Crimmins A1 - Michael D Hurd KW - Biomarkers KW - Health Shocks KW - Job loss KW - Older Adults KW - Retirement Planning and Satisfaction AB - We estimate the effect of job loss on objective measures of physiological dysregulation using biomarker measures collected by the Health and Retirement Study in 2006 and 2008 and longitudinal self-reports of work status. We distinguish between group or individual layoffs, and business closures. Workers who are laid off from their job have lower health as measured by biomarker, whereas workers laid off in the context of a business closure do not. Estimates matching respondents wave-by-wave on self-reported health conditions and subjective job loss expectations prior to job loss, suggest strong effects of layoffs on biomarkers, in particular for glycosylated hemoglobin (HbA1c). A layoff could increase annual mortality rates by 10.3%, consistent with other evidence of the effect of group layoffs on mortality. VL - 41 UR - http://linkinghub.elsevier.com/retrieve/pii/S0927537116300288http://api.elsevier.com/content/article/PII:S0927537116300288?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0927537116300288?httpAccept=text/plain JO - Labour Economics ER - TY - JOUR T1 - Effects of Recent Stress and Variation in the Serotonin Transporter Polymorphism (5-HTTLPR) on Depressive Symptoms: A Repeated-Measures Study of Adults Age 50 and Older. JF - Behavior Genetics Y1 - 2016 A1 - Thalida E. Arpawong A1 - Jinkook Lee A1 - Drystan F. Phillips A1 - Eileen M. Crimmins A1 - Morgan E. Levine A1 - Carol A Prescott KW - Aged KW - Alleles KW - depression KW - Depressive Disorder KW - Ethnic Groups KW - Female KW - Gene-Environment Interaction KW - Genetic Association Studies KW - Genetic Predisposition to Disease KW - Haplotypes KW - Humans KW - Life Change Events KW - Male KW - Middle Aged KW - Polymorphism, Single Nucleotide KW - Promoter Regions, Genetic KW - Serotonin Plasma Membrane Transport Proteins KW - Stress, Psychological AB -

Depending on genetic sensitivity to it, stress may affect depressive symptomatology differentially. Applying the stress-diathesis hypothesis to older adults, we postulate: (1) recent stress will associate with increased depressive symptom levels and (2) this effect will be greater for individuals with at least one short allele of the serotonin transporter gene promoter region (5-HTTLPR). Further, we employ a design that addresses specific limitations of many prior studies that have examined the 5-HTTLPR × SLE relation, by: (a) using a within-person repeated-measures design to address fluctuations that occur within individuals over time, increase power for detecting G × E, and address GE correlation; (b) studying reports of exogenous stressful events (those unlikely to be caused by depression) to help rule out reverse causation and negativity bias, and in order to assess stressors that are more etiologically relevant to depressive symptomatology in older adults. The sample is drawn from the Health and Retirement Study, a U.S. population-based study of older individuals (N = 28,248; mean age = 67.5; 57.3 % female; 80.7 % Non-Hispanic White, 14.9 % Hispanic/Latino, 4.5 % African American; genetic subsample = 12,332), from whom measures of depressive symptoms and exogenous stressors were collected biannually (1994-2010). Variation in the 5-HTTLPR was characterized via haplotype, using two single nucleotide polymorphisms (SNPs). Ordered logit models were constructed to predict levels of depressive symptoms from 5-HTTLPR and stressors, comparing results of the most commonly applied statistical approaches (i.e., comparing allelic and genotypic models, and continuous and categorical predictors) used in the literature. All models were stratified by race/ethnicity. Overall, results show a main effect of recent stress for all ethnic groups, and mixed results for the variation in 5-HTTLPR × stress interaction, contingent upon statistical model used. Findings suggest there may be a differential effect of stressors and 5-HTTLPR on depressive symptoms by ethnicity, but further research is needed, particularly when using a haplotype to characterize variation in 5-HTTLPR in population-based sample with a diverse ethnic composition.

PB - 46 VL - 46 IS - 1 U2 - PMC4720538 U4 - 5-HTTLPR/Depressive symptoms/G/Older adults/Race differences/Stressful life events/Genetic analysis ER - TY - JOUR T1 - Female disability disadvantage: a global perspective on sex differences in physical function and disability. JF - Ageing Soc Y1 - 2016 A1 - Felicia V Wheaton A1 - Eileen M. Crimmins AB -

The objectives were to determine whether women always fare more poorly in terms of physical function and disability across countries that vary widely in terms of their level of development, epidemiologic context and level of gender equality. Sex differences in self-reported and objective measures of disability and physical function were compared among older adults aged 55-85 in the United States of America, Taiwan, Korea, Mexico, China, Indonesia and among the Tsimane of Bolivia using population-based studies collected between 2001 and 2011. Data were analysed using logistic and ordinary least-squares regression. Confidence intervals were examined to see whether the effect of being female differed significantly between countries. In all countries, women had consistently worse physical functioning (both self-reported and objectively measured). Women also tended to report more difficulty with activities of daily living (ADL), although differences were not always significant. In general, sex differences across measures were less pronounced in China. In Korea, women had significantly lower grip strength, but sex differences in ADL difficulty were non-significant or even reversed. Education and marital status helped explain sex differences. Overall, there was striking similarity in the magnitude and direction of sex differences across countries despite considerable differences in context, although modest variations in the effect of sex were observed.

VL - 36 UR - http://www.journals.cambridge.org/abstract_S0144686X15000227 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27453613?dopt=Abstract JO - Ageing and Society ER - TY - JOUR T1 - A Genetic Network Associated With Stress Resistance, Longevity, and Cancer in Humans. JF - J Gerontol A Biol Sci Med Sci Y1 - 2016 A1 - Morgan E. Levine A1 - Eileen M. Crimmins KW - Aged KW - Aged, 80 and over KW - Aging KW - Alleles KW - Case-Control Studies KW - Gene Regulatory Networks KW - Genome-Wide Association Study KW - Genotype KW - Humans KW - Longevity KW - Longitudinal Studies KW - Middle Aged KW - Neoplasms KW - Phenotype KW - Polymorphism, Single Nucleotide KW - Smoking KW - Stress, Physiological KW - United States AB -

Human longevity and diseases are likely influenced by multiple interacting genes within a few biologically conserved pathways. Using long-lived smokers as a phenotype (n = 90)-a group whose survival may signify innate resilience-we conducted a genome-wide association study comparing them to smokers at ages 52-69 (n = 730). These results were used to conduct a functional interaction network and pathway analysis, to identify single nucleotide polymorphisms that collectively related to smokers' longevity. We identified a set of 215 single nucleotide polymorphisms (all of which had p <5×10(-3) in the genome-wide association study) that were located within genes making-up a functional interaction network. These single nucleotide polymorphisms were then used to create a weighted polygenic risk score that, using an independent validation sample of nonsmokers (N = 6,447), was found to be significantly associated with a 22% increase in the likelihood of being aged 90-99 (n = 253) and an over threefold increase in the likelihood of being a centenarian (n = 4), compared with being at ages 52-79 (n = 4,900). Additionally, the polygenic risk score was also associated with an 11% reduction in cancer prevalence over up to 18 years (odds ratio: 0.89, p = .011). Overall, using a unique phenotype and incorporating prior knowledge of biological networks, this study identified a set of single nucleotide polymorphisms that together appear to be important for human aging, stress resistance, cancer, and longevity.

VL - 71 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26355015?dopt=Abstract ER - TY - JOUR T1 - Genetic variants near MLST8 and DHX57 affect the epigenetic age of the cerebellum. JF - Nat Commun Y1 - 2016 A1 - Lu, Ake T A1 - Hannon, Eilis A1 - Morgan E. Levine A1 - Hao, Ke A1 - Eileen M. Crimmins A1 - Lunnon, Katie A1 - Kozlenkov, Alexey A1 - Mill, Jonathan A1 - Dracheva, Stella A1 - Horvath, Steve KW - Adaptor Proteins, Signal Transducing KW - Aging KW - Cell Line KW - Cerebellum KW - Epigenesis, Genetic KW - Gene Expression Regulation KW - Genetic Variation KW - Genome-Wide Association Study KW - Humans KW - Linkage Disequilibrium KW - mTOR Associated Protein, LST8 Homolog AB -

DNA methylation (DNAm) levels lend themselves for defining an epigenetic biomarker of aging known as the 'epigenetic clock'. Our genome-wide association study (GWAS) of cerebellar epigenetic age acceleration identifies five significant (P<5.0 × 10(-8)) SNPs in two loci: 2p22.1 (inside gene DHX57) and 16p13.3 near gene MLST8 (a subunit of mTOR complex 1 and 2). We find that the SNP in 16p13.3 has a cis-acting effect on the expression levels of MLST8 (P=6.9 × 10(-18)) in most brain regions. In cerebellar samples, the SNP in 2p22.1 has a cis-effect on DHX57 (P=4.4 × 10(-5)). Gene sets found by our GWAS analysis of cerebellar age acceleration exhibit significant overlap with those of Alzheimer's disease (P=4.4 × 10(-15)), age-related macular degeneration (P=6.4 × 10(-6)), and Parkinson's disease (P=2.6 × 10(-4)). Overall, our results demonstrate the utility of a new paradigm for understanding aging and age-related diseases: it will be fruitful to use epigenetic tissue age as endophenotype in GWAS.

VL - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26830004?dopt=Abstract ER - TY - JOUR T1 - Becoming centenarians: disease and functioning trajectories of older US Adults as they survive to 100. JF - J Gerontol A Biol Sci Med Sci Y1 - 2015 A1 - Jennifer A Ailshire A1 - Hiram Beltrán-Sánchez A1 - Eileen M. Crimmins KW - Activities of Daily Living KW - Aged, 80 and over KW - Aging KW - Chronic disease KW - Cognition KW - Disability Evaluation KW - Educational Status KW - Female KW - Geriatric Assessment KW - Health Status KW - Health Surveys KW - Humans KW - Longevity KW - Longitudinal Studies KW - Male KW - Marital Status KW - Prospective Studies KW - Sex Factors KW - United States AB -

BACKGROUND: Little is known about the health and functioning of individuals who become centenarians in the years prior to reaching age 100. We examined long-term trajectories of disease, disability, and cognitive function in a sample of U.S. centenarians to determine how their aging experience differs from their nonsurviving cohort counterparts, and if there is heterogeneity in the aging experience of centenarians.

METHODS: Data are from the 1993-2010 waves of the nationally representative Health and Retirement Study. Among those who had the potential to become centenarians, we identified 1,045 respondents who died before reaching age 100 and 96 who survived to their 100th birthday. Respondents, or their proxies, reported on diagnosis of six major diseases (hypertension, heart disease, lung disease, stroke, cancer, and diabetes), limitations in activities of daily living, and cognitive function.

RESULTS: As they age to 100, centenarians are generally healthier than nonsurviving members of their cohort, and a number of individuals who become centenarians reach 100 with no self-reported diseases or functional impairments. About 23% of centenarians reached age 100 with no major chronic disease and approximately the same number had no disability (18%). Over half (55%) reached 100 without cognitive impairment. Disease and functioning trajectories of centenarians differ by sex, education, and marital status.

CONCLUSIONS: While some centenarians have poor health and functioning upon reaching age 100, others are able to achieve exceptional longevity in relatively good health and without loss of functioning. This study underscores the importance of examining variation in the growing centenarian population.

PB - 70 VL - 70 UR - http://biomedgerontology.oxfordjournals.org/content/70/2/193.abstract IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25136001?dopt=Abstract ER - TY - JOUR T1 - Childhood and later life stressors and increased inflammatory gene expression at older ages. JF - Soc Sci Med Y1 - 2015 A1 - Morgan E. Levine A1 - Steven W. Cole A1 - David R Weir A1 - Eileen M. Crimmins KW - Adolescent KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Body Mass Index KW - Continental Population Groups KW - Cyclooxygenase 2 KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Interleukin-1beta KW - Interleukin-8 KW - Life Change Events KW - Male KW - Middle Aged KW - Obesity KW - RNA KW - Sex Factors KW - Smoking KW - Socioeconomic factors KW - Stress, Psychological AB -

Adverse experiences in early life have the ability to "get under the skin" and affect future health. This study examined the relative influence of adversities during childhood and adulthood in accounting for individual differences in pro-inflammatory gene expression in late life. Using a pilot-sample from the Health and Retirement Study (N = 114) aged from 51 to 95, OLS regression models were run to determine the association between a composite score from three proinflammatory gene expression levels (PTGS2, ILIB, and IL8) and 1) childhood trauma, 2) childhood SES, 3) childhood health, 4) adult traumas, and 5) low SES in adulthood. Our results showed that only childhood trauma was found to be associated with increased inflammatory transcription in late life. Furthermore, examination of interaction effects showed that childhood trauma exacerbated the influence of low SES in adulthood on elevated levels of inflammatory gene expression-signifying that having low SES in adulthood was most damaging for persons who had experienced traumatic events during their childhood. Overall our study suggests that traumas experienced during childhood may alter the stress response, leading to more sensitive reactivity throughout the lifespan. As a result, individuals who experienced greater adversity in early life may be at higher risk of late life health outcomes, particularly if adulthood adversity related to SES persists.

PB - 130 VL - 130 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25658624?dopt=Abstract U2 - PMC4394113 U4 - childhood health/adverse events/adverse events/trauma ER - TY - JOUR T1 - Diagnosis and control of hypertension in the elderly populations of Japan and the United States JF - International Journal of Population Studies Y1 - 2015 A1 - Saito, Yasuhiko A1 - Davarian, Shieva A1 - Takahashi, Atsuhiko A1 - Schneider, Edward A1 - Eileen M. Crimmins KW - Blood pressure KW - Cross-National KW - Health Conditions and Status KW - Heart disease KW - Hypertension KW - Older Adults AB - The Japanese have the highest life expectancy in the world while the United States (U.S.) has relatively low life expectancy. Furthermore, the Americans have relatively poorer health compared to the Japanese. Examination of the treatment of specific conditions such as hypertension in these two countries may provide insights into how the health care system con-tributes to the relative health in these two countries. In this study, we focus on the treatment of hypertension, as this is the most common condition requiring therapeutic interventions in se-niors. This study examines hypertension diagnoses and controls in nationally representative samples of the older populations (68 years old or older) of Japan and the U.S. Data come from two nationally representative samples: the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) (n = 2,309) and the U.S. Health and Retirement (HRS) Study (n = 3,517). The overall prevalence of hypertension is higher in Japan than the U.S. Undiagnosed hyperten-sion is about four times higher in Japan than in the U.S., while the control of blood pressure is more than four times higher in the U.S. than in Japan. Thus, the use of antihypertensive medi-cation is much more frequent and more effective in the U.S. The medical care system seems to be more effective in controlling hypertension in the U.S. than in Japan. This may be due to the more aggressive diagnosis and treatment of hypertension in the U.S. VL - 1 UR - http://ijps.whioce.com/index.php/ijps/article/view/01008 ER - TY - JOUR T1 - Disease incidence and mortality among older Americans and Europeans. JF - Demography Y1 - 2015 A1 - Sole-Auro, Aida A1 - Pierre-Carl Michaud A1 - Michael D Hurd A1 - Eileen M. Crimmins KW - Age Distribution KW - Aged KW - Chronic disease KW - Europe KW - Health Behavior KW - Humans KW - Incidence KW - Middle Aged KW - Neoplasms KW - Prevalence KW - Risk Factors KW - Sex Distribution KW - Socioeconomic factors KW - United States AB -

Recent research has shown a widening gap in life expectancy at age 50 between the United States and Europe as well as large differences in the prevalence of diseases at older ages. Little is known about the processes determining international differences in the prevalence of chronic diseases. Higher prevalence of disease could result from either higher incidence or longer disease-specific survival. This article uses comparable longitudinal data from 2004 and 2006 for populations aged 50 to 79 from the United States and from a selected group of European countries to examine age-specific differences in prevalence and incidence of heart disease, stroke, lung disease, diabetes, hypertension, and cancer as well as mortality associated with each disease. Not surprisingly, we find that Americans have higher disease prevalence. For heart disease, diabetes, and cancer, incidence is lower in Europe when we control for sociodemographic and health behavior differences in risk, and these differences explain much of the prevalence gap at older ages. On the other hand, incidence is higher in Europe for lung disease and not different between Europe and the United States for hypertension and stroke. Our findings do not suggest a survival advantage conditional on disease in Europe compared with the United States. Therefore, the origin of the higher disease prevalence at older ages in the United States is to be found in higher prevalence earlier in the life course and, for some conditions, higher incidence between ages 50 and 79.

VL - 52 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25715676?dopt=Abstract ER - TY - RPRT T1 - Documentation of Biomarkers in the 2010 and 2012 Health and Retirement Study Y1 - 2015 A1 - Eileen M. Crimmins A1 - Jessica Faul A1 - Jung K Kim A1 - David R Weir KW - Biomarkers KW - Meta-analyses KW - Survey Methodology PB - Survey Research Center, University of Michigan CY - Ann Arbor, Michigan ER - TY - JOUR T1 - Lifespan and Healthspan: Past, Present, and Promise. JF - Gerontologist Y1 - 2015 A1 - Eileen M. Crimmins KW - Aged KW - Aged, 80 and over KW - Aging KW - Disabled Persons KW - Humans KW - Life Expectancy KW - Socioeconomic factors KW - United States AB -

The past century was a period of increasing life expectancy throughout the age range. This resulted in more people living to old age and to spending more years at the older ages. It is likely that increases in life expectancy at older ages will continue, but life expectancy at birth is unlikely to reach levels above 95 unless there is a fundamental change in our ability to delay the aging process. We have yet to experience much compression of morbidity as the age of onset of most health problems has not increased markedly. In recent decades, there have been some reductions in the prevalence of physical disability and dementia. At the same time, the prevalence of disease has increased markedly, in large part due to treatment which extends life for those with disease. Compressing morbidity or increasing the relative healthspan will require "delaying aging" or delaying the physiological change that results in disease and disability. While moving to life expectancies above age 95 and compressing morbidity substantially may require significant scientific breakthroughs; significant improvement in health and increases in life expectancy in the United States could be achieved with behavioral, life style, and policy changes that reduce socioeconomic disparities and allow us to reach the levels of health and life expectancy achieved in peer societies.

VL - 55 IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26561272?dopt=Abstract ER - TY - JOUR T1 - Loneliness, eudaimonia, and the human conserved transcriptional response to adversity. JF - Psychoneuroendocrinology Y1 - 2015 A1 - Steven W. Cole A1 - Morgan E. Levine A1 - Jesusa M. G. Arevalo A1 - Ma, Jeffrey A1 - David R Weir A1 - Eileen M. Crimmins KW - Aged KW - Aged, 80 and over KW - Down-Regulation KW - Female KW - Humans KW - Inflammation KW - Loneliness KW - Longitudinal Studies KW - Male KW - Mental Health KW - Middle Aged KW - social isolation KW - Social Support KW - Stress, Psychological KW - Transcriptome AB -

BACKGROUND: Chronic social adversity activates a conserved transcriptional response to adversity (CTRA) marked by increased expression of pro-inflammatory genes and decreased expression of antiviral- and antibody-related genes. Recent findings suggest that some psychological resilience factors may help buffer CTRA activation, but the relative impact of resilience and adversity factors remains poorly understood. Here we examined the relative strength of CTRA association for the two best-established psychological correlates of CTRA gene expression-the risk factor of perceived social isolation (loneliness) and the resilience factor of eudaimonic well-being (purpose and meaning in life).

METHODS: Peripheral blood samples and validated measures of loneliness and eudaimonic well-being were analyzed in 108 community-dwelling older adults participating in the longitudinal US Health and Retirement Study (56% female, mean age 73). Mixed effect linear model analyses quantified the strength of association between CTRA gene expression and measures of loneliness and eudaimonic well-being in separate and joint analyses.

RESULTS: As in previous studies, separate analyses found CTRA gene expression to be up-regulated in association with loneliness and down-regulated in association with eudaimonic well-being. In joint analyses, effects of loneliness were completely abrogated whereas eudaimonic well-being continued to associate with CTRA down-regulation. Similar eudaimonia-dominant effects were observed for positive and negative affect, optimism and pessimism, and anxiety symptoms. All results were independent of demographic and behavioral health risk factors.

CONCLUSIONS: Eudaimonic well-being may have the potential to compensate for the adverse impact of loneliness on CTRA gene expression. Findings suggest a novel approach to targeting the health risks associated with social isolation by promoting purpose and meaning in life.

PB - 62 VL - 62 UR - http://www.sciencedirect.com/science/article/pii/S0306453015002358 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26246388?dopt=Abstract U2 - PMC4637182 U4 - Social genomics/Psychoneuroimmunology/Gene expression/Transcriptome/Microarray/Stress/Social support/Psychological well-being/Eudaimonia/Positive psychology ER - TY - RPRT T1 - The Effect of Job Loss on Health: Evidence from Biomarkers Y1 - 2014 A1 - Pierre-Carl Michaud A1 - Eileen M. Crimmins A1 - Michael D Hurd KW - Demographics KW - Employment and Labor Force KW - Health Conditions and Status KW - Methodology AB - The effect of job loss on health may play an important role in the development of the SES-health gradient. In this paper, we estimate the effect of job loss on objective measures of physiological dysregulation using longitudinal data from the Health and Retirement Study and biomarker measures collected in 2006 and 2008. We use a variety of econometric methods to account for selection and reverse causality.Distinguishing between layoffs and business closures, we find no evidence that business closures lead to worse health outcomes. We also find no evidence that biomarker health measures predict subsequent job loss because of business closures. We do find evidence that layoffs lead to diminished health. Although this finding appears to be robust to confounders, we find that reverse causality tends to bias downward our estimates. Matching estimates, which account for self-reported health conditions prior to the layoff and subjective job loss expectations, suggest even stronger estimates of the effect of layoffs on health as measured from biomarkers, in particular for glycosylated hemoglobin (HbA1c) and C-reactive protein (CRP). Overall, we estimate that a layoff could increase annual mortality rates by 9.4 , which is consistent with other evidence of the effect of mass layoffs on mortality. PB - Bonn, Germany, Institute for the Study of Labor U4 - job loss/health/SES-health gradient/biomarkers/Socioeconomic Status/Self assessed health/Layoffs/biomarkers ER - TY - JOUR T1 - Fine particulate matter air pollution and cognitive function among older US adults. JF - Am J Epidemiol Y1 - 2014 A1 - Jennifer A Ailshire A1 - Eileen M. Crimmins KW - Aged KW - Aged, 80 and over KW - Cognition KW - Cognition Disorders KW - Cross-Sectional Studies KW - Female KW - Humans KW - Inhalation Exposure KW - Male KW - Memory, Episodic KW - Middle Aged KW - Neuropsychological tests KW - Particulate Matter KW - Socioeconomic factors KW - United States KW - Urban Population AB -

Existing research on the adverse health effects of exposure to pollution has devoted relatively little attention to the potential impact of ambient air pollution on cognitive function in older adults. We examined the cross-sectional association between residential concentrations of particulate matter with aerodynamic diameter of 2.5 μm or less (PM2.5) and cognitive function in older adults. Using hierarchical linear modeling, we analyzed data from the 2004 Health and Retirement Study, a large, nationally representative sample of US adults aged 50 years or older. We linked participant data with 2000 US Census tract data and 2004 census tract-level annual average PM2.5 concentrations. Older adults living in areas with higher PM2.5 concentrations had worse cognitive function (β = -0.26, 95% confidence interval: -0.47, -0.05) even after adjustment for community- and individual-level social and economic characteristics. Results suggest that the association is strongest for the episodic memory component of cognitive function. This study adds to a growing body of research highlighting the importance of air pollution to cognitive function in older adults. Improving air quality in large metropolitan areas, where much of the aging US population resides, may be an important mechanism for reducing age-related cognitive decline.

PB - 180 VL - 180 UR - http://aje.oxfordjournals.org/content/early/2014/06/24/aje.kwu155.abstract IS - 4 N1 - Ailshire, Jennifer A Crimmins, Eileen M eng K99 AG039528/AG/NIA NIH HHS/ K99AG039528/AG/NIA NIH HHS/ P30 AG017265/AG/NIA NIH HHS/ P30AG17265/AG/NIA NIH HHS/ R00 AG039528/AG/NIA NIH HHS/ R21 AG045625/AG/NIA NIH HHS/ T32 AG000037/AG/NIA NIH HHS/ T32AG0037/AG/NIA NIH HHS/ U01 AG009740/AG/NIA NIH HHS/ U01AG009740/AG/NIA NIH HHS/ Research Support, N.I.H., Extramural 2014/06/27 06:00 Am J Epidemiol. 2014 Aug 15;180(4):359-66. doi: 10.1093/aje/kwu155. Epub 2014 Jun 24. U1 - http://www.ncbi.nlm.nih.gov/pubmed/24966214?dopt=Abstract ER - TY - THES T1 - International sex and age differences in physical function and disability Y1 - 2014 A1 - Felicia V Wheaton KW - CHARLS KW - Cross-National KW - Demographics KW - Disabilities KW - Health Conditions and Status KW - IFLS KW - KLoSA KW - Methodology KW - MHAS AB - Worldwide population aging will undoubtedly be accompanied by an increase in the number of disabled older adults. Female gender and increased age are two of the most widely identified risk factors for poor physical functioning and disability. Yet the contexts in which people are aging vary markedly across countries. Countries differ greatly in their level of economic development, both past and present. Economic development is in turn related to improvements in infrastructure, health care, public health, education, etc. that are hypothesized to be related to improved physical function and less disability. Therefore, this dissertation examined whether sex and age differences/changes in both objectively-measured physical performance and reported difficulties with functional tasks and activities of daily living (ADLs) were similar or varied across seven countries whose per capita GNP ranged from $200 to $40,100 (United Sates, Taiwan, Korea, Mexico, China, Indonesia, and the Tsimane of Bolivia). It also sought to determine if sex differences and age differences varied systematically in terms of macro-level indicators including GDP, life expectancy, and measures of gender equality. Overall, sex differences were remarkably consistent across countries with very different contexts. Sex differences in physical performance and functional limitations were more pronounced than sex differences in difficulty with basic self-care tasks, but the magnitude of differences did not vary systematically in relation to country-level measures of development or gender equality. This may be because gender equality can be either protective or detrimental, depending on the domain. In terms of age differences, it was necessary to consider both the level of performance/prevalence of difficulty at younger ages as well as age differences, since poor performance/high levels of difficulty among the young-old indicate that "aging" has already occurred. Some populations did appear to be "aging" more rapidly, particularly those at the lowest end of the development spectrum, however, there was no clear evidence for a linear correlation between macro-level indicators of development and age differences. Interestingly, findings showed that functioning in some domains could be fairly well maintained despite declines in other domains, and these varied across countries. For example, Indonesians appeared to be "aging" more rapidly in terms of upper body strength, but showed relatively high levels of lower body function and less age-related decline. This may be due to differences across populations in patterns of work, physical activity, the built environment, etc. PB - University of Southern California CY - Los Angeles VL - 3644708 UR - http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1625050780?accountid=14667http://mgetit.lib.umich.edu/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/ProQuest+Dissertations+%26+Theses+A%26I&rft_val_fmt=info:ofi/fmt: N1 - Copyright - Copyright ProQuest, UMI Dissertations Publishing 2014 Last updated - 2014-11-27 First page - n/a U4 - ADL/IADL JO - International sex and age differences in physical function and disability ER - TY - JOUR T1 - A polygenic risk score associated with measures of depressive symptoms among older adults. JF - Biodemography Soc Biol Y1 - 2014 A1 - Morgan E. Levine A1 - Eileen M. Crimmins A1 - Carol A Prescott A1 - Drystan F. Phillips A1 - Thalida E. Arpawong A1 - Jinkook Lee KW - Aged KW - Aged, 80 and over KW - Depressive Disorder, Major KW - Female KW - Genetic Predisposition to Disease KW - Genetic Variation KW - Genome-Wide Association Study KW - Humans KW - Male KW - Middle Aged KW - Multifactorial Inheritance KW - Odds Ratio KW - Risk Factors AB -

It has been suggested that depression is a polygenic trait, arising from the influences of multiple loci with small individual effects. The aim of this study is to generate a polygenic risk score (PRS) to examine the association between genetic variation and depressive symptoms. Our analytic sample included N = 10,091 participants aged 50 and older from the Health and Retirement Study (HRS). Depressive symptoms were measured by Center for Epidemiological Studies-Depression scale (CESD) scores assessed on up to nine occasions across 18 years. We conducted a genome-wide association analysis for a discovery set (n = 7,000) and used the top 11 single-nucleotide polymorphisms, all with p < 10(-5) to generate a weighted PRS for our replication sample (n = 3,091). Results showed that the PRS was significantly associated with mean CESD score in the replication sample (β = .08, p = .002). The R(2) change for the inclusion of the PRS was .003. Using a multinomial logistic regression model, we also examined the association between genetic risk and chronicity of high (4+) CESD scores. We found that a one-standard-deviation increase in PRS was associated with a 36 percent increase in the odds of having chronically high CESD scores relative to never having had high CESD scores. Our findings are consistent with depression being a polygenic trait and suggest that the cumulative influence of multiple variants increases an individual's susceptibility for chronically experiencing high levels of depressive symptoms.

PB - 60 VL - 60 IS - 2 N1 - Times Cited: 0 SI 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/25343367?dopt=Abstract U2 - PMC4298361 U4 - GENOME-WIDE ASSOCIATION/INDIVIDUAL GENETIC RISK/MAJOR DEPRESSION/DISEASE RISK/HERITABILITY/genetics/genetics/depression/Depressive Symptoms/CES Depression Scale/CES Depression Scale/regression Analysis ER - TY - JOUR T1 - Validation of blood-based assays using dried blood spots for use in large population studies. JF - Biodemography Soc Biol Y1 - 2014 A1 - Eileen M. Crimmins A1 - Jung K Kim A1 - Heather McCreath A1 - Jessica Faul A1 - David R Weir A1 - Teresa Seeman KW - Biomarkers KW - C-reactive protein KW - Cholesterol KW - Cholesterol, HDL KW - Cystatin C KW - Dried Blood Spot Testing KW - Glycated Hemoglobin A KW - Humans KW - Middle Aged KW - Reference Values KW - Reproducibility of Results AB -

Assessment of health in large population studies has increasingly incorporated measures of blood-based biomarkers based on the use of dried blood spots (DBS). The validity of DBS assessments made by labs used by large studies is addressed by comparing assay values from DBS collected using conditions similar to those used in the field with values from whole blood samples. The DBS approach generates values that are strongly related to whole blood levels of HbA1c, cystatin C, and C-reactive protein. Assessing lipid levels reliably with DBS appears to be a greater challenge. However, even when DBS values and values from venous blood are highly correlated, they are often on a different scale, and using conventional cutoffs may be misleading.

VL - 60 UR - http://www.tandfonline.com/doi/abs/10.1080/19485565.2014.901885 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24784986?dopt=Abstract JO - Biodemography and Social Biology ER - TY - JOUR T1 - The Value of Delaying Alzheimer's Disease Onset. JF - Forum Health Econ Policy Y1 - 2014 A1 - Julie M Zissimopoulos A1 - Eileen M. Crimmins A1 - Clair, Patricia A. St. AB -

Alzheimer's disease (AD) extracts a heavy societal toll. The value of medical advances that delay onset of AD could be significant. Using data from nationally representative samples from the Health and Retirement Study (1998-2008) and Aging Demographics and Memory Study (2001-2009), we estimate the prevalence and incidence of AD and the formal and informal health care costs associated with it. We use microsimulation to project future prevalence and costs of AD under different treatment scenarios. We find from 2010 to 2050, the number of individuals ages 70+ with AD increases 153%, from 3.6 to 9.1 million, and annual costs increase from $307 billion ($181B formal, $126B informal costs) to $1.5 trillion. 2010 annual per person costs were $71,303 and double by 2050. Medicare and Medicaid are paying 75% of formal costs. Medical advances that delay onset of AD for 5 years result in 41% lower prevalence and 40% lower cost of AD in 2050. For one cohort of older individuals, who would go on to acquire AD, a 5-year delay leads to 2.7 additional life years (about 5 AD-free), slightly higher formal care costs due to longer life but lower informal care costs for a total value of $511,208 per person. We find Medical advances delaying onset of AD generate significant economic and longevity benefits. The findings inform clinicians, policymakers, businesses and the public about the value of prevention, diagnosis, and treatment of AD.

VL - 18 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27134606?dopt=Abstract ER - TY - JOUR T1 - Who cares? A comparison of informal and formal care provision in Spain, England and the USA. JF - Ageing Soc Y1 - 2014 A1 - Sole-Auro, Aida A1 - Eileen M. Crimmins AB -

This paper investigates the prevalence of incapacity in performing daily activities and the associations between household composition and availability of family members and receipt of care among older adults with functioning problems in Spain, England and the United States of America (USA). We examine how living arrangements, marital status, child availability, limitations in functioning ability, age and gender affect the probability of receiving formal care and informal care from household members and from others in three countries with different family structures, living arrangements and policies supporting care of the incapacitated. Data sources include the 2006 Survey of Health, Ageing and Retirement in Europe for Spain, the third wave of the English Longitudinal Study of Ageing (2006), and the eighth wave of the USA Health and Retirement Study (2006). Logistic and multinomial logistic regressions are used to estimate the probability of receiving care and the sources of care among persons age 50 and older. The percentage of people with functional limitations receiving care is higher in Spain. More care comes from outside the household in the USA and England than in Spain. The use of formal care among the incapacitated is lowest in the USA and highest in Spain.

PB - 34 VL - 34 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/24550574?dopt=Abstract ER - TY - RPRT T1 - Documentation of Biomarkers in the 2006 and 2008 Health and Retirement Study Y1 - 2013 A1 - Eileen M. Crimmins A1 - Jessica Faul A1 - Jung K Kim A1 - Heidi M Guyer A1 - Kenneth M. Langa A1 - Mary Beth Ofstedal A1 - Amanda Sonnega A1 - Robert B Wallace A1 - David R Weir KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - Biomarkers refer to the general range of physiological, metabolic, biochemical, endocrine and genetic measures that can be obtained in living organisms. The term is most commonly used to refer to one-time biochemical or hematological measures made on blood or other available bodily fluids, but perhaps the term should be used for a broader range of measures. In 2006 and 2008, HRS included the following biomarkers measurements, administered in this order: Saliva collection for DNA extraction; Blood spot collection for cholesterol, hemoglobin A1C, CRP and cystatin C analysis (results for C-reactive protein and cystatin C are forthcoming). This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions. PB - Institute for Social Research, University of Michigan CY - Ann Arbor, Michigan U4 - Biomarker data/survey Methods/health measures ER - TY - CHAP T1 - Physical and biological indicators of health and functioning in U.S. oldest old T2 - Annual Review of Gerontology and Geriatrics Y1 - 2013 A1 - Jennifer A Ailshire A1 - Eileen M. Crimmins ED - Robine, Jean-Marie ED - Jagger, Carol ED - Eileen M. Crimmins KW - End of life decisions KW - Health Conditions and Status KW - Healthcare AB - This chapter examines biomarkers of aging, including indicators of physical performance and biomarkers of physiological dysregulation, among a representative national sample of U.S. adults aged 80 years and older with the aim of addressing three questions about the oldest old U.S. population: (a) How do levels of biomarkers of aging vary by age? (b) Are biomarkers of aging patterned by gender, race, ethnicity, and education? and (c) Which biomarkers of aging predict health and mortality. Data for this study come from the Health and Retirement Study (HRS). This large population-based study of U.S. adults aged 80 years and older provides confirmation of the importance of biomarkers of aging for understanding health and longevity in the oldest old. The results indicate that physical functioning declines across age groups even among the oldest old, and that the oldest adults are more likely to have levels of physical performance, inflammation, and organ function that are considered to be high risk for poor health outcomes. In addition, social disparities in physical functioning continue to be evident among the oldest segment of the U.S. population. We also provide evidence for the value of several biomarkers of aging in predicting poor health outcomes among the oldest old. In particular, indicators of high risk for walking dysfunction and dysregulation in the lungs and kidneys were found to predict hospitalization and short-term mortality. JF - Annual Review of Gerontology and Geriatrics PB - Springer CY - New York VL - 33 U4 - biomarkers/Physical function/health Status/HOSPITALIZATION/Mortality/decline JO - Physical and Biological Indicators of Health and Functioning in U.S. Oldest Old ER - TY - JOUR T1 - Trends in late-life activity limitations in the United States: an update from five national surveys. JF - Demography Y1 - 2013 A1 - Vicki A Freedman A1 - Brenda C Spillman A1 - Patricia Andreski A1 - Jennifer C. Cornman A1 - Eileen M. Crimmins A1 - Kramarow, Ellen A1 - Lubitz, James A1 - Linda G Martin A1 - Sharon S. Merkin A1 - Robert F. Schoeni A1 - Teresa Seeman A1 - Timothy A Waidmann KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Disabled Persons KW - Female KW - Health Surveys KW - Humans KW - Male KW - Mobility Limitation KW - Models, Statistical KW - United States AB -

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65-84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.

PB - 50 VL - 50 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/23104207?dopt=Abstract U2 - PMC3586750 U4 - methodology/Meta-analysis/ADL and IADL Impairments/Public Policy/health Care Costs/PREVALENCE ER - TY - JOUR T1 - Assessment of cognition using surveys and neuropsychological assessment: the Health and Retirement Study and the Aging, Demographics, and Memory Study. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2011 A1 - Eileen M. Crimmins A1 - Jung K Kim A1 - Kenneth M. Langa A1 - David R Weir KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Cognition KW - Cognition Disorders KW - Dementia KW - Educational Status KW - Female KW - Humans KW - Interviews as Topic KW - Logistic Models KW - Longitudinal Studies KW - Male KW - Multivariate Analysis KW - Neuropsychological tests KW - Odds Ratio KW - Prevalence KW - Sex Factors KW - United States AB -

OBJECTIVES: This study examines the similarity of cognitive assessments using 1 interview in a large population study, the Health and Retirement Study (HRS), and a subsample in which a detailed neuropsychiatric assessment has been performed (Aging, Demographics, and Memory Study [ADAMS]).

METHODS: Respondents are diagnosed in ADAMS as demented, cognitively impaired without dementia (CIND), or as having normal cognitive function. Multinomial logistic analysis is used to predict diagnosis using a variety of cognitive and noncognitive measures from the HRS and additional measures and information from ADAMS.

RESULTS: The cognitive tests in HRS predict the ADAMS diagnosis in 74% of the sample able to complete the HRS survey on their own. Proxy respondents answer for a large proportion of HRS respondents who are diagnosed as demented in ADAMS. Classification of proxy respondents with some cognitive impairment can be predicted in 86% of the sample. Adding a small number of additional tests from ADAMS can increase each of these percentages to 84% and 93%, respectively.

DISCUSSION: Cognitive assessment appropriate for diagnosis of dementia and CIND in large population surveys could be improved with more targeted information from informants and additional cognitive tests targeting other areas of brain function.

PB - 66 Suppl 1 VL - 66 Suppl 1 IS - Suppl 1 N1 - Crimmins, Eileen M Kim, Jung Ki Langa, Kenneth M Weir, David R P30 AG17265/AG/NIA NIH HHS/United States U01 AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States The journals of gerontology. Series B, Psychological sciences and social sciences J Gerontol B Psychol Sci Soc Sci. 2011 Jul;66 Suppl 1:i162-71. U1 - http://www.ncbi.nlm.nih.gov/pubmed/21743047?dopt=Abstract U2 - PMC3165454 U4 - Age Factors/Aged, 80 and over/Cognition/Cognition Disorders/ diagnosis/epidemiology/psychology/Cognition Disorders/ diagnosis/epidemiology/psychology/Dementia/ diagnosis/epidemiology/psychology/Dementia/ diagnosis/epidemiology/psychology/Educational Status/Female/Logistic Models/Longitudinal Studies/Multivariate Analysis/Neuropsychological Tests/Odds Ratio/Prevalence/Sex Factors/United States/epidemiology/United States/epidemiology ER - TY - JOUR T1 - Do biological measures mediate the relationship between education and health: A comparative study. JF - Soc Sci Med Y1 - 2011 A1 - Goldman, Noreen A1 - Cassio M. Turra A1 - Rosero-Bixby, Luis A1 - David R Weir A1 - Eileen M. Crimmins KW - Biomarkers KW - Blood pressure KW - Body Mass Index KW - Cholesterol KW - Costa Rica KW - Educational Status KW - Female KW - Health Status Disparities KW - Health Status Indicators KW - Health Surveys KW - Humans KW - Male KW - Middle Aged KW - Qualitative Research KW - Taiwan KW - United States AB -

Despite a myriad of studies examining the relationship between socioeconomic status and health outcomes, few have assessed the extent to which biological markers of chronic disease account for social disparities in health. Studies that have examined this issue have generally been based on surveys in wealthy countries that include a small set of clinical markers of cardiovascular disease. The availability of recent data from nationally representative surveys of older adults in Costa Rica and Taiwan that collected a rich set of biomarkers comparable to those in a recent US survey permits us to explore these associations across diverse populations. Similar regression models were estimated on three data sets - the Social Environment and Biomarkers of Aging Study in Taiwan, the Costa Rican Study on Longevity and Healthy Aging, and the Health and Retirement Study in the USA - in order to assess (1) the strength of the associations between educational attainment and a broad range of biomarkers; and (2) the extent to which these biomarkers account for the relationships between education and two measures of health status (self-rated health, functional limitations) in older populations. The estimates suggest non-systematic and weak associations between education and high risk biomarker values in Taiwan and Costa Rica, in contrast to generally negative and significant associations in the US, especially among women. The results also reveal negligible or modest contributions of the biomarkers to educational disparities in the health outcomes. The findings are generally consistent with previous research suggesting stronger associations between socioeconomic status and health in wealthy countries than in middle-income countries and may reflect higher levels of social stratification in the US. With access to an increasing number of longitudinal biosocial surveys, researchers may be better able to distinguish true variations in the relationship between socioeconomic status and health across different settings from methodological differences.

PB - 72 VL - 72 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/21159415?dopt=Abstract U2 - PMC3039215 U4 - Costa Rica/Taiwan/Biomarkers/Biosocial survey/Socioeconomic disparities/Health outcomes/Longitudinal/Biological measurement/EDUCATION ER - TY - JOUR T1 - Gender differences in health: results from SHARE, ELSA and HRS. JF - Eur J Public Health Y1 - 2011 A1 - Eileen M. Crimmins A1 - Jung K Kim A1 - Sole-Auro, Aida KW - Activities of Daily Living KW - Aged KW - Aging KW - Body Weights and Measures KW - Chronic disease KW - Employment KW - Female KW - Global Health KW - Health Behavior KW - Health Status KW - Humans KW - Male KW - Middle Aged KW - Self Report KW - Sex Factors AB -

BACKGROUND: We examine gender differences in health at ages 50 years and older in 11 European countries, England and the USA.

METHODS: We use the Survey of Health, Ageing and Retirement (SHARE) for 11 Continental European countries; the English Longitudinal Study of Ageing (ELSA) and the Health and Retirement Study (HRS) for the USA to examine gender differences in health behaviours, functioning problems, disability, disease prevalence and self-rated health.

RESULTS: Women in all countries are more likely than men to have disabling, non-lethal conditions including functioning problems [odds ratio (OR) indicating the effect of female is 1.57-2.43], IADL difficulties (OR 1.45-2.94), arthritis (OR 1.46-2.90) and depressive symptoms (OR 1.45-3.35). On the other hand, self-reported heart disease is more common among men (OR indicating effect of female ranges from 0.43 to 0.86). These differences are not eliminated by controlling for smoking behaviour and weight. Self-reported hypertension (OR 0.72-1.53) is generally more common among women; stroke and diabetes do not show consistent sex differences. While subjective assessment of health is poorer among women, this is not true when indicators of functioning, disability and diseases are controlled.

CONCLUSION: There is remarkable consistency in direction of gender differences in health across these 13 countries. The size of the differences is affected in many cases by the similarity in behaviours of men and women.

VL - 21 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20237171?dopt=Abstract U2 - PMC3023013 U4 - cross-national comparison/gender Differences/ELSA_/SHARE/SELF-RATED HEALTH/health Behavior/disease prevalence/DISABILITY/DISABILITY ER - TY - CHAP T1 - Links Between Biomarkers and Mortality T2 - International Handbook of Adult Mortality Y1 - 2011 A1 - Eileen M. Crimmins A1 - Vasunilashorn, Sarinnapha ED - Rebecca G Rogers ED - Eileen M. Crimmins KW - Demographics KW - Health Conditions and Status KW - Healthcare AB - A biomarker is an objectively measured indicator of a physiological state. Biomarkers include indicators of genotype, normal biological processes, pathogenic processes, and pharmacologic responses to a therapeutic intervention (Biomarkers Definitions Working Group 2001; National Heart Lung and Blood Institute 2007). Biomarkers can serve as objective indicators of health status within a sample, indicators of health change over time, and, with comparable measurement, indicators of differences across populations. They signal disease status, early physiological dysregulation preceding disease, or change in organ reserve or functioning. And they can clarify how the social, psychological, and behavioral factors traditionally examined in social science research get under the skin to influence biology and subsequent health outcomes (Crimmins and Seeman 2001, 2004; Crimmins et al. 2008a; Seeman and Crimmins 2001). JF - International Handbook of Adult Mortality PB - Springer VL - 2 SN - 978-90-481-9995-2 N1 - Times Cited: 2 U4 - biomarkers/health Status/population Dynamics/therapeutic intervention/MORBIDITY JO - Links Between Biomarkers and Mortality ER - TY - JOUR T1 - Psychosocial Factors Associated with Longevity in the United States: Age Differences between the Old and Oldest-Old in the Health and Retirement Study. JF - J Aging Res Y1 - 2011 A1 - Jennifer A Ailshire A1 - Eileen M. Crimmins AB -

Recent growth in the number of adults surviving to advanced ages raises questions about the quality of life associated with increased longevity. Psychosocial factors have received relatively little attention in research on quality of life among the oldest-old. This study uses nationally representative data on older US adults to examine how social relationships, feelings of loneliness, and satisfaction with life and the aging experience differ between the oldest-old, those who have survived to age 90 or older, and older adults in their 70s. We find that the oldest-old are able to maintain social relationships with family and friends and receive more social support than younger elderly adults. Yet, the oldest-old are more likely to feel lonely due to their greater rates of widowhood. Satisfaction with life was higher among the oldest-old, but the oldest-old had more negative perceptions of the aging experience. Psychosocial dimensions of longevity should be considered in research on quality of life among the oldest-old.

PB - 2011 VL - 2011 U1 - http://www.ncbi.nlm.nih.gov/pubmed/22028969?dopt=Abstract U2 - PMC3199053 ER - TY - RPRT T1 - Results from the Health and Retirement Study Biomarker Validation Project Y1 - 2011 A1 - Eileen M. Crimmins A1 - Jung K Kim A1 - Heather McCreath A1 - Teresa Seeman KW - Health Conditions and Status KW - Methodology PB - Ann Arbor, The University of Michigan U4 - Survey Methods/Biomarker data ER - TY - JOUR T1 - Social characteristics and health status of exceptionally long-lived Americans in the Health and Retirement Study. JF - J Am Geriatr Soc Y1 - 2011 A1 - Jennifer A Ailshire A1 - Hiram Beltrán-Sánchez A1 - Eileen M. Crimmins KW - Age Factors KW - Aged, 80 and over KW - Female KW - Geriatric Assessment KW - Health Status KW - Humans KW - Longevity KW - Longitudinal Studies KW - Male KW - Social Class KW - Sociology KW - United States AB -

OBJECTIVES: To characterize the social characteristics and physical, functional, mental, and cognitive health of exceptional survivors in the United States and how the experience of exceptional longevity differs according to social status.

DESIGN: Nationally representative longitudinal study of older Americans.

SETTING: United States.

PARTICIPANTS: One thousand six hundred forty-nine men and women born from 1900 to 1911 from the Health and Retirement Study: 1,424 nonsurvivors who died before reaching the age of 97 and 225 exceptional survivors who survived to age 97 and older.

MEASUREMENTS: Self-reported data on sociodemographic characteristics, social environment, physical and mental health, and physical and cognitive function.

RESULTS: At baseline, exceptional survivors were more likely to live independently and had fewer diseases, better mental health, and better physical and cognitive function than those who did not survive to age 97. Exceptional survivors experienced declines from baseline in all health domains upon reaching 97 years of age, but between one-fifth and one-third of exceptional survivors remained disease free, with no functional limitations or depressive symptoms, and one-fifth retained high cognitive function. Of exceptional survivors, men were healthier than women, and whites were generally healthier than nonwhites. Highly educated exceptional survivors had better cognitive function than their less-educated counterparts.

CONCLUSION: On average, exceptional survivors are relatively healthy and high functioning for most of their lives and experience health declines only upon reaching maximum longevity. Heterogeneity in the population of exceptionally old adults indicates that, although many individuals reach maximum longevity in a state of poor health and functioning, a considerable portion of exceptional survivors remain healthy and high-functioning even in very old age.

PB - 59 VL - 59 IS - 12 N1 - Ailshire, Jennifer A Beltran-Sanchez, Hiram Crimmins, Eileen M United States Journal of the American Geriatrics Society J Am Geriatr Soc. 2011 Dec;59(12):2241-8. doi: 10.1111/j.1532-5415.2011.03723.x. U1 - http://www.ncbi.nlm.nih.gov/pubmed/22188072?dopt=Abstract U2 - PMC3470876 ER - TY - CHAP T1 - Are International Differences in Health Similar to International Differences in Life-Expectancy? T2 - International Differences in Mortality at Older Ages: Dimensions and Sources Y1 - 2010 A1 - Eileen M. Crimmins A1 - Krista Garcia A1 - Jung K Kim ED - Eileen M. Crimmins ED - Samuel H. Preston ED - Barney Cohen KW - ELSA KW - Methodology KW - SHARE AB - The question addressed in this chapter is whether people in countries with relatively low life expectancy after age 50 have worse health than those in countries with longer life expectancy. We begin with a short discussion of the theoretical relationships between mortality and population health and the potential complexity of the link between measures of health and mortality. We then examine how indicators of health vary across countries and how closely differences in a set of health indicators correspond to differences in mortality across 10 countries. We note at the outset that most of the data we examine reflect analysis of cross-sectional differences in health; without comparable longitudinal data, there is little we can say about how the differences arose. The countries compared include Australia, Canada, Denmark, England, France, Italy, Japan, the Netherlands, Spain, and the United States. JF - International Differences in Mortality at Older Ages: Dimensions and Sources PB - National Academies Press CY - Washington, D.C. UR - https://www.ncbi.nlm.nih.gov/books/NBK62588/#:~:text=Two%20countries%20with%20the%20same,life%20expectancy%20could%20be%20higher. U4 - cross Cultural Comparison ER - TY - JOUR T1 - Cross-national comparison of sex differences in health and mortality in Denmark, Japan and the US. JF - Eur J Epidemiol Y1 - 2010 A1 - Oksuzyan, Anna A1 - Eileen M. Crimmins A1 - Saito, Yasuhiko A1 - Angela M O'Rand A1 - James W Vaupel A1 - Christensen, Kaare KW - Aged KW - Aged, 80 and over KW - Denmark KW - Disability Evaluation KW - Female KW - Health Status KW - Humans KW - Japan KW - Male KW - Middle Aged KW - Mortality KW - Sex Distribution KW - United States AB -

The present study aims to compare the direction and magnitude of sex differences in mortality and major health dimensions across Denmark, Japan and the US. The Human Mortality Database was used to examine sex differences in age-specific mortality rates. The Danish twin surveys, the Danish 1905-Cohort Study, the Health and Retirement Study, and the Nihon University Japanese Longitudinal Study of Aging were used to examine sex differences in health. Men had consistently higher mortality rates at all ages in all three countries, but they also had a substantial advantage in handgrip strength compared with the same-aged women. Sex differences in activities of daily living (ADL) became pronounced among individuals aged 85+ in all three countries. Depression levels tended to be higher in women, particularly, in Denmark and the HRS, and only small sex differences were observed in the immediate recall test and Mini-Mental State Exam. The present study revealed consistent sex differentials in survival and physical health, self-rated health and cognition at older ages, whereas the pattern of sex differences in depressive symptoms was country-specific.

PB - 25 VL - 25 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/20495953?dopt=Abstract U2 - PMC2903692 U4 - cross-national comparison/Activities of Daily Living/Sex Differences/depression/SELF-RATED HEALTH/NUJLSOA/NUJLSOA ER - TY - RPRT T1 - Documentation of Physical Measures, Anthropometrics and Blood Pressure in the Health and Retirement Study Y1 - 2008 A1 - Eileen M. Crimmins A1 - Heidi M Guyer A1 - Kenneth M. Langa A1 - Mary Beth Ofstedal A1 - Robert B Wallace A1 - David R Weir KW - Health Conditions and Status KW - Healthcare KW - Methodology AB - The assessment of physical performance is an important component of the evaluation of functioning of older persons. The HRS has employed a set of standardized assessments of lung function, grip strength, balance, and walking speed. In addition, HRS collected measures of blood pressure, height, weight, and waist circumference. In 2006, HRS included the following measurements, administered in this order: Blood pressure; Lung function; Hand grip strength; Balance tests; Timed walk; Height; Weight; Waist circumference. This report describes the following for each of the measures listed above: Rationale and key citations; Sample description; Measure description; Equipment; Protocol description; Special instructions PB - Institute for Social Research, University of Michigan CY - Ann Arbor, Michigan U4 - health measures/survey Methods/Physical Activity ER - TY - JOUR T1 - Educational differentials in life expectancy with cognitive impairment among the elderly in the United States. JF - J Aging Health Y1 - 2008 A1 - Agnès Lièvre A1 - Dawn E Alley A1 - Eileen M. Crimmins KW - Aged KW - Aged, 80 and over KW - Cognition Disorders KW - Educational Status KW - Female KW - Humans KW - Life Expectancy KW - Male KW - United States AB -

OBJECTIVE: This article provides estimates of education differentials in life expectancy with and without cognitive impairment for the noninstitutionalized population aged 70 years and older in the United States.

METHOD: Life expectancy with cognitive impairment was calculated using multistate models, allowing transitions between cognitively intact and cognitively impaired states and from each of these states to death and allowing transition rates to vary across age and education. Four waves of the Assets and Health Dynamics of the Oldest Old survey were used.

RESULTS: Those with low levels of education are more likely to become cognitively impaired and do so at an earlier age. After age 70, persons with low educational levels can expect to live 11.6 years, and persons with high education 14.1 years, without cognitive impairment. Length of life with cognitive impairment differs by education (1.6 years and 1.0 years at age 70, respectively) but differs little by age.

DISCUSSION: Although those with higher education have lower rates of both cognitive impairment and mortality, those who do become cognitively impaired appear to be in poorer health, leading to a reduced probability of improved cognition and increased probability of mortality relative to those with lower educational levels.

PB - 20 VL - 20 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18448687?dopt=Abstract U2 - PMC2966893 U4 - cognition Disorders/cognitive Impairment/educational Status/life Expectancy/education/MORTALITY ER - TY - JOUR T1 - Life with and without heart disease among women and men over 50. JF - J Women Aging Y1 - 2008 A1 - Eileen M. Crimmins A1 - Mark D Hayward A1 - Ueda, Hiroshi A1 - Saito, Yasuhiko A1 - Jung K Kim KW - Activities of Daily Living KW - Aged KW - Female KW - Health Status KW - Heart Diseases KW - Humans KW - Life Expectancy KW - Male KW - Middle Aged KW - Myocardial Infarction KW - Patient Education as Topic KW - Prejudice KW - Risk Factors KW - United States KW - Women's Health KW - Women's Health Services AB -

This article uses a demographic approach and data from the Health and Retirement Survey, a nationally representative sample of the U.S. population, to investigate sex differences in the length of life lived with heart disease and after a heart attack for persons in the United States age 50 and older. On average, women live longer than men with heart disease. At age 50 women can expect to live 7.9 years and men 6.7 years with heart disease. The average woman experiences heart disease onset three years older and heart attacks 4.4 years older than men.

PB - 20 VL - 20 IS - 1-2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/18581697?dopt=Abstract U2 - PMC2994551 U4 - Activities of Daily Living/health Status/Heart disease/life Expectancy/EDUCATION/risk factors/WOMEN ER - TY - JOUR T1 - Racial and Ethnic Differences in Undiagnosed and Poorly Managed Diabetes and Hypertension: Combining Population Surveys with Biomarker Data (HRS2006). JF - The Gerontologist Y1 - 2008 A1 - David R Weir A1 - Eileen M. Crimmins KW - Demographics KW - Health Conditions and Status AB - CA Diabetes and hypertension are common conditions of aging that increase risk for cardiovascular events if not properly treated.Concerns about undiagnosed, and inadequately treated disease, are particularly strong for minority populations.Diabetes diagnosis rates vary from 16 among whites to 29 for blacks and 27 for Hispanics. PB - 48 VL - 48 IS - SPECIAL ISSUE III U4 - Diabetes/ethnic differences/sociodemographic differences/sociodemographic differences ER - TY - JOUR T1 - Education and Cognitive Decline in Older Americans: Results From the AHEAD Sample. JF - Res Aging Y1 - 2007 A1 - Dawn E Alley A1 - Suthers, Kristen A1 - Eileen M. Crimmins AB -

Although education is consistently related to better cognitive performance, findings on the relationship between education and age-associated cognitive change have been conflicting. Using measures of multiple cognitive domains from four waves of the Asset and Health Dynamics of the Oldest Old study, a representative sample of Americans aged 70 years and older, the authors performed growth curve modeling to examine the relationships between education, initial cognitive score, and the rate of decline in cognitive function. More years of education were linked to better initial performance on each of the cognitive tests, and higher levels of education were linked to slower decline in mental status. However, more education was unrelated to the rate of decline in working memory, and education was associated with somewhat faster cognitive decline on measures of verbal memory. These findings highlight the role of early-life experiences not only in long-term cognitive performance but also in old-age cognitive trajectories.

PB - 29 VL - 29 IS - 1 U1 - http://www.ncbi.nlm.nih.gov/pubmed/19830260?dopt=Abstract U2 - PMC2760835 U4 - cognitive decline/Cognitive Impairment/EDUCATION/growth curve modeling/methodology ER - TY - CHAP T1 - Consequences of Educational Change for the Burden of Chronic Health Problems in the Population T2 - Allocating Public and Private Resources across Generations Y1 - 2006 A1 - Mark D Hayward A1 - Eileen M. Crimmins A1 - Zhang, Zhenmei ED - Gauthier, Anne H. ED - Chu, Cyrus ED - Tuljapurkar, Shripad KW - Educational attainment KW - Educational Change KW - Functional Limitation KW - Functional Problem KW - Life Table AB - Changes in the public and individual burden of chronic health problems have significant implications for the allocation of public and private resources across generations. Preston (1984) noted almost two decades ago that population ageing in the United States was accompanied by the rapid expansion of public programs benefiting the health of elderswhile public programs benefiting children’s education contracted. Health care is the principal public service provided to the elderly while education is the counterpart for children. Within a historical time period, political choices about the funding of age-targeted service programs have an urgency that oftentimes sweeps aside the fact that investments in children’s well-being pay substantial dividends decades later when children become the elders of a population. In large part, this reflects a lack of attention both by policy makers and by demographers of these long-run associations. Here, we provide new insights into the longrun consequences of investments in children for the burden of chronic health problems by conducting a thought experiment in which we simulate how sweeping historical changes in a population’s educational achievement potentially alters active life expectancy and the prevalence of functioning problems in the population. JF - Allocating Public and Private Resources across Generations PB - Oxford University Press CY - Oxford, UK SN - 978-1-4020-4480-9 N1 - ProCite field 8 : eds. U4 - Education/Health Status/Life Expectancy ER - TY - JOUR T1 - The impact of obesity on active life expectancy in older American men and women. JF - Gerontologist Y1 - 2005 A1 - Sandra L Reynolds A1 - Saito, Yasuhiko A1 - Eileen M. Crimmins KW - Activities of Daily Living KW - Aged KW - Female KW - Health Status KW - Health Surveys KW - Humans KW - Life Expectancy KW - Life Tables KW - Logistic Models KW - Male KW - Markov chains KW - Obesity KW - Risk Factors KW - United States AB -

PURPOSE: The purpose of this article is to estimate the effect of obesity on both the length of life and length of nondisabled life for older Americans.

DESIGN AND METHODS: Using data from the first 3 waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, this article develops estimates of total, active, and disabled life expectancy for obese and nonobese older men and women. We used the Interpolation of Markov Chains (IMaCh) method to estimate the average number of years obese and nonobese older persons can expect to live with and without activity of daily living (ADL) disability.

RESULTS: Our findings indicate that obesity has little effect on life expectancy in adults aged 70 years and older. However, the obese are more likely to become disabled. This means that obese older adults live both more years and a higher proportion of their remaining lives disabled.

IMPLICATIONS: The lack of significant differences in life expectancy by obesity status among the old suggests that obesity-related death is less of a concern than disability in this age range. Given steady increases in obesity among Americans at all ages, future disability rates may be higher than anticipated among older U.S. adults. In order to reduce disability among future cohorts of older adults, more research is needed on the causes and treatment of obesity and evaluations done on interventions to accomplish and maintain weight loss.

PB - 45 VL - 45 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/16051906?dopt=Abstract U4 - Disability/Disability/Obesity/Life Expectancy ER - TY - CHAP T1 - Integrating Biology into the Study of Health Disparities T2 - Aging, Health, and Public Policy: Demographic and Economic Perspectives Y1 - 2005 A1 - Eileen M. Crimmins A1 - Teresa Seeman ED - Linda J. Waite KW - Methodology JF - Aging, Health, and Public Policy: Demographic and Economic Perspectives T3 - Population and Development Review PB - Population Council CY - New York VL - 30 N1 - ProCite field 6 : In ProCite field 8 : ed. U4 - Health Care Surveys JO - Integrating Biology into the Study of Health Disparities ER - TY - JOUR T1 - Socioeconomic Differentials in Mortality and Health at the Older Ages JF - Genus Y1 - 2005 A1 - Eileen M. Crimmins KW - Demographics KW - Health Conditions and Status KW - Healthcare PB - LXI VL - 61 IS - 1 U4 - MORTALITY/socioeconomic Status/health outcomes ER - TY - CHAP T1 - Race/Ethnicity, Socioeconomic Status, and Health T2 - Critical Perspectives on Race and Ethnic Differences in Health in Later Life Y1 - 2004 A1 - Eileen M. Crimmins A1 - Mark D Hayward A1 - Teresa Seeman ED - Norman B. Anderson ED - Randy A. Bulatao ED - Barney Cohen KW - Demographics KW - Health Conditions and Status KW - Healthcare KW - Women and Minorities AB - Mounting evidence indicates that racial/ethnic differences in morbidity and mortality are tied to socioeconomic resources (Hayward, Crimmins, Miles, and Yu, 2000; Williams and Collins, 1995). Largely because of data availability, most of this evidence is based on the health experiences of blacks and whites, with much less evidence on the role of socioeconomic factors in understanding racial/ethnic disparities when Americans of Asian or Pacific Island descent, Hispanics, and Native Americans are part of the picture. The potential power of the socioeconomic status (SES) paradigm in understanding health disparities—including racial/ethnic disparities—is evident in the fact that socioeconomic differences in health outcomes have been widely documented for most health conditions in most countries. People who are poorer and who have less education are more likely to suffer from diseases, to experience loss of functioning, to be cognitively and physically impaired, and to experience higher mortality rates (Adler, Boyce, Chesney, Folkman, and Syme, 1993; Adler et al., 1994; Marmot, Kogevinas, and Elston, 1987; Marmot, Ryff, Bumpass, Shipley, and Marks, 1997; Preston and Taubman, 1994; Williams, 1990). In the United States, few health problems are more likely to occur among those who are better off, and some health conditions are particularly sensitive to SES. In recent years socioeconomic differences in health also appear to be increasing in the United States and in other developed countries (Crimmins and Saito, 2001; Feldman, Makuc, Kleinman, and Coroni-Huntley, 1989; Manton, 1997; Marmot, 1994; Pappas, Queen, Hadden, and Fisher, 1993; Preston and Elo, 1995). JF - Critical Perspectives on Race and Ethnic Differences in Health in Later Life PB - National Academy of Sciences UR - https://www.ncbi.nlm.nih.gov/books/NBK25526/#:~:text=Socioeconomic%20status%20is%20obviously%20related,health%20outcomes%20relative%20to%20whites. U4 - Racial Differences/socioeconomic Status/African Americans/Hispanic/health disparities/MORTALITY ER - TY - JOUR T1 - Resolving inconsistencies in trends in old-age disability: report from a technical working group. JF - Demography Y1 - 2004 A1 - Vicki A Freedman A1 - Eileen M. Crimmins A1 - Robert F. Schoeni A1 - Brenda C Spillman A1 - Aykan, Hakan A1 - Kramarow, Ellen A1 - Land, Kenneth A1 - Lubitz, James A1 - Kenneth G. Manton A1 - Linda G Martin A1 - Shinberg, Diane A1 - Timothy A Waidmann KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Chronic disease KW - Disabled Persons KW - Female KW - Health Surveys KW - Homemaker Services KW - Humans KW - Male KW - Models, Statistical KW - Self-Help Devices KW - United States AB -

In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1%-2.5% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.

PB - 41 VL - 41 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15461008?dopt=Abstract U4 - Disability/Disability/ADL and IADL Impairments/Elderly/Caregiving ER - TY - JOUR T1 - Workplace characteristics and work disability onset for men and women. JF - Soz Praventivmed Y1 - 2004 A1 - Eileen M. Crimmins A1 - Mark D Hayward KW - Disabled Persons KW - Female KW - Humans KW - Logistic Models KW - Male KW - Middle Aged KW - Occupational Diseases KW - Proportional Hazards Models KW - Retirement KW - Risk KW - Sex Factors KW - Sick Leave KW - Stress, Psychological KW - United States KW - Workers' compensation KW - Workload KW - Workplace AB -

OBJECTIVES: This paper investigates the association between job characteristics and work disability among men and women in older working ages in the United States. We examine whether the association persists when controlling for major chronic disease experience. We also address whether job characteristics are ultimately associated with the receipt of disability benefits.

METHODS: Data are from the Health and Retirement Survey and are nationally representative of noninstitutionalized persons 51-61 in 1992. Disability onset is estimated using a hazard modeling approach for those working at wave 1 (N = 5,999). A logistic regression analysis of disability benefits is based on a risk set of 525 persons who become work-disabled before the second interview.

RESULTS: Women's disability onset and health problems appear less related to job characteristics than men's. For men, work disability is associated with stressful jobs, lack of job control, and environmentally hazardous conditions but is not associated with physical demands. Participation in disability benefit programs among those with work disability is unrelated to most job characteristics or health conditions.

CONCLUSIONS: Understanding of the differing process to work disability for men and women and the relationship between work and health by gender is important for current policy development.

PB - 49 VL - 49 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/15150864?dopt=Abstract U4 - Disabled Persons/occupation/risk Factors/DISABILITY/DISABILITY/stress/environment/Job Characteristics/labor Force Participation ER - TY - JOUR T1 - Life expectancy with cognitive impairment in the older population of the United States. JF - J Gerontol B Psychol Sci Soc Sci Y1 - 2003 A1 - Suthers, Kristen A1 - Jung K Kim A1 - Eileen M. Crimmins KW - Aged KW - Aged, 80 and over KW - Alzheimer disease KW - Cross-Sectional Studies KW - Female KW - Humans KW - Life Expectancy KW - Male KW - Neuropsychological tests KW - Probability KW - Psychometrics KW - Sex Factors KW - Survival Analysis KW - United States AB -

OBJECTIVES: This article provides estimates of the prevalence of cognitive impairment by age and sex for a nationally representative sample of the U.S. population aged 70 and over. From these estimates, years of life with and without cognitive impairment are calculated.

METHODS: Using data from the Assets and Health Dynamics of the Oldest Old (AHEAD) survey, the prevalence of cognitive impairment is estimated for a sample representing both the community-dwelling and institutionalized older American population. Sullivan's method is used to calculate the average number of years an elderly person can expect to live with and without cognitive impairment.

RESULTS: The prevalence of moderate to severe cognitive impairment in the total U.S. population aged 70 and over is 9.5%. At age 70, the average American can expect 1.5 years with cognitive impairment. Expected length of life with cognitive impairment is longer for women than men because of their longer life expectancy.

DISCUSSION: As total life expectancy continues to increase, the length of life with cognitive impairment for the American population will increase unless age-specific prevalence is reduced. There is great potential for improvement in future early treatment and diagnosis of this condition.

PB - 58B VL - 58 IS - 3 U1 - http://www.ncbi.nlm.nih.gov/pubmed/12730319?dopt=Abstract U4 - Cognitive Function/Life Expectancy ER - TY - JOUR T1 - Does Childhood Health Affect Chronic Morbidity in Later Life? JF - Social Science and Medicine Y1 - 2001 A1 - Blackwell, Debra L. A1 - Mark D Hayward A1 - Eileen M. Crimmins KW - Adult children KW - Demographics KW - Health Conditions and Status AB - Examines whether childhood health has long-term and enduring consequences for chronic morbidity, and addresses two methodological issues of concern in the literature: (1) Is adult height a surrogate for childhood health experiences in modeling chronic disease in later life? and (2) Are the effects of adult socioeconomic status on chronic disease overestimated when childhood health is not accounted for? The analysis is based on a topical module to the third wave of the Health and Retirement Study, a representative survey of US adults, ages 55 -65, in 1996. Our results support the hypothesis that poor childhood health increases morbidity in later life. This association is found for cancer, lung disease, cardiovascular conditions, and arthritis/rheumatism. The associations were highly persistent in the face of statistical controls for both adult and childhood socioeconomic status. No support was found for using adult height as a proxy for the effects of childhood health experiences. Further, the effects of adult socioeconomic status were not overestimated when childhood health was excluded from the explanatory models. Results point to the importance of an integrated health care policy based on the premise of maximizing health over the entire life cycle. 6 Tables, 43 References. Adapted from the source document PB - 52 VL - 52 IS - 8 U4 - Health/Childhood/Chronic Illness/Socioeconomic Status/Morbidity/Body Height ER - TY - JOUR T1 - The Significance of Socioeconomic Status in Explaining the Racial Gap in Chronic Health Conditions JF - American Sociological Review Y1 - 2000 A1 - Mark D Hayward A1 - Eileen M. Crimmins A1 - Toni Miles A1 - Yang, Yu KW - Health Conditions and Status KW - Net Worth and Assets AB - Using Wave 1 (1992) and Wave 2 (1994) of the Health and Retirement Study the researchers try to detect the differences in life without health problems between different races so as to understand disparities in mortality rate and quality of life. Do Blacks have a higher risk of acquiring chronic health impairments of all types? How do differences in social conditions produce differences in the prevalence of fatal chronic diseases among races? The researchers notice that Blacks have a lower chance of surviving to middle age then do Whites. Blacks have a far greater level of morbidity in middle age, as well as, chances in having multiple fatal disease conditions. The author s give possible reasons for their findings, with much of it based on social status and life events. PB - 65 VL - 65 U4 - Health Status/Economic Status ER - TY - JOUR T1 - Do medical conditions affect cognition in older adults? JF - Health Psychol Y1 - 1998 A1 - Elizabeth Zelinski A1 - Eileen M. Crimmins A1 - Sandra L Reynolds A1 - Teresa Seeman KW - Aged KW - Aged, 80 and over KW - Aging KW - Cerebrovascular Disorders KW - Cognition KW - Diabetes Complications KW - Diabetes Mellitus KW - Female KW - Health Status KW - Humans KW - Hypertension KW - Male KW - Mental Health AB -

Analyses of a nationally representative sample who completed a list recall task (weighted n = 6,446) and 2 mental status tasks (weighted n = 6,646) were conducted to determine whether specific medical conditions such as high blood pressure and diabetes as well as general health ratings predict cognitive performance in adults aged 70 to 103. Presence of stroke and poorer health ratings predicted poorer performance on the 3 tasks. Presence of diabetes predicted poorer performance on recall and 1 mental status task. Age interacted with medical conditions including high blood pressure and diabetes in predicting mental status, with condition-related deficits confined to the younger end of the age continuum. Global health ratings interacted with age, with poorer ratings associated with worse mental status in the younger participants. Findings suggest that stroke and diabetes are associated with cognitive deficits. Some deficits are more pronounced in younger old adults with high blood pressure and poorer health ratings.

PB - 17 VL - 17 UR - https://pubmed.ncbi.nlm.nih.gov/9848800/ IS - 6 U1 - http://www.ncbi.nlm.nih.gov/pubmed/9848800?dopt=Abstract U4 - Aged, 80 and Over/Aging/Psychology/Cerebrovascular Disorders/Cognition/Diabetes Mellitus/Gender/Health Status/Hypertension/Support, U.S. Government--PHS ER - TY - RPRT T1 - Prevalence and Incidence of Health Problems in the First Two Waves of the Health and Retirement Study Y1 - 1995 A1 - Eileen M. Crimmins A1 - Mark D Hayward A1 - Linda A. Wray A1 - Lu, Ranyan KW - Health Conditions and Status U4 - Health status ER -