%0 Journal Article %J Journal of Family Issues %D Forthcoming %T Child–Parent Relationships and Older Adults’ Health: A Cross-Cultural Comparison Between China and the United States %A Lu, Peiyi %A Kong, Dexia %A Shelley, Mack %K CHARLS %K child–parent relationship %K cognitive function %K Cross-Cultural Comparison %K Depressive symptoms %K functional ability %X This study compared the associations of child?parent relationships with older adults? multidimensional health in the United States and China. Two waves of data from the US Health and Retirement Study and its sister study in China (2012?2015) were used (2174 non-Hispanic [NH] White Americans and 4467 Chinese). Linear regression models were conducted for cross-sectional and longitudinal comparisons. Results showed most child?parent relationships had nonsignificant associations with NH White Americans? health. In contrast, closer child?parent relationships were linked to fewer depressive symptoms and better cognitive function among Chinese. Co-residence was associated with poorer health among older Chinese. Over a 2-year period, living nearby was linked to poorer cognitive function among NH White Americans and fewer depressive symptoms among Chinese. Having weekly contact was predictive of better cognition among Chinese. This study revealed cross-cultural differences in the associations between child?parent relationships and older adults? health. Family relationships in accordance with Chinese culture could improve health. %B Journal of Family Issues %@ 0192-513X %G eng %R https://doi.org/10.1177/0192513X211064866 %0 Journal Article %J Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences %D Forthcoming %T Memory trajectories and disability among older couples: the mediating role of depressive symptoms. %A Kong, Dexia %A Lu, Peiyi %A Jiang, Da %A Chan, Helen Yue Lai %K Dyad research %K latent class growth analysis %K Memory %K Older couples %K trajectory %X

OBJECTIVE: Using a dyadic approach, this study examined the mediating effect of depressive symptoms on the longitudinal relationships between husbands' and wives' memory trajectories and their prospective disability status.

METHODS: Longitudinal data from the Health and Retirement Study 2004-2018 were used. Older (aged 50+) heterosexual couples who had no limitations in activity of daily living at the baseline (2004) were included (N = 1,310). Latent class growth analysis grouped wives and husbands into distinct memory trajectories in 2004-2014. A structural equation model examined the actor and partner effects of memory trajectories on depressive symptoms in 2016 and disability status in 2018. The mediating effect of depressive symptoms was tested.

RESULTS: Four distinct memory trajectories were found: persistently high, high and slow decline, moderate and slow decline, and low and rapid decline. Only the wife's low and rapid decline memory trajectory predicted her own more depressive symptoms (β = 0.588, 95% CI = 0.209, 0.967) and her husband's more depressive symptoms (β = 0.326, 95% CI = 0.004, 0.648). Meanwhile, depressive symptoms had strong and significant actor effects on disability (β = 0.046, 95% CI = 0.036, 0.057 for wives; β = 0.060, 95% CI = 0.046, 0.074 for husbands).

DISCUSSION: The wife's low and rapid decline trajectory was associated with her own and her husband's more depressive symptoms, which in turn increased the disability risk for both partners. Timely identification and treatment of memory decline among wives have the potential to mitigate couples' depressive symptoms and, ultimately, disability risks.

%B Journal of Applied Gerontology, Series B, Psychological Sciences and social sciences %G eng %R 10.1093/geronb/gbad163 %0 Journal Article %J Social Work Public Health %D Forthcoming %T Racial/ethnic/gender-Based Differences in Health Trajectories Among American Older Adults: 10-Year Longitudinal Evidence from the Health and Retirement Study. %A Kong, Dexia %A Lu, Peiyi %A Davitt, Joan %A Shelley, Mack %K ethnicity %K growth curve model %K Health differences %K Intersectionality %K race %X

Health disparity by race/ethnicity or gender has been well-documented. However, few researchers have examined health outcomes based on the intersection of individuals' race, ethnicity, and gender or investigated various health dimensions. Guided by an intersectionality framework, this study explores racial/ethnic/gender-based differences in trajectories of multiple health outcomes over a ten-year period among American older adults. Longitudinal data from the Health and Retirement Study (2004-2014) were used ( = 16,654). Older adults (65+) were stratified into six mutually-exclusive groups based on their race, ethnicity, and gender: Non-Hispanic (NH) White Men, NH White Women, NH Black Men, NH Black Women, Hispanic Men, and Hispanic Women. Growth curve models examined the trajectories of three health measures, including cognitive function, physical function limitations (i.e. activities of daily living and instrumental activities of daily living), and depressive symptoms. NH White men and women reported significantly better outcomes in cognition and physical function trajectories than racial/ethnic minority groups. Women in all racial/ethnic groups had more depressive symptoms but better cognition than men. Hispanic women reported the most depressive symptoms. Hispanic women and NH Black women had the worst physical function limitations. NH Black men/women were the most disadvantaged in cognition. Racial/ethnic/gender-based differences were stable over time in all health trajectories. Study findings highlight the utility of an intersectional framework in understanding how multiple social identities intersect to generate protective and/or risk effects on cognitive, mental, and physical health. Multilevel intervention strategies are warranted to reduce the persistent health inequity gap.

%B Social Work Public Health %P 1-15 %G eng %R 10.1080/19371918.2024.2320795 %0 Journal Article %J Diabetes %D 2023 %T 1249-P: Lack of Concordance of Blood Pressure Control among Heterosexual Couples with Diabetes—An Analysis of Aging Cohorts from USA, China, and India %A SAM VARGHESE, JITHIN %A LI, CHIHUA %A Lu, Peiyi %X Background: Previous studies observed high concordance of diabetes and hypertension among married or partnered couples globally due to assortative mating and cohabitation. However, whether there is concordance in controlled blood pressure (BP) among couples with diabetes, an important risk factor for micro/macrovascular complications, is unknown. Methods: Using cross-sectional data from Health and Retirement Study (HRS 2016-17, n = 1749) and its international partner studies from China (CHARLS 2015-16, n = 923) and India (LASI 2017-19, n = 4582), we identified couples (aged 21-97 years) among whom at least one partner had diabetes and both partners had standardized BP measurements. We defined controlled BP as systolic BP < 140 mmHg and diastolic BP < 90 mmHg. We used multiple imputation and survey-weighted modified Poisson regression to study the association of controlled BP between couples for wives and husbands respectively. We adjusted for current medication use, individual and household characteristics. We additionally examined between-country differences in the association. Results: Our analytic sample consisted of 3802 wives and 4504 husbands with diabetes. The proportion of wives with controlled blood pressure were 76.6% [73.2, 80.1] in the USA, 67.5% [63.3, 71.8] in China and 65.1% [62.6, 67.6] in India. The proportion of husbands with controlled blood pressure were 70.8% [67.4, 74.1] in the USA, 63.6% [58.5, 68.6] in China and 60.0% [57.8, 62.3] in India. Partner’s control of BP was not associated with own controlled BP for wives (prevalence ratio, PR: 1.05 [0.97, 1.14]) and husbands (PR: 1.07 [0.94, 1.21]) with diabetes. Estimates of association were null across all countries. Estimates were similar when restricted to couples (n = 1076) when both partners had diabetes. Conclusions: Lack of concordance in BP control among couples with diabetes suggest continuation of strategies for individualized management of high blood pressure. %B Diabetes %V 72 %P 1249-P %G eng %R 10.2337/db23-1249-P %0 Journal Article %J Neurology %D 2023 %T Association Between Supplemental Nutrition Assistance Program Use and Memory Decline: Findings From the Health and Retirement Study. %A Lu, Peiyi %A Kezios, Katrina %A Lee, Jongseong %A Calonico, Sebastian %A Wimer, Christopher %A Al Hazzouri, Adina Zeki %K cognitive aging %K government food benefits %K health policy %K SNAP %X

BACKGROUND AND OBJECTIVES: Studies on the effect of the Supplemental Nutrition Assistance Program (SNAP) on the cognitive health of older adults are scarce. We sought to examine the associations between SNAP use and memory decline among SNAP-eligible US older adults.

METHODS: Participants aged 50+ and SNAP-eligible in 1996 from the Health and Retirement Study were included. Participants' SNAP eligibility was constructed using federal criteria. Participants also self-reported whether they used SNAP. Memory function was assessed biennially from 1996 through 2016 using a composite score. To account for pre-existing differences in characteristics between SNAP users and non-users, we modeled the probability of SNAP use using demographic and health covariates. Using linear mixed-effect models, we then modeled trajectories of memory function for SNAP users and non-users using inverse probability (IP) weighting and propensity score (PS) matching techniques. In all models, we accounted for study attrition.

RESULTS: Of the 3,555 SNAP-eligible participants, a total of 15.7% were SNAP users. At baseline, SNAP users had lower socioeconomic status and a greater number of chronic conditions than non-users, and were more likely to be lost to follow-up. Our multivariable IP-weighted models (N=3,555) suggested SNAP users had worse memory scores at baseline but slower rates of memory decline compared with non-users (annual decline rate is -0.038 standardized units [95%CI=-0.044, -0.032] for users and -0.046 [95%CI=-0.049, -0.043] for non-users). Results were slightly stronger from the PS-matched sample (N=1,014) (annual decline rate was -0.046 units [95%CI=-0.050; -0.042] for users and -0.060 units [95%CI=-0.064, -0.056] for non-users). Put in other words, our findings suggested that SNAP users had about 2 fewer years of cognitive aging over a 10-year period compared with non-users.

DISCUSSION: After accounting for pre-existing differences between SNAP users and non-users as well as differential attrition, we find SNAP use to be associated with slower memory function decline.

%B Neurology %G eng %R 10.1212/WNL.0000000000201499 %0 Journal Article %J JAMA Netw Open %D 2023 %T Associations of Food Insecurity and Memory Function Among Middle to Older-Aged Adults in the Health and Retirement Study. %A Lu, Peiyi %A Kezios, Katrina %A Jawadekar, Neal %A Swift, Samuel %A Vable, Anusha %A Zeki Al Hazzouri, Adina %K Adult %K Aged %K Cohort Studies %K Cross-Sectional Studies %K Female %K Food insecurity %K Food Supply %K Humans %K Male %K Memory Disorders %K Middle Aged %K Retirement %X

IMPORTANCE: Food insecurity is a leading public health issue in the US. Research on food insecurity and cognitive aging is scarce, and is mostly cross-sectional. Food insecurity status and cognition both can change over the life course, but their longitudinal relationship remains unexplored.

OBJECTIVE: To examine the longitudinal association between food insecurity and changes in memory function during a period of 18 years among middle to older-aged adults in the US.

DESIGN, SETTING, AND PARTICIPANTS: The Health and Retirement Study is an ongoing population-based cohort study of individuals aged 50 years or older. Participants with nonmissing information on their food insecurity in 1998 who contributed information on memory function at least once over the study period (1998-2016) were included. To account for time-varying confounding and censoring, marginal structural models were created, using inverse probability weighting. Data analyses were conducted between May 9 and November 30, 2022.

MAIN OUTCOMES AND MEASURES: In each biennial interview, food insecurity status (yes/no) was assessed by asking respondents whether they had enough money to buy food or ate less than they felt they should. Memory function was a composite score based on self-completed immediate and delayed word recall task of a 10-word list and proxy-assessed validated instruments.

RESULTS: The analytic sample included 12 609 respondents (mean [SD] age, 67.7 [11.0] years, 8146 [64.60%] women, 10 277 [81.51%] non-Hispanic White), including 11 951 food-secure and 658 food-insecure individuals in 1998. Over time, the memory function of the food-secure respondents decreased by 0.045 SD units annually (β for time, -0.045; 95% CI, -0.046 to -0.045 SD units). The memory decline rate was faster among food-insecure respondents than food-secure respondents, although the magnitude of the coefficient was small (β for food insecurity × time, -0.0030; 95% CI, -0.0062 to -0.00018 SD units), which translates to an estimated 0.67 additional (ie, excess) years of memory aging over a 10-year period for food-insecure respondents compared with food-secure respondents.

CONCLUSIONS AND RELEVANCE: In this cohort study of middle to older-aged individuals, food insecurity was associated with slightly faster memory decline, suggesting possible long-term negative cognitive function outcomes associated with exposure to food insecurity in older age.

%B JAMA Netw Open %V 6 %P e2321474 %G eng %N 7 %R 10.1001/jamanetworkopen.2023.21474 %0 Journal Article %J Journal of Aging and Health %D 2023 %T Depressive Symptom Trajectories and Cognition Among Older American Couples: A Dyadic Perspective. %A Kong, Dexia %A Lu, Peiyi %A Solomon, Phyllis %A Woo, Jean %A Shelley, Mack %K Couples %K depressive symptom trajectory %K dyadic data %K latent class growth analysis %K Memory %X

OBJECTIVES: This study examined whether trajectories of depressive symptoms of one spouse are associated with the other spouse's memory.

METHODS: Longitudinal data from the Health and Retirement Study (2004-2016) were used ( = 5690 heterosexual couples). Latent-class growth analysis and structural equation models examined the actor and partner effects of depressive symptom trajectories on memory.

RESULTS: Four depressive symptom trajectories were identified (i.e., persistently low, increasing, decreasing, and persistently high). Compared to the low trajectory group, the increasing and persistently high trajectories were associated with worse memory for both men and women. While none of the wives' depressive symptom trajectories was significantly associated with husbands' memory ( > .05), husbands' decreasing trajectory was linked to wives' better memory (β = 0.498, 95% CI = 0.106, 0.890).

DISCUSSION: Older adults with increasing and persistently high depressive symptoms may experience worse memory. Psychosocial interventions targeting depressive symptoms among older men may be beneficial to their spouses' memory.

%B Journal of Aging and Health %G eng %R 10.1177/08982643221125838 %0 Journal Article %J JAMA %D 2023 %T History of Low Hourly Wage and All-Cause Mortality Among Middle-aged Workers. %A Kezios, Katrina L %A Lu, Peiyi %A Calonico, Sebastian %A Al Hazzouri, Adina Zeki %K Employment %K Income %K Poverty %K Salaries and Fringe Benefits %X

IMPORTANCE: Earning a low wage is an increasingly recognized public health concern, yet little research exists on the long-term health consequences of sustained low-wage earning.

OBJECTIVE: To examine the association of sustained low-wage earning and mortality in a sample of workers with hourly wage reported biennially during peak midlife earning years.

DESIGN, SETTING, AND PARTICIPANTS: This longitudinal study included 4002 US participants, aged 50 years or older, from 2 subcohorts of the Health and Retirement Study (1992-2018) who worked for pay and reported earning hourly wages at 3 or more time points during a 12-year period during their midlife (1992-2004 or 1998-2010). Outcome follow-up occurred from the end of the respective exposure periods until 2018.

EXPOSURES: Low-wage-less than the hourly wage for full-time, full-year work at the federal poverty line-earning history was categorized as never earning a low wage, intermittently earning a low wage, and sustained earning a low wage.

MAIN OUTCOMES AND MEASURES: Cox proportional hazards and additive hazards regression models sequentially adjusted for sociodemographics, and economic and health covariates were used to estimate associations between low-wage history and all-cause mortality. We examined interaction with sex or employment stability on multiplicative and additive scales.

RESULTS: Of the 4002 workers (aged 50-57 years at the beginning of exposure period and 61-69 years at the end), 1854 (46.3%) were female; 718 (17.9%) experienced employment instability; 366 (9.1%) had a history of sustained low-wage earning; 1288 (32.2%) had intermittent low-wage earning periods; and 2348 (58.7%) had never earned a low wage. In unadjusted analyses, those who had never earned low wages experienced 199 deaths per 10 000 person-years, those with intermittent low wages, 208 deaths per 10 000 person-years, and those with sustained low wages, 275 deaths per 10 000 person-years. In models adjusted for key sociodemographic variables, sustained low-wage earning was associated with mortality (hazard ratio [HR], 1.35; 95% CI, 1.07-1.71) and excess deaths (66; 95% CI, 6.6-125); these findings were attenuated with additional adjustments for economic and health covariates. Significant excess death and elevated mortality risk were observed for workers with sustained low-wage exposure and employment fluctuations (eg, for sustained low-wage × employment fluctuated, HR, 2.18; 95% CI, 1.35-3.53; for sustained low-wage × stable employment, HR, 1.17; 95% CI, 0.89,-1.54; P for interaction = .003).

CONCLUSIONS AND RELEVANCE: Sustained low-wage earning may be associated with elevated mortality risk and excess deaths, especially when experienced alongside unstable employment. If causal, our findings suggest that social and economic policies that improve the financial standing of low-wage workers (eg, minimum wage laws) could improve mortality outcomes.

%B JAMA %V 329 %P 561-573 %G eng %N 7 %R 10.1001/jama.2023.0367 %0 Journal Article %J Clin Gerontol %D 2023 %T Insomnia Symptom Trajectory of Spouse Caregivers of Older Adults with Functional Limitations. %A Kong, Dexia %A Lu, Peiyi %A Lou, Vivian W Q %A Shelley, Mack %X

OBJECTIVES: This study examined the long-term impact of spouse caregiving on insomnia symptoms, compared to propensity-score matched non-caregivers.

METHODS: Health and Retirement Study data between 2006 and 2018 were used. Caregivers ( = 403) were respondents (aged 50+) who assisted their heterosexual spouses in performing (instrumental) activities of daily living at baseline. Non-caregivers were matched using a propensity score matching procedure based on baseline characteristics. Insomnia symptoms were measured every 4 years for both groups. Poisson mixed-effect models estimated the association between caregiver status and insomnia symptoms.

RESULTS: Compared to matched non-caregivers, caregivers had similar severity of insomnia symptoms at baseline ( = 0.018, 95% CI = -0.089, 0.124) and reported a similar yearly change rate ( = -0.008, 95% CI = -0.017, 0.001). No moderation effects of care-recipients' dementia status and social support were significant.

CONCLUSIONS: In this study sample, there is no evidence that spouse caregivers, specifically those who performed light duties, experience more severe insomnia symptoms than non-caregivers.

CLINICAL IMPLICATIONS: Spouse caregiving, especially in a light-duty capacity, may not be detrimental to the caregivers' sleep health. More data are needed regarding insomnia in spouse caregivers with heavy duties of care to fully assess the health impact of the caregiving experience.

%B Clin Gerontol %P 1-12 %G eng %R 10.1080/07317115.2023.2211560 %0 Journal Article %J Am J Prev Med %D 2023 %T Racial Differences in Employment and Poverty Histories and Health in Older Age. %A Lu, Peiyi %A Kezios, Katrina %A Milazzo, Floriana %A Jawadekar, Neal %A Shelley, Mack %A Zeki Al Hazzouri, Adina %K Aged %K Black or African American %K Employment %K Humans %K Middle Aged %K Poverty %K Race Factors %K White %X

INTRODUCTION: Black Americans encounter more barriers in the job market and earn less than White Americans. However, the extent to which racial disparities in employment and poverty histories impact health is not fully understood. This study characterized employment‒poverty histories for Black and White middle-aged adults and examined their association with health.

METHODS: Respondents born in 1948-1953 and enrolled in the 2004 Health and Retirement Study (N=555, N=2,209) were included. Sequence analysis grouped respondents with similar employment‒poverty trajectories from 2004 to 2016, and confounder-adjusted regression analyses estimated the associations between these trajectories and health in 2018. Analyses were conducted in 2021-2022.

RESULTS: More than 23% of Black respondents experienced both employment and poverty fluctuations, including bouts of extreme poverty (<50% of the federal poverty threshold), whereas no trajectory for White respondents included extreme poverty. Adversities in employment‒poverty were associated with worse health. For example, among Black respondents, those who experienced both employment and poverty fluctuations had worse cognition than those employed and not poor (β= -0.55 standardized units, 95% CI= -0.81, -0.30). Similarly, among White respondents, those who experienced employment fluctuations had worse cognition than those employed (β= -0.35, 95% CI= -0.46, -0.24). Notably, the employed and not poor trajectory was associated with worse survival among Black respondents than among White respondents.

CONCLUSIONS: Employment fluctuations were associated with worse health, especially cognitive function, where the association was stronger among Black Americans who experienced both employment fluctuations and poverty. Findings highlight the importance of enhancing employment stability and of antipoverty programs, especially for Black Americans.

%B Am J Prev Med %V 64 %P 543-551 %G eng %N 4 %R 10.1016/j.amepre.2022.10.018 %0 Journal Article %J Journal of the American Heart Association %D 2023 %T Spousal Concordance of Hypertension Among Middle-Aged and Older Heterosexual Couples Around the World: Evidence From Studies of Aging in the United States, England, China, and India. %A Varghese, Jithin Sam %A Lu, Peiyi %A Choi, Daesung %A Lindsay C Kobayashi %A Ali, Mohammed K %A Patel, Shivani A %A LI, CHIHUA %K CHARLS %K cross‐national study %K ELSA %K Hypertension %K LASI %K spousal concordance %X

BACKGROUND: Health concordance within couples presents a promising opportunity to design interventions for disease management, including hypertension. We compared the concordance of prevalent hypertension within middle-aged and older heterosexual couples in the United States, England, China, and India.

METHODS AND RESULTS: Cross-sectional dyadic data on heterosexual couples were used from contemporaneous waves of the HRS (US Health and Retirement Study, 2016/17, n=3989 couples), ELSA (English Longitudinal Study on Aging, 2016/17, n=1086), CHARLS (China Health and Retirement Longitudinal Study, 2015/16, n=6514), and LASI (Longitudinal Aging Study in India, 2017/19, n=22 389). Concordant hypertension was defined as both husband and wife in a couple having hypertension. The prevalence of concordant hypertension within couples was 37.9% (95% CI, 35.8-40.0) in the United States, 47.1% (95% CI, 43.2-50.9) in England, 20.8% (95% CI, 19.6-21.9) in China, and 19.8% (95% CI, 19.0-20.5) in India. Compared with wives married to husbands without hypertension, wives married to husbands with hypertension were more likely to have hypertension in the United States (prevalence ratio, 1.09 [95% CI, 1.01- 1.17), England (prevalence ratio, 1.09, 95% CI, 0.98-1.21), China (prevalence ratio, 1.26 [95% CI, 1.17-1.35), and India (prevalence ratio, 1.19 [95% CI, 1.15-1.24]). Within each country, similar associations were observed for husbands. Across countries, associations in the United States and England were similar, whereas they were slightly larger in China and India.

CONCLUSIONS: Concordance of hypertension within heterosexual couples was consistently observed across these 4 socially and economically diverse countries. Couple-centered interventions may be an efficient strategy to prevent and manage hypertension in these countries.

%B Journal of the American Heart Association %G eng %R 10.1161/JAHA.123.030765 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Advance Directives Completion among Older American Couples: A Dyadic Perspective on the Role of Cognitive Function and Other Factors. %A Lu, Peiyi %A Kong, Dexia %A Lee, Jeongeun %A Shelley, Mack %K actor-partner interdependence model %K advance directive %K Couples %K dyadic analysis %X

OBJECTIVE: Dyadic perspective is scarce in existing advance directive (AD) literature. Particularly, the significance of one's own and/or one's partner's cognitive function on AD remains unknown. This study investigates the relationship of cognitive function and other factors with AD completion within the spousal context.

METHODS: Data from the Health and Retirement Study (2014-2015) were used. Older heterosexual couples (age ≥65) married for 10+ years were asked if they had a living will and/or appointed a durable power of attorney for healthcare (DPAHC). Structural Equation Models examined the actor and partner effects of sociodemographic, health, and couple-level characteristics on wife's and husband's AD, respectively.

RESULTS: Moderate spousal interdependence was observed in living will (Kappa coefficient, k =0.60) and DPAHC (k=0.53). Older age and higher education were related to both spouses having AD. Less household wealth and being racial/ethnic minority were associated with a lower probability of having AD. Notable gender contrasts in actor and partner effects were found. Wife's higher level of cognitive function was associated with husband's AD completion. Contrarily, husband's lower level of cognitive function was associated with wife's AD completion. Retirement status had primarily actor effects for both husbands and wives. More chronic conditions were linked to husband's AD completion.

DISCUSSION: The spousal interdependence of AD warrants practitioner efforts to facilitate family-oriented end-of-life planning. Wives and husbands may have different thoughts regarding their spouse's cognitive capacity to surrogate. Facilitating couple-based discussions may be a feasible approach to promote engagement with AD among older adults.

%B The Journals of Gerontology, Series B %V 77 %P 1144-1153 %G eng %N 6 %R 10.1093/geronb/gbab077 %0 Journal Article %J American Journal of Epidemiology %D 2022 %T Association of Low Hourly Wages in Middle Age With Faster Memory Decline in Older Age: Evidence From the Health and Retirement Study. %A Kezios, Katrina L %A Zhang, Adina %A Kim, Soohyun %A Lu, Peiyi %A Glymour, M Maria %A Elfassy, Tali %A Al Hazzouri, Adina Zeki %K Employment %K low-wage workers %K Memory %K occupational groups %K salaries %K wages %X

Little research has investigated the long-term relationship between low wages and memory decline, despite the growing share of low-wage workers in the US labor market. Here, we examined whether cumulative exposure to low wages over 12 years in midlife is associated with memory decline in later life. Using 1992-2016 data from the Health and Retirement Study, we analyzed data from 2,879 individuals born in 1936-1941 using confounder-adjusted linear mixed-effects models. Low-wage work was defined as an hourly wage lower than two-thirds of the federal median wage for the corresponding year and was categorized into "never," "intermittent," and "sustained" based on wages earned from 1992 to 2004. Memory function was measured at each study visit from 2004 to 2016 via a memory composite score. The confounder-adjusted annual rate of memory decline among "never" low-wage earners was -0.12 standard units (95% confidence interval: -0.13, -0.10). Compared with this, memory decline among workers with sustained earning of low midlife wages was significantly faster (βtime×sustained = -0.014, 95% confidence interval: -0.02, -0.01), corresponding to an annual rate of -0.13 standard units for this group. Sustained low-wage earning in midlife was significantly associated with a downward trajectory of memory performance in older age. Enhancing social policies to protect low-wage workers may be especially beneficial for their cognitive health.

%B American Journal of Epidemiology %V 191 %P 2051-2062 %G eng %N 12 %R 10.1093/aje/kwac166 %0 Journal Article %J Aging & Mental Health %D 2022 %T Gender-based depression trajectories following heart disease onset: significant predictors and health outcomes. %A Kong, Dexia %A Lu, Peiyi %A Solomon, Phyllis %A Shelley, Mack %K Depression trajectory %K Disability %K gender comparison %K growth mixture model %K Mortality %X

BACKGROUND: Using a nationally representative sample of U.S. older adults (50+), this study investigates gender-based depression trajectories following heart disease onset and associated risk of disability and mortality over an 8-year period.

METHOD: Six waves of longitudinal data from the Health and Retirement Study (2006-2016) were used ( = 1787). Heart disease onset was defined as self-reporting no heart disease at baseline but reporting a positive diagnosis in a subsequent wave. Growth Mixture Modelling identified depression trajectories. Multinomial logistic regression models determined significant predictors of depression trajectories. Cox proportional-hazards models examined the associated disability and mortality risks.

RESULTS: Three distinct depression trajectories were identified, including persistent minimal depression (men: 68.65%; women: 60.17%), moderate depression (women: 29.70%; men: 17.97%), and chronic depression (women: 10.12%) or emerging depression (men: 13.38%). Younger age and depression status at baseline were associated with women's chronic depression and men's emerging depression. Chronic/emerging and moderate depression were associated with higher disability risks than was minimal depression among both women and men (hazard ratios [HR] ranged from 2.12 to 3.92,  < 0.001). Only men's emerging depression was linked to higher mortality risk compared to minimal depression (HR = 2.03,  < 0.001).

CONCLUSION: Longitudinal course of depression following onset of heart disease is heterogeneous in later life. Unfavorable depression trajectories (i.e. moderate, chronic, and emerging) were associated with higher disability risk compared to the minimal depression trajectory. Study findings characterize risk stratification regarding depression after heart disease onset, which can inform the development of interventions to improve health outcomes among older adults with heart conditions.

%B Aging & Mental Health %V 26 %P 754-761 %G eng %N 4 %R 10.1080/13607863.2021.1891202 %0 Journal Article %J The International Journal of Aging and Human Development %D 2022 %T Intersectional Discrimination Attributions and Health Outcomes Among American Older Adults: A Latent Class Analysis. %A Lu, Peiyi %A Kong, Dexia %A Shelley, Mack %A Joan Davitt %K Discrimination %K Intersectionality %K Latent Class Analysis %X

Guided by an intersectionality framework, this study examined intersectional discrimination attributions and their associations with health outcomes. Older respondents (aged ≥50) from the Health and Retirement Study in 2014-2015 were included ( = 6286). Their reasons for discrimination (age, gender, sexual orientation, race, national origin, religion, financial status, weight, physical appearance, disability, and others) were examined. Latent class analysis examined the subgroup profiles. Six classes were identified: class 1 (54.52% of the sample) had no/minimal discrimination; Class 2 (21.89%) experienced primarily ageism; class 3 (8.81%) reported discrimination based on age/gender/national origin/race; class 4 (7.99%) attributed discrimination to financial/other reasons; class 5 (5.87%) experienced discrimination based on age/weight/physical appearance/disability; and class 6 (0.92%) perceived high discrimination. Intersectional discrimination was associated with poorer self-rated health and higher depressive symptoms compared to the no/minimal discrimination group. Multiple marginalized identities co-occur and contribute to discrimination. An intersectional approach is recommended to understand discrimination in later life.

%B The International Journal of Aging and Human Development %V 95 %P 267-285 %G eng %N 3 %R 10.1177/00914150211066560 %0 Journal Article %J Social Policy and Society %D 2021 %T Government Transfers and Poverty Alleviation among Older Adults in the United States from 2002 to 2014 %A Lu, Peiyi %A Shelley, Mack %A Liu, Yi-Long %K antipoverty policy %K Government transfers %K Older Adults %X Studies have indicated government transfers greatly alleviate poverty among older Americans. Yet recent social policy changes were suggested to increase older Americans’ fiscal insecurity. New evidence is needed to expand the evaluation of government transfers. Longitudinal Health and Retirement Study data from 2002 to 2014 were used. We computed individuals’ poverty status both when household income included and did not include government transfers. Results indicated the poverty rate dropped dramatically when household income included government transfers. The poverty alleviation effect was significantly greater among people who were female, older, members of a minority group, having fewer years of education, residing in the South, and living in a bigger household. Evidence from this study solidified the overall poverty alleviation effect of government transfers in old age. Differential effects among various demographic groups could be attributed to their initial status and divergent political beliefs about who should receive government transfers. %B Social Policy and Society %V 20 %P 561-579 %G eng %N 4 %R 10.1017/S147474642000041X %0 Journal Article %J Journal of Applied Gerontology %D 2021 %T Making the Decision to Move to a Nursing Home: Longitudinal Evidence From the Health and Retirement Study %A Lu, Peiyi %A Kong, Dexia %A Shelley, Mack %K decision-making %K moving %K nursing home %K theory of planned behavior %X This study applied the theory of planned behavior to examine predictors of U.S. older adults? (65+ years) intention and behavior of moving to a nursing home. Two waves of Health and Retirement Study data were used (N = 9,969). Moving intention was measured by respondents? self-reported probability to move in the next 5 years in Wave 1. Moving behavior was measured by whether they actually moved in Wave 2. Structural equation modeling was used to examine the relationships of demographic and health predictors with moving intention and behavior. For both genders, advanced age, poorer health, having fewer children, and long-term care insurance were associated with higher levels of moving intention and behavior. Men?s intention was a significant predictor of subsequent moving behavior. However, women?s intention was not associated with moving behavior, probably due to inadequate resources to support their preference. The findings provide meaningful personhood-centered insights into nursing home entry decisions. %B Journal of Applied Gerontology %V 40 %P 1197-1205 %@ 0733-4648 %G eng %N 10 %R https://doi.org/10.1177/0733464820949042 %0 Thesis %B Gerontology %D 2021 %T Social resources, pension policy, and older adults’ mental, physical, and cognitive health: A cross-national comparison between China, England, Mexico, and the United States %A Lu, Peiyi %K CHARLS %K Cognitive health %K ELSA %K Mental Health %K MHAS %K pension policy %K Physical Health %X Population aging is accelerating across the globe. A cross-national comparison perspective is imperative and important because such comparison provides an opportunity to contrast experiences of different countries and learn from each other. Promoting healthy aging is one of the ultimate goals of social policies related to older adults. Guided by the integrative theoretical framework based on the social ecological model and life course perspective, this dissertation investigates the relationship of social resources with older adults’ physical, mental, and cognitive health in China, the United States, England, and Mexico using the Harmonized Health and Retirement Study (HRS) dataset and its international sister studies. Four countries were chosen primarily based on their geographic location, different level of economic development, and availability in the Harmonized HRS dataset. The dissertation comprises three projects.The first project explored the relationship between retirement/pension and depressive symptoms of older adults across the life course. Regression models were estimated using structural equation modelling. Results indicated that retirement was associated with higher levels of depressive symptoms for the U.S. and with lower levels of depressive symptoms for Mexico and England. Having a public pension was associated with lower levels of depressive symptoms for Mexico and with higher levels of depressive symptoms for the U.S. and China. Having a private pension was associated with lower levels of depressive symptoms for the U.S., China, and England. The study showed that continuity theory demonstrates cross-national variation in explaining the association between retirement and depressive symptoms. The second project tested the cross-cultural applicability of the shared resource hypothesis in explaining mental health concordance among older couples. Dyadic data were analyzed to examine the actor and partner effects of demographic, health, and household variables on depressive symptoms using both multilevel model and structural equation model. Results indicated both husbands’ and wives’ depressive symptoms were associated with their own and the spouses’ social and health status. Most couple-level resources were nonsignificant predictors for Chinese and Mexican couples’ concordance, but having more social and financial resources was associated with higher concordance among British and American couples. It is concluded that the shared resource hypothesis was more applicable to depressive symptom concordance within couples in the U.S. and England, but not in China and Mexico. The third project examined health inequalities between genders and countries in the context of cumulative dis/advantage (CDA) and welfare state theories. Regression models were fitted to examine the moderation roles of country and gender. Health patterns across age groups were cross-examined by linear regression models and negative binomial models. Results indicated older Chinese and Mexican respondents had poorer health status than their British and American counterparts consistently except for Mexicans’ memory. Cumulative health gaps between developing and developed countries existed only for functional ability. However, there is no evidence of gender gaps in health status across age groups. CDA explains the increasing gaps of functional ability across age groups between countries. General health and mental health, however, may depend more on individuals’ intrinsic capacity and human agency. Findings from these interconnected projects corroborate the person-in-environment perspective and suggest older adults’ health is influenced by multilevel factors including micro demographic characteristics, meso household resources, and macro culture/policy contexts across countries. The cross-national comparisons provide a unique perspective on variables associated with older adults’ health in different societal contexts. Suggestions were recommended for clinical practice to work with diverse aging population and for decision makers to improve policy design, with the ultimate goal to promote healthy aging and reduce health disparity in later life. %B Gerontology %I Iowa State University %C Ames, IA %V Ph.D. %G eng %U https://lib.dr.iastate.edu/cgi/viewcontent.cgi?article=9554&context=etd %0 Thesis %B Statistics %D 2021 %T Testing the Missingness Mechanism in Longitudinal Health Survey among Older Adults: A Case Study on Health and Retirement Study %A Lu, Peiyi %K Demographics %K health variables %K MAR %K MCAR %X Background: Studies using data from longitudinal health survey of older adults usually assumed the data were missing completely at random (MCAR) or missing at random (MAR). Thus subsequent analyses used multiple imputation or likelihood-based methods to handle missing data. However, little existing research actually examines whether the data met the MCAR/MAR assumptions before performing data analyses. Methods: This study first summarized seven commonly used statistical methods to test the missing mechanism and discussed their application conditions. Then using two-wave longitudinal data from the Health and Retirement Study (HRS; wave 2014-2015 and wave 2016- 2017; n=18,747), this study applied different approaches to test the missingness mechanism of several demographic and health variables. Results: Results indicated the data did not meet the MCAR assumption even though they had a very low nonresponse rate. Health measures met the MAR assumptions. Demographic variables provided good auxiliary information for health variables. Ridout’s logistic regression model demonstrated applicability to a wide range of scenarios. Conclusion: Our findings supported the MAR assumptions for the demographic and health variables in HRS, and therefore provided statistical justification to HRS researchers about using imputation or likelihood-based methods to deal with missing data. However, researchers are encouraged to test the missingness mechanism of the specific variables/data when using a new dataset, and choose the appropriate methods depending on the research goal and nature of the data. Development of related statistical packages is urgently needed to facilitate the application of methods testing missingness mechanism to social and behavioral research. %B Statistics %I Iowa State University %C Ames, IA %V MS %G eng %U https://lib.dr.iastate.edu/cgi/viewcontent.cgi?article=1781&context=creativecomponents %0 Journal Article %J Innovation in Aging %D 2020 %T Intersectional Discrimination Attributions and Health Outcome among American Older Adults %A Lu, Peiyi %A Kong, Dexia %A Shelley, Mack %A Joan Davitt %K health outcomes %K intersectional discrimination %X Discrimination has been consistently documented to relate to adverse health outcomes. However, most existing research focused on a single discrimination attribution (e.g. ageism). Few studies considered multifaceted discrimination attributions. Guided by an intersectionality framework, this study examined intersectional discrimination attributions and their associations with health outcomes. Older respondents (aged >50) from the Health and Retirement Study in 2014-2015 were included in the analysis (n=6,286). Their experiences and self-perceived reasons (age, gender, sexual orientation, race, national origin, religion, financial status, weight, physical appearance, disability, and others) for everyday discrimination were examined. Latent class analysis was employed to ascertain the profiles of subgroups characterized by their intersectional discrimination attributions. Regression models examined the correlates of the class memberships and the associations with health outcomes. Six classes were identified: class 1 (54.52% of the sample) had no/minimal discrimination experience; Class 2 (21.89%) experienced primarily ageism; class 3 (8.81%) reported discrimination based on age/gender/national origin/race; class 4 (7.99%) attributed discrimination to financial/other reasons; class 5 (5.87%) experienced discrimination based on age/weight/physical appearance/disability; and class 6 (0.92%) perceived discrimination from almost every aspect. Intersectional discrimination attributions were associated with poorer self-rated health, and greater levels of depressive symptoms and loneliness. The associations between intersectional discrimination and cognition were not statistically significant. This study found multiple marginalized identities co-occur and compound to contribute to perceived everyday discrimination among American older adults. Those experiencing discrimination due to multiple reasons warrant particular attention. Results underscore the utility of an intersectional approach in understanding discrimination in later life. %B Innovation in Aging %V 4 %P 871 %@ 2399-5300 %G eng %N Supplement_1 %R https://doi.org/10.1093/geroni/igaa057.3222 %0 Journal Article %J Innovation in Aging %D 2020 %T Racial/ethnic/gender-based Disparities in Health Trajectories among American Older Adults %A Kong, Dexia %A Lu, Peiyi %A Joan Davitt %A Shelley, Mack %K Disparities %K ethnicity %K gender %K Health Trajectories %K race %X Numerous studies have examined racial/ethnic- or gender-based disparities in health. However, few examined health outcomes based on a combination of individuals’ race, ethnicity, and gender. Guided by an intersectionality framework, this study explores racial/ethnic/gender-based differences in older adults’ health trajectories over a ten-year period. Longitudinal data from the Health and Retirement Study (2004-2014) were used (n=16,654). Older adults (65+) were stratified into six groups based on their race, ethnicity, and gender, including (1) Non-Hispanic (NH) White Men; (2) NH White Women; (3) NH Black Men; (4) NH Black Women; (5) Hispanic Men; and (6) Hispanic Women. Growth curve models were used to examine the trajectories of three health indicators over time, including cognitive function, physical function (i.e. the sum of activities of daily living and instrumental activities of daily living), and depressive symptoms. The results indicated that NH White men and women outperformed racial/ethnic minority groups in cognition and physical function trajectories. Females in all racial/ethnic groups had more depressive symptoms but better cognition than their male counterparts. Hispanic women reported the most depressive symptoms. Hispanic women and NH Black women had the poorest physical function. NH Black men/women had the lowest cognition. Study findings highlighted the utility of an intersectionality framework in understanding health disparities in later life. Multiple social identities intersect with each other and generate protective and/or risk effects on cognitive, mental, and physical health status. Multilevel intervention strategies are warranted to close the health equity gap among various marginalized population groups. %B Innovation in Aging %V 4 %P 894 %@ 2399-5300 %G eng %N Supplement_1 %R https://doi.org/10.1093/geroni/igaa057.3295 %0 Journal Article %J International Journal of Social WelfareInternational Journal of Social Welfare %D 2020 %T Reexamining the poverty cycle in middle and late adulthood: Evidence from the Health and Retirement Study 2002–2014 %A Lu, Peiyi %A Shelley, Mack %A Liu, Yi-Long %K Life-course perspective %K life-table approach %K Older Adults %K poverty cycle %X This study re-examined the poverty cycle among American middle-aged (45~64) and older (≥65) adults using contemporary data and has expanded the understanding of sociodemographic differences in the poverty cycle. Longitudinal data from the Health and Retirement Study (2002?2014) were used. Life tables examined age-specific and cumulative percentages of poverty. Mixed-effect logistic regression models examined the moderation role of sociodemographic characteristics in the relationship between age and poverty. The poverty proportion increased rapidly starting at age 75. The growth rate of poverty risk in late adulthood was found to be greater among women and those who did not receive public pensions. Gender divides in poverty risk in late adulthood could be attributed to the cumulative disadvantages of women?s social roles. The beneficial role of Social Security in late adulthood was supported. Policy advocacy efforts should address the needs of those who are financially vulnerable. Policy options such as financial education and retirement planning were recommended. %B International Journal of Social WelfareInternational Journal of Social Welfare %@ 1369-6866 %G eng %R https://doi.org/10.1111/ijsw.12454 %0 Journal Article %J Innovation in Aging %D 2020 %T Testing the Missing Mechanism of Demographic and Health Variables in the Health and Retirement Study %A Lu, Peiyi %A Shelley, Mack %K Demographics %K Missing data %X Studies using data from longitudinal health survey of older adults usually assumed the data were missing completely at random (MCAR) or missing at random (MAR). Thus subsequent analyses used multiple imputation or likelihood-based method to handle missing data. However, little existing research actually examines whether the data met the MCAR/MAR assumptions before performing data analyses. This study first summarized the commonly used statistical methods to test missing mechanism and discussed their application conditions. Then using two-wave longitudinal data from the Health and Retirement Study (HRS; wave 2014-2015 and wave 2016-2017; N=18,747), this study applied different approaches to test the missing mechanism of several demographic and health variables. These approaches included Little’s test, logistic regression method, nonparametric tests, false discovery rate, and others. Results indicated the data did not meet the MCAR assumption even though they had a very low rate of missing values. Demographic variables provided good auxiliary information for health variables. Health measures (e.g., self-reported health, activity of daily life, depressive symptoms) met the MAR assumptions. Older respondents could drop out and die in the longitudinal survey, but attrition did not significantly affect the MAR assumption. Our findings supported the MAR assumptions for the demographic and health variables in HRS, and therefore provided statistical justification to HRS researchers about using imputation or likelihood-based methods to deal with missing data. However, researchers are strongly encouraged to test the missing mechanism of the specific variables/data they choose when using a new dataset. %B Innovation in Aging %V 4 %P 509 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.1644 %0 Journal Article %J Asian Social Work and Policy Review %D 2019 %T Why spouses depress each other: A cross-national study to test the shared resource hypothesis in depressive symptom concordance within older adult couples %A Lu, Peiyi %A Shelley, Mack %K actor–partner interdependence model %K CHARLS %K cross-national study %K Depressive symptoms %K ELSA %K health concordance %K MHAS %K shared resource hypothesis %X Abstract The shared resource hypothesis suggests that married couples share the same environmental resources, which shape their health concordance. This study tests its cross-national applicability. Cross-sectional 2012?2013 Health and Retirement Study data from China, England, Mexico, and the United States were analyzed. Heterosexual couples (age ≥60) who were married or partnered were studied (N = 20,565 pairs). Dyadic data were analyzed by multilevel models to examine the effect of self and spousal social and physical health statuses on depressive symptoms. Regression models were used to test the relationship between couples' shared resources and depressive symptom concordance. Results indicated both husbands and wives' depressive symptoms were associated with their own and spouses' social and health statuses. Most couple-level resources were insignificant predictors for Chinese and Mexican couples' concordance, but having more social and financial resources was associated with higher concordance among British and American couples. Self-reported health was the most consistent predictor in all countries. The shared resource hypothesis was more applicable to depressive symptom concordance within couples in the United States and England, but not in China and Mexico. Couple-centered intervention is suggested for clinical practice, and the spousal effect should be considered in policymaking. %B Asian Social Work and Policy Review %8 08/2019 %@ 1753-1403 %G eng %U https://onlinelibrary.wiley.com/doi/full/10.1111/aswp.12183 %! Asian Social Work and Policy Review %R https://doi.org/10.1111/aswp.12183