%0 Journal Article %J European Journal of Public Health %D 2022 %T Association of perceived job security and chronic health conditions with retirement in older UK and US workers. %A Mutambudzi, Miriam %A Flowers, Paul %A Demou, Evangelia %K attenuation %K Chronic disease %K community health centers %K ELSA %K epidemiologic studies %K health outcomes %K insecurity %K labor market %K Safety %K Sister studies %K Social Welfare %K Survival Analysis %K Workplace %X

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

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

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

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

%B European Journal of Public Health %V 32 %P 52-58 %G eng %N 1 %R 10.1093/eurpub/ckab170 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Subjective Age and Falls in Older Age: Evidence from two Longitudinal Cohorts. %A Fundenberger, Hervé %A Stephan, Yannick %A Terracciano, Antonio %A Dupré, Caroline %A Bongue, Bienvenu %A Hupin, David %A Barth, Nathalie %A Canada, Brice %K falling %K Felt age %K Survival Analysis %X

OBJECTIVES: Falls are a common and serious health problem. The present study examined the association between subjective age (i.e., feeling younger or older than one's chronological age) and falls in two large national samples.

METHOD: Participants, aged 65 to 105 years old, were drawn from the National Health and Aging Trends Study (NHATS) and the Health and Retirement Study (HRS). Data on falls, subjective age, demographic factors, was available from 2,382 participants in HRS and 3,449 in NHATS. Falls were tracked for up to 8 (HRS) and 7 (NHATS) years.

RESULTS: Cox regression analyses that included demographic covariates indicated that older subjective age increased the risk of falling in HRS (hazard ratio [HR]=1.17, 95% confidence interval [CI]=1.08-1.27), and in NHATS (HR=1.06, 95%CI=1.00-1.13). When compared to people who felt younger, people who reported an older subjective age had a higher risk of fall (HRS: HR=1.65, 95% CI=1.33-2.04; NHATS: HR=1.44, 95% CI=1.15-1.79). The associations remained significant after accounting for depressive symptoms, handgrip strength, chronic diseases, and cognitive impairment in HRS only.

DISCUSSION: These results confirm the role of subjective age as an important health marker in the aging population. Subjective age assessment can help identify individuals at greater risk of falls.

%B The Journals of Gerontology, Series B %V 77 %P 1814-1819 %G eng %N 10 %R 10.1093/geronb/gbac094 %0 Journal Article %J Computer Methods and Programs in Biomedicine %D 2021 %T A Novel Method for Identifying a Parsimonious and Accurate Predictive Model for Multiple Clinical Outcomes. %A L Grisell Diaz-Ramirez %A Lee, Sei J %A Alexander K Smith %A Gan, Siqi %A W John Boscardin %K backward elimination %K Bayesian Information Criterion %K prognostic models %K Survival Analysis %K variable selection %X

BACKGROUND AND OBJECTIVE: Most methods for developing clinical prognostic models focus on identifying parsimonious and accurate models to predict a single outcome; however, patients and providers often want to predict multiple outcomes simultaneously. As an example, for older adults one is often interested in predicting nursing home admission as well as mortality. We propose and evaluate a novel predictor-selection computing method for multiple outcomes and provide the code for its implementation.

METHODS: Our proposed algorithm selected the best subset of common predictors based on the minimum average normalized Bayesian Information Criterion (BIC) across outcomes: the Best Average BIC (baBIC) method. We compared the predictive accuracy (Harrell's C-statistic) and parsimony (number of predictors) of the model obtained using the baBIC method with: 1) a subset of common predictors obtained from the union of optimal models for each outcome (Union method), 2) a subset obtained from the intersection of optimal models for each outcome (Intersection method), and 3) a model with no variable selection (Full method). We used a case-study data from the Health and Retirement Study (HRS) to demonstrate our method and conducted a simulation study to investigate performance.

RESULTS: In the case-study data and simulations, the average Harrell's C-statistics across outcomes of the models obtained with the baBIC and Union methods were comparable. Despite the similar discrimination, the baBIC method produced more parsimonious models than the Union method. In contrast, the models selected with the Intersection method were the most parsimonious, but with worst predictive accuracy, and the opposite was true in the Full method. In the simulations, the baBIC method performed well by identifying many of the predictors selected in the baBIC model of the case-study data most of the time and excluding those not selected in the majority of the simulations.

CONCLUSIONS: Our method identified a common subset of variables to predict multiple clinical outcomes with superior balance between parsimony and predictive accuracy to current methods.

%B Computer Methods and Programs in Biomedicine %V 204 %P 106073 %G eng %R 10.1016/j.cmpb.2021.106073 %0 Journal Article %J Elife %D 2019 %T Genomics of 1 million parent lifespans implicates novel pathways and common diseases and distinguishes survival chances. %A Paul Rhj Timmers %A Mounier, Ninon %A Lall, Kristi %A Fischer, Krista %A Ning, Zheng %A Feng, Xiao %A Bretherick, Andrew D %A Clark, David W %A Shen, Xia %A Tõnu Esko %A Kutalik, Zoltán %A James F Wilson %A Joshi, Peter K %K Age Factors %K Aged %K Bayes Theorem %K Disease %K DNA Methylation %K Female %K Genetic Loci %K Genome-Wide Association Study %K Genomics %K Humans %K Longevity %K Male %K Middle Aged %K Multifactorial Inheritance %K Parents %K Polymorphism, Single Nucleotide %K Risk Factors %K Sex Characteristics %K Signal Transduction %K Survival Analysis %X

We use a genome-wide association of 1 million parental lifespans of genotyped subjects and data on mortality risk factors to validate previously unreplicated findings near , , , , , and 13q21.31, and identify and replicate novel findings near , , and . We also validate previous findings near 5q33.3/ and , whilst finding contradictory evidence at other loci. Gene set and cell-specific analyses show that expression in foetal brain cells and adult dorsolateral prefrontal cortex is enriched for lifespan variation, as are gene pathways involving lipid proteins and homeostasis, vesicle-mediated transport, and synaptic function. Individual genetic variants that increase dementia, cardiovascular disease, and lung cancer - but not other cancers - explain the most variance. Resulting polygenic scores show a mean lifespan difference of around five years of life across the deciles.

Editorial note: This article has been through an editorial process in which the authors decide how to respond to the issues raised during peer review. The Reviewing Editor's assessment is that all the issues have been addressed (see decision letter).

%B Elife %V 8 %P e39856 %G eng %R 10.7554/eLife.39856 %0 Journal Article %J Psychological Science %D 2019 %T Having a Happy Spouse Is Associated With Lowered Risk of Mortality. %A Stavrova, Olga %K Aged %K Aged, 80 and over %K Exercise %K Female %K Happiness %K Humans %K Interpersonal Relations %K Longevity %K Male %K Middle Aged %K Mortality %K Personal Satisfaction %K Risk Reduction Behavior %K Self Report %K Sexual Partners %K Socioeconomic factors %K Spouses %K Survival Analysis %X

Studies have shown that individuals' choice of a life partner predicts their life outcomes, from their relationship satisfaction to their career success. The present study examined whether the reach of one's spouse extends even further, to the ultimate life outcome: mortality. A dyadic survival analysis using a representative sample of elderly couples ( N = 4,374) followed for up to 8 years showed that a 1-standard-deviation-higher level of spousal life satisfaction was associated with a 13% lower mortality risk. This effect was robust to controlling for couples' socioeconomic situation (e.g., household income), both partners' sociodemographic characteristics, and baseline health. Exploratory mediation analyses pointed toward partner and actor physical activity as sequential mediators. These findings suggest that life satisfaction has not only intrapersonal but also interpersonal associations with longevity and contribute to the fields of epidemiology, positive psychology, and relationship research.

%B Psychological Science %V 30 %P 798-803 %G eng %N 5 %R 10.1177/0956797619835147 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2018 %T Survival Advantage Mechanism: Inflammation as a Mediator of Positive Self-Perceptions of Aging on Longevity. %A Becca R Levy %A Bavishi, Avni %K Aged %K Aged, 80 and over %K Aging %K Biomarkers %K C-reactive protein %K Female %K Humans %K Inflammation %K Longevity %K Male %K Middle Aged %K Self Concept %K Surveys and Questionnaires %K Survival Analysis %X

OBJECTIVE: Previous studies have found that positive self-perceptions of aging (SPA) are associated with longer survival; however, a biological mechanism was unknown. We examined whether C-reactive protein (CRP), a marker of cumulative stress-related inflammation, mediates the relationship between SPA and survival.

METHOD: The SPA of participants aged 50 and older in the Health and Retirement Study (N = 4,149) were assessed at baseline. Inflammation was measured by the level of CRP 4 years later. Survival was followed for up to 6 years.

RESULTS: As hypothesized, CRP mediated the impact of SPA on survival. Following the steps of a mediation analysis, positive SPA at baseline predicted lower CRP after 4 years (β = -.29, p = .03) and longer survival in the 2 years following the CRP measurement (β = .20, p =.003); additionally, lower CRP predicted longer survival, after adjusting for positive SPA (β = -.02, p = .0001). All models adjusted for baseline age, CRP, health, sex, race, and education.

DISCUSSION: It was found that lower CRP partially mediates the relationship between positive SPA and longer survival. Hence, this study presents a novel pathway to explain the process by which positive SPA extend longevity.

%B J Gerontol B Psychol Sci Soc Sci %V 73 %P 409-412 %8 2018 Mar 02 %G eng %U http://psychsocgerontology.oxfordjournals.org/content/early/2016/03/26/geronb.gbw035.abstractN2 - %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/27032428?dopt=Abstract %4 Aging/C-reactive protein/Inflammation/Longevity/Mechanism/Mortality/Self-perceptions of aging/Social cognition/Survival %$ 999999 %R 10.1093/geronb/gbw035 %0 Journal Article %J BMC Geriatr %D 2017 %T Control beliefs and risk for 4-year mortality in older adults: a prospective cohort study. %A Wei Duan-Porter %A Susan Nicole Hastings %A Brian Neelon %A Courtney Harold Van Houtven %K Activities of Daily Living %K Age Factors %K Aged %K Diabetes Mellitus %K Female %K Heart Failure %K Humans %K Internal-External Control %K Lung Diseases %K Male %K Middle Aged %K Neoplasms %K Prospective Studies %K Risk Factors %K Self Concept %K Survival Analysis %X

BACKGROUND: Control beliefs are important psychological factors that likely contribute to heterogeneity in health outcomes for older adults. We evaluated whether control beliefs are associated with risk for 4-year mortality, after accounting for established "classic" biomedical risk factors. We also determined if an enhanced risk model with control beliefs improved identification of individuals with low vs. high mortality risk.

METHODS: We used nationally representative data from the Health and Retirement Study (2006-2012) for adults 50 years or older in 2006 (n = 7313) or 2008 (n = 6301). We assessed baseline perceived global control (measured as 2 dimensions-"constraints" and "mastery"), and health-specific control. We also obtained baseline data for 12 established biomedical risk factors of 4-year mortality: age, sex, 4 medical conditions (diabetes mellitus, cancer, lung disease and heart failure), body mass index less than 25 kg/m, smoking, and 4 functional difficulties (with bathing, managing finances, walking several blocks and pushing or pulling heavy objects). Deaths within 4 years of follow-up were determined through interviews with respondents' family and the National Death Index.

RESULTS: After accounting for classic biomedical risk factors, perceived constraints were significantly associated with higher mortality risk (third quartile scores odds ratio [OR] 1.37, 95% CI 1.03-1.81; fourth quartile scores OR 1.45, 95% CI, 1.09-1.92), while health-specific control was significantly associated with lower risk (OR 0.69-0.78 for scores above first quartile). Higher perceived mastery scores were not consistently associated with decreased risk. The enhanced model with control beliefs found an additional 3.5% of participants (n = 222) with low predicted risk of 4-year mortality (i.e., 4% or less); observed mortality for these individuals was 1.8% during follow-up. Compared with participants predicted to have low mortality risk only by the classic biomedical model, individuals identified by only the enhanced model were older, had higher educational status, higher income, and higher prevalence of diabetes mellitus and cancer.

CONCLUSION: Control beliefs were significantly associated with risk for 4-year mortality; accounting for these factors improved identification of low-risk individuals. More work is needed to determine how assessment of control beliefs could enable targeting of clinical interventions to support at-risk older adults.

%B BMC Geriatr %V 17 %P 13 %8 2017 01 11 %G eng %U https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28077089/ %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/28077089?dopt=Abstract %R 10.1186/s12877-016-0390-3 %0 Journal Article %J Gerontologist %D 2017 %T The Influence of the Transportation Environment on Driving Reduction and Cessation. %A Jonathon M Vivoda %A Steven G Heeringa %A Amy J Schulz %A Grengs, Joe %A Cathleen M. Connell %K Aged %K Aging %K Automobile Driving %K environment %K Family Characteristics %K Female %K Geographic Information Systems %K Health Status %K Humans %K Longitudinal Studies %K Male %K Marital Status %K Risk %K Survival Analysis %K Transportation %K United States %X

Purpose of the Study: Driving is by far the most common mode of transportation in the United States, but driving ability is known to decline as people experience age-related functional declines. Some older adults respond to such declines by self-limiting their driving to situations with a low perceived risk of crashing, and many people eventually stop driving completely. Previous research has largely focused on individual and interpersonal predictors of driving reduction and cessation (DRC). The purpose of this study was to assess the influence of the transportation environment on DRC.

Design and Methods: Data were combined from the Health and Retirement Study, the Urban Mobility Scorecard, and StreetMap North America (GIS data). Longitudinal survival analysis techniques were used to analyze seven waves of data spanning a 12-year period.

Results: As roadway density and congestion increased in the environment, the odds of DRC also increased, even after controlling for individual and interpersonal predictors. Other predictors of DRC included demographics, relationship status, health, and household size.

Implications: The current study identified an association between the transportation environment and DRC. Future research is needed to determine whether a causal link can be established. If so, modifications to the physical environment (e.g., creating livable communities with goods and services in close proximity) could reduce driving distances in order to improve older drivers' ability to remain engaged in life. In addition, older individuals who wish to age in place should consider how their local transportation environment may affect their quality of life.

%B Gerontologist %V 57 %P 824-832 %8 2017 10 01 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27342439 %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/27342439?dopt=Abstract %R 10.1093/geront/gnw088 %0 Journal Article %J Soc Sci Med %D 2016 %T A chapter a day: Association of book reading with longevity. %A Bavishi, Avni %A Martin D Slade %A Becca R Levy %K Aged %K Aged, 80 and over %K Books %K Chi-Square Distribution %K Cohort Studies %K Female %K Humans %K Longevity %K Male %K Michigan %K Middle Aged %K Reading %K Survival Analysis %X

Although books can expose people to new people and places, whether books also have health benefits beyond other types of reading materials is not known. This study examined whether those who read books have a survival advantage over those who do not read books and over those who read other types of materials, and if so, whether cognition mediates this book reading effect. The cohort consisted of 3635 participants in the nationally representative Health and Retirement Study who provided information about their reading patterns at baseline. Cox proportional hazards models were based on survival information up to 12 years after baseline. A dose-response survival advantage was found for book reading by tertile (HRT2 = 0.83, p < 0.001, HRT3 = 0.77, p < 0.001), after adjusting for relevant covariates including age, sex, race, education, comorbidities, self-rated health, wealth, marital status, and depression. Book reading contributed to a survival advantage that was significantly greater than that observed for reading newspapers or magazines (tT2 = 90.6, p < 0.001; tT3 = 67.9, p < 0.001). Compared to non-book readers, book readers had a 23-month survival advantage at the point of 80% survival in the unadjusted model. A survival advantage persisted after adjustment for all covariates (HR = .80, p < .01), indicating book readers experienced a 20% reduction in risk of mortality over the 12 years of follow up compared to non-book readers. Cognition mediated the book reading-survival advantage (p = 0.04). These findings suggest that the benefits of reading books include a longer life in which to read them.

%B Soc Sci Med %V 164 %P 44-48 %8 2016 09 %G eng %U http://www.sciencedirect.com/science/article/pii/S0277953616303689 %1 http://www.ncbi.nlm.nih.gov/pubmed/27471129?dopt=Abstract %R 10.1016/j.socscimed.2016.07.014 %0 Journal Article %J J Am Geriatr Soc %D 2016 %T One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index. %A Irena Cenzer %A Victoria L. Tang %A W John Boscardin %A Christine S Ritchie %A Margaret Wallhagen %A Espaldon, Roxanne %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Cause of Death %K Cohort Studies %K Comorbidity %K Disability Evaluation %K Female %K Hip Fractures %K Humans %K Incidence %K Longitudinal Studies %K Male %K Prognosis %K Retrospective Studies %K Risk Assessment %K Survival Analysis %K United States %X

OBJECTIVES: To develop a prediction index for 1-year mortality after hip fracture in older adults that includes predictors from a wide range of domains.

DESIGN: Retrospective cohort study.

SETTINGS: Health and Retirement Study (HRS).

PARTICIPANTS: HRS participants who experienced hip fracture between 1992 and 2010 as identified according to Medicare claims data (N = 857).

MEASUREMENTS: Outcome measure was death within 1 year of hip fracture. Predictor measures were participant demographic characteristics, socioeconomic status, social support, health, geriatric symptoms, and function. Variables independently associated with 1-year mortality were identified, and best-subsets regression was used to identify the final model. The selected variables were weighted to create a risk index. The index was internally validated using bootstrapping to estimate model optimism.

RESULTS: Mean age at time of hip fracture was 84, and 76% of the participants were women. There were 235 deaths (27%) during the 1-year follow up. Five predictors of mortality were included in the final model: aged 90 and older (2 points), male sex (2 points), congestive heart failure (2 points), difficulty preparing meals (2 points), and not being able to drive (1 point). The point scores of the index were associated with 1-year mortality, with 0 points predicting 10% risk and 7 to 9 points predicting 66% risk. The c-statistic for the final model was 0.73, with an estimated optimism penalty of 0.01, indicating very little evidence of overfitting.

CONCLUSION: The prognostic index combines demographic, comorbidity, and function variables and can be used to differentiate between individuals at low and high risk of 1-year mortality after hip fracture.

%B J Am Geriatr Soc %V 64 %P 1863-8 %8 2016 09 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27295578 %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/27295578?dopt=Abstract %R 10.1111/jgs.14237 %0 Journal Article %J Prev Chronic Dis %D 2014 %T Longitudinal predictors of self-rated health and mortality in older adults. %A Diane C Wagner %A Jerome L Short %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Chronic disease %K depression %K Educational Status %K Female %K Health Behavior %K Health Status Indicators %K Humans %K Longitudinal Studies %K Male %K Mental Recall %K Middle Aged %K Proportional Hazards Models %K Psychometrics %K Retirement %K Self Report %K Survival Analysis %K United States %X

INTRODUCTION: Few studies have compared the effects of demographic, cognitive, and behavioral factors of health and mortality longitudinally. We examined predictors of self-rated health and mortality at 3 points, each 2 years apart, over 4 years.

METHODS: We used data from the 2006 wave of the Health and Retirement Study and health and mortality indicators from 2006, 2008, and 2010. We analyzed data from 17,930 adults (aged 50-104 y) to examine predictors of self-rated health and data from a subgroup of 1,171 adults who died from 2006 through 2010 to examine predictors of mortality.

RESULTS: Time 1 depression was the strongest predictor of self-rated health at all points, independent of age and education. Education, mild activities, body mass index, delayed word recall, and smoking were all associated with self-rated health at each point and predicted mortality. Delayed word recall mediated the relationships of mild activity with health and mortality. Bidirectional mediation was found for the effects of mild activity and depression on health.

CONCLUSION: Medical professionals should consider screening for depression and memory difficulties in addition to conducting medical assessments. These assessments could lead to more effective biopsychosocial interventions to help older adults manage risks for mortality.

%B Prev Chronic Dis %I 11 %V 11 %P E93 %8 2014 Jun 05 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/24901793?dopt=Abstract %2 PMC4049199 %4 Self assessed health/depression/mortality/memory decline/psychosocial influences/psychosocial influences %$ 999999 %R 10.5888/pcd11.130241 %0 Journal Article %J Am J Respir Crit Care Med %D 2012 %T Spurious inferences about long-term outcomes: the case of severe sepsis and geriatric conditions. %A Theodore J Iwashyna %A Netzer, Giora %A Kenneth M. Langa %A Christine T Cigolle %K Aged %K Aged, 80 and over %K Body Mass Index %K Chronic pain %K Cohort Studies %K Comorbidity %K Critical Illness %K Disabled Persons %K disease progression %K Female %K Geriatric Assessment %K Hearing Disorders %K Hospitalization %K Humans %K Incidence %K Male %K Musculoskeletal Diseases %K Prognosis %K Retrospective Studies %K Risk Assessment %K Sepsis %K Survival Analysis %K Survivors %K Thinness %K Time %K Treatment Outcome %K Urinary incontinence %K Vision Disorders %X

RATIONALE: Survivors of critical illness suffer significant limitations and disabilities.

OBJECTIVES: Ascertain whether severe sepsis is associated with increased risk of so-called geriatric conditions (injurious falls, low body mass index [BMI], incontinence, vision loss, hearing loss, and chronic pain) and whether this association is measured consistently across three different study designs.

METHODS: Patients with severe sepsis were identified in the Health and Retirement Study, a nationally representative cohort interviewed every 2 years, 1998 to 2006, and in linked Medicare claims. Three comparators were used to assess an association of severe sepsis with geriatric conditions in survivors: the prevalence in the United States population aged 65 years and older, survivors' own pre-sepsis levels assessed before hospitalization, or survivors' own pre-sepsis trajectory.

MEASUREMENTS AND MAIN RESULTS: Six hundred twenty-three severe sepsis hospitalizations were followed a median of 0.92 years. When compared with the 65 years and older population, surviving severe sepsis was associated with increased rates of low BMI, injurious falls, incontinence, and vision loss. Results were similar when comparing survivors to their own pre-sepsis levels. The association of low BMI and severe sepsis persisted when controlling for patients' pre-sepsis trajectories, but there was no association of severe sepsis with injurious falls, incontinence, vision loss, hearing loss, and chronic pain after such controls.

CONCLUSIONS: Geriatric conditions are common after severe sepsis. However, severe sepsis is associated with increased rates of only a subset of geriatric conditions, not all. In studying outcomes after acute illness, failing to measure and control for both preillness levels and trajectories may result in erroneous conclusions.

%B Am J Respir Crit Care Med %I 185 %V 185 %P 835-41 %8 2012 Apr 15 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/22323301?dopt=Abstract %2 PMC3360570 %4 Body Mass Index/Cohort Studies/Comorbidity/DISABILITY/DISABILITY/Geriatric Assessment/Hearing Disorders/Hospitalization/Musculoskeletal Diseases/Risk Assessment/Sepsis/Survival Analysis/body Weight/Treatment Outcome/Urinary Incontinence/Vision Disorders %$ 69456 %R 10.1164/rccm.201109-1660OC %0 Journal Article %J Soc Sci Med %D 2012 %T Transition to retirement and risk of cardiovascular disease: prospective analysis of the US health and retirement study. %A J Robin Moon %A M. Maria Glymour %A Subramanian, S V %A Mauricio Avendano %A Ichiro Kawachi %K Age Factors %K Aged %K Cardiovascular Diseases %K Female %K Health Behavior %K Health Surveys %K Humans %K Longitudinal Studies %K Male %K Middle Aged %K Prospective Studies %K Retirement %K Risk Factors %K Sex Factors %K Socioeconomic factors %K Survival Analysis %K Time Factors %K United States %X

Transitioning from work to retirement could be either beneficial or harmful for health. We investigated the association between transition to retirement and risk of stroke and myocardial infarction (MI). We followed US Health and Retirement Study participants age 50+ working full-time for pay and free of major cardiovascular disease (n = 5422) in 1998 up to 10 years for transition to full retirement and self- or proxy-report of either stroke or MI (CVD; 665 events). We used discrete-time survival analysis to compare the CVD incidence for the fully retired versus the full-time working population. To distinguish short-term from long-term risks, we compared the association in the first year after retirement to estimates 2+ years after retirement. In the full model adjusting for age, sex, childhood and adult SES, behavior, and co-morbidities, being retired was associated with elevated odds of CVD onset (OR = 1.40, 95% CI: 1.04, 1.90) compared to those remaining in the full-time labor force. The odds ratio for CVD incidence within the first year of retirement was 1.55 (95% CI: 1.03, 2.33). From the second year post-retirement and thereafter, the retired had marginally elevated risk of CVD compared to those still working (OR = 1.35; 95% CI: 0.96, 1.91). Although confidence intervals were wide for some sub-groups, there were no significant interactions by sex or socioeconomic status. Results suggest that CVD risk is increased after retirement.

%B Soc Sci Med %I 75 %V 75 %P 526-30 %8 2012 Aug %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/22607954?dopt=Abstract %2 PMC3367095 %4 Transitions/Retirement/Risk factors/Cardiovascular disease/Survival analysis/Medical research/Myocardial Infarction/Stroke %$ 69428 %R 10.1016/j.socscimed.2012.04.004 %0 Journal Article %J Am J Public Health %D 2010 %T The longevity gap between Black and White men in the United States at the beginning and end of the 20th century. %A Frank A Sloan %A Padmaja Ayyagari %A Salm, Martin %A Grossman, Daniel %K Aged %K Black or African American %K Health Status Disparities %K Humans %K Longevity %K Longitudinal Studies %K Male %K Men's health %K Middle Aged %K Mortality %K Proportional Hazards Models %K Survival Analysis %K United States %K Veterans %K White People %X

OBJECTIVES: We sought to assess whether the disparity in mortality rates between Black and White men decreased from the beginning to the end of the 20th century.

METHODS: We used Cox proportional hazard models for mortality to estimate differences in longevity between Black and White Civil War veterans from 1900 to 1914 (using data from a pension program) and a later cohort of male participants (using data from the 1992 to 2006 Health and Retirement Study). In sensitivity analysis, we compared relative survival of veterans for alternative baseline years through 1914.

RESULTS: In our survival analysis, the Black-White male difference in mortality, both unadjusted and adjusted for other influences, did not decrease from the beginning to the end of the 20th century. A 17% difference in Black-White mortality remained for the later cohort even after we controlled for other influences. Although we could control for fewer other influences on longevity, the Black-White differences in mortality for the earlier cohort was 18%.

CONCLUSIONS: In spite of overall improvements in longevity, a major difference in Black-White male mortality persists.

%B Am J Public Health %I 100 %V 100 %P 357-63 %8 2010 Feb %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/20019309?dopt=Abstract %2 PMC2804648 %4 African Americans/European Continental Ancestry Group/Health Status Disparities/Longevity/Longitudinal Studies/Mens Health: ethnology/Middle Aged/Mortality: ethnology/Mortality: trends/Proportional Hazards Models/Survival Analysis/United States: epidemiology/Veterans: statistics and numerical data %$ 22190 %R 10.2105/AJPH.2008.158188 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2009 %T Recent hospitalization and the risk of hip fracture among older Americans. %A Frederic D Wolinsky %A Suzanne E Bentler %A Li Liu %A Maksym Obrizan %A Elizabeth A Cook %A Kara B Wright %A John F Geweke %A Elizabeth A Chrischilles %A Claire E Pavlik %A Robert L. Ohsfeldt %A Michael P Jones %A Kelly K Richardson %A Gary E Rosenthal %A Robert B Wallace %K Accidental Falls %K Age Distribution %K Aged %K Aged, 80 and over %K Aging %K Cohort Studies %K Female %K Follow-Up Studies %K Geriatric Assessment %K Hip Fractures %K Hospitalization %K Humans %K Logistic Models %K Male %K Multivariate Analysis %K Probability %K Proportional Hazards Models %K Prospective Studies %K Risk Factors %K Sex Distribution %K Survival Analysis %K United States %X

BACKGROUND: We identified hip fracture risks in a prospective national study.

METHODS: Baseline (1993-1994) interview data were linked to Medicare claims for 1993-2005. Participants were 5,511 self-respondents aged 70 years and older and not in managed Medicare. ICD9-CM 820.xx (International Classification of Diseases, 9th Edition, Clinical Modification) codes identified hip fracture. Participants were censored at death or enrollment into managed Medicare. Static risk factors included sociodemographic, socioeconomic, place of residence, health behavior, disease history, and functional and cognitive status measures. A time-dependent marker reflecting postbaseline hospitalizations was included.

RESULTS: A total of 495 (8.9%) participants suffered a postbaseline hip fracture. In the static proportional hazards model, the greatest risks involved age (adjusted hazard ratios [AHRs] of 2.01, 2.82, and 4.91 for 75-79, 80-84, and > or =85 year age groups vs those aged 70-74 years; p values <.001), sex (AHR = 0.45 for men vs women; p < .001), race (AHRs of 0.37 and 0.46 for African Americans and Hispanics vs whites; p values <.001 and <.01), body mass (AHRs of 0.40, 0.77, and 1.73 for obese, overweight, and underweight vs normal weight; p values <.001, <.05, and <.01), smoking status (AHRs = 1.49 and 1.52 for current and former smokers vs nonsmokers; p values <.05 and <.001), and diabetes (AHR = 1.99; p < .001). The time-dependent recent hospitalization marker did not alter the static model effect estimates, but it did substantially increase the risk of hip fracture (AHR = 2.51; p < .001).

CONCLUSIONS: Enhanced discharge planning and home care for non-hip fracture hospitalizations could reduce subsequent hip fracture rates.

%B J Gerontol A Biol Sci Med Sci %I 64 %V 64 %P 249-55 %8 2009 Feb %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/19196641?dopt=Abstract %2 PMC2655029 %4 Accidental Falls/Aged, 80 and over/Geriatric Assessment/Hip Fractures/Hospitalization/Prospective Studies/Risk Factors/Sex Distribution/Survival Analysis %$ 23100 %R 10.1093/gerona/gln027 %0 Journal Article %J Am J Public Health %D 2008 %T Chronic conditions and mortality among the oldest old. %A Sei J. Lee %A Alan S Go %A Lindquist, Karla %A Bertenthal, Daniel %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Chronic disease %K Female %K Health Behavior %K Health Status %K Humans %K Male %K Middle Aged %K Models, Statistical %K Predictive Value of Tests %K Proportional Hazards Models %K Reproducibility of Results %K Risk Adjustment %K Severity of Illness Index %K Socioeconomic factors %K Survival Analysis %K United States %X

OBJECTIVES: We sought to determine whether chronic conditions and functional limitations are equally predictive of mortality among older adults.

METHODS: Participants in the 1998 wave of the Health and Retirement Study (N=19430) were divided into groups by decades of age, and their vital status in 2004 was determined. We used multivariate Cox regression to determine the ability of chronic conditions and functional limitations to predict mortality.

RESULTS: As age increased, the ability of chronic conditions to predict mortality declined rapidly, whereas the ability of functional limitations to predict mortality declined more slowly. In younger participants (aged 50-59 years), chronic conditions were stronger predictors of death than were functional limitations (Harrell C statistic 0.78 vs. 0.73; P=.001). In older participants (aged 90-99 years), functional limitations were stronger predictors of death than were chronic conditions (Harrell C statistic 0.67 vs. 0.61; P=.004).

CONCLUSIONS: The importance of chronic conditions as a predictor of death declined rapidly with increasing age. Therefore, risk-adjustment models that only consider comorbidities when comparing mortality rates across providers may be inadequate for adults older than 80 years.

%B Am J Public Health %I 98 %V 98 %P 1209-14 %8 2008 Jul %G eng %N 7 %L newpubs20080822_AJPH1209 %1 http://www.ncbi.nlm.nih.gov/pubmed/18511714?dopt=Abstract %2 PMC2424085 %4 Chronic Disease/Mortality/Age Factors %$ 19110 %R 10.2105/AJPH.2007.130955 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2007 %T Educational disparities in the prevalence and consequence of physical vulnerability. %A Daniel O. Clark %A Timothy E. Stump %A Douglas K Miller %A Long, J. Scott %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Chronic disease %K Cohort Studies %K Cross-Sectional Studies %K Educational Status %K Female %K Geriatric Assessment %K Health Surveys %K Humans %K Male %K Mobility Limitation %K Risk Factors %K Socioeconomic factors %K Survival Analysis %K United States %X

OBJECTIVES: The purpose of this study was to estimate educational differences in the prevalence and mortality consequence of physical vulnerability among older adults in the United States.

METHODS: Data came from the 1998 and 2000 waves of the Health and Retirement Study, a nationally representative cross-sectional and prospective cohort study of community-based adults aged 65 and older. We created a physical vulnerability score from age, gender, and self-reported disability measures and measured socioeconomic status via educational attainment. Mortality data came from the National Death Index.

RESULTS: In the 1998 cohort, high physical vulnerability was more than 3 times more prevalent in individuals with less than 12 years of education compared to those with 16 or more years of education. Although less educated older adults had a higher probability of death overall, evidence of educational differences in the mortality consequence of high physical vulnerability was limited. In 2000, 2.16 million older adults had high physical vulnerability, and more than one half (53%) of these adults had less than 12 years of education.

DISCUSSION: In persons 65 years of age or older, educational differences are more apparent in the prevalence of physical vulnerability than in the mortality consequence of that vulnerability.

%B J Gerontol B Psychol Sci Soc Sci %I 62B %V 62 %P S193-7 %8 2007 May %G eng %N 3 %L newpubs20070611_EdDisparities.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/17507595?dopt=Abstract %4 Mortality/Physical Vulnerability/Education/ADULT HEALTH/DISABILITY/DISABILITY %$ 17800 %R 10.1093/geronb/62.3.s193 %0 Journal Article %J Am J Public Health %D 2007 %T Racial/ethnic differences in the development of disability among older adults. %A Dorothy D Dunlop %A Song, Jing %A Larry M Manheim %A Daviglus, Martha L. %A Rowland W Chang %K Activities of Daily Living %K Aged %K Black or African American %K Disabled Persons %K Female %K Health Behavior %K Health Status Disparities %K Health Surveys %K Hispanic or Latino %K Humans %K Male %K Prevalence %K Proportional Hazards Models %K Prospective Studies %K Risk %K Socioeconomic factors %K Survival Analysis %K United States %K White People %X

OBJECTIVES: We investigated differences in the development of disability in activities of daily living among non-Hispanic Whites, African Americans, Hispanics interviewed in Spanish, and Hispanics interviewed in English.

METHODS: We estimated 6-year risk for disability development among 8161 participants 65 years or older and free of baseline disability. We evaluated mediating factors amenable to clinical and public health intervention on racial/ethnic difference.

RESULTS: The risk for developing disability among Hispanics interviewed in English was similar to that among Whites (hazard ratio [HR]=0.99; 95% confidence interval [CI] = 0.6, 1.4) but was substantially higher among African Americans (HR=1.6; 95% CI=1.3, 1.9) and Hispanics interviewed in Spanish (HR=1.8; 95% CI=1.4, 2.1). Adjustment for demographics, health, and socioeconomic status reduced a large portion of those disparities (African American adjusted HR=1.1, Spanish-interviewed Hispanic adjusted HR=1.2).

CONCLUSIONS: Higher risks for developing disability among older African Americans, and Hispanics interviewed in Spanish compared with Whites were largely attenuated by health and socioeconomic differences. Language- and culture-specific programs to increase physical activity and promote weight maintenance may reduce rates of disability in activities of daily living and reduce racial/ethnic disparities in disability.

%B Am J Public Health %I 97 %V 97 %P 2209-15 %8 2007 Dec %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/17971548?dopt=Abstract %4 aging/Chronic Disease/DISABILITY/DISABILITY/Racial Differences %$ 18500 %R 10.2105/AJPH.2006.106047 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2007 %T Self-rated health trajectories and mortality among older adults. %A Thomas R Miller %A Frederic D Wolinsky %K Age Factors %K Aged %K Aged, 80 and over %K Attitude to Health %K Cardiovascular Diseases %K Cause of Death %K Female %K Follow-Up Studies %K Health Status %K Health Status Indicators %K Humans %K Logistic Models %K Longitudinal Studies %K Lung Diseases %K Male %K Mortality %K Multivariate Analysis %K Risk Factors %K Sex Factors %K Smoking %K Socioeconomic factors %K Survival Analysis %K United States %X

OBJECTIVES: For this article, we evaluated whether measures of prior self-rated health (SRH) trajectories had associations with subsequent mortality that were independent of current SRH assessment and other covariates.

METHODS: We used multivariable logistic regression that incorporated four waves of interview data (1993, 1995, 1998, and 2000) from the Asset and Health Dynamics Among the Oldest Old Survey in order to predict mortality during 2000-2002. We defined prior SRH trajectories for each individual based on the slope estimated from a simple linear regression of their own SRH between 1993 and 1998 and the variance around that slope. In addition to SRH reported in 2000, other covariates included in the mortality models reflected health status, health-related behaviors, and individual resources.

RESULTS: Among the 3,129 respondents in the analytic sample, SRH in 2000 was significantly (p <.0001) associated with mortality, but the measures of prior SRH trajectories were not. Prior SRH trajectory was, however, a significant determinant of current SRH. We observed significant independent associations with mortality for age, sex, education, lung disease, and having ever smoked.

DISCUSSION: Although measures of prior SRH trajectories did not have significant direct associations with mortality, they did have important indirect effects via their influence on current SRH.

%B J Gerontol B Psychol Sci Soc Sci %I 62 %V 62 %P S22-7 %8 2007 Jan %G eng %N 1 %L newpubs20070403_Miller-Wolinsky %1 http://www.ncbi.nlm.nih.gov/pubmed/17284562?dopt=Abstract %4 SELF-RATED HEALTH/mortality %$ 17270 %R 10.1093/geronb/62.1.s22 %0 Journal Article %J Med Sci Sports Exerc %D 2004 %T Physical activity and mortality across cardiovascular disease risk groups. %A Richardson, Caroline R. %A Kriska, Andrea M. %A Lantz, Paula M. %A Rodney A. Hayward %K Cardiovascular Diseases %K Cohort Studies %K Female %K Follow-Up Studies %K Humans %K Life Style %K Logistic Models %K Male %K Middle Aged %K Motor Activity %K Multivariate Analysis %K Odds Ratio %K Prospective Studies %K Risk Assessment %K Risk Factors %K Socioeconomic factors %K Survival Analysis %K United States %X

PURPOSE: Several cohort studies suggest that sedentary individuals have an increased risk of death compared with individuals who are physically active. Most of these studies have been conducted in highly selected patient populations who tend to be healthier and are from higher socioeconomic status (SES) groups. We examined the impact of a sedentary lifestyle on mortality by cardiovascular disease (CVD) risk group in a national sample of U.S. adults who represent a wide range of activity levels, health conditions, and SES groups.

METHODS: Using data from the HRS, a nationally representative, observational study of 9824 U.S. adults aged 51-61 yr in 1992, we estimated the relative risk of death comparing sedentary individuals with those who are physically active by CVD risk group in a multivariate logistic regression model.

RESULTS: Even after adjusting for confounders, regular moderate to vigorous physical activity was associated with substantially lower overall mortality (odds ratio (OR) = 0.62 (95% CI 0.44-0.86)) compared with sedentary individuals. High CVD risk individuals (21% of the population) accounted for 64% of deaths attributable to a sedentary lifestyle. Those with high CVD risk had the most significant benefit from being active (regular moderate to vigorous exercisers OR = 0.55 (95% CI 0.31-0.97) and occasional or light exercisers OR 0.55 (95% CI 0.41-0.74)) compared with high CVD risk individuals who were sedentary.

CONCLUSION: A sedentary lifestyle is associated with a higher risk of death in preretirement-aged U.S. adults. Individuals with high CVD risk appear to get the largest benefit from being physically active. Physical activity interventions targeting high CVD risk individuals should be a medical and public health priority.

%B Med Sci Sports Exerc %V 36 %P 1923-9 %8 2004 Nov %G eng %N 11 %L pubs_2004_Richardson_etal_MSSE.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/15514508?dopt=Abstract %4 Exercise/Mortality/Socioeconomic Status %$ 12642 %R 10.1249/01.mss.0000145443.02568.7a %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2003 %T Life expectancy with cognitive impairment in the older population of the United States. %A Suthers, Kristen %A Jung K Kim %A Eileen M. Crimmins %K Aged %K Aged, 80 and over %K Alzheimer disease %K Cross-Sectional Studies %K Female %K Humans %K Life Expectancy %K Male %K Neuropsychological tests %K Probability %K Psychometrics %K Sex Factors %K Survival Analysis %K United States %X

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.

%B J Gerontol B Psychol Sci Soc Sci %I 58B %V 58 %P S179-86 %8 2003 May %G eng %N 3 %L pubs_2003_Suthers_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12730319?dopt=Abstract %4 Cognitive Function/Life Expectancy %$ 9902 %R 10.1093/geronb/58.3.s179 %0 Journal Article %J Gerontology %D 2003 %T Self-rated life expectancy as a predictor of mortality: evidence from the HRS and AHEAD surveys. %A Michele J. Siegel %A Elizabeth H Bradley %A Stanislav V Kasl %K Aged %K Female %K Health Status %K Health Surveys %K Humans %K Life Expectancy %K Male %K Mortality %K Prognosis %K Proportional Hazards Models %K Self Concept %K Sex Distribution %K Survival Analysis %X

BACKGROUND: An extensive literature has demonstrated that self-ratings of health predict mortality, even after controlling for more objective measures of health, health habits and sociodemographic characteristics. We examine the role of a related concept, self-rated life expectancy, in predicting mortality.

OBJECTIVE: To assess whether self-rated life expectancy predicts mortality after controlling for measures of health, self-rated health, and sociodemographic characteristics.

METHODS: Using data from the 1992 Health and Retirement Survey (HRS), the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, and the second Tracker file (2.0), Cox proportional hazard models were estimated to assess whether self-rated life expectancy predicts mortality, after adjusting for self-rated health and several potential confounders that might otherwise explain this relationship. The AHEAD sample included 2,102 men and 3,160 women. During the 2 years of follow-up, 9% (n = 185) of the men died and 5% (n = 166) of the women died. The HRS sample was comprised of 4,090 men and 4,885 women. Four percent (n = 164) of the men died and 2% (n = 99) of the women died in the 3 years of follow-up.

RESULTS: In the older, AHEAD sample, both self-rated life expectancy (p < 0.01) and self-rated health (p < 0.05) predicted mortality for both men and women, even when the two measures were included in the model together. In the younger, HRS sample, self-rated life expectancy was not significantly associated with mortality when self-rated health was included in the model.

CONCLUSION: Our findings suggest that, although self-rated life expectancy and self-rated health may be conceptually related, they have independent empirical effects on mortality.

%B Gerontology %I 49 %V 49 %P 265-71 %8 2003 Jul-Aug %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/12792164?dopt=Abstract %4 Subjective expectations/Mortality/Health %$ 11972 %R 10.1159/000070409 %0 Journal Article %J Am J Public Health %D 1997 %T Do smokers understand the mortality effects of smoking? Evidence from the Health and Retirement Survey. %A Michael Schoenbaum %K Cognition %K Female %K Health Surveys %K Humans %K Life Tables %K Longevity %K Male %K Middle Aged %K Retirement %K Risk %K Sex Factors %K Smoking %K Survival Analysis %X

OBJECTIVES: This study examined whether smokers recognize that smoking is likely to shorten their lives and, if so, whether they understand the magnitude of this effect.

METHODS: People's expectations about their chances of reaching age 75 were compared with epidemiological predictions from life tables for never, former, current light, and current heavy smokers. Data on expectations of reaching age 75 came from the Health and Retirement Survey, a national probability sample of adults aged 50 through 62 years. Predictions came from smoking-specific life tables constituted from the 1986 National Mortality Followback Survey and the 1985 and 1987 National Health Interview Surveys.

RESULTS: Among men and women, the survival expectations of never, former, and current light smokers were close to actual predictions. However, among current heavy smokers, expectations of reaching age 75 were nearly twice as high as actuarial predictions.

CONCLUSIONS: These findings suggest that at least heavy smokers significantly underestimate their risk of premature mortality.

%B Am J Public Health %I 87 %V 87 %P 755-9 %8 1997 May %G eng %N 5 %L pubs_1997_Schoenbaum_MAJPH.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/9184501?dopt=Abstract %4 Actuarial Analysis/Cognition/Female/Health Surveys/Life Tables/Longevity/Middle Age/Retirement/Sex Factors/Smoking/Mortality/Support, Non U.S. Government/Support, U.S. Government--PHS/Survival Analysis %$ 4160 %R 10.2105/ajph.87.5.755