Dementia Attributable Healthcare Utilizations in the Caribbean versus United States.

BACKGROUND: Despite the high burden of Alzheimer's disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region. OBJECTIVE: This study examines healthcare utilization associated with Alzheimer's disease and other dementias among older adults in the Caribbean as compared to the US. METHODS: We conducted harmonized analyses of two population-based surveys, the 10/66 Dementia Group Research data collected in Dominican Republic, Cuba, and Puerto Rico, and the US-based Health and Retirement Study. We examined changes in hospital nights and physician visits in response to incident and ongoing dementias. RESULTS: Incident dementia significantly increased the risk of hospitalization and number of hospital nights in both populations. Ongoing dementia increased the risk of hospitalization and hospital nights in the US, with imprecise estimates for the Caribbean. The number of physician visits was elevated in the US but not in the Caribbean. CONCLUSIONS: The concentration of increased healthcare utilization on hospital care and among patients with incident dementia suggests an opportunity for improved outpatient management of new and existing dementia patients in the Caribbean.

Apolipoprotein E (APOE) genotype, dementia, and memory performance among Caribbean Hispanic versus US populations.

INTRODUCTION: Apolipoprotein E (APOE) is considered the major susceptibility gene for developing Alzheimer's disease. However, the strength of this risk factor is not well established across diverse Hispanic populations. METHODS: We investigated the associations among APOE genotype, dementia prevalence, and memory performance (immediate and delayed recall scores) in Caribbean Hispanics (CH), African Americans (AA), Hispanic Americans (HA) and non-Hispanic White Americans (NHW). Multivariable logistic regressions and negative binomial regressions were used to examine these associations by subsample. RESULTS: Our final dataset included 13,516 participants (5198 men, 8318 women) across all subsamples, with a mean age of 74.8 years. Prevalence of APOE ε4 allele was similar in CHs, HAs, and NHWs (21.8%-25.4%), but was substantially higher in AAs (33.6%; P < 0.001). APOE ε4 carriers had higher dementia prevalence across all groups. DISCUSSION: APOE ε4 was similarly associated with increased relative risk of dementia and lower memory performance in all subsamples.

Color disparities in cognitive aging among Puerto Ricans on the archipelago.

This research seeks to contribute new understanding of color disparities and gender in cognitive aging among older adults residing in Puerto Rico. We use the island-representative Puerto Rican Elderly Health Conditions (PREHCO) longitudinal study that measures cognitive health at baseline and cognitive decline between waves. In pooled models, we discern little or no color disparities in cognition at baseline. Sex-stratified models of baseline cognition indicate that Trigueño men slightly outperform white men. In contrast, color disparities in cognitive decline are apparent. In just four years between the two waves of PREHCO, on a 20-point cognitive test scale, Black men experienced 0.78 more points of cognitive decline, while Trigueño men experienced 0.44 more points of cognitive decline than white men in Puerto Rico. Mestiza women experience 0.80 less points of cognitive decline relative to white women. Nearly all of the color/race association with cognitive decline appears to be independent from health behaviors and conditions, individual human capital attainment, and family background. While lower-status color groups more frequently report discrimination, discrimination does not mediate the impact of color/skin tone and cognitive performance, suggesting the importance of further research on the role of broader dimensions of life course structural racism.

Race/Ethnic Differences, Skin Tone, and Memory Among Older Latinos in the United States.

OBJECTIVES: U.S. Latino populations are diverse. Research on racial identity, skin tone, and Latino health is imperative for understanding and combating racism and colorism. We examined differences in memory performance: among non-Latinos and Latinos who identified as Black, other, and White in the United States and then among Puerto Ricans in Boston whose skin tones ranged from dark, medium, light to "white." METHODS: We used 2010 Health and Retirement Study and 2004 Boston Puerto Rican Health Survey data, respectively, to examine racial and color differences in memory performance among 50 and older adults in the United States and Puerto Rican older adults in Boston. We applied ordinary least squares regression to immediate and delayed word recall test scores and adjusted for education, health conditions, and health behaviors. RESULTS: In adjusted models, White non-Latinos had better memory performance than White Latinos. Black Latinos, other Latinos, and Black non-Latinos had lower delayed word recall scores than White Latinos. Black Latinos and Black non-Latinos had similar scores. Intra-Latino racial disparities endured despite the inclusion of education and other covariates. Among Puerto Ricans in Boston, medium-toned individuals had higher scores than "white"-toned individuals. DISCUSSION: Findings support the importance of examining self-identified race and skin tone in Latino aging research. Further investigation is needed to understand the stubborn intra-Latino racial disparities in memory performance and surprising adverse cognitive performance among "white"-toned relative to darker-toned Puerto Ricans in Boston.

Associations between education and dementia in the Caribbean and the United States: An international comparison.

INTRODUCTION: Despite high dementia prevalence in Hispanic populations globally, especially Caribbean Hispanics, no study has comparatively examined the association between education and dementia among Hispanics living in the Caribbean Islands and older adults in the United States. METHODS: We used data on 6107 respondents aged 65 and older in the baseline wave of the population-based and harmonized 10/66 survey from Cuba, the Dominican Republic, and Puerto Rico, collected between 2003 and 2008, and 11,032 respondents aged 65 and older from the U.S.-based Health and Retirement Study data in 2014, a total of 17,139 individuals. We estimated multivariable logistic regression models examining the association between education and dementia, adjusted for age, income, assets, and occupation. The models were estimated separately for the Caribbean population (pooled and by setting) and the U.S. population by race/ethnicity (Hispanic, Black, and White), followed by pooled models across all populations. RESULTS: In the Caribbean population, the relative risk of dementia among low versus high educated adults was 1.45 for women (95% confidence interval [CI] 1.17, 1.74) and 1.92 (95% CI 1.35, 2.49) for men, smaller compared to those in the United States, especially among non-Hispanic Whites (women: 2.78, 95% CI 1.94, 3.61; men: 5.98, 95% CI 4.02, 7.95). DISCUSSION: The differential associations between education and dementia across the Caribbean and US settings may be explained by greater disparities in social conditions in the United States compared to the Caribbean, such as access to health care, healthy behaviors, and social stressors, which serve as potentially important mediators.

Prospects for the Comparative Study of International Migration using quasi-longitudinal micro-data.

BACKGROUND: Longitudinal micro-level data about international migration behavior are notoriously difficult to collect, but data collection efforts have become more frequent in recent years. Comparative research of the patterns and processes of international migration, however, remains quite rare, especially that which compares across regions. OBJECTIVE: We highlight the promises and difficulties of comparative international migration research, by offering a detailed comparison of two prominent data collection efforts. METHODS: We systematically review existing sources of longitudinal and quasi-longitudinal individual-level and household-level data of international migration. We then compare two widely-used data sources: the Mexican Migration Project (MMP) and the Migration between Africa and Europe project (MAFE). RESULTS: Data collection efforts are increasingly diverse, yet public accessibility of data remains limited. Also, comparability of data collected across settings can be complicated. In our MMP-MAFE analysis, we show some ways in which comparability can be achieved. CONCLUSIONS: A primary roadblock to international comparative research is that, with some exceptions, the public accessibility of data remains low. Even when data is public and surveys are modeled after one another, comparability is not easy due to necessary trade-offs in adapting surveys to local settings and to developments in the field. CONTRIBUTION: We demonstrate that, despite great strides in collecting quasi-longitudinal data of international migration, data accessibility still hinders the study of migration. With regards to comparability, our article provides important lessons for future data collection and analysis efforts that could improve comparability and thus advance understanding of the complex dynamics of international migration.

Migrant networks and international migration: testing weak ties.

This article examines the role of migrant social networks in international migration and extends prior research by testing the strength of tie theory, decomposing networks by sources and resources, and disentangling network effects from complementary explanations. Nearly all previous empirical research has ignored friendship ties and has largely neglected extended-family ties. Using longitudinal data from the Migration between Africa and Europe project collected in Africa (Senegal) and Europe (France, Italy, and Spain), this article tests the robustness of network theory-and in particular, the role of weak ties-on first-time migration between Senegal and Europe. Discrete-time hazard model results confirm that weak ties are important and that network influences appear to be gendered, but they do not uphold the contention in previous literature that strong ties are more important than weak ties for male and female migration. Indeed, weak ties play an especially important role in male migration. In terms of network resources, having more resources as a result of strong ties appears to dampen overall migration, while having more resources as a result of weaker ties appears to stimulate male migration. Finally, the diversity of resources has varied effects for male and female migration.