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OBJECTIVES: This study compared the United States and China in examining the predictors of community-based residential relocation and its associated mortality risk. METHODS: Data from the 2010 to 2018 US Health and Retirement Study and from 2011 to 2018 China Health and Retirement Longitudinal Study were used (NUS = 20,292 and NChina = 11,694). Community-dwelling respondents (aged 50+) reported whether they had relocated and were followed up until 2018. Log-binomial regression and Cox survival analysis were used. RESULTS: In both countries, younger age, higher education, urban residence, and being a renter were associated with higher likelihood of relocation. Community-based relocation was associated with a lower mortality risk (US: HR = 0.63, 95% CI = 0.57, 0.70; China: HR = 0.40, 95% CI = 0.31, 0.50), and this association was significantly stronger in China compared to the United States. DISCUSSION: Common predictors of community-based relocation were found in the United States and China. The relocation-related survival advantages may be attributed to a better post-move adaptation and living environment.
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ABSTRACT: Using cross-sectional data from the United States, England, China, and India, we examined the relationship between education and frequent pain, alongside the modification role of gender in this relationship. We further examined patterns of 3 pain dimensions among participants who reported frequent pain, including pain severity, interference with daily activities, and medication use (these pain dimension questions were not administered in all countries). Our analytical sample included 92,204 participants aged 50 years and above. We found a high prevalence of frequent pain across the 4 countries ranging from 28% to 41%. Probit models showed that higher education was associated with lower risk of pain (United States: -0.26, 95% CI: -0.33, -0.19; England: -0.32, 95% CI: -0.39, -0.25; China: -0.33, 95% CI -0.41, -0.26; India: -0.18, 95% CI -0.21, -0.15). Notably, in China and India, the negative association between higher education and frequent pain was less pronounced among women compared with men, which was not observed in the United States or England. Further analysis showed that individuals with higher education experiencing frequent pain reported less severity, fewer daily activity interferences, and less medication use compared with those with lower education. In the United States, these associations were stronger among women. Our findings highlight the prevalent pain among middle-aged and older adults in these 4 countries and emphasize the potentially protective role of higher education on frequent pain, with nuanced gender differences across different settings. This underscores the need for tailored strategies considering educational and gender differences to improve pain management and awareness.
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BACKGROUND AND OBJECTIVES: The nature of associations between depressive symptoms and cognition early in the life course remains unclear, and racial differences in these associations are not well characterized. The aim of this study was to examine the relationship between trajectories of depressive symptom over 20 years, beginning in young adulthood, and cognitive functions in middle-age among Black and White adults. METHODS: We used prospective data from participants of the Coronary Artery Risk Development in Young Adults Study. Depressive symptoms were measured at 5 study visits between 1990 and 2010 using the Center for Epidemiologic Studies Depression scale. We used latent class group-based modeling to identify 4 trajectories: "persistently low," "persistently medium," "medium decreasing," and "high increasing" depressive symptoms. In 2015, cognitive function was measured using the Digit Symbol Substitution Test (DSST), Stroop test (reverse coded), and Rey Auditory-Verbal Learning Test (RAVLT).We excluded participants who missed the cognitive battery or had no depressive symptoms measurements, resulting in a total of 3,117 participants. All cognitive tests were standardized, and linear regression was used to relate depressive trajectories with 2015 cognitive functions. RESULTS: The mean [SD] baseline age was 30.1 [3.6] years, and 57% were female. The associations between depressive symptoms and cognition significantly differed by race (p < 0.05). Among Black individuals, compared with having "persistently low," having "medium decreasing," "persistently medium," or "high increasing" depressive symptoms were associated with worse verbal memory, processing speed, and executive function scores (RAVLT persistently medium vs low: ß = -0.30, 95% CI -0.48 to -0.12; and high increasing vs low: ß = -0.49, 95% CI -0.70 to -0.27; DSST persistently medium vs low: ß = -0.28, 95% CI -0.47 to -0.09; and high increasing vs low: ß = -0.64, 95% CI -0.87 to -0.42; Stroop persistently medium vs low: ß = -0.46, 95% CI -0.70 to -0.23; and high increasing vs low: ß = -0.76, 95% CI -1.04 to -0.47). Associations were slightly weaker among White individuals, but we still found that having 'high increasing' depressive symptoms was associated with worse verbal memory and processing speed scores (high increasing vs low: ß = -0.38, 95% CI -0.61 to -0.15; and ß = -0.40, 95% CI -0.63 to -0.18, respectively). DISCUSSION: Prolonged exposure to elevated depressive symptoms beginning in young adulthood may result in worse cognitive function over midlife. This association was stronger among Black adults.
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Depressão , Humanos , Feminino , Masculino , Depressão/epidemiologia , Adulto , População Branca , Pessoa de Meia-Idade , Cognição/fisiologia , Testes Neuropsicológicos , Estudos Prospectivos , Negro ou Afro-Americano , Adulto Jovem , Estudos Longitudinais , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/epidemiologiaRESUMO
Background and Objectives: Cultural differences in intergenerational relationships have been well established in prior research. However, cross-national comparison evidence on the parent-child relationship and its health implications remains limited. Research Design and Methods: Data from the 2014 U.S. Health and Retirement Study and the 2015 Health and Retirement Longitudinal Study in China were used (N US, non-Hispanic Whites onlyâ =â 3,918; N China = 4,058). Relationship indicators included coresidence, living nearby, having weekly contact, receiving assistance with daily activities, providing grandchild care, and financial transfer to/from children. Latent class and regression analyses were conducted. Results: Four classes were identified for non-Hispanic White older Americans: (1) distant and uninvolved (6.58%), (2) geographically proximate with frequent contact and downward support (47.04%), (3) coresident with frequent contact and upward support (13.1%), and (4) geographically proximate with frequent contact (33.28%). Three classes were identified among older Chinese: (1) coresident with frequent contact and upward support (37.46%), (2) coresident/interdependent (25.65%), and (3) geographically proximate with frequent contact and upward financial support (36.89%). For non-Hispanic White older Americans, providing downward support was associated with fewer functional limitations and better cognition. Receiving instrumental support from children was associated with more depressive symptoms, more functional limitations, and poorer cognition among older Chinese. Discussion and Implications: Cultural contrasts were evident in parent-child relationship typologies and their health implications. Compared to the U.S. non-Hispanic Whites, parent-child relationships in China tended to be closer and associated with poorer health status. The findings call for culturally relevant strategies to improve parent-child relationships and ultimately promote the health of older adults.
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This study investigates the interdependence of dietary knowledge and preference and potential rural-urban differences among middle-aged and older Chinese couples. Couple-level data from the 2015 China Health and Nutrition Survey were included (N = 2933). Structural Equation Model examined the actor and partner effects of dietary knowledge on dietary preferences. Findings indicated that greater dietary knowledge was associated with one's healthier diet preferences among both rural and urban residents (P < .01). In rural areas, ones' dietary knowledge was associated with their partners' dietary preferences (P < .01). However, in urban areas, husbands' dietary knowledge was not associated with their wives' dietary preferences (P = .58), whereas wives' dietary knowledge was associated with their husbands' dietary preferences (P < .05). The rural-urban difference indicates the greater decision-making power of men in rural households. A couple-based approach is suggested for dietary interventions and guidelines promoting healthy eating in China, particularly in rural regions.
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Preferências Alimentares , Conhecimentos, Atitudes e Prática em Saúde , População Rural , Cônjuges , População Urbana , Humanos , China , Masculino , Feminino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Cônjuges/psicologia , Cônjuges/estatística & dados numéricos , Idoso , População Urbana/estatística & dados numéricos , Preferências Alimentares/psicologia , Inquéritos Nutricionais , Dieta/estatística & dados numéricos , Dieta/psicologia , População do Leste AsiáticoRESUMO
Polysocial risk scores were recently proposed as a strategy to improve clinical relevance of knowledge about social determinants of health. The objective of this paper was to assess if the polysocial risk score model improves prediction of cognition and all-cause mortality in middle-aged and older adults beyond simpler models including a smaller set of key social determinants of health. We used a sample of 13,773 individuals aged 50+ at baseline from the 2006 to 2018 waves of the Health and Retirement Study, a US population-based longitudinal cohort. Four linear mixed models were compared: two simple models including a priori selected covariates and two polysocial risk score models which used LASSO regularization to select covariates among 9 or 21 candidate social predictors. All models included age. Predictive accuracy was assessed via R-squared and root mean-squared prediction error (RMSPE) using training/test split and cross-validation. For predicting cognition, the simple model including age, race, gender, and education had an R-squared of 0.31 and an RMSPE of 0.880. Compared with this, the most complex polysocial risk score selected 12 predictors (R-squared=0.35 and RMSPE=0.858; 2.2% improvement). For all-cause mortality, the simple model including age, race, gender, and education had an AUROC of 0.747, while the most complex polysocial risk score did not demonstrate improved performance (AUROC = 0.745). Models built on a smaller set of key social determinants performed comparably to models built on a more complex set of social "risk factors".
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The study compared care source typologies for older adults in China and the United States. Data from the 2014 U.S. Health and Retirement Study and the 2013 China Health and Retirement Longitudinal Study were used. The respondents included community-dwelling older adults aged 65 years or older with at least one limitation in activities of daily living (ADLs) or instrumental ADLs (IADLs) (NChina = 2476, NUS = 2898). Respondents reported whether they received assistance from spouse, child/grandchild, relatives, others, and formal helpers. Latent class analysis and multinomial logistic regression were applied. Four classes were identified in China and the U.S, separately. In both countries, ADLs and IADLs were strong determinants of care source typologies. Care sources were more diverse and included formal assistance among older Americans. Older Chinese relied largely on their spouses and children/grandchildren for support. Policy efforts are needed to expand formal long-term services and supports, particularly in China.
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Atividades Cotidianas , Cuidadores , Humanos , Idoso , Feminino , Masculino , Estados Unidos , China , Estudos Longitudinais , Idoso de 80 Anos ou mais , Vida Independente , Modelos Logísticos , Análise de Classes LatentesRESUMO
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 (N = 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.
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Etnicidade , Aposentadoria , Idoso , Feminino , Humanos , Masculino , Atividades Cotidianas , Hispânico ou Latino , Grupos Minoritários , Estados Unidos , Brancos , Negro ou Afro-AmericanoRESUMO
OBJECTIVES: 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 the 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: A total of 4 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 (ß = 0.588, 95% CI: 0.209, 0.967) and her husband's more depressive symptoms (ß = 0.326, 95% CI: 0.004, 0.648). Meanwhile, depressive symptoms had strong and significant actor effects on disability (ß = 0.046, 95% CI: = 0.036, 0.057 for wives; ß = 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.
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Depressão , Casamento , Feminino , Humanos , Depressão/epidemiologia , Estudos Prospectivos , Cônjuges , AposentadoriaRESUMO
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 (n = 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 (ßcaregiver = 0.018, 95% CI = -0.089, 0.124) and reported a similar yearly change rate (ßcaregiver×time = -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.
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Cuidadores , Distúrbios do Início e da Manutenção do Sono , Humanos , Idoso , Atividades Cotidianas , Cônjuges , AposentadoriaRESUMO
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.
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Heterossexualidade , Hipertensão , Pessoa de Meia-Idade , Humanos , Estados Unidos/epidemiologia , Idoso , Estudos Longitudinais , Estudos Transversais , Envelhecimento , Cônjuges , Hipertensão/diagnóstico , Hipertensão/epidemiologiaRESUMO
OBJECTIVES: We sought to identify trajectories of patient-reported outcomes, specifically physical well-being of the chest (PWBC), in patients who underwent postmastectomy breast reconstruction, and further assessed its significant predictors, and its relationship with health-related quality of life (HRQOL). METHODS: We used data collected as part of the Mastectomy Reconstruction Outcomes Consortium study within a 2-year follow-up in 2012-2017, with 1422, 1218,1199, and 1417 repeated measures at assessment timepoints of 0,3,12, and 24 months, respectively. We performed latent class growth analysis (LCGA) in the implant group (IMPG) and autologous group (AUTOG) to identify longitudinal change trajectories, and then assessed its significant predictors, and its relationship with HRQOL by conducting multinomial logistic regression. RESULTS: Of the included 1424 patients, 843 were in IMPG, and 581 were in AUTOG. Both groups experienced reduced PWBC at follow-up. LCGA identified four distinct PWBC trajectories (χ2 = 1019.91, p<0.001): low vs medium high vs medium low vs high baseline PWBC that was restored vs. not-restored after 2 years. In 76.63%(n = 646) of patients in IMPG and 62.99% (n = 366) in AUTOG, PWBC was restored after two years. Patients in IMPG exhibited worse PWBC at 3 months post-surgery than that in AUTOG. Patients with low baseline PWBC that did not improve at 2-year follow up (n = 28, 4.82% for AUTOG) were characterized by radiation following reconstruction and non-white ethnicity. In IMPG, patients with medium low-restored trajectory were more likely to experience improved breast satisfaction, while patients developing high-restored trajectories were less likely to have worsened psychosocial well-being. CONCLUSION: Although more women in IMPG experienced restored PWBC after 2 years, those in AUTOG exhibited a more favorable postoperative trajectory of change in PWBC. This finding can inform clinical treatment decisions, help manage patient expectations for recovery, and develop rehabilitation interventions contributing to enhancing the postoperative quality of life for breast cancer patients.
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Neoplasias da Mama , Mamoplastia , Humanos , Feminino , Mastectomia/psicologia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/psicologia , Qualidade de Vida , Satisfação do Paciente , Estudos ProspectivosRESUMO
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 12â¯609 respondents (mean [SD] age, 67.7 [11.0] years, 8146 [64.60%] women, 10â¯277 [81.51%] non-Hispanic White), including 11â¯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 (ß 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 (ß 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.
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Abastecimento de Alimentos , Aposentadoria , Humanos , Adulto , Feminino , Pessoa de Meia-Idade , Idoso , Masculino , Estudos de Coortes , Estudos Transversais , Insegurança Alimentar , Transtornos da MemóriaRESUMO
Climate warming leads to frequent extreme precipitation events, which is a prominent manifestation of the variation of the global water cycle. In this study, data from 1842 meteorological stations in the Huang-Huai-Hai-Yangtze River Basin and 7 climate models of CMIP6 were used to obtain the historical and future precipitation data using the Anusplin interpolation, BMA method, and a non-stationary deviation correction technique. The temporal and spatial variations of extreme precipitation in the four basins were analysed from 1960 to 2100. The correlation between extreme precipitation indices and their relationship with geographical factors was also analysed. The result of the study indicates that: (1) in the historical period, CDD and R99pTOT showed an upward trend, with growth rates of 14.14% and 4.78%, respectively. PRCPTOT showed a downward trend, with a decreasing rate of 9.72%. Other indices showed minimal change. (2) Based on SSP1-2.6, the intensity, frequency, and duration of extreme precipitation changed by approximately 5% at SSP3-7.0 and 10% at SSP5-8.5. The sensitivity to climate change was found to be highest in spring and autumn. The drought risk decreased, while the flood risk increased in spring. The drought risk increased in autumn and winter, and the flood risk increased in the alpine climate area of the plateau in summer. (3) Extreme precipitation index is significantly correlated with PRCPTOT in the future period. Different atmospheric circulation factors significantly affected different extreme precipitation indices of FMB. (4) CDD, CWD, R95pD, R99pD, and PRCPTOT are affected by latitude. On the other hand, RX1day and RX5day are affected by longitude. The extreme precipitation index is significantly correlated with geographical factors, and areas above 3000 m above sea level are more sensitive to climate change.
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Mudança Climática , Secas , Estações do Ano , Inundações , ChinaRESUMO
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 10â¯000 person-years, those with intermittent low wages, 208 deaths per 10â¯000 person-years, and those with sustained low wages, 275 deaths per 10â¯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.
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Renda , Salários e Benefícios , Pessoa de Meia-Idade , Humanos , Feminino , Masculino , Estudos Longitudinais , Emprego , PobrezaRESUMO
PURPOSE: This study aimed to investigate the association of change in food insecurity over time with cognitive function in midlife, and whether depressive symptoms mediated that relationship. METHODS: We used longitudinal data from the Coronary Artery Risk Development in Young Adults study. Change in food insecurity in 2000-2005 was coded as "persistently food-secure," "persistently food-insecure," "became food-insecure," and "became food-secure." Depressive symptoms were measured in 2010, and cognitive function was measured in 2015. Multivariable linear regression controlled for sociodemographic and cardiovascular health factors was used. We also conducted causal mediation analysis. RESULTS: Our study population included 2448 participants (57.23% female and 43.18% Black, mean age = 40.31 in 2000). Compared with persistent food security, persistently and became food-insecure were associated with worse cognition, particularly with processing speed (ßpersistent = -0.20 standard unit, 95% CI = -0.36, -0.04; ßbecame = -0.17, 95% CI = -0.31, -0.03), and these associations appeared mediated by depressive symptoms (proportion-mediated = 14% for persistently food-insecure and 18% for became food-insecure). CONCLUSIONS: Persistent and transition to food insecurity were associated with worse cognition, both directly and indirectly through increasing depressive symptoms. Targeting food insecurity or depressive symptoms among persistently or became food-insecure individuals may have the potential to slow premature cognitive aging.
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Cognição , Depressão , Insegurança Alimentar , Adulto , Feminino , Humanos , Masculino , Adulto Jovem , Depressão/epidemiologia , Depressão/psicologia , Abastecimento de Alimentos , Análise de MediaçãoRESUMO
Objectives: Studies on the interdependence of couples' health behaviors and subsequent cognitive outcomes remain limited. Methods: Longitudinal data from the China Health and Retirement Longitudinal Study (2011-2018) were used (N = 1869 heterosexual couples). Latent class analysis identified the dyadic pattern of health behaviors in 2011 (i.e., alcohol consumption, smoking, and physical inactivity). Stratified Cox models examined the association of latent classes with risk of developing memory-related disorders in 2013-2018. Results: Three classes were identified: class 1 (21.25%, only husband smoke, and both active), class 2 (47.55%, both inactive, neither drink nor smoke), and class 3 (31.20%, both drink and smoke, and both active). Couples' sedentary lifestyle was associated with an increased risk of memory-related disorders among both husbands and wives. Conclusion: Couples were moderately concordant in their physical activity but weakly in smoking and drinking. Couple-based interventions, especially promoting physical activity, may reduce cognitive aging among middle-aged and older Chinese couples.
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População do Leste Asiático , Comportamentos Relacionados com a Saúde , Transtornos da Memória , Cônjuges , Idoso , Humanos , Pessoa de Meia-Idade , População do Leste Asiático/estatística & dados numéricos , Comportamentos Relacionados com a Saúde/etnologia , Estudos Longitudinais , Cônjuges/etnologia , Cônjuges/psicologia , Cônjuges/estatística & dados numéricos , Transtornos da Memória/epidemiologia , Transtornos da Memória/etnologia , Transtornos da Memória/psicologia , RiscoRESUMO
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 employmentâpoverty 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 (NBlack=555, NWhite=2,209) were included. Sequence analysis grouped respondents with similar employmentâpoverty 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 employmentâpoverty 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 (ß= -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 (ß= -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.
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Negro ou Afro-Americano , Pobreza , Idoso , Humanos , Pessoa de Meia-Idade , Emprego , Fatores Raciais , BrancosRESUMO
OBJECTIVES: This study examines how nativity, dementia classification, and age of migration (AOM) of older foreign-born (FB) adults are associated with caregiver psychological well-being and care burden. METHODS: We used linked data from Round 1 and Round 5 of the National Health and Aging Trends Study and Round 5 of the National Study of Caregiving for a sample of nondementia caregivers (n = 941), dementia caregivers (n = 533), and matched care recipients. Ordinary least squares regression models were estimated, adjusting for caregiver characteristics. RESULTS: Relative to nondementia caregivers, dementia caregivers were more likely to provide care for an older FB adult (8.69% vs. 26.70%), reported more assistance with caregiving activities, worse quality of relationship with care recipients, and higher care burden than nondementia caregivers. In adjusted models, interactions of nativity status × dementia and AOM × dementia revealed that overall, caregivers of older FB adults with dementia who migrated in late life (50+) reported lower psychological well-being than those caring for older FB older adults who migrated at (20-49 years) and (0-19 years). Moderating effects of AOM on the link between dementia caregiving and care burden were not observed. DISCUSSION: Age of migration of older FB adults with probable dementia may have unique effects on the caregiver's psychological well-being. Our results underscore the importance of considering sociocultural factors of FB adults beyond nativity and the need for research to develop culturally appropriate interventions to enhance psychological well-being and reduce the care burden among dementia caregivers.
Assuntos
Demência , Humanos , Idoso , Demência/psicologia , Envelhecimento , Cuidadores/psicologia , Sobrecarga do Cuidador , Coleta de DadosRESUMO
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 (N = 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 (p > .05), husbands' decreasing trajectory was linked to wives' better memory (ß = 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.