Effect of Low-Fat Dietary Modification on Incident Open-Angle Glaucoma.

PURPOSE: We tested whether dietary modification (DM) altered the risk for incident primary open-angle glaucoma (POAG). DESIGN: Secondary analysis of a randomized intervention trial. PARTICIPANTS: We linked Medicare claims data to 45 203 women in the Women's Health Initiative Dietary Modification Trial, of which 23 776 participants were enrolled in fee-for-service Medicare Part B and had physician claims. METHODS: Women were randomized to follow either DM (a low-fat diet, with increased vegetable, fruit, and grain intake) or their usual diet without modification. Nine thousand three hundred forty women were randomized to the DM intervention, whereas 13 877 women were randomized to the control group. Our analyses were based on an intention-to-treat design, with a follow-up to the end of continuous Medicare coverage, death, or the last claims date (12/31/2018), whichever occurred first. Primary open-angle glaucoma was defined as the first claim with the International Classification of Diseases, Ninth or Tenth Revision, codes. Dietary data were assessed using a food frequency questionnaire. MAIN OUTCOME MEASURES: We used Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of POAG. Subgroup analyses were performed with P values for interaction. RESULTS: After exclusion of women with Medicare-derived glaucoma before randomization, the final analysis included 23 217 women (mean age, 64.4 ± 5.8 years). Baseline characteristics were balanced between the intervention and control groups. Primary open-angle glaucoma incidence was 11.1 per 1000 woman-years (mean follow-up, 11.6 ± 7.4 years; mean DM duration, 5.2 ± 3.2 years). We found no overall benefit of DM in reducing incident POAG (HR, 1.04; 95% CI, 0.96-1.12). Race and participant age did not modify this relation (P = 0.08 and P = 0.24 for interaction, respectively). In further analysis of baseline nutrient and food intake stratified by quartile groups, risk of open-angle glaucoma (OAG) in DM participants in the lowest quartile group for percentage calories (kilocalories) from total fat (33.8 or lower) was increased (HR, 1.22; 95% CI, 1.05-1.41; P = 0.007 for interaction). CONCLUSIONS: Analysis suggests that DM in participants in the lowest quartile group for percentage calories from total fat at baseline increased the risk of incident OAG among women regardless of age or race. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Allostatic Load, Unhealthy Behaviors, and Depressive Symptoms by Birthplace Among Older Adults in the Sacramento Area Latino Study on Aging (SALSA).

Objective: To assess whether unhealthy behaviors moderated the relationship between allostatic load (AL) and future significant depressive symptoms (SDSs) among 1,789 older Latinos. Method: Longitudinal data included baseline AL, three unhealthy behaviors (UBs), and 2-year follow-up SDS. Multivariable logistic regression analyses, stratified by birthplace (U.S. vs. foreign born), modeled the effects of AL, UB count (range = 0-3), and their interaction on follow-up SDS. Results: Compared with U.S.-born, foreign-born participants engaged in fewer UBs (0.52 vs. 0.60 behaviors, p = .01) and had higher baseline SDS (31% vs. 20%, p < .001). Among foreign-born participants, the effect of AL on future SDS (adjusted odds ratios [aORs]; 95% confidence interval [CI]) significantly increased across UB counts of 0 to 3: 1.06 [0.83, 1.35], 1.46 [1.14, 1.87], 2.00 [1.18, 3.41], and 2.75 [1.18, 6.44], respectively. Discussion: Among foreign-born Latinos, these results were most pronounced for women and adults above age 80, which may represent higher risk groups requiring more intensive screening for depression.

Perceived discrimination and depressive symptoms among US Latinos: the modifying role of educational attainment.

OBJECTIVE: Despite growing evidence that discrimination may contribute to poor mental health, few studies have assessed this association among US Latinos. Furthermore, the interaction between discrimination and educational attainment in shaping Latino mental health is virtually unexplored. This study aims to examine the association between perceived discrimination and depressive symptoms and the modifying role of education among a population of Mexican-origin adults. DESIGN: We utilized population-based data from 629 Mexican-origin adults (mean age = 52.8 years) participating the Niños Lifestyle and Diabetes Study (2013-2014). Perceived discrimination was defined as responding 'sometimes' or 'often' to at least one item on the 9-item Everyday Discrimination Scale. High depressive symptoms were defined as scoring ≥10 on the CESD-10. We used log-binomial and linear-binomial models to estimate prevalence ratios (PR) and prevalence differences (PD), respectively, of high depressive symptoms for levels of perceived discrimination. Final models were adjusted for age, sex, education, cultural orientation, and nativity. General estimating equations were employed to account for within-family clustering. RESULTS: Prevalence of perceived discrimination and high depressive symptoms were 49.5% and 29.2%, respectively. Participants experiencing discrimination had higher depressive symptom prevalence than those never or rarely experiencing discrimination [PR = 1.94, 95% confidence interval (CI): 1.46-2.58; PD = 0.19, 95% CI: 0.12-0.27]. The strength of this association varied by education level. The association between discrimination and depressive symptoms was stronger among those with >12 years of education (PR = 2.69; PD = 0.24) compared to those with ≤12 years of education (PR = 1.36; PD = 0.09). CONCLUSION: US Latinos suffer a high burden of depressive symptoms, and discrimination may be an important driver of this burden. Our results suggest that effortful coping strategies, such as achieving high education despite high perceived discrimination, may magnify discrimination's adverse effect on Latino mental health.

Progress and future challenges in aging and diversity research in the United States.

In 2016, the UC Davis Latino Aging Research Resource Center and UC Davis Alzheimer's Disease Center brought together experts from across the country to consolidate current knowledge and identify future directions in aging and diversity research. This report disseminates the research priorities that emerged from this conference, building on an earlier Gerontological Society of America preconference. We review key racial/ethnic differences in cognitive aging and dementia and identify current knowledge gaps in the field. We advocate for a systems-level framework for future research whereby environmental, sociocultural, behavioral, neuropathological, genetic, and psychometric levels of analysis are examined together to identify pathways and mechanisms that influence disparities. We then discuss steps to increase the recruitment and retention of racial/ethnic minorities in aging studies, as none of the recommendations will be possible without strong collaboration between racial/ethnic minority communities and researchers. This approach is consistent with the National Institute on Aging Health Disparities Research Framework.

Neighborhood language isolation and depressive symptoms among elderly U.S. Latinos.

PURPOSE: Neighborhood segregation related to cultural factors, such as language use, may influence elderly Latino depression. We examined the association between neighborhood-level Spanish language segregation and individual depressive symptoms among elderly Latinos. METHODS: We linked U.S. Census language use data with geocoded population-based data from 1789 elderly Latinos (mean age = 70.6 years) participating in the Sacramento Area Latino Study on Aging (1998-2008). Neighborhood language segregation was measured with the Index of Concentration at the Extremes, which demonstrates the extent to which residents are concentrated at extremes of deprivation and privilege. We fit two-level generalized linear-mixed models with random intercepts for census tracts to quantify the association between neighborhood-level language segregation and depressive symptoms, adjusting for identified confounders. RESULTS: After adjusting for age, sex, and nativity, residents of highly segregated Spanish-speaking neighborhoods had more depressive symptoms than those in highly segregated English-only-speaking neighborhoods (ß = -4.410; 95% confidence interval [CI] = -6.851 to -1.970). This association was largely attenuated upon adjustment for individual-level education (ß = -2.119; 95% CI = -4.650 to 0.413). CONCLUSIONS: Linguistically segregated communities may benefit from targeted outreach given the high depression prevalence in these neighborhoods. Furthermore, our findings suggest that limited access to fundamental social protections, such as education, may drive the segregation-depression association among U.S. Latinos.

Racial Differences in the Effects of Hormone Therapy on Incident Open-Angle Glaucoma in a Randomized Trial.

PURPOSE: We conducted a secondary analysis of a randomized, placebo-controlled trial to test if hormone therapy (HT) altered the risk of open-angle glaucoma (OAG), and if the risk reduction varied by race. DESIGN: Secondary analysis of randomized controlled trial data. METHODS: We linked Medicare claims data to 25 535 women in the Women's Health Initiative. Women without a uterus were randomized to receive either oral conjugated equine estrogens (CEE 0.625 mg/day) or placebo, and women with a uterus received oral CEE and medroxyprogesterone acetate (CEE 0.625 mg/day + MPA 2.5 mg/day) or placebo. We used Cox proportional hazards models to calculate hazard ratios (HR) and 95% confidence interval. RESULTS: After exclusion of women with prevalent glaucoma or without claims for eye care provider visits, the final analysis included 8102 women (mean age = 68.5 ± 4.8 years). The OAG incidence was 7.6% (mean follow-up = 11.5 ± 5.2 years; mean HT duration = 4.4 ± 2.3 years). Increased age (P trend = .01) and African-American race (HR = 2.69, 95% CI = 2.13-3.42; white as a reference) were significant risk factors for incident OAG. We found no overall benefit of HT in reducing incident OAG (HR = 1.01, 95% CI = 0.79-1.29 in the CEE trial, and HR = 1.05, 95% CI = 0.85-1.29 in the CEE + MPA trial). However, race modified the relationship between CEE use and OAG risk (P interaction = .01), and risk was reduced in African-American women treated with CEE (HR = 0.49, 95% CI = 0.27-0.88), compared to placebo. Race did not modify the relation between CEE + MPA use and OAG risk (P interaction = .68). CONCLUSIONS: Analysis suggests that HT containing estrogen, but not a combination of estrogen and progesterone, reduces the risk of incident OAG among African-American women. Further investigation is needed.

Cross-border ties, nativity, and inflammatory markers in a population-based prospective study of Latino adults.

Even after migration, immigrants and their descendants may continue to have ties to family and friends who remain in places of origin. Recent research suggests that these cross-border social ties have implications for health, although this scholarship has been limited to self-reported outcomes. Using data from the Sacramento Area Latino Study on Aging (SALSA), we estimate associations between cross-border social ties and inflammatory biomarkers among Latino adults (n = 1786). We find that immigrants who maintained any cross-border connection to family and friends in Latin America had significantly lower levels of baseline interleukin-6 (IL-6) and C-reactive protein (CRP) compared to their US-born counterparts with no cross-border ties. These results held for values of CRP at five-year follow-up for men only. In contrast, US-born women with cross-border ties to family and friends in Latin America had both significantly higher levels of CRP and significantly lower levels of tumor necrosis factor-alpha (TNF-α) at five-year follow-up relative to their US-born counterparts with no cross-border ties. We find descriptively that men who have cross-border ties are also less likely to be socially isolated within local contexts. Considering place-of-origin social connections may contribute critical nuance to studies of immigrant health, including disparities in inflammatory markers that may serve as indicators of underlying chronic disease.

Educational Mobility Across Generations and Depressive Symptoms Over 10 Years Among US Latinos.

Few studies have collected intergenerational data to assess the association between educational mobility across multiple generations and offspring depression. Using data from the Sacramento Area Latino Study on Aging (1998-2008), we assessed the influence of intergenerational education on depressive symptoms over 10 years among 1,786 Latino individuals (mean age = 70.6 years). Educational mobility was classified as stable-low (low parental/low offspring education), upwardly mobile (low parental/high offspring education), stable-high (high parental/high offspring education), or downwardly mobile (high parental/low offspring education). Depressive symptoms were measured with the Center for Epidemiological Studies-Depression Scale (CES-D); higher scores indicated more depressive symptoms. To quantify the association between educational mobility and CES-D scores over follow-up, we used generalized estimating equations to account for repeated CES-D measurements and adjusted for identified confounders. Within individuals, depressive symptoms remained relatively stable over follow-up. Compared with stable-low education, stable-high education and upward mobility were associated with significantly lower CES-D scores (ß = -2.75 and -2.18, respectively). Downwardly mobile participants had slightly lower CES-D scores than stable-low participants (ß = -0.77). Our results suggest that sustained, low educational attainment across generations may have adverse mental health consequences, and improved educational opportunities in underresourced communities may counteract the adverse influence of low parental education on Latino depression.

Life-Space Assessment Predicts Hospital Readmission in Home-Limited Adults.

OBJECTIVES: To describe the association between restricted life-space and characteristics of community-dwelling adults hospitalized for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), to estimate the effect of hospitalization on postdischarge mobility, and to determine whether baseline restricted life-space predicts hospital readmission. DESIGN: Observational. SETTING: Urban academic hospital that serves as a safety net for urban and rural populations with low resources and serves central and northern Alabama. PARTICIPANTS: Individuals with CHF or COPD hospitalized from home (N = 478). MEASUREMENTS: The Life-Space Assessment (LSA) measures mobility by asking about movement in situations ranging from within one's dwelling to beyond one's town. LSA scores below 60 correspond to "restricted life-space." Baseline LSA scores before admission were measured during an index hospitalization; follow-up LSA scores were determined over the telephone at 90 days. Participant characteristics were examined according to baseline restricted life-space using the chi-square test and Student's t-test. Each characteristic's association with restricted life-space was estimated uisng logistic regression. RESULTS: Of the participants, 372 (77.8%) were classified as having baseline restricted life-space. Baseline restricted life-space was associated with older age (odds ratio (OR) = 1.29 per decade, 95% confidence interval (CI) = 1.17-1.42, P = .001), female sex (OR = 2.69, 95% CI = 1.69-4.29, P < .001), African-American race (OR = 1.55, 95% CI = 1.00-2.41, P = .05), and having inadequate financial resources (OR = 2.03, 95% CI = 1.22-3.38, P = .006). In the baseline unrestricted life-space group, 49.5% (n = 49) had restricted life-space at 90-day follow-up. Baseline restricted life-space was associated with greater odds of 90-day hospital readmission (unadjusted OR = 1.64, 95% CI = 1.00-2.70, P = .05; adjusted OR = 1.72, 95% CI = 1.04-2.85, P = .03). CONCLUSION: Baseline restricted life-space was associated with greater risk of hospital readmission within 90 days after hospital discharge. These findings suggest a need to customize the management of individuals hospitalized with CHF or COPD based on baseline life-space level.

Early life socioeconomic position and immune response to persistent infections among elderly Latinos.

Persistent infections, such as cytomegalovirus (CMV), herpes simplex virus-1 (HSV-1), Helicobacter pylori (H. pylori), and Toxoplasma gondii (T. gondii), are common in the U.S. but their prevalence varies by socioeconomic status. It is unclear if early or later life socioeconomic position (SEP) is a more salient driver of disparities in immune control of these infections. Using data from the Sacramento Area Latino Study on Aging, we examined whether early or later life SEP was the strongest predictor of immune control later in life by contrasting two life course models, the critical period model and the chain of risk model. Early life SEP was measured as a latent variable, derived from parental education and occupation, and food availability. Indicators for SEP in later life included education level and occupation. Individuals were categorized by immune response to each pathogen (seronegative, low, medium and high) with increasing immune response representing poorer immune control. Cumulative immune response was estimated using a latent profile analysis with higher total immune response representing poorer immune control. Structural equation models were used to examine direct, indirect and total effects of early life SEP on each infection and cumulative immune response, controlling for age and gender. The direct effect of early life SEP on immune response was not statistically significant for the infections or cumulative immune response. Higher early life SEP was associated with lower immune response for T. gondii, H. pylori and cumulative immune response through pathways mediated by later life SEP. For CMV, higher early life SEP was both directly associated and partially mediated by later life SEP. No association was found between SEP and HSV-1. Findings from this study support a chain of risk model, whereby early life SEP acts through later life SEP to affect immune response to persistent infections in older age.

Influence of neighbourhood socioeconomic position on the transition to type II diabetes in older Mexican Americans: the Sacramento Area Longitudinal Study on Aging.

OBJECTIVE: To examine the influence of neighbourhood socioeconomic position (NSEP) on development of diabetes over time. DESIGN: A longitudinal cohort study. SETTING: The data reported were from the Sacramento Area Latino Study on Aging, a longitudinal study of the health of 1789 older Latinos. PARTICIPANTS: Community-dwelling older Mexican Americans residing in the Sacramento Metropolitan Statistical Area. MAIN OUTCOME: Multistate Markov regression were used to model transitions through four possible states over time: 1=normal; 2=pre-diabetic; 3=diabetic; and 4=death without diabetes. RESULTS: At baseline, nearly 50% were non-diabetic, 17.5% were pre-diabetic and nearly 33% were diabetic. At the end of follow-up, there were a total of 824 people with type 2 diabetes. In a fully adjusted MSM regression model, among non-diabetics, higher NSEP was not associated with a transition to pre-diabetes. Among non-diabetics, higher NSEP was associated with an increased risk of diabetes (HR=1.66, 95% CI 1.14 to 2.42) and decreased risk of death without diabetes (HR: 0.56, 95% CI 0.33 to 0.96). Among pre-diabetics, higher NSEP was significantly associated with a transition to non-diabetic status (HR: 1.22, 95% CI 0.99 to 1.50). Adjusting for BMI, age, education, physical activity, smoking, alcohol consumption, medical insurance and nativity did not affect this relationship. CONCLUSIONS: Our findings show that high NSEP poses higher risk of progression from normal to diabetes compared with a lower risk of death without diabetes. This work presents a possibility that these associations are modified by nativity or culture.

Intergenerational education mobility and depressive symptoms in a population of Mexican origin.

PURPOSE: Low educational attainment has been associated with depression among Latinos. However, few studies have collected intergenerational data to assess mental health effects of educational mobility across generations. METHODS: Using data from the Niños Lifestyle and Diabetes Study, we assessed the influence of intergenerational education on depressive symptoms among 603 Mexican-origin individuals. Intergenerational educational mobility was classified: stable-low (low parent and/or low offspring education), upwardly mobile (low parent and/or high offspring education), stable-high (high parent and/or high offspring education), or downwardly mobile (high parent and/or low offspring education). High depressive symptoms were defined as scoring ≥10 on the Center for Epidemiological Studies Depression Scale-10 (CESD-10). We examined prevalence ratios (PRs) for depressive symptoms with levels of educational mobility. We used general estimating equations with log-binomial models to account for within-family clustering, adjusting for age, gender, and offspring and parent nativity. RESULTS: Compared with stable-low participants, the lowest prevalence of CESD-10 score ≥10 occurred in upwardly mobile (PR = 0.55; 95% confidence interval [CI] = 0.39-0.78) and stable-high (PR = 0.62; 95% CI = 0.44-0.87) participants. Downwardly mobile participants were also less likely to have a CESD-10 score ≥10 compared with stable-low participants (PR = 0.65; 95% CI = 0.38-1.11), although the estimate was not statistically significant. CONCLUSIONS: Sustained stress from low intergenerational education may adversely affect depression. Latinos with stable-low or downwardly mobile intergenerational educational attainment may need closer monitoring for depressive symptoms.

The Impact of Neighborhood Socioeconomic Position on Prevalence of Diabetes and Prediabetes in Older Latinos: The Sacramento Area Latino Study on Aging.

Diabetes is a leading cause of morbidity and mortality in Latinos, but few studies of disease risk in this subpopulation examine both area-level socioeconomic position (SEP) and its association with individual-level risk factors. This study sought to examine the cross-sectional relationship between neighborhood socioeconomic position (NSEP) and prevalent diabetes and prediabetes status among older Latinos. Longitudinal health data were collected from 1,789 participants in the Sacramento Area Latino Study on Aging (SALSA). Among SALSA participants, higher NSEP was associated with lower diabetes prevalence (p = .001). Adjustment for body mass index and other individual-level factors did not affect this relationship. No association was observed between NSEP and prediabetes in both unadjusted and adjusted models. Neighborhoods with higher SEP had a lower prevalence of diabetes. This study highlights the importance of considering neighborhood factors that may place older Latinos at high risk for this disease.

Las generaciones de inmigrantes y sus descendientes y el riesgo de diabetes en la población de los Estados Unidos de origen o ascendencia mexicana: el Estudio sobre Envejecimiento en Latinos del Área de Sacramento (estudio SALSA) / Immigrant generation and diabetes risk among Mexican Americans: the Sacramento Area Latino Study on Aging

OBJETIVO: Se investigó si la aculturación de los inmigrantes y sus descendientes y la generación a la que pertenecen, un marcador de la asimilación, se relacionan con el riesgo de diabetes en una población de adultos mayores de ascendencia u origen mexicano. MÉTODOS: Se analizaron los datos sobre 1 789 adultos de 60 a 101 años de edad del Estudio sobre Envejecimiento en Latinos del Área de Sacramento (estudio SALSA). Se determinó la presencia de diabetes tipo 2 con base en el uso de medicamentos antidiabéticos, la mención por el paciente del diagnóstico de un médico, o una glucosa en ayunas de 126 mg/dl o mayor. Se aplicó un modelo de regresión logística para la prevalencia de diabetes. RESULTADOS: Tras ajustar por edad y sexo, se observaron asociaciones significativas pero divergentes entre las generaciones de inmigrantes y sus descendientes, la aculturación y el riesgo de diabetes. En relación con los adultos de la primera generación, los de la segunda tuvieron una razón de posibilidades (odds ratio, OR) de padecer diabetes de 1,8 (intervalo de confianza [IC] de 95% = 1,4, 2,4) y los adultos de la tercera generación tuvieron una OR de 2,1 (IC de 95% = 1,4, 3,1). Sin embargo, una mayor aculturación a los Estados Unidos se relacionó con una tasa ligeramente menor de diabetes. En el modelo completo, tras la incorporación de ajustes para tener en cuenta los factores socioeconómicos y del modo de vida, la relación entre la generación y la diabetes seguía siendo significativa, no así la relación de esta última con la aculturación. CONCLUSIONES: El presente estudio respalda la idea, anteriormente cuestionada, de que la asimilación se relaciona con un mayor riesgo de diabetes entre los inmigrantes de origen mexicano. Los investigadores deben analizar más detalladamente la presencia de una relación causal entre la asimilación y la salud.

OBJECTIVE: We examined whether acculturation and immigrant generation, a marker for assimilation, are associated with diabetes risk in an aging Mexican origin population. METHODS: We analyzed data on 1789 adults aged 60 to 101 years from the Sacramento Area Latino Study on Aging. We ascertained type 2 diabetes on the basis of diabetic medication use, self-report of physician diagnosis, or a fasting glucose of 126 milligrams/deciliter or greater. Logistic regression modeled prevalent diabetes. RESULTS: Adjusting for age and gender, we observed significant but divergent associations between immigrant generation, acculturation, and diabetes risk. Relative to first-generation adults, second-generation adults had an odds ratio (OR) of 1.8 (95% confidence interval [CI] = 1.4, 2.4) and third-generation adults had an OR of 2.1 (95% CI = 1.4, 3.1) of having diabetes. Greater US acculturation, however, was associated with a slightly decreased diabetes rate. In the full model adjusting for socioeconomic and lifestyle factors, the association between generation (but not acculturation) and diabetes remained significant. CONCLUSIONS: Our study lends support to the previously contested notion that assimilation is associated with an increased diabetes risk in Mexican immigrants. Researchers should examine the presence of a causal link between assimilation and health more closely.

Effectiveness Guidance Document (EGD) for acupuncture research - a consensus document for conducting trials.

BACKGROUND: There is a need for more Comparative Effectiveness Research (CER) to strengthen the evidence base for clinical and policy decision-making. Effectiveness Guidance Documents (EGD) are targeted to clinical researchers. The aim of this EGD is to provide specific recommendations for the design of prospective acupuncture studies to support optimal use of resources for generating evidence that will inform stakeholder decision-making. METHODS: Document development based on multiple systematic consensus procedures (written Delphi rounds, interactive consensus workshop, international expert review). To balance aspects of internal and external validity, multiple stakeholders including patients, clinicians and payers were involved. RESULTS: Recommendations focused mainly on randomized studies and were developed for the following areas: overall research strategy, treatment protocol, expertise and setting, outcomes, study design and statistical analyses, economic evaluation, and publication. CONCLUSION: The present EGD, based on an international consensus developed with multiple stakeholder involvement, provides the first systematic methodological guidance for future CER on acupuncture.

Life-course exposure to early socioeconomic environment, education in relation to late-life cognitive function among older Mexicans and Mexican Americans.

OBJECTIVES: To examine the associations between life-course education and late-life cognitive function along with the modifying role of migration history. METHOD: The combined sample includes 1,789 participants from the Sacramento Area Latino Study on Aging and 5,253 participants from the Mexican Health and Aging Study. Aged 60+ at baseline, participants were classified as Mexican residents, Mexicans-return migrants, Mexicans-immigrants to the United States, and Mexicans-U.S. born. Cognitive function was measured using standardized z scores of a short-term verbal recall test. Multivariate linear regression analysis was conducted. RESULTS: Participants' z scores were higher among those whose mother had more than elementary education (ß = 0.28, p < .05). Participant's education mediated this association. For 5-year difference in education, the cognitive z score increased by 0.3 points for a U.S. born. Results were similar with father's education. DISCUSSION: Adult educational attainment mediates the effect of childhood socioeconomic status on late-life cognition. Migration plays a role in shaping cognitive aging.

Life-span socioeconomic trajectory, nativity, and cognitive aging in Mexican Americans: the Sacramento Area Latino Study on Aging.

OBJECTIVES: Early life circumstances influence health across the life span. Migration and ethnicity may modify the lifetime trajectory of socioeconomic status (SES) and lead to heterogeneity in cognitive aging in later life. METHODS: We examined the effects of both lifetime socioeconomic trajectory and cumulative disadvantage from childhood through adulthood on late life cognitive performance in a 9-year cohort of 1,789 Mexican Americans aged 60-100 years in 1998-1999. RESULTS: Compared with those with low SES sustained over the life course, we found that those with more advantaged lifetime SES trajectories experienced fewer declines on a test of global cognitive function and a short-term verbal memory test. These associations are larger in first- and second-generation immigrant families. DISCUSSION: Heterogeneity of cognitive aging among diverse race/ethnic groups may be influenced by intergenerational changes in SES, cultural norms, and behaviors and changes in health related to changes in the social and physical environment.

Life-course socioeconomic position and incidence of dementia and cognitive impairment without dementia in older Mexican Americans: results from the Sacramento area Latino study on aging.

There have been few investigations of the link between changes in life-course socioeconomic position (SEP) and cognitive decline or incidence of dementia. The authors examined the impact of changes in life-course SEP on incidence of dementia and cognitive impairment but not dementia (CIND) over a decade of follow-up. Participants of Mexican origin (n = 1,789) were members of the Sacramento Area Latino Study on Aging cohort. Incidence of dementia/CIND was ascertained by using standard diagnostic criteria. SEP indicators at 3 life stages (childhood, adulthood, and midlife) were used to derive a measure of cumulative SEP (range, 0 to 8) and SEP mobility. Nearly 24% of the sample maintained a low SEP throughout life. Hazard ratios and 95% confidence intervals were computed from Cox proportional hazards regression models. In fully adjusted models, participants with a continuously high SEP had lower hazard ratios for dementia/CIND compared with those with a continuously low SEP at all 3 life stages (hazard ratio = 0.49, 95% confidence interval: 0.24, 0.98; P = 0.04). In age-adjusted models, participants experienced a 16% greater hazard of dementia/CIND with every 1-unit increase in cumulative SEP disadvantage across the life course (hazard ratio = 1.16, 95% confidence interval: 1.01, 1.33; P = 0.04). Early exposures to social disadvantage may increase the risk of late-life dementia.

Socioeconomic position and incident mobility impairment in the Cardiovascular Health Study.

BACKGROUND: We investigated if personal socioeconomic position (SEP) factors and neighborhood characteristics were associated with incident mobility impairment in the elderly. METHODS: We used data from the Cardiovascular Health Study, a longitudinal, population-based examination of coronary heart disease and stroke among persons aged 65 and older in the United States. RESULTS: Among 3,684 persons without baseline mobility impairment, lower baseline SEP was associated with increased risk of incident mobility disability during the 10-year follow-up period, although the strengths of these associations varied by socioeconomic indicator and race/sex group. CONCLUSION: Among independent-living elderly, SEP affected development of mobility impairment into later life. Particular effort should be made to prevent or delay its onset among the elderly with low income, education, and/or who live in economically disadvantaged neighborhoods.