The effect of prevalent cardiovascular conditions on the association between alcohol consumption and mortality among older Mexican American men.

PURPOSE: To examine the association between alcohol consumption and mortality among older Mexican American men, with and without pre-existing cardiovascular conditions. METHODS: We conducted survival analysis among 908 men aged 65-80 years from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE), a longitudinal population-based study of older Mexican Americans who reside in the southwestern United States. Men were categorized into four alcohol-consumption groups: lifetime abstainers, former drinkers, low risk drinkers (< or =30 drinks/month and < or =3 drinks/occasion) and at-risk drinkers (>30 drinks/month or >3 drinks/occasion) and stratified into two groups: those with and those without pre-existing cardiovascular conditions. Mortality was ascertained from 1993-1994 to 2007. RESULTS: Among participants without pre-existing cardiovascular conditions, former, low risk, and at-risk drinkers had a lower risk for all-cause mortality compared to lifetime abstainers [HR: .70, 95% CI (.50-.99), .64 (.42-.97) and .60 (.40-.92), respectively]. There was no statistically significant association between mortality and any of the alcohol consumption groups among those with cardiovascular conditions. CONCLUSIONS: Among older Mexican-American men without cardiovascular conditions, former and current drinkers had lower mortality compared to abstainers. No such associations were observed between alcohol use and mortality among those with cardiovascular conditions.

Social support, stressors, and frailty among older Mexican American adults.

BACKGROUND: There is little research on the effects of stressors and social support on frailty. Older Mexican Americans, in particular, are at higher risk of medical conditions, such as diabetes, that could contribute to frailty. Given that the Mexican American population is rapidly growing in the United States, it is important to determine whether there are modifiable social factors related to frailty in this older group. METHOD: To address the influence of social support and stressors on frailty among older Mexican Americans, we utilized five waves of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (Hispanic EPESE) to examine the impact of stressors and social support on frailty over a 12-year period. Using a modified version of the Fried and Walston Frailty Index, we estimated the effects of social support and stressors on frailty over time using trajectory modeling (SAS 9.2, PROC TRAJ). RESULTS: We first grouped respondents according to one of three trajectories: low, progressive moderate, and progressive high frailty. Second, we found that the effects of stressors and social support on frailty varied by trajectory and by type of stressor. Health-related stressors and financial strain were related to increases in frailty over time, whereas social support was related to less-steep increases in frailty. CONCLUSION: Frailty has been hypothesized to reflect age-related physiological vulnerability to stressors, and the analyses presented indicate partial support for this hypothesis in an older sample of Mexican Americans. Future research needs to incorporate measures of stressors and social support in examining those who become frail, especially in minority populations.

Self-reported sleep characteristics and mortality in older adults of mexican origin: results from the Hispanic established population for the epidemiologic study of the elderly.

OBJECTIVES: To determine how poor sleep affects the health of older ethnic minorities. DESIGN: Cross-sectional study involving a population-based survey. SETTING: Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE) survey conducted in the southwestern United States. PARTICIPANTS: Two thousand two hundred fifty-six Mexican-American men and women aged 65 and older. MEASUREMENTS: The association between self-reported sleep problems and mortality over a 15-year period in a population based sample of older Mexican Americans was examined. Using five waves of data (1993-2008) from the H-EPESE, Cox proportional hazard models stratified according to sex were used to model the risk of death as a function of chronic sleep problems. RESULTS: Having any sleeping problems during the last month was associated with greater risk of mortality (hazard ratio = 1.14, 95% confidence interval = 1.00-1.29) in unadjusted models, although the association was attenuated after accounting for covariates. CONCLUSIONS: Similar factors explained the association between sleep and mortality in men and women: health behaviors, depressive symptoms, and health conditions. These factors are related to stress, and both may lead to poor sleep quality. Research is needed to better understand the factors moderating the relationship between sleep, mortality, and sex.

Prevalence of health conditions and predictors of mortality in oldest old Mexican Americans and non-Hispanic whites.

BACKGROUND: The oldest old represent a unique group of older adults. This group is rapidly growing worldwide and yet there are gaps in the knowledge related to their health condition. Ethnic differences in disease prevalence and mortality must be understood to better care for the oldest old. OBJECTIVE: To compare prevalence of common health conditions and predictors of mortality in oldest old Mexican Americans and non-Hispanic whites. METHODS: This study included 568 community-dwelling Mexican Americans (MA) aged 85 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly 2004-2005 and 933 non-Hispanic whites (NHW) of the same age from the Health and Retirement Study 2004. Measures included sociodemographic variables, self-reported medical conditions, activities of daily living (ADLs), and instrumental activities of daily living. Logistic regression analysis was used to examine 2-year mortality in both populations. RESULTS: Heart attack was significantly more prevalent in oldest old NHW compared with MA, regardless of gender. Conversely, diabetes was significantly more prevalent among MA men and women compared with their NHW counterparts. Compared with NHW men, MA men had significantly higher prevalence of cognitive impairment and hypertension. Additionally, prevalence of hip fracture was significantly higher for MA women compared with NHW women. Significant differences in ADL disability were observed only between both groups of women, whereas significant differences in instrumental activities of daily living disability were observed only between men. MA men and women had higher prevalence of obesity compared with NHW. Predictors of 2-year mortality for both ethnic groups included older age, male gender, and ADL disability. Cognitive impairment was a mortality predictor only for NHW. Similarly, lung disease was a predictor only for MA. CONCLUSION: Health-related conditions that affect the oldest old vary by gender and ethnicity and entail careful evaluation and monitoring in the clinical setting. Better care requires inclusion of such differences as part of the comprehensive evaluation of the oldest old adults.

The protective effect of neighborhood composition on increasing frailty among older Mexican Americans: a barrio advantage?

OBJECTIVE: Little is known about the nature of the frailty syndrome in older Hispanics who are projected to be the largest minority older population by 2050. The authors examine prospectively the relationship between medical, psychosocial, and neighborhood factors and increasing frailty in a community-dwelling sample of Mexican Americans older than 75 years. METHOD: Based on a modified version of the Cardiovascular Health Study Frailty Index, the authors examine 2-year follow-up data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) to ascertain the rates and determinants of increasing frailty among 2,069 Mexican American adults 75+ years of age at baseline. RESULTS: Respondents at risk of increasing frailty live in a less ethnically dense Mexican-American neighborhood, are older, do not have private insurance or Medicare, have higher levels of medical conditions, have lower levels of cognitive functioning, and report less positive affect. DISCUSSION: Personal as well as neighborhood characteristics confer protective effects on individual health in this representative, well-characterized sample of older Mexican Americans. Potential mechanisms that may be implicated in the protective effect of ethnically homogenous communities are discussed.

Trends in hypertension prevalence, awareness, treatment and control in older Mexican Americans, 1993-2005.

PURPOSE: To describe trends in hypertension prevalence, awareness, treatment, and control among older Mexican Americans living in the Southwestern United States from 1993-1994 to 2004-2005. METHODS: This study is a comparison between two separate cross-sectional cohorts of non-institutionalized Mexican Americans 75 years of age or older from the Hispanic Established Population for the Epidemiological Study of the Elderly (919 subjects from the 1993-1994 cohort and 738 from the 2004-2005 cohort). Data were collected on self-reported hypertension, measured blood pressure, medications, as well as sociodemographic and other health-related factors. RESULTS: Hypertension prevalence increased from 73.0% in the period 1993-1994 to 78.4% in 2004-2005. Cross-cohort multivariate analyses showed that the higher odds of hypertension in the 2004-2005 cohort was attenuated by adding diabetes and obesity to the model. There was a significant increase in hypertension awareness among hypertensives (63.0% to 82.6%) and in control among treated hypertensives (42.5% to 55.4%). Cross-cohort multivariate analyses showed that the higher odds of control in 2004-2005 cohorts were accentuated by adding diabetes to the model. There were no significant changes in treatment rates (62.2% to 65.6%) CONCLUSION: Hypertension prevalence in very old Mexican Americans residing in the Southwestern United States was higher in 2004-2005 than in 1993-1994 and was accompanied by a significant increase in awareness and control rates.

The rural-urban divide: health services utilization among older Mexicans in Mexico.

CONTEXT: Mexico. PURPOSE: Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. METHODS: The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen's "model of health services" of predisposing (ie, age, sex, etc.), enabling (education, insurance coverage, etc.) and need factors (diabetes, hypertension, etc.) to predict ever being in the hospital and physician visits in the past year by place of residence (urban, rural, semi-rural). FINDINGS: Results showed that older Mexicans living in the most rural areas (populations of 2,500 or fewer) were significantly less likely to have been hospitalized in the previous year and visited the physician less often (P < .0001) than their urban counterparts. The significant difference in hospitalization between rural and urban residing older Mexicans was largely accounted for by having health care coverage. Certain need factors such as diabetes, previous heart attack, hypertension, depression, and functional limitations predicted frequency of physician visits and hospitalization, but they did not explain variations between rural and urban older Mexicans. CONCLUSIONS: Not having insurance coverage was associated with a lower likelihood of spending an overnight visit in the hospital and visiting a physician for older Mexicans. This lower utilization may be due to barriers to access rather than better health.

Infant obesity: are we ready to make this diagnosis?

OBJECTIVES: To assess the prevalence, risk factors, diagnosis and treatment of infant obesity (weight-for-length) in a pediatric practice. STUDY DESIGN: This was a retrospective nested case-control design. The investigators reviewed and abstracted data from the records of the mothers (while pregnant) and their offspring. RESULTS: The prevalence of infant obesity was 16%. Children who were obese at age 24 months were highly likely to have been obese at age 6 months (odds ratio=13.3, 95% CI=4.50-39.53). Mothers of obese infants gained more weight during pregnancy (+6.9 kg, P<.05) than mothers of healthy weight infants. Obese infants were more likely to have been large for gestational age (Odds ratio=2.81, 95% CI=1.27-6.22). However, only 14% and 23% of obese infants aged 6 and 24 months were diagnosed with obesity. CONCLUSION: Infant obesity was common in our practice. Infant obesity strongly predicted obesity at age 24 months. Risk factors included excessive intrapartum weight gain or being born large for gestational age. Clinicians diagnosed obesity in only a minority of children. Primary care providers need to diagnose obesity in infants and work to develop effective interventions.

Attrition of older Mexican American survey respondents.

OBJECTIVE: The purpose of this study is to compare sample attrition between foreign born and US born older Mexican Americans. METHODS: Prospective cohort data over five waves (Hispanic established population for the epidemiological study of the elderly) of 3,050 older Mexican Americans were used to estimate the number and proportion of drop outs. Multivariate logistic regression of predictors of attrition included nativity, age, gender, race/ethnicity, marital status, financial strain, employment status, education, chronic conditions, cognitive function, disability, and depressive symptoms. RESULTS: Over 11 years of follow-up, 62% of the respondents dropped out of the study, but the difference between respondents born in the US and Mexico differed by only 2% points. Multivariate analyses of correlates for attrition related to death, refusal, and lost to follow-up revealed that older respondents in poor health were more likely to die and be lost to follow up. CONCLUSION: Over 11 years of follow-up, immigrants were no more likely to drop out than US born respondents.

Frailty and incidence of activities of daily living disability among older Mexican Americans.

OBJECTIVE: To examine the association between frailty status and incidence of disability among non-disabled older Mexican Americans. DESIGN: A 10-year prospective cohort study. SUBJECTS: A total of 1645 non-institutionalized Mexican Americans aged 67 years and older from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE), who reported no limitation in activities of daily living at baseline. METHODS: Frailty was defined as meeting 3 or more of the following components: (i) unintentional weight loss of > 2.26 kg; (ii) weakness (lowest 20% in hand grip strength); (iii) self-reported exhaustion; (iv) slow walking speed; and (v) low physical activity level. Socio-demographic factors, Mini Mental State Examination, medical conditions, body mass index, and self-reported activities of daily living were obtained. RESULTS: Of the 1645 non-disabled subjects at baseline, 820 (50%) were not frail, 749 (45.7%) were pre-frail, and 71 (4.3%) were frail. The hazard ratio of activities of daily living disability at 10-year follow-up for pre-frail subjects was 1.32 (95% confidence interval 1.10-1.58) and 2.42 (95% confidence interval 70-3.46) for frail subjects compared with not frail subjects. This association remained statistically significant after controlling for potential confounding factors at baseline. CONCLUSION: Pre-frail and frail status in older Mexican Americans was associated with an increased risk of activities of daily living disability over a 10-year period among non-disabled subjects.

Frailty and 10-year mortality in community-living Mexican American older adults.

BACKGROUND: The older Hispanic population of the United States is growing rapidly. Hispanic older adults have relatively high-risk profiles for increased morbidity and disability, yet little is known about how the construct of frailty is related to health trajectories in this population. OBJECTIVE: The purpose of this study was to examine the relationship between frailty and 10-year mortality in older community-dwelling Mexican Americans. METHODS: Data were from the Hispanic Established Populations for Epidemiologic Studies of the Elderly and included 1,996 Mexican Americans, aged 65 and older, living in the southwestern US. Primary measures included mortality and a 5-item frailty index comprised of weight loss, exhaustion, walking speed, grip strength, and physical activity. RESULTS: Mean baseline age was 74.5 years (SD 6.1) and 58.5% were women. Baseline frailty assessments yielded the following distribution: 44.9% non-frail, 47.3% pre-frail, and 7.8% frail. Overall, 892 (44.7%) participants died during the 10-year study period. Hazard ratios (HR), adjusted for sociodemographic, health, and medical factors, demonstrated increased odds for mortality in the pre-frail (HR = 1.25, 95% confidence interval, CI(95%), 1.07-1.46) and frail (HR = 1.81, CI(95%) 1.41-2.31) groups compared to the non-frail cohort. CONCLUSION: The 5-item frailty index differentiated odds of 10-year mortality in older community-dwelling Mexican Americans. This clinical index has the potential to identify older minorities at risk for poor health outcomes and mortality.

History of fractures as predictor of subsequent hip and nonhip fractures among older Mexican Americans.

OBJECTIVE: To examine the association between previous fracture and risk of new hip and nonhip fractures over a seven-year period among older Mexican Americans. METHOD: Data used are from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE) (1993-2001). Measures included history of previous fracture (hip fracture only, a nonhip fracture, hip and nonhip fractures, and no fractures), sociodemographic factors, smoking status, medical conditions (arthritis, diabetes, stroke and cancer), activities of daily living disability, and high depressive symptoms. Cox proportional regression model was used to estimate the seven-year incidence of fractures. RESULTS: Of the 2,589 subjects, 42 reported a hip fracture, 328 reported a nonhip fracture, and 2,219 did not report a fracture at baseline. After controlling for all covariates, the hazard ratio (HR) of new hip fracture at seven-year follow-up was 6.48 (95% CI: 3.26-12.97) for subjects with only hip fracture at baseline and 1.96 (95% CI: 1.22-3.16) for subjects with nonhip fracture at baseline. The HR of new nonhip fracture was 1.90 (95% CI: 0.96-3.77) for subjects with only hip fracture at baseline and 2.62 (95% CI: 1.95-3.52) for subjects with nonhip fracture at baseline. CONCLUSIONS: A previous history of fractures in older Mexican Americans is the strongest predictor of recurrent fractures at hip and nonhip sites, independent of other health measures. Our findings of recurrent fractures suggest the need for more aggressive detection and adequate treatment of osteoporosis- and fall-related factors in this population.

Factors associated with seven-year incidence of diabetes complications among older Mexican Americans.

BACKGROUND: Diabetes is common in elderly persons and is highly prevalent in Mexican Americans. Little is known about factors associated with the incidence of diabetes complications. OBJECTIVE: To examine the social, demographic and health factors associated with a 7-year incidence of diabetes complications among older Mexican Americans with diabetes. METHODS: A 7-year prospective cohort of 536 non-institutionalized Mexican Americans aged > or =65 years with diabetes residing in the Southwest of USA. Measures included socio-demographic factors, duration of diabetes, diabetes treatment, medical conditions and body mass index. Diabetes complications were assessed by self-reports of any kidney, eye and circulation problems or amputation due to diabetes over a 7-year period. RESULTS: Subjects with disease duration of > or =10 years were found to have an increased incidence of kidney, eye and circulation problems or amputation over a 7-year period. Hazard ratio (HR) for circulation problems was significantly higher in foreign-born subjects with >15 years in the USA. Foreign-born subjects with <15 years in the USA and those with a frequent number of physician visits were at increased risk of kidney complications. Subjects with baseline eye complications had a higher HR for incidence of amputations in the next 7 years. Subjects with baseline circulation complications had a higher incidence of amputations, eye and kidney complications in the next 7 years. CONCLUSIONS: Our data suggest that risks of diabetes complications are influenced by different factors. Prolonged diabetes duration, being foreign-born, living in the USA for a longer period, and frequent physician visits were factors associated with diabetes complications. Designing intervention strategies to reduce diabetes complication risks requires an understanding of the differences in demographic and health predictors of such risks.

Risk of mortality related to widowhood in older Mexican Americans.

PURPOSE: To examine the risk and correlates of mortality after death of a spouse and whether mortality risk varies by sex. METHODS: Prospective cohort study (1993 to 2000) of 1693 Mexican Americans ages 65 years and older who were married at baseline. Mortality was confirmed by matching records with the National Death Index or through proxy report. Risk of death related to incidence of widowhood was estimated by using proportional hazard regression and adjusted for age, education, US nativity, financial strain, social support, health behaviors, medical conditions, disability, and depressive symptoms. RESULTS: In the unadjusted Cox hazard analysis, widowed men are significantly more likely to die (HR=2.32, CI=1.48 to 3.61), but loss of spouse has no significant effect on the subsequent risk of death for widowed women (HR=1.50, CI=0.90 to 2.49). After adjustment for covariates known to influence survival, the association between widowhood and mortality in men remained significant, but the magnitude of the association decreased by 26%, which suggests a partial mediation effect of these factors on survival. The trajectory of the survival curve shows that the risk of death associated with widowhood is highest within the first 2 years. CONCLUSIONS: Widowhood in older Mexican American men is a risk factor for mortality.

Predictors of healthcare utilization among older Mexican Americans.

OBJECTIVE: To examine the effects of predisposing, enabling, and need factors on physician and hospital use among older Mexican Americans. DESIGN: A two-year prospective cohort study. SETTING: Five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California. PARTICIPANTS: A population-based sample of 1987 non-institutionalized Mexican American men and women age > or =65 years. MAIN OUTCOMES MEASURES: Physician and hospital utilization. Predictor variables included predisposing, enabling, and need factors. Ordinary least square and logistic regression analysis were used to model the effects of predictor factors specified in the Andersen model of health service use on physician and hospital use. RESULTS: After two years of follow-up, predisposing and enabling factors accounted for <5% of the variance in physician and hospital use. Need factors explained 21% of the variance in physician use and 7% of the variance in hospital use. Older age; being female; insurance coverage; having arthritis, diabetes, heart attack, hypertension, stroke, or cancer; and number of medications were factors associated with higher physician utilization. Subjects with arthritis, diabetes, hip fracture, high depressive symptoms, activities of daily living (ADL) disability, or high number of medications increased the odds of having any hospitalization. Subjects with diabetes, heart attack, hip fracture, ADL disabled, and high number of medications had a greater number of hospital nights than their counterparts. CONCLUSIONS: Older age, female sex, insurance coverage, and prevalent medical conditions are determinants of healthcare use among older Mexican Americans.

Near vision impairment predicts cognitive decline: data from the Hispanic Established Populations for Epidemiologic Studies of the Elderly.

OBJECTIVES: To estimate the association between sensory impairment and cognitive decline in older Mexican Americans. DESIGN: A prospective cohort study. SETTING: The Hispanic Established Populations for Epidemiologic Studies of the Elderly from five southwestern states. PARTICIPANTS: The sample consisted of 2,140 noninstitutionalized Mexican Americans aged 65 and older followed from 1993/1994 until 2000/2001. MEASUREMENTS: The outcome, cognitive function decline, was assessed using the Mini-Mental State Examination blind version (MMSE-blind) at baseline and at 2, 5, and 7 years of follow-up. Other variables were near vision, distance vision, hearing, demographics (age, sex, marital status, living arrangements, and education), depressive symptoms, hypertension, diabetes mellitus, stroke, heart attack, and functional status. A general linear mixed model was used to estimate cognitive decline at follow-up. RESULTS: In a fully adjusted model, MMSE-blind scores of subjects with near vision impairment decreased 0.62 points (standard error (SE)=0.29, P=.03) over 2 years and decreased (slope of decline) 0.13 points (SE=0.07, P=.045) more per year than scores of subjects with adequate near vision. Other independent predictors of cognitive decline were baseline MMSE-blind score, age, education, marital status, depressive symptoms, and number of activity of daily living limitations. CONCLUSION: Near vision impairment, but not distance vision or hearing impairments, was associated with cognitive decline in older Mexican Americans.

Risk factors for falling in older Mexican Americans.

OBJECTIVE: To estimate the prevalence of falls and the risk factors associated with falls in Mexican-American men and women aged 72 and older, from the Hispanic Established Population for the Epidemiological Study of the Elderly. DESIGN: A 2-year cohort study. SETTING: Five Southwestern states: Texas, New Mexico, Colorado, Arizona, and California. METHODS: Data on sociodemographic characteristics, health status, cognitive function, affective function, functional status, body mass index, and summary performance measures of lower body function, were obtained (1998-1999). Two years later (2000-2001), falls in the previous 12 months were assessed by self-report. Chi-square, univariate statistics, and multivariate logistic regression analyses were used. RESULTS: Of the 1,391 participants, 31.8% fell one or more times, and 14.2% reported 2 or more falls. In the logistic regression analysis, aged > or = 80 years (adjusted odds ratio [OR]=1.52, 95% confidence interval [CI]=1.17-1.98), being female (OR=1.45, 95% CI 1.13-1.86), having diabetes (OR=1.37, 95% CI 1.06-1.77), having arthritis (OR=1.32, 95% CI 1.04-1.68), experiencing impairment of instrumental activities of daily living (OR=1.05, 95% CI 1.01-1.10), and exhibiting high depressive symptoms (OR=1.59, 95% CI 1.16-2.19), were significant (P<.05) independent risk factors for one or more falls. The risk of falling increased linearly with the number of risk factors, from 14% with none, to 41% with 3 or more risk factors (P<.001). CONCLUSIONS: Prevalence of falls among older Mexican Americans was similar to that reported in non-Hispanic Caucasians. Potential modifiable conditions, such as functional deficits, arthritis, diabetes, and depressive symptoms were independent risk factors for falls in this population.

Cognitive status and incident disability in older Mexican Americans: findings from the Hispanic established population for the epidemiological study of the elderly.

OBJECTIVE: To determine the effects of baseline cognitive function on incidence of disability in activities of daily living (ADL) in initially non-disabled Mexican-American elderly over a 7-year period. DESIGN: A prospective cohort study. SETTING: Southwestern United States: Texas, California, Arizona, New Mexico, and Colorado. PARTICIPANTS: A population-based sample of Mexican Americans aged 65 and over who completed the Mini-Mental State Examination (MMSE) and other relevant variables at baseline. The sample at baseline consisted of 2731 subjects, of which 2431 were non-ADL disabled. MEASUREMENTS: In-home interviews in 1993-94, 1995-96, 1998-99, and 2000-2001 assessed sociodemographic variables, selected medical conditions (stroke, cancer, diabetes, arthritis, and hip fracture), cognitive function, depressive symptomatology, and ADLs. RESULTS: In a Cox proportional regression analysis, a significant relationship was evident between MMSE score at baseline and risk of incident ADL disability over a 7-year period. Among non-disabled subjects at baseline, the hazard ratio of any new ADL limitation was 1.58 (95% CI, 1.18-2.12) for those with impaired cognition (MMSE score 0-21), 1.38 (95% CI, 1.04-1.82) for low normal cognition (MMSE score 22-24), and 1.30 (95% CI, 1.02-1.66) for normal cognition (MMSE score 25-28) when compared to subjects with high-normal cognition (MMSE score 29-30), adjusting for sociodemographic variables, presence of selected medical conditions and depressive symptoms at baseline. Similar results were also found when MMSE score was used as a continuous variable. Among non-disabled subjects at baseline, each unit increase in MMSE score decreased the risk of onset of any ADL limitation over a 7-year follow-up period, controlling for relevant variables at baseline (HR=0.97; 95% CI, 0.95-0.99). CONCLUSION: Low MMSE score was associated with increased risk for incident ADL disability over a 7-year period in older Mexican Americans. Given the social, economic, and health impact of cognitive impairment, these findings suggest a need to develop effective intervention programs that delay or prevent the onset of cognitive and ADL disability in the elderly.

Evaluation of mortality data for older Mexican Americans: implications for the Hispanic paradox.

The authors evaluated underascertainment bias in Hispanic mortality rates from population surveys linked to the US National Death Index (NDI). They compared vital status through 7 years ascertained from an NDI search and from active follow-up for 2,886 Mexican-American subjects, aged >/=65 years at baseline in 1993-1994, from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (EPESE). Estimates of NDI underascertainment were applied to mortality rate ratios for 66,667 older Mexican Americans and non-Hispanic Whites from the 1986-1994 National Health Interview Surveys linked to the NDI. The NDI and active follow-up agreed on vital status for 91.2% of Hispanic EPESE subjects. The NDI did not identify 177 deaths (20.7%) reported by proxies. Underascertainment was greater for women and when stratified by age and nativity. The ratios of proxy-reported to NDI mortality rates were 1.31 (95% confidence interval (CI): 1.06, 1.62) for immigrant men and 1.65 (95% CI: 1.32, 2.08) for immigrant women. Before adjustment, National Health Interview Surveys-NDI age-standardized mortality rate ratios comparing Mexican Americans with non-Hispanic Whites were 0.77 (95% CI: 0.65, 0.92) for men and 0.92 (95% CI: 0.77, 1.09) for women but were 0.84 and 1.18, respectively, with adjustment for underascertainment. Findings suggest that NDI-based Hispanic mortality rates may be understated.