Relationship between Cerebral Microinfarcts and Dementia by Sex: Findings from a community-based Autopsy Study.

Cerebral microinfarcts are common in older adults and are associated with cognitive impairment. Less is known about sex-related variation in the relationship between cerebral microinfarcts and dementia in older adults, the examination of which was the objective of this study. This case-control study was based on the 727 participants (419 women) in the Adult Changes in Thought (ACT) autopsy data. Microinfarcts were ascertained by blinded board-certified neuropathologists, and dementia diagnoses were made by the ACT Consensus Diagnosis Conference per DSM-IV. Multivariable logistic regression models were used to estimate adjusted odds ratio (aOR) and 95% confidence interval (CI). Microinfarcts were present in 49% (356/727) of the participants, which was numerically higher in women: 51% (213/419) vs 46% (143/308). aOR (95% CI) for dementia associated with any microinfarct for female and male participants were 1.45 (0.91-2.30) and 1.24 (0.75-2.06), respectively (p for interaction, 0.34). Respective aORs (95%CIs) associated with ≥2 microinfarcts were 1.37 (0.79-2.36) and 1.53 (0.84-2.78), with interaction p, 0.84. Subcortical microinfarcts were present in 36% (138/381) and 23% (78/346) of patients with and without dementia (aOR, 1.65; 95% CI, 1.14-2.38). Respective aOR (95% CI) in female and male participants were 1.70 (1.03-2.82) and 1.59 (0.90-2.80), (p for interaction, 0.55). There was no association with cortical microinfarcts (aOR, 1.19; 95% CI, 0.83-1.69). These findings suggest that association between microinfarcts and dementia is primarily mediated by subcortical microinfarcts, but we found no evidence of sex-related variation. Future studies with greater power are needed to determine if the associations we found are replicable.

Relationships between Late-Life Blood Pressure and Cerebral Microinfarcts in Octogenarians: An Observational Autopsy Study.

Mid-life high blood pressure (BP) is a risk factor for cerebral microinfarcts. Less is known about the relationship between late-life BP and cerebral microinfarcts, the examination of which is the objective of the current study. This case-control study analyzed data from 551 participants (94.6% aged ≥80 years; 58.6% women) in the Adult Changes in Thought (ACT) study who had autopsy data on microinfarcts and four values of systolic and diastolic blood pressure (SBP and DBP) before death. Using the average of four values, SBP was categorized using 10 mmHg intervals; a trend was defined as a ≥10 mmHg rise or fall from the first to fourth values (average gap of 6.5 years). Multivariable-adjusted regression models were used to examine the associations of BP and microinfarcts, adjusting for age, sex, last BP-to-death time, APOE genotype, and antihypertensive medication use. Microinfarcts were present in 274 (49.7%) participants; there were multiple in 51.8% of the participants, and they were located in cortical areas in 40.5%, subcortical areas in 29.6%, and both areas in 29.9% of the participants. All SBP categories (reference of 100-119 mmHg) and both SBP trends were associated with higher odds of both the presence and number of microinfarcts. The magnitude of these associations was numerically greater for subcortical than cortical microinfarcts. Similar associations were observed with DBP. These hypothesis-generating findings provide new information about the overall relationship between BP and cerebral microinfarcts in octogenarians.

Impact of the COVID-19 Pandemic on the Provision of Dialysis Service and Mortality in Veterans Receiving Maintenance Hemodialysis in the VA: An Interrupted Time-Series Analysis.

INTRODUCTION: According to the US Renal Data System (USRDS), patients with end-stage kidney disease (ESKD) on maintenance dialysis had higher mortality during early COVID-19 pandemic. Less is known about the effect of the pandemic on the delivery of outpatient maintenance hemodialysis and its impact on death. We examined the effect of pandemic-related disruption on the delivery of dialysis treatment and mortality in patients with ESKD receiving maintenance hemodialysis in the Veterans Health Administration (VHA) facilities, the largest integrated national healthcare system in the USA. METHODS: Using national VHA electronic health records data, we identified 7,302 Veterans with ESKD who received outpatient maintenance hemodialysis in VHA healthcare facilities during the COVID-19 pandemic (February 1, 2020, to December 31, 2021). We estimated the average change in the number of hemodialysis treatments received and deaths per 1,000 patients per month during the pandemic by conducting interrupted time-series analyses. We used seasonal autoregressive moving average (SARMA) models, in which February 2020 was used as the conditional intercept and months thereafter as conditional slope. The models were adjusted for seasonal variations and trends in rates during the pre-pandemic period (January 1, 2007, to January 31, 2020). RESULTS: The number (95% CI) of hemodialysis treatments received per 1,000 patients per month during the pre-pandemic and pandemic periods were 12,670 (12,525-12,796) and 12,865 (12,729-13,002), respectively. Respective all-cause mortality rates (95% CI) were 17.1 (16.7-17.5) and 19.6 (18.5-20.7) per 1,000 patients per month. Findings from SARMA models demonstrate that there was no reduction in the dialysis treatments delivered during the pandemic (rate ratio: 0.999; 95% CI: 0.998-1.001), but there was a 2.3% (95% CI: 1.5-3.1%) increase in mortality. During the pandemic, the non-COVID hospitalization rate was 146 (95% CI: 143-149) per 1,000 patients per month, which was lower than the pre-pandemic rate of 175 (95% CI: 173-176). In contrast, there was evidence of higher use of telephone encounters during the pandemic (3,023; 95% CI: 2,957-3,089), compared with the pre-pandemic rate (1,282; 95% CI: 1,241-1,324). CONCLUSIONS: We found no evidence that there was a disruption in the delivery of outpatient maintenance hemodialysis treatment in VHA facilities during the COVID-19 pandemic and that the modest rise in deaths during the pandemic is unlikely to be due to missed dialysis.

Relationships between Cerebral Vasculopathies and Microinfarcts in a Community-Based Cohort of Older Adults.

Cerebral microinfarcts are associated with cognitive impairment and dementia. Small vessel diseases such as cerebral arteriolosclerosis and cerebral amyloid angiography (CAA) have been found to be associated with microinfarcts. Less is known about the associations of these vasculopathies with the presence, numbers, and location of microinfarcts. These associations were examined in the clinical and autopsy data of 842 participants in the Adult Changes in Thought (ACT) study. Both vasculopathies were categorized by severity (none, mild, moderate, and severe) and region (cortical and subcortical). Odds ratios (OR) and 95% CIs for microinfarcts associated with arteriolosclerosis and CAA adjusted for possible modifying covariates such as age at death, sex, blood pressure, APOE genotype, Braak, and CERAD were estimated. 417 (49.5%) had microinfarcts (cortical, 301; subcortical, 249), 708 (84.1%) had cerebral arteriolosclerosis, 320 (38%) had CAA, and 284 (34%) had both. Ors (95% CI) for any microinfarct were 2.16 (1.46-3.18) and 4.63 (2.90-7.40) for those with moderate (n = 183) and severe (n = 124) arteriolosclerosis, respectively. Respective Ors (95% CI) for the number of microinfarcts were 2.25 (1.54-3.30) and 4.91 (3.18-7.60). Similar associations were observed for cortical and subcortical microinfarcts. Ors (95% Cis) for the number of microinfarcts associated with mild (n = 75), moderate (n = 73), and severe (n = 15) amyloid angiopathy were 0.95 (0.66-1.35), 1.04 (0.71-1.52), and 2.05 (0.94-4.45), respectively. Respective Ors (95% Cis) for cortical microinfarcts were 1.05 (0.71-1.56), 1.50 (0.99-2.27), and 1.69 (0.73-3.91). Respective Ors (95% Cis) for subcortical microinfarcts were 0.84 (0.55-1.28), 0.72 (0.46-1.14), and 0.92 (0.37-2.28). These findings suggest a significant association of cerebral arteriolosclerosis with the presence, number, and location (cortical and subcortical) of microinfarcts, and a weak and non-significant association of CAA with each microinfarct, highlighting the need for future research to better understand the role of small vessel diseases in the pathogenesis of cerebral microinfarcts.

Characteristics and Predictors of Alzheimer's Disease Resilience Phenotype.

Alzheimer's disease (AD) is characterized by cognitive impairment in the presence of cerebral amyloid plaques and neurofibrillary tangles. Less is known about the characteristics and predictors of resilience to cognitive impairment in the presence of neuropathological evidence of AD, the focus of this study. Of 3170 adults age ≥65 years in the National Alzheimer's Coordinating Center (NACC) brain autopsy cohort, 1373 had evidence of CERAD level moderate to frequent neuritic plaque density and Braak stage V-VI neurofibrillary tangles. Resilience was defined by CDR-SOB and CDR-Global scores of 0-2.5 and 0-0.5, respectively, and non-resilience, CDR-SOB and CDR-Global scores >2.5 and >0.5, respectively. Multivariable logistic regression models were used to examine the independent associations of patient characteristics with resilience. There were 62 participants (4.8%) with resilience. Those with resilience were older (mean age, 88.3 vs. 82.4 years), more likely to be women (61.3% vs. 47.3%) and had a lower prevalence of the APOE-e4 carrier (41.9% vs. 56.2%). They also had a higher prevalence of hypertension, heart failure, atrial fibrillation, diuretic use, beta-blocker use, and APOE-e2 carrier status. Greater age at death, diuretic use, and APOE-e2 were the only characteristics independently associated with higher odds of the AD resilience phenotype (adjusted OR, 1.09; 95% CI, 1.05-1.13; p < 0.01; 2.00 (1.04-3.87), p = 0.04, 2.71 (1.31-5.64), p < 0.01, respectively). The phenotype of resilience to cognitive impairment is uncommon in older adults who have neuropathological evidence of AD.

Risk of Stroke in Older Adults With Heart Failure.

Heart failure (HF) is a risk factor for incident stroke. However, less is known about the independent nature of this association and to what extent various baseline characteristics may mediate this risk. Of the 5,795 community-dwelling adults aged ≥65 years in the Cardiovascular Health Study, 5,448 were free of baseline stroke, of whom 229 had baseline HF. We used a multivariable-adjusted Cox regression model to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for centrally adjudicated incident stroke associated with HF. Participants had a mean age of 73 years, 58% were women, and 15% were African-American. During 23 years of follow-up, incident stroke occurred in 18.8% and 19.3% of those with and without HF, respectively, but the time to first stroke was shorter in those with HF (age-gender-race-adjusted HR 1.64, 95% CI 1.21 to 2.25). The association remained essentially unchanged after adjustments for tobacco, alcohol, and physical activity (HR 1.63, 95% CI 1.21 to 2.24), attenuated after adjustment for hypertension, atrial fibrillation, myocardial infarction, and diabetes mellitus (HR 1.26, 95% CI 0.92 to 1.72), and further attenuated after additional adjustment for 10 baseline functional and subclinical variables (HR 1.05, 95% CI 0.76 to 1.46). In conclusion, despite a similar 23-year stroke incidence, time to first stroke was shorter in older adults with HF than without. However, this extra risk appears to be mediated primarily by 4 cardiovascular diseases that are also risk factors for HF. These findings highlight the importance of the primary prevention of these HF risk factors to reduce the extra risk of stroke in HF.

Assessment of Lung Cancer Risk Among Smokers for Whom Annual Screening Is Not Recommended.

Importance: The US Preventive Services Task Force does not recommend annual lung cancer screening with low-dose computed tomography (LDCT) for adults aged 50 to 80 years who are former smokers with 20 or more pack-years of smoking who quit 15 or more years ago or current smokers with less than 20 pack-years of smoking. Objective: To determine the risk of lung cancer in older smokers for whom LDCT screening is not recommended. Design, Settings, and Participants: This cohort study used the Cardiovascular Health Study (CHS) data sets obtained from the National Heart, Lung and Blood Institute, which also sponsored the study. The CHS enrolled 5888 community-dwelling individuals aged 65 years and older in the US from June 1989 to June 1993 and collected extensive baseline data on smoking history. The current analysis was restricted to 4279 individuals free of cancer who had baseline data on pack-year smoking history and duration of smoking cessation. The current analysis was conducted from January 7, 2022, to May 25, 2022. Exposures: Current and prior tobacco use. Main Outcomes and Measures: Incident lung cancer during a median (IQR) of 13.3 (7.9-18.8) years of follow-up (range, 0 to 22.6) through December 31, 2011. A Fine-Gray subdistribution hazard model was used to estimate incidence of lung cancer in the presence of competing risk of death. Cox cause-specific hazard regression models were used to estimate hazard ratios (HRs) and 95% CIs for incident lung cancer. Results: There were 4279 CHS participants (mean [SD] age, 72.8 [5.6] years; 2450 [57.3%] women; 663 [15.5%] African American, 3585 [83.8%] White, and 31 [0.7%] of other race or ethnicity) included in the current analysis. Among the 861 nonheavy smokers (<20 pack-years), the median (IQR) pack-year smoking history was 7.6 (3.3-13.5) pack-years for the 615 former smokers with 15 or more years of smoking cessation, 10.0 (5.3-14.9) pack-years for the 146 former smokers with less than 15 years of smoking cessation, and 11.4 (7.3-14.4) pack-years for the 100 current smokers. Among the 1445 heavy smokers (20 or more pack-years), the median (IQR) pack-year smoking history was 34.8 (26.3-48.0) pack-years for the 516 former smokers with 15 or more years of smoking cessation, 48.0 (35.0-70.0) pack-years for the 497 former smokers with less than 15 years of smoking cessation, and 48.8 (31.6-57.0) pack-years for the 432 current smokers. Incident lung cancer occurred in 10 of 1973 never smokers (0.5%), 5 of 100 current smokers with less than 20 pack-years of smoking (5.0%), and 26 of 516 former smokers with 20 or more pack-years of smoking with 15 or more years of smoking cessation (5.0%). Compared with never smokers, cause-specific HRs for incident lung cancer in the 2 groups for whom LDCT is not recommended were 10.54 (95% CI, 3.60-30.83) for the current nonheavy smokers and 11.19 (95% CI, 5.40-23.21) for the former smokers with 15 or more years of smoking cessation; age, sex, and race-adjusted HRs were 10.06 (95% CI, 3.41-29.70) for the current nonheavy smokers and 10.22 (4.86-21.50) for the former smokers with 15 or more years of smoking cessation compared with never smokers. Conclusions and Relevance: The findings of this cohort study suggest that there is a high risk of lung cancer among smokers for whom LDCT screening is not recommended, suggesting that prediction models are needed to identify high-risk subsets of these smokers for screening.

Oral health for healthy ageing.

Over the past 70 years, the global population and age structure have been changing rapidly. Analyses from the 2017 Global Burden of Diseases, Injuries, and Risk Factors Study forecasted a continuation of global ageing throughout the remainder of the 21st century, creating major challenges for health-care systems to ensure healthy longevity for ageing societies. Oral health is an intrinsic constituent of general health and wellbeing; however, oral health is largely overlooked on the global health agenda. Oral conditions are mostly preventable or treatable, yet older people often do not receive the necessary routine care to maintain a good standard of oral health. The neglect of oral health constitutes a failure of global health policy and a failure to deliver the basic human rights of older people. The aim of this Personal View is to encourage a refreshed vision of oral health, enabling policy makers to recognise the implications of poor oral health in older adults. We call for urgent action to manage the projected challenges throughout the coming decades, to ensure that additional years of life are spent in a state of good health and to help mark global ageing, not as a burden, but as a major anthropological achievement.

Clinical effect of toothpaste and mouth rinse containing zinc lactate on oral malodor reduction.

BACKGROUND: This study aimed to investigate the effect of toothpaste and mouth rinse containing 0.14% zinc lactate on the reduction of three volatile oral malodor gases. MATERIAL AND METHODS: Ten subjects with good health were recruited to take part in a crossover design study with a 7-day washout period. They were randomly assigned to use the test (toothpaste and rinse containing 0.14% zinc lactate) or placebo (negative control) treatment regimens within the two-week period. All subjects were asked to refrain from tooth brushing and eating in the morning prior to the gas collection periods. The assessment of malodor measured the quantity of three volatile sulphur compounds (VSCs) using an OralChromaTM device. Oral gas collecting was divided into four time periods; before breakfast and the morning oral hygiene practice (baseline); after oral hygiene at 30 minutes, 1 hour and 2 hours. After the baseline assessment, each subject used the test or placebo treatment regimen for 7 days. After 7 and 14 days, subjects returned to the study site to repeat the same procedures with different products. Kruskal-Wallis was used to analyze the mean differences of malodor gases between the two test regimens. RESULTS: The baseline mean of total VSCs in test and control groups was 6.5±3.7 and 1.7±9.3 ng/10 ml, respectively. The percent reduction of H2S at 30 minutes, 1 hour and 2 hours was statistically significant (p<0.005) in both treatments. The percent reduction of (CH3)2S and total VSCs in both treatments after 1 hour was statistically significant (p<0.005). CONCLUSIONS: The test treatment regimen was more effective than the placebo treatment regimen. Key words:Zinc lactate, molodor, volatile sulphur compound, mouth rinse, toothpaste.

The Prevalence and Severity of Tooth Wear in Type 2 Diabetic Patients.

OBJECTIVE: To assess the prevalence and severity of tooth wear in type 2 diabetic patients. METHODS: Attendees at a diabetic clinic at Wiang Pa Pao Hospital in Chiang Rai province, Thailand, were invited to take part in this cross-sectional study. All participants were aged 35-74 and had type 2 diabetes. Participants were required to have been diagnosed with diabetes for at least three months. 179 subjects accepted a clinical oral examination and completed the questionnaire. Tooth wear was assessed clinically using the Smith and Knight Tooth Wear Index. RESULTS: The mean age of diabetic patients was 56.5 ± 7.8 years. The majority (44.1%) had diabetes more than 5 years. The average years of having had diabetes was 6.5 ± 6.3 years. The most prevalent type of tooth wear was attrition (99.4%). The prevalence of erosion, abrasion, and abfraction were 64.8%, 31.3%, and 7.3%, respectively. The majority of the tooth wear was moderate to high severity (62.1%). Erosion and abfraction showed significant association with age group (p < 0.05). Age group was significantly associated with the severity level (p=0.017). Mild tooth wear severity was the highest in age groups 35-44 and 45-54 (53.8% and 41.2%, respectively). Moderate tooth wear was the highest proportion in age groups 55-65 and 65-74 (52.2% and 44.0%, respectively). There were no significant differences between specific diabetic symptoms and types of tooth wear. CONCLUSION: There was a high prevalence of tooth wear among diabetic patients. The role of prevention is vital in maintaining the integrity of the teeth and to avoid treating these worn teeth in diabetic patients.

Trends over Time in Dental Caries status in Urban and Rural Thai Children.

BACKGROUND: Historically, the prevalence of dental caries was higher in urban areas than rural areas of Thailand. This study aim to examine the time trends in caries status in children in Thailand. MATERIAL AND METHODS: Linear regression was used to examine trend of dental caries prevalence and mean number of teeth with caries, filled and missing due to caries (dmft/DMFT) in urban and rural, of 3-, 5-6 and 12-year olds from seven Thailand National Oral Health Surveys conducted approximately every 5 years from 1977 to 2012. RESULTS: There were declines in the caries prevalence and mean dmft/DMFT in every age group. Significant results were observed in the mean dmft of 3 year-olds and the mean DMFT of 12 year-olds (p= 0.03 and p=0.05, respectively). A significant trend of declining prevalence of dental caries was observed in urban children ages 5-6 (p=0.002), along with urban 12 year-olds (p<0.001). A declining trend of mean dmft for 3 and 5-6 year-olds, and mean DMFT for 12 year-olds was observed in both rural and urban areas, but significant results were shown in urban 3 and 5-6 year-olds (P=0.04, and p<0.001, respectively), and urban 12 year-olds (p=0.001). For restoration outcome, both urban and rural of all age groups have an increasing trend of mean ft/FT index. CONCLUSIONS: There have been differences over time in the prevalence and quantity of dental caries between urban and rural school children. A significant reduction was observed in urban areas. More effort needs to be given to supply rural areas in order to have fair and equal access of all citizens to oral health care. Key words:Dental caries, prevalence, children, Thailand, rural, urban, time trend, national survey.

Estimate of Impact on the Oral Health-Related Quality of Life of Older Thai People by the Provision of Dentures through the Royal Project.

Purpose. To estimate the impact of the provision of dentures to Thai older people by the Royal Project on their oral health-related quality of life. Methods. A purposive cross-sectional study of a sample of 812 subjects was conducted. The Oral Impacts on Daily Performances (OIDP) measure was used to assess the oral health-related quality of life. Results. Four groups of older people with different tooth types were studied. 216 (26.6%) had natural teeth (NT). 189 (23.3%) had natural and replaced teeth (NRT). 167 (20.6%) had below the minimum number of teeth but had no dentures (Edent) and 240 were edentate with complete dentures provided by the Royal Project (ECD) (29.6%). Overall, 36.5% had at least one oral impact. Eating was the most affected oral impact. When compared to the group with natural teeth (NT), the Edent group was significantly more likely to report having impacts on eating OR = 6.5 (3.9-10.9), speaking clearly OR = 43.7 (12.7-15.07), emotional stability OR = 16.5 (6.0-45.6), and social contacts OR = 4.6 (2.2-9.5) (p < 0.001). Conclusion. Those who are edentulous are much more likely to have an oral impact on their daily performances than those provided dentures. Provision of dentures may lead to improvement of considerable oral impacts.

Discharge Hospice Referral and Lower 30-Day All-Cause Readmission in Medicare Beneficiaries Hospitalized for Heart Failure.

BACKGROUND: Heart failure (HF) is the leading cause for hospital readmission. Hospice care may help palliate HF symptoms but its association with 30-day all-cause readmission remains unknown. METHODS AND RESULTS: Of the 8032 Medicare beneficiaries hospitalized for HF in 106 Alabama hospitals (1998-2001), 182 (2%) received discharge hospice referrals. Of the 7850 patients not receiving hospice referrals, 1608 (20%) died within 6 months post discharge (the hospice-eligible group). Propensity scores for hospice referral were estimated for each of the 1790 (182+1608) patients and were used to match 179 hospice-referral patients with 179 hospice-eligible patients who were balanced on 28 baseline characteristics (mean age, 79 years; 58% women; 18% non-white). Overall, 22% (1742/8032) died in 6 months, of whom 8% (134/1742) received hospice referrals. Among the 358 matched patients, 30-day all-cause readmission occurred in 5% and 41% of hospice-referral and hospice-eligible patients, respectively (hazard ratio associated with hospice referral, 0.12; 95% confidence interval, 0.06-0.24). Hazard ratios (95% confidence intervals) for 30-day all-cause readmission associated with hospice referral among the 126 patients who died and 232 patients who survived 30-day post discharge were 0.03 (0.04-0.21) and 0.17 (0.08-0.36), respectively. Although 30-day mortality was higher in the hospice referral group (43% versus 27%), it was similar at 90 days (64% versus 67% among hospice-eligible patients). CONCLUSIONS: A discharge hospice referral was associated with lower 30-day all-cause readmission among hospitalized patients with HF. However, most patients with HF who died within 6 months of hospital discharge did not receive a discharge hospice referral.

Race- and sex-specific associations of parental education with insulin resistance in middle-aged participants: the CARDIA study.

Low childhood socioeconomic status (SES) has been linked with insulin resistance (HOMA-IR) in adulthood. Our aim was to examine if maternal and paternal education, as indicators of childhood SES, equally contributed to increased HOMA-IR in later life. Of 5,115 adults from the Coronary Artery Disease Risk Development in Young Adults (CARDIA) Study aged 18-30 years in 1985-1986, data on 1,370 females and 1,060 males with baseline and 20 year follow-up data were used to estimate associations of maternal and paternal education with HOMA-IR, adjusting for personal education, BMI, lipids, blood pressure, and lifestyle factors. Parental education was determined as high with ≥ 12 years of schooling and classified as both high, only mother high, only father high, both low education. Distinct combinations of maternal and paternal education were associated with HOMA-IR across race and sex groups. Lowest year 20 HOMA-IR in European American (EA) females occurred when both parents were better educated, but was highest when only the father had better education. HOMA-IR was lowest in African American (AA) participants when the mother was better educated but the father had less education, but was highest when both parents were better educated. Parental education was unrelated to HOMA-IR in EA males. Associations of parental education with HOMA-IR are seen in AA females, AA males, and EA females but not in EA males. The distinct combinations of parental education and their associations with HOMA-IR especially in AA participants need to be addressed in further research on health disparities.

Regional and racial differences in smoking and exposure to secondhand smoke: the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

INTRODUCTION: Stroke mortality rates differ by race and region, and smoking and exposure to secondhand smoke are associated with stroke. We evaluated regional and racial differences in current smoking and secondhand smoke exposure among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. METHODS: African American and white adults (n = 26,373) aged 45 years or older were recruited during 2003 through 2007. Logistic regression was used to examine the likelihood of current smoking and secondhand smoke exposure by race (African American vs white) and region. We compared the buckle of the stroke belt (the coastal plain region of North Carolina, South Carolina, and Georgia) with the stroke belt (the remainder of North Carolina, South Carolina, and Georgia, plus Alabama, Mississippi, Tennessee, Arkansas, and Louisiana) and compared each of these regions with the remaining contiguous states. RESULTS: Among whites, no regional differences in current smoking were seen, but among African Americans, the odds of current smoking were 5% lower in the stroke belt, and 24% lower in the stroke buckle than those in the nonbelt region. Similarly, among whites no regional differences in exposure to secondhand smoke were found, whereas among African Americans, the odds of being exposed to secondhand smoke were 14% lower in the stroke buckle than for nonbelt residents. CONCLUSION: These data suggest that rates of current smoking and secondhand smoke exposure are not higher in regions that have higher stroke mortality and therefore cannot contribute to geographic disparities; nevertheless, given that 15% of our participants reported current smoking and 16% reported secondhand smoke exposure, continued implementation of tobacco control policies is needed.

Serum urate and its relationship with alcoholic beverage intake in men and women: findings from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort.

OBJECTIVE: To investigate if beer, liquor (spirits), wine and total alcohol intakes have different associations with serum urate (SU) concentrations at different ages in a cohort of young men and women. METHODS: Data from 3123 participants at baseline and follow-up at 20 years were used, with balanced proportions of Caucasians and African Americans. The relationships of SU with categories of beer, liquor, wine and total alcohol intake referent to no intake were examined in sex-specific, cross-sectional analyses. RESULTS: Mean age (SD) at the beginning of follow-up was 25.1 (3.6) years. Compared with non-drinkers, significant associations between higher SU concentrations and greater beer intake were observed among men and women, with more pronounced and consistent associations for women. An association between greater liquor intake and higher SU concentrations was only seen for men at the year 20 evaluation. Wine intake was not associated with SU in either sex and total alcohol was associated with higher SU concentrations in both men and women. The magnitude of the associations between alcoholic beverages intake and SU was modest (≤0.03 mg/dl/alcoholic beverage serving). CONCLUSION: An association between higher SU concentrations and greater beer intake was consistent and pronounced among women, but also present in men. Despite the small magnitude of the increases in SU associated with alcohol intake, clinical implications in conditions such as cardiovascular disease and gout in young adults who are moderate and heavy drinkers cannot be ruled out.

Factor analysis of metabolic syndrome components in the Coronary Artery Risk Development in Young Adults (CARDIA) study: examination of factors by race-sex groups and across time.

PURPOSE: This study tests hypotheses of one-, two-, three-, and four-factor models of metabolic syndrome (MetS) components and assesses the consistency and fit of the factor models 10 years later using confirmatory factor analysis in a large biracial sample of men and women. METHODS: With the use of data from the baseline and year-10 exams of the Coronary Artery Risk Development in Young Adults Study, confirmatory factor analysis was performed overall and for race- and sex-specific groups for one-, two-, three-, and four-factor MetS models in 3403 white and black men and women at baseline and in 2532 white and black men and women 10 years later. Metabolic risk variables used in the factor analysis were insulin resistance (HOMA-IR), fasting glucose, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, systolic and diastolic blood pressure, waist circumference, waist-hip ratio, triceps skinfolds, and uric acid. RESULTS: Three- and four-factor models of MetS achieved excellent fits of the data, ranging from 0.92 to 0.96 for race- and sex-specific models and from the baseline to year-10 exams. CONCLUSIONS: The results suggest that MetS factors are consistent across time and race-sex groups. When investigating the MetS, it is necessary to evaluate race-sex groups.

Trajectories of life-space mobility after hospitalization.

BACKGROUND: Life space is a measure of where a person goes, the frequency of going there, and the dependency in getting there. It may be a more accurate measure of mobility in older adults because it reflects participation in society as well as physical ability. OBJECTIVE: To assess effects of hospitalization on life space in older adults, and to compare life-space trajectories associated with surgical and nonsurgical hospitalizations. DESIGN: Prospective observational study. SETTING: Central Alabama. PARTICIPANTS: 687 community-dwelling Medicare beneficiaries at least 65 years of age with surgical (n = 44), nonsurgical (n = 167), or no (n = 476) hospitalizations. MEASUREMENTS: Life-Space Assessment (LSA) scores before and after hospitalization (range, 0 to 120; higher scores reflect greater mobility). RESULTS: Mean age of participants was 74.6 years (SD, 6.3). Fifty percent were black, and 46% were male. Before hospitalization, adjusted LSA scores were similar in participants with surgical and nonsurgical admissions. Life-space assessment scores decreased in both groups immediately after hospitalization; however, participants with surgical hospitalizations had a greater decrease in scores (12.1 more points [95% CI, 3.6 to 20.7 points]; P = 0.005) than those with nonsurgical hospitalizations. However, participants with surgical hospitalizations recovered more rapidly over time (gain of 4.7 more points [CI, 2.0 to 7.4 points] per ln [week after discharge]; P < 0.001). Score recovery for participants with nonsurgical hospitalizations did not significantly differ from the null (average recovery, 0.7 points [CI, -0.6 to 1.9 points] per ln [week after discharge]). LIMITATION: Life space immediately before and after hospitalization was self-reported, often after hospital discharge. CONCLUSION: Hospitalization decreases life space in older adults. Surgical hospitalizations are associated with immediate marked life-space declines followed by rapid recovery, in contrast to nonsurgical hospitalizations, which are associated with more modest immediate declines and little evidence of recovery after several years of follow-up. PRIMARY FUNDING SOURCE: National Institute on Aging.

Marital status and health: exploring pre-widowhood.

BACKGROUND: Health and function vary by marital status across the life-course, but little is known about older adults approaching spousal loss (pre-widowed). OBJECTIVE: To explore health and function by marital status focusing on the pre-widowed and to examine factors associated with shorter time to spousal loss. PARTICIPANTS, DESIGN, AND MEASUREMENTS: We used 3 years of data from African American and white community-dwelling older adults in the UAB Study of Aging (N = 1000). Participants were categorized as "continuously married" (married at baseline and 3 years), "widowed" (widowed at baseline), "single" (never married/divorced); and "pre-widowed" (married at baseline and widowed within 3 years). Assessments included sociodemographic characteristics, and measures of depression, anxiety, life-space mobility, and self-reported health. chi(2) and analysis of variance (ANOVA) were used to examine baseline differences. Using Cox regression, we explored factors having independent and significant associations with shorter time to spousal loss among married older adults. RESULTS: There were significant differences by marital status category for sociodemographic factors, health, and function. Pre-widows differed from other categories by sociodemographic characteristics as well as levels of depression, anxiety and self-reported health. Among married older adults, being female and having lower self-reported health at baseline were independent significant hazards for shorter time to widowhood; while rural residence and providing spousal care were independent significant hazards for a longer progression to widowhood. CONCLUSIONS: Health deficits associated with spousal bereavement may be evident earlier in the marital transition than previously thought, warranting attention to the health of elderly persons whose spouses have chronic/life-limiting conditions.

Regional differences in diabetes as a possible contributor to the geographic disparity in stroke mortality: the REasons for Geographic And Racial Differences in Stroke Study.

BACKGROUND AND PURPOSE: Diabetes and hypertension impart approximately the same increased relative risk for stroke, although hypertension has a larger population-attributable risk because of its higher population prevalence. With a growing epidemic of obesity and associated increasing prevalence of diabetes that disproportionately impacts the southeastern Stroke Belt states, any potential contribution of diabetes to the geographic disparity in stroke mortality will only increase. METHODS: Racial and geographic differences in diabetes prevalence and diabetes awareness, treatment, and control were assessed in the REasons for Geographic And Racial Differences in Stroke study, a national population-based cohort of black and white participants older than 45 years of age. At the time of this report, 21 959 had been enrolled. RESULTS: The odds of diabetes were significantly increased in both white and black residents of the stroke buckle (OR, 1.26; [1.10, 1.44]; OR, 1.45 [1.26, 1.66], respectively) and Stroke Belt (OR, 1.22; [1.09, 1.36]; OR, 1.13 [1.02, 1.26]) compared to the rest of the United States. In the buckle, regional differences were not fully mediated and remained significant when controlling for socioeconomic status and risk factors. Addition of hypertension to the models did not reduce the magnitude of the associations. There were no significant differences by region with regard to awareness, treatment, or control for either race. CONCLUSIONS: These analyses support a possible role of regional variation in the prevalence of diabetes as, in part, an explanation for the regional variation in stroke mortality but fail to support the potential for a contribution of regional differences in diabetes management.