Psychiatric history and later-life cognitive change: effect modification by sex, race and ethnicity.

Objective: We explored associations between psychiatric history and cognitive functioning, and differences by sex and race/ethnicity (SRE) in 20,155 Health and Retirement Study (1995-2014) participants aged 65 or older.Methods: Multi-level growth curve models examined cognition scores and their trajectories over time by SRE.Results: A history of psychiatric, emotional, or nervous problems was significantly related to cognition scores and rates of decline. Hispanic and Black participants had significantly lower cognition scores at age 75 and steeper rates of decline than White females, and Black race and the Hispanic race/ethnicity-sex interaction erased the protective effects of being female.Conclusions: Future research should include specific psychiatric diagnoses. Population level findings as reported here, along with aggregate findings from similar studies, can inform interventions and policies regarding support for populations that are vulnerable to mental illness and to subsequent cognitive decline.

Association of perceived job security and chronic health conditions with retirement in older UK and US workers.

BACKGROUND: The relationship between job insecurity, chronic health conditions (CHCs) and retirement among older workers are likely to differ between countries that have different labor markets and health and social safety nets. To date, there are no epidemiological studies that have prospectively assessed the role of job insecurity in retirement incidence, while accounting for CHC trajectories in two countries with different welfare systems. We investigated the strength of the association between baseline job insecurity and retirement incidence over an 11-year period while accounting for CHC trajectories, among workers 50-55 years of age at baseline in the UK and USA. METHODS: We performed Cox proportional hazards regression analysis, using 2006-2016 data from the Health and Retirement Study (US cohort, n = 570) and English Longitudinal Study on Aging (UK cohort n = 1052). RESULTS: Job insecurity was associated with retirement after adjusting for CHC trajectories (HR = 0.69, 95% CI = 0.50-0.95) in the UK cohort only. CHC trajectories were associated with retirement in both cohorts; however, this association was attenuated in the US cohort, but remained significant for the medium-increasing trajectory in the UK cohort (HR = 1.41, 95% CI = 1.01-1.97) after adjustment for all covariates. Full adjustment for relevant covariates attenuated the association between job insecurity and retirement indicating that CHCs, social and health factors are contributing mechanistic factors underpinning retirement incidence. CONCLUSIONS: The observed differences in the two cohorts may be driven by macro-level factors operating latently, which may affect the work environment, health outcomes and retirement decisions uniquely in different settings.

Occupation and risk of severe COVID-19: prospective cohort study of 120 075 UK Biobank participants.

OBJECTIVES: To investigate severe COVID-19 risk by occupational group. METHODS: Baseline UK Biobank data (2006-10) for England were linked to SARS-CoV-2 test results from Public Health England (16 March to 26 July 2020). Included participants were employed or self-employed at baseline, alive and aged <65 years in 2020. Poisson regression models were adjusted sequentially for baseline demographic, socioeconomic, work-related, health, and lifestyle-related risk factors to assess risk ratios (RRs) for testing positive in hospital or death due to COVID-19 by three occupational classification schemes (including Standard Occupation Classification (SOC) 2000). RESULTS: Of 120 075 participants, 271 had severe COVID-19. Relative to non-essential workers, healthcare workers (RR 7.43, 95% CI 5.52 to 10.00), social and education workers (RR 1.84, 95% CI 1.21 to 2.82) and other essential workers (RR 1.60, 95% CI 1.05 to 2.45) had a higher risk of severe COVID-19. Using more detailed groupings, medical support staff (RR 8.70, 95% CI 4.87 to 15.55), social care (RR 2.46, 95% CI 1.47 to 4.14) and transport workers (RR 2.20, 95% CI 1.21 to 4.00) had the highest risk within the broader groups. Compared with white non-essential workers, non-white non-essential workers had a higher risk (RR 3.27, 95% CI 1.90 to 5.62) and non-white essential workers had the highest risk (RR 8.34, 95% CI 5.17 to 13.47). Using SOC 2000 major groups, associate professional and technical occupations, personal service occupations and plant and machine operatives had a higher risk, compared with managers and senior officials. CONCLUSIONS: Essential workers have a higher risk of severe COVID-19. These findings underscore the need for national and organisational policies and practices that protect and support workers with an elevated risk of severe COVID-19.

Subjective neighborhood assessment and physical inactivity: An examination of neighborhood-level variance.

Research suggests a linkage between perceptions of neighborhood quality and the likelihood of engaging in leisure-time physical activity. Often in these studies, intra-neighborhood variance is viewed as something to be controlled for statistically. However, we hypothesized that intra-neighborhood variance in perceptions of neighborhood quality may be contextually relevant. We examined the relationship between intra-neighborhood variance of subjective neighborhood quality and neighborhood-level reported physical inactivity across 48 neighborhoods within a medium-sized city, Texas City, Texas using survey data from 2706 residents collected between 2004 and 2006. Neighborhoods where the aggregated perception of neighborhood quality was poor also had a larger proportion of residents reporting being physically inactive. However, higher degrees of disagreement among residents within neighborhoods about their neighborhood quality was significantly associated with a lower proportion of residents reporting being physically inactive (p=0.001). Our results suggest that intra-neighborhood variability may be contextually relevant in studies seeking to better understand the relationship between neighborhood quality and behaviors sensitive to neighborhood environments, like physical activity.

Mental distress and health care use among survivors of adolescent and young adult cancer: A cross-sectional analysis of the National Health Interview Survey.

BACKGROUND: The current study was conducted to examine the prevalence and correlates of mental distress among survivors of adolescent and young adult (AYA) cancer and a comparison group. METHODS: A total of 875 AYA cancer survivors who were diagnosed between the ages of 15 and 39 years and who were at least 5 years from their initial diagnosis were identified from the 2013 and 2014 National Health Interview Surveys. A comparison group was created. The Kessler nonspecific mental/psychological distress scale was used to examine none/low, moderate, and severe distress. The issues of whether individuals talked to mental health professionals within the previous year and if they could afford mental health care also were examined. Variables (ie, demographics, behavioral [eg, smoking status], comorbidity, and mental health visits) associated with distress among the 2 groups were identified using multinomial logistic regressions. RESULTS: Survivors reported mental distress more often than the comparison group (moderate: 23.2% vs 16.9%; and severe: 8.4% vs 3.0% [P<.001]). Survivors cited not being able to afford mental health care more often (6.4% vs 2.3%; P = .002). Moreover, 74.7% and 52.2% of survivors, respectively, with moderate and severe distress had not talked to a mental health professional. Contrary to the comparison group, survivors who were current smokers reported severe distress more often compared with nonsmokers (relative risk, 3.59; 95% confidence interval, 1.46-8.84 [P = .01]). Having public and no insurance versus private insurance and report of sleep-related trouble within the previous week were found to be associated with greater distress among survivors. CONCLUSIONS: AYA cancer survivors are more likely to demonstrate mental distress than individuals without cancer. Nevertheless, few survivors may be receiving professional mental health services. Survivors need greater access to mental health screening and counseling to address the current gaps in care delivery. Cancer 2017;123:869-78. © 2016 American Cancer Society.

A review of recent literature on materialist and psychosocial models for racial and ethnic disparities in birth outcomes in the US, 2000-2014.

OBJECTIVE: Material and psychosocial factors exacerbate racial disparities in health outcomes. This review sought to ascertain recent knowledge of the effects of materialist and psychosocial factors on differences in low birthweight (LBW) and preterm delivery (PTD) outcomes between Black and White mothers. DESIGN: Search and review was conducted for studies that examined: (a) neighborhood-level deprivation as an indicator of material conditions, and (b) racial discrimination or occupational stressors as indicators of psychosocial stress. The outcomes of interest were LBW and PTD. RESULTS: Material and psychosocial factors significantly and negatively affected Blacks more than Whites, and were associated with increased adverse outcomes. Of five studies with a homogeneous Black study sample, three reported no effect on outcomes in women exposed to material or psychosocial factors. CONCLUSION: Through this review we find that in comparison to White women, Black women are at higher risk of adverse outcomes due to both psychosocial stress and meso-level deprivation, after accounting for personal factors. A better understanding of effects on health outcomes of material and psychosocial factors in Black women is needed. Further investigation into materialist and psychosocial factors, will allow us to better understand the factors driving PTD and LBW disparities in the US.

Association between workplace psychosocial factors and mental health in Black, Hispanic, and White women: Cross-sectional findings from the National Health Interview Survey.

Research evaluating the relation of workplace psychosocial factors to mental health among U.S. women of different racial/ethnic backgrounds is limited. This study investigated the relationship between work-related psychosocial factors and mental health among non-Hispanic Black, Hispanic, and non-Hispanic White women using data from the 2010 National Health Interview Survey. Independent variables of interest included job insecurity, workplace harassment, and work-family conflict (WFC). Multiple Poisson regression models were used to examine the associations between the outcome and independent variables. The prevalence of unfavorable mental health was highest among non-Hispanic Black women (36%) compared to Hispanic (34%) and non-Hispanic White (30%) women. A higher proportion of non-Hispanic Black women reported WFC compared to Hispanics and non-Hispanic Whites (χ2 = 15.50, p < .01), while more Hispanics reported job insecurity (χ2 = 116.81, p < .01). Prevalence of workplace harassment did not differ significantly by race/ethnicity. Odds of unfavorable mental health were significantly higher for women reporting psychosocial work factors. Unexpectedly, a greater association between psychosocial work factors and unfavorable mental health was observed among non-Hispanic White women compared to non-White women; however, caution should be taken in interpreting these cross-sectional results. Future studies should investigate temporal associations and additional psychosocial variables that were not available for use in the current study.

Child-street migration among HIV-affected families in Kenya: a mediation analysis from cross-sectional data.

Within Kenya, an estimated quarter of a million children live on the streets, and 1.8 million children are orphaned. In this study, we analyze how HIV contributes to the phenomenon of child-street migration. We interviewed a random community sample of caregiving women (n = 1974) in Meru County, Kenya, using a structured questionnaire in summer 2015. Items included reported HIV prevalence of respondent and her partner, social support, overall health, school enrollment of biologically related children and whether the respondent has a child currently living on the streets. Controlling for alcohol use, education, wealth, age and household size, we found a positive-graded association between the number of partners living with HIV and the probability that a child lives on the street. There was little difference in the odds of a child living on the street between maternally affected and paternally affected households. Lower maternal social support, overall health and school enrollment of biologically related children mediated 14% of the association between HIV-affected households and reporting child-street migration. Street-migration of children is strongly associated with household HIV, but the small percentage of mediated effect presents a greater need to focus on interactions between household and community factors in the context of HIV. Programs and policies responding to these findings will involve targeting parents and children in HIV-affected households, and coordinate care between clinical providers, social service providers and schools.

Construction of early and midlife work trajectories in women and their association with birth weight.

OBJECTIVES: We derived trajectories of the substantive complexity (SC) of work across mid-adult life in women and determined their association with term birth weight. SC is a concept that encompasses decision latitude, active learning, and ability to use and expand one's abilities at work. METHODS: Using occupational data from the National Longitudinal Survey of Youth 1979 and O*NET work variables, we used growth mixture modeling (GMM) to construct longitudinal trajectories of work SC from the ages of 18 to 34 years. The association between work trajectories and birth weight of infants born to study participants was modeled using generalized estimating equations, adjusting for education, income, and relevant covariates. RESULTS: GMM yielded a 5-class solution for work trajectories in women. Higher work trajectories were associated with higher term birth weight and were robust to the inclusion of both education and income. A work trajectory that showed a sharp rise after age 24 years was associated with marked improvement in birth weight. CONCLUSIONS: Longitudinal modeling of work characteristics might improve capacity to integrate occupation into a life-course model that examines antecedents and consequences for maternal and child health.

Association of Epigenetic Age and Everyday Discrimination With Longitudinal Trajectories of Chronic Health Conditions in Older Adults.

We investigated the strength of the association between baseline epigenetic age, everyday discrimination, and trajectories of chronic health conditions (CHCs) across 3 study waves, among adults 50 years of age and older. We used 2016-2020 data from the Health and Retirement Study (HRS). Data for the PhenoAge and DNAm GrimAge second-generation epigenetic clocks were from the 2016 HRS Venous Blood Study. CHC trajectories were constructed using latent class growth curve models. Multinomial logistic regression models assessed the strength of the association between accelerated epigenetic age, everyday discrimination, and the newly constructed CHC trajectories for participants with complete data (n = 2 893). In the fully adjusted model, accelerated PhenoAge (relative risk ratios [RRR] = 2.53, 95% confidence interval [95% CI] = 1.81, 3.55) and DNAm GrimAge (RRR = 2.79, 95% CI = 1.95, 4.00) were associated with classification into the high CHC trajectory class. Racial disparities were evident, with increased risk of classification into the high trajectory class for Black (PhenoAge: RRR = 1.69, 95% CI = 1.07, 2.68) and reduced risk for Hispanic (PhenoAge: RRR = 0.32, 95% CI = 0.16, 0.64; DNAm GrimAge: RRR = 0.34, 95% CI = 0.17, 0.68), relative to White participants. Everyday discrimination was associated with classification into the medium-high (RRR = 1.28, 95% CI = 1.00, 1.64) and high (RRR = 1.52, 95% CI = 1.07, 2.16) trajectory classes in models assessing DNAm GrimAge. More research is needed to better understand the longitudinal health outcomes of accelerated aging and adverse social exposures. Such research may provide insights into vulnerable adults who may need varied welfare supports earlier than the mandated chronological age for access to federal and state resources.

Effects of Prevalent and Newly Diagnosed Arthritis on Changes in Perceived Physical Demands and Work Stress Among Older Workers: Results of a 3 Year Panel Study.

OBJECTIVES: Examine the effects of prevalent and newly diagnosed arthritis on changes in perceived physical demands and general work stress. METHODS: Conditional change logistic regression models examined the strength of association between arthritis and perceived (1) work stress and (2) physical demands, using data from the NIDI Pension Panel Study (n = 2099). RESULTS: Prevalent and newly diagnosed arthritis were associated with increased odds of perceived work stress and high physical demands. Manual workers with newly diagnosed arthritis exhibited a 6.73-fold (95% CI = 2.87-15.77) increased odds of physical demands. Arthritis in three body extremities was differentially associated with increased odds of work stress and physical demands in manual and non-manual workers. DISCUSSION: Prevalent and incident arthritis were associated with changes in work stress and physical demands in older workers. Policies and workplace interventions to reduce stress and physical demands and improve workability in older workers with arthritis are needed.

Risk of Nursing Home Use Among Older Americans: The Impact of Psychiatric History and Trajectories of Cognitive Function.

OBJECTIVES: Mental illness and cognitive functioning may be independently associated with nursing home use. We investigated the strength of the association between baseline (1998) psychiatric history, 8-year cognitive function trajectories, and prospective incidence of nursing home use over a 10-year period while accounting for relevant covariates in U.S. adults aged 65 and older. We hypothesized that self-reported baseline history of psychiatric, emotional, or nervous problems would be associated with a greater risk of nursing home use and that cognition trajectories with the greatest decline would be associated with a subsequent higher risk of nursing home use. METHODS: We used 8 waves (1998-2016) of Health and Retirement Study data for adults aged 65 years and older. Latent class mixture modeling identified 4 distinct cognitive function trajectory classes (1998-2006): low-declining, medium-declining, medium-stable, and high-declining. Participants from the 1998 wave (N = 5,628) were classified into these 4 classes. Competing risks regression analysis modeled the subhazard ratio of nursing home use between 2006 and 2016 as a function of baseline psychiatric history and cognitive function trajectories. RESULTS: Psychiatric history was independently associated with greater risk of nursing home use (subhazard ratio [SHR] 1.26, 95% confidence interval [CI] 1.06-1.51, p < .01), net the effects of life course variables. Furthermore, "low-declining" (SHR 2.255, 95% CI 1.70-2.99, p < .001) and "medium-declining" (2.103, 95% CI 1.69-2.61, p < .001) trajectories predicted increased risk of nursing home use. DISCUSSION: Evidence of these associations can be used to educate policymakers and providers about the need for appropriate psychiatric training for staff in community-based and residential long-term care programs.

Trajectories of concurrent depressive symptoms and cognitive function on health outcomes and mortality among older Mexican Americans.

BACKGROUND: We sought to identify distinctive concurrent trajectory classes of depressive symptoms (DS) and cognitive function (CF) in Mexican Americans aged 75+ years, and to examine whether these trajectories were associated with an increased risk of adverse outcomes. METHODS: We used 4 waves of Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) data from 2004 to 5 to 2013. Latent growth curve analysis was used to identify distinctive concurrent trajectory classes of DS and CF. Generalized linear mixed models were further used to examine the association between the concurrent trajectories and health outcomes. Cox proportional hazards regression model was used to examine the risk of mortality as a function of the concurrent trajectories. RESULTS: 1,302 older adults followed-up approximately 9-years were successfully classified into 6 distinct concurrent trajectory classes of DS (low-increasing, high) and CF (high, high-declining, medium-declining). Compared to the co-occurrence of low DS and high CF trajectories, those with the high DS and declining CF trajectories were at greater risk of ADL and IADL functional limitations (1.6 - 2.9 times), more medical visits (1.3 - 1.4 times), hospital admissions (1.6 - 1.9 times), and mortality (1.7 - 2.6 times). CONCLUSIONS: Differences in adverse health outcomes across concurrent trajectory classes of DS and CF suggest that differences in underlying co-occurrence and progression have important implications for public health interventions as well as development of aging social and health policies.

Effects of psychosocial characteristics of work on pregnancy outcomes: a critical review.

Birth outcomes may influence subsequent susceptibility to chronic diseases. With the increased number of women who continue to work during pregnancy, occupational stress has been hypothesized to be a potential contributor to adverse reproductive health outcomes. The Job Demand and Control model has been primarily used in investigating associations between work-related stress and outcomes such as preterm delivery, low birth weight, and spontaneous abortion. A literature review of occupational factors that have been associated with adverse reproductive outcomes was conducted. In studies assessing preterm delivery and low birth weight, some evidence has suggested a modest association with work-related stress but has not been conclusive. In the literature on psychosocial characteristics of work and spontaneous abortion, job strain alone was often not associated with adverse outcomes. However the presence of other risk factors resulted in a synergistic effect which strengthened the odds of an adverse outcome. Future studies should use a prospective design with a large study sample, in which work-related stress exposure data are collected before or in the early stages of the pregnancy. In addition, future research should measure psychosocial characteristics of work both objectively and subjectively.

Impact of Retirement on Sleep Problems Among Older Workers and Their Partners.

BACKGROUND AND OBJECTIVES: Sleep problems are a public health burden and have adverse health consequences in older adults. Despite sleep being a shared biological process between couples, to date, there have not been any studies that have assessed the association between retirement and sleep in older couples. The objective of this study was to examine the impact of retirement on diagnosed sleep problems in older Dutch couples. RESEARCH DESIGN AND METHODS: This study used data from 2 waves of the Netherlands Interdisciplinary Demographic Institute Pension Panel Study for older Dutch adults living with a partner (n = 3,726). Logistic regression models examined the strength of association between retirement and sleep problems, while accounting for the moderating role of relationship characteristics. RESULTS: Retirement was associated with decreased odds of sleep problems at Wave 2 (odds ratio [OR] = 0.60, 95% confidence interval [95% CI] = 0.46-0.78). Lower relationship quality was associated with increased odds of sleep problems in the fully adjusted model (OR = 1.81, 95% CI = 1.32-2.49). Having a partner with sleep problems was associated with an increased risk of sleep problems as well (OR = 1.51, 95% CI = 1.07-2.13). There was evidence of effect modification by relationship quality (OR = 1.87, 95% CI = 1.05-3.31). DISCUSSION AND IMPLICATIONS: Retirement and sleep do not occur in a social vacuum and have implications beyond the individual level. More research is therefore needed to understand the impact of sleep and its health consequences on older coupled workers. Such research may provide valuable insights for the management and treatment of sleep problems and may have implications for the public health of aging communities.

Chronic health conditions and work-related stress in older adults participating in the Dutch workforce.

The proportion of workers with chronic health conditions (CHCs) will increase over the years as pension reform is increasing the age of retirement in many European countries. This will increase the percentage of older adults with CHCs performing highly demanding work. This study sought to examine the association between common CHCs [cardiovascular disease (CVD), diabetes, arthritis, respiratory and sleep disorders] and three domains of work stress in older Dutch workers. This study used data from the first wave of the NIDI Pension Panel Study for working adults aged 60-65 years (n = 6793). Logistic regression models examined the strength of association between CHCs and (1) general work stress, (2) emotional, and (3) physical demands. All five CHC were independently associated with one or more domains of stress. After including all CHCs in the model, CVD, sleep disorders, and arthritis were significantly associated with general stress. Respiratory disorders, sleep disorders, and arthritis were significantly associated with physical demands. Diabetes (1.25, 95% CI 1.01-1.53), sleep disorders (1.99, 95% CI 1.72-2.31), and arthritis (1.18, 95% CI 1.06-1.31) were significantly associated with emotional demands. Our findings demonstrate that work stress is associated with prevalent CHCs, and these conditions are differentially associated with several domains of work stress in adults approaching retirement. More research is needed to understand the causal relationship between CHCs and work stress. Such research may provide insights for effective workplace and public health interventions to ensure that older workers remain physically and mentally healthy, and productive through their working years.

Impact of Diabetes and Disease Duration on Work Status Among U.S. Older Adults.

Objectives: To examine the effects of diabetes and disease duration on work status over a 9-year period. Method: Multinomial logistic regression models examined the probability of retirement and disability impeding work, using data from the Health and Retirement Study (n = 5,576). Results: Among participants who had retired in 2012, almost 14% had incident diabetes (4.91 mean years with diabetes, 95% confidence interval [CI] = [4.67, 5.15]). Approximately 22% of participants who reported a disability impeded labor force participation had prevalent diabetes (17.1 mean years with diabetes, 95%CI = [16.41, 17.71]). Only prevalent diabetes that indicated longer disease duration was associated with disability (relative risk ratio [RRR] = 1.83, 95% CI = [1.30, 2.57]). There was evidence of effect modification among Hispanics only (p = .02). Discussion: Diabetes increased risk of exiting the workforce due to disability, and mean disease duration was associated with changes. Disease management and workplace interventions may enable older adults to continue being productive should they choose to remain in the workforce.

Association Between Baseline Glycemic Markers (HbA1c) and 8-Year Trajectories of Functional Disability.

BACKGROUND: This study assessed whether baseline (i) HbA1c (low [<5.7%], intermediate [5.7%-6.4%], and high [≥6.5%]) and (ii) glycemic control (7% HbA1c cutoff) in participants with self-reported diabetes were associated with differential 8-year functional disability trajectories. METHODS: We used data from the 2006-2014 waves of the Health and Retirement Study for adults aged 50 years and older. Latent class mixture modeling was used to identify distinct functional disability trajectory classes. Multinomial logistic regression analysis examined the association between the newly constructed trajectories and baseline HbA1c levels, and glycemic control, respectively. RESULTS: All participants (N = 5,966) were classified into four functional disability trajectory classes (no disability, low disability, low-increasing, and high-increasing). Participants with elevated HbA1c were at greater risk of being classified into the high-increasing (relative risk ratios = 1.63, 95% confidence interval [CI] = 1.25-2.11) trajectory class. Results showed significant effect modification by age and race. Three functional disability trajectories (no disability, low-increasing, and high-increasing) were identified for participants with self-reported diabetes (n = 1,119). There was no significant association between glycemic control in adults with self-reported diabetes and functional disability trajectory classes. CONCLUSIONS: Participants with intermediate HbA1c and elevated HbA1c were more likely to be classified into the trajectories with progressing disability over the study period. More research is needed to better understand the association between glycemic markers and functional disability trajectories. Such research may provide insights into improvements for clinical care, self-management, and public health interventions for both conditions.

Job Strain and Long-Term Sickness Absence From Work: A Ten-Year Prospective Study in German Working Population.

OBJECTIVE: The aim of this study was to examine the prospective associations between baseline job strain and 10-year cumulative incidence of long-term sickness absence (LTSA) in the German workforce. METHODS: This study used longitudinal data from the 2001 to 2011 waves of The German Socio-Economic Panel (SOEP) (n = 9794). Kaplan-Meier survival curves and Cox proportional hazard regression models were used to examine the prospective association between job strain and incidence of LTSA. RESULTS: High strain [hazard ratio (HR) = 1.28, 95% confidence interval (95% CI) = 1.12 to 1.46] and passive jobs (HR = 1.14, 95% CI = 1.01 to 1.30) were significantly associated with LTSA after full adjustment for covariates, with greater risk in the older participants (>45) in passive (HR = 1.33, 95% CI = 1.08 to 1.63) and high strain (HR = 1.56, 95% CI = 1.27 to 1.92) jobs. CONCLUSION: Jobs with low control over work were associated with LTSA in German workers. More studies using longitudinal employment data, and more detailed job strain measures are warranted.

Physical Performance Trajectories and Mortality Among Older Mexican Americans.

Background: We sought to identify distinct trajectory classes of physical performance in Mexican Americans aged 75 years and older and to examine whether these trajectories predict mortality. Methods: We used four waves of Hispanic Established Populations for Epidemiologic Studies of the Elderly (H-EPESE) data for adults 75 years and older from 2004-2005 to 2013. Latent growth curve analysis was used to identify distinct trajectory classes. Multinomial logistic regression analysis was used to examine the association between baseline characteristics and the newly constructed trajectories. Cox proportional hazards regression models examined the hazard of mortality as a function of Short Physical Performance Battery (SPPB) trajectories. Results: The study follow-up period was approximately 9.5 years. One thousand four hundred and eleven adults were successfully classified into three (low-declining, high-declining, and high-stable) physical performance trajectory classes. Depressive symptoms (relative risk ratio = 1.94, 95% confidence interval [CI] = 1.17-3.22), diabetes (relative risk ratio = 2.44, 95% CI = 1.63-3.65), number of other comorbid health conditions (relative risk ratio = 1.40, 95% CI = 1.16-1.68), and obesity (relative risk ratio = 2.83, 95% CI = 1.67-4.80), increased the relative risk of classification into the low, relative to high-stable trajectory class. Male gender and foreign-born status significantly reduced risk of classification in the low-declining and high-declining trajectory classes. We observed a statistically significant association between low-declining (hazard ratio = 3.01, 95% CI = 2.34-3. 87) and high-declining (hazard ratio = 1.64, 95% CI = 1.32-2.03) trajectories and increased risk of mortality. Conclusions: Differences in mortality across physical performance trajectory classes suggest that these physical performance classes represent differences in underlying disease progression, and thus differences in mortality risk among older Mexican Americans, which warrants additional research to better understand differential physical performance trajectories and their effects on morbidity and mortality in heterogeneous aging populations.