Assessing cognitive impairment in an ethnically diverse cohort of oldest-old: the life after 90 study
Though dementia rates vary by racial or ethnic groups, it is unknown if these disparities remain among those aged 90 or older. To test this hypothesis, we used baseline clinical evaluation of 541 ethnically and racially diverse individuals participating in…
Glycemic Control Over Multiple Decades and Dementia Risk in People With Type 2 Diabetes
The levels of glycemic control associated with the lowest risk of dementia in people with type 2 diabetes are unknown. This knowledge is critical to inform patient-centered glycemic target setting. To examine the associations between cumulative exposure to various ranges…
Working at a mentally challenging job linked to lower chance of later cognitive decline
Association of primary lifetime occupational cognitive complexity and cognitive decline in a diverse cohort: Results from the KHANDLE study
Higher occupational complexity has been linked to favorable cognitive outcomes, but rarely examined in racially and ethnically diverse populations. In a diverse cohort (n = 1536), linear mixed-effects models estimated associations between main lifetime occupational complexity and domain-specific cognitive decline (z-standardized). Occupational…
Association of Early Adulthood Hypertension and Blood Pressure Change With Late-Life Neuroimaging Biomarkers
The association between hypertension developed before midlife and late-life brain health is understudied and, because of the cardioprotective benefits of estrogen before menopause, may differ by sex. To assess the association of early adulthood hypertension and blood pressure (BP) change…
State-Level Indicators of Childhood Educational Quality and Incident Dementia in Older Black and White Adults
Higher educational attainment is associated with reduced dementia risk, but the role of educational quality is understudied, presenting a major evidence gap, especially as it may contribute to racial inequities. To evaluate the association between state-level educational quality during childhood…
Association of Education With Dementia Incidence Stratified by Ethnicity and Nativity in a Cohort of Older Asian American Individuals
High education protects against dementia, but returns on educational attainment may be different across sociodemographic groups owing to various social factors. Asian American individuals are a growing and diverse group, but little research has assessed dementia determinants in this population.…
The impact of attending historically Black colleges and universities on cognitive decline in Black adults: A longitudinal analysis in the KHANDLE and STAR cohorts
Black students attending predominantly White institutions (PWIs) versus historically Black colleges and universities (HBCUs) report more harmful discrimination and develop worse mental health outcomes, potentially offsetting the established benefits of college for lowering dementia incidence. Black participants in two cohorts…
State-level educational quality linked to risk of dementia
Evaluating interpersonal discrimination and depressive symptoms as partial mediators of the effects of education on cognition: Evidence from the Study of Healthy Aging in African Americans (STAR)
Education is correlated with positive health outcomes, but associations are sometimes weaker among African Americans. The extent to which exposure to discrimination and depressive symptoms attenuates the education-cognition link has not been investigated. Study of Healthy Aging in African Americans…
Rural residence across the life course and late-life cognitive decline in KHANDLE: A causal inference study
Modifiable risks for dementia are more prevalent in rural populations, yet there is a dearth of research examining life course rural residence on late-life cognitive decline. The association of rural residence and socioeconomic status (SES) in childhood and adulthood with…
Neighborhood disadvantage and dementia incidence in a cohort of Asian American and non-Latino White older adults in Northern California
Some evidence suggests that neighborhood socioeconomic disadvantage is associated with dementia-related outcomes. However, prior research is predominantly among non-Latino Whites. We evaluated the association between neighborhood disadvantage (Area Deprivation Index [ADI]) and dementia incidence in Asian American (n = 18,103)…
Generation and age of immigration on later life cognitive performance in KHANDLE
We examined the association of generational status and age at immigration with later life cognitive outcomes in a diverse sample of Latinos and Asian Americans. Baseline data were obtained from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study,…
Consideration of sex and gender in Alzheimer’s disease and related disorders from a global perspective
Sex or gender differences in the risk of Alzheimer's disease and related dementias (ADRD) differ by world region, suggesting that there are potentially modifiable risk factors for intervention. However, few epidemiological or clinical ADRD studies examine sex differences; even fewer…
Brain pathologies, reserve, and cognition in aging and dementia
This study is examining racial/ethnic group similarities and differences in brain mechanisms underlying cognitive reserve and functional reserve, and their life course determinants, by conducting secondary data analysis and harmonization of existing data from 4 ongoing longitudinal studies: Alzheimer's Disease…
Epidemiology of Age-related Dementia, Mild Cognitive Impairment and Brain Pathology in a Multiethnic Cohort of Oldest-Old – DUPLICATED DO NOT ACTIVATE
This study is following a diverse cohort of approximately 1,000 KPNC members over 90 years old to examine life-course risk and protective factors of healthy brain aging in order to 1) Evaluate differences in dementia incidence and rate of cognitive…
Accounting for lack of representation in dementia research: Generalizing KHANDLE study findings on the prevalence of cognitive impairment to the California older population
Most dementia studies are not population-representative; statistical tools can be applied to samples to obtain critically-needed population-representative estimates, but are not yet widely used. We pooled data from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study and the…
Association of Social Integration with Cognitive Status in a Multi-Ethnic Cohort: Results From the Kaiser Healthy Aging and Diverse Life Experiences Study
We evaluated overall and race-specific relationships between social integration and cognition in older adults. Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) cohort participants included 1343 Asian, Black, Latino, or non-Latino White Kaiser Permanente Northern California members. We estimated the…
Epidemiology of Age-related Dementia, Mild Cognitive Impairment and Brain Pathology in a Multiethnic Cohort of Oldest-Old
The Life After 90 Study (LA90) is a collaborative study between DOR, UC Davis, and UC Irvine following a diverse cohort of approximately 1,000 KPNC members age 90 and over to examine life course risk factors of cognitive decline and…
The role of nativity in heterogeneous dementia incidence in a large cohort of three Asian American groups and white older adults in California
Literature shows lower dementia incidence in Asian American groups versus whites, varying by Asian ethnicity. One hypothesized driver is nativity differences (eg, healthy immigrant effect). We followed a cohort of 6243 Chinese, 4879 Filipino, 3256 Japanese, and 141,158 white Kaiser…
Prevalence of Instrumental Activities of Daily Living (IADL) Difficulties and Associated Cognitive Predictors Across Racial/Ethnic Groups: Findings from the KHANDLE Study
Cognitive functioning is associated with instrumental activity of daily living (IADL) performance among older adults. The present study examines potential differences in the prevalence of IADL difficulty and association with cognition across diverse groups. Participants included 455 non-Hispanic Whites, 395…
Comparison of dementia incidence and prevalence between individuals with and without HIV infection in primary care from 2000 to 2016
To compare dementia incidence and prevalence after age 50 years by HIV status. Observational cohort, 2000-2016. People with HIV (PWH) on antiretroviral therapy (ART) and demographically similar people without HIV (PWoH), all aged 50 years and older, were identified from Kaiser…
Comparison of cognitive function in older adults with type 1 diabetes, type 2 diabetes, and no diabetes: results from the Study of Longevity in Diabetes (SOLID)
The incidence of both type 1 diabetes (T1D) and type 2 diabetes (T2D) is increasing. Life expectancy is improving in T1D, resulting in a growing population of elderly adults with diabetes. While it is well established that older adults with…
Perceived Discrimination, Nativity, and Cognitive Performance in a Multi-ethnic Study of Older Adults: Findings from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study
Despite growing research on the association between discrimination and disparities in cognitive aging, an evidence gap remains on how the association varies by racial/ethnic group. This study evaluates the associations of experiences of discrimination with cognitive function and whether these…
Measuring cognitive health in ethnically diverse older adults
Understanding racial/ethnic disparities in late-life cognitive health is a public health imperative. We used baseline data from the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study to examine how age, education, gender, and clinical diagnosis, a proxy for brain…
Lifecourse health, cerebral pathology and ethnic disparities in dementia (KHANDLE Study)
The Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study, a collaborative study between DOR and UC Davis, follows a diverse cohort of Kaiser Permanente Northern California members who participated in at least one optional check-up (Multiphasic Health Checkups) during…
Marginal structural models for life-course theories and social epidemiology: Definitions, sources of bias, and simulated illustrations
Social epidemiology aims to identify social structural risk factors, thus informing targets and timing of interventions. Ascertaining which interventions will be most effective and when they should be implemented is challenging because social conditions vary across the life course and…
Stroke Belt Birth State and Late-life Cognition in The Study of Healthy Aging in African Americans (STAR)
We examined the association of Stroke Belt birth state with late-life cognition in The Study of Healthy Aging in African Americans (STAR). STAR enrolled 764 Black Americans ages 50+ who were long-term Kaiser Permanente Northern California members. Participants completed Multiphasic…
Association of Timing of School Desegregation in the United States With Late-Life Cognition in the Study of Healthy Aging in African Americans (STAR) Cohort
Prior research suggests schooling differences for Black individuals in the US are associated with worse cognitive aging. It is unknown whether age when experiencing school desegregation is associated with differences in late-life cognition in this population. To examine patterns of…
Impact of Cardiovascular Risk Factors in Adolescence, Young Adulthood, and Midlife on Late-Life Cognition: Study of Healthy Aging in African Americans
Midlife cardiovascular risk factors (CVRFs) increase risk of dementia. Black Americans experience an elevated prevalence of CVRFs and dementia. However, little is known of how CVRFs prior to midlife affect late-life cognition. We examined CVRFs in adolescence, young adulthood, and…
Operationalizing Social Environments in Cognitive Aging and Dementia Research: A Scoping Review
Social environments are a contributing determinant of health and disparities. This scoping review details how social environments have been operationalized in observational studies of cognitive aging and dementia. A systematic search in PubMed and Web of Science identified studies of…
Participant education, spousal education and dementia risk in a diverse cohort of members of an integrated health care delivery system in Northern California
The role of spousal education on dementia risk and how it may differ by gender or race/ethnicity is unknown. This study examines the association between one's own education separate from and in conjunction with spousal education and risk of dementia.…
Association of Type 1 Diabetes and Hypoglycemic and Hyperglycemic Events and Risk of Dementia
To determine whether severe hypoglycemic and hyperglycemic events are associated with longitudinal dementia risk in older adults with type 1 diabetes. A longitudinal cohort study followed 2,821 members of an integrated healthcare delivery system with type 1 diabetes from 1997-2015.…
Impact of Cardiovascular Risk Factors in Adolescence, Young Adulthood, and Midlife on Late-life Cognition: Study of Healthy Aging in African Americans (STAR)
Midlife cardiovascular risk factors (CVRF) increase risk of dementia. Black Americans experience an elevated prevalence of CVRF and dementia. However, little is known of how CVRF prior to midlife affect late-life cognition. We examined CVRF in adolescence, young adulthood, and…
Lifecourse socioeconomic changes and late-life cognition in a cohort of U.S.-born and U.S. immigrants: findings from the KHANDLE study
Low socioeconomic status (SES) in early and late life has been associated with lower late-life cognition. Less is known about how changes in SES from childhood to late life are associated with late-life cognition, especially among diverse populations of older…
Temporal Trends in Stroke-Related Memory Change: Results From a US National Cohort 1998-2016
Findings from the Framingham Heart Study suggest that declines in dementia incidence rates over recent decades are partially due to decreases in stroke incidence and mortality; however, whether trends of declining dementia rates extend to survivors of incident stroke remains…
Comparison of dementia risk after age 50 between individuals with and without HIV infection
To compare risk of dementia after age 50 by HIV status among individuals in a primary care setting. Observational cohort study; participants were identified from 2013 to 2017 and followed through 2019. Participants were people with HIV (PWH) on antiretroviral…
Racial/Ethnic Disparities in Young Adulthood and Midlife Cardiovascular Risk Factors and Late-life Cognitive Domains: The Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study
Midlife cardiovascular risk factors (CVRF) increase dementia risk. Less is known about whether CVRF identified before midlife impact late-life cognition in diverse populations. Linear regression models examined hypertension, hyperlipidemia, and overweight/obesity at ages 30 to 59 with late-life executive function,…
Do the Benefits of Educational Attainment for Late-life Cognition Differ by Racial/Ethnic Group?: Evidence for Heterogenous Treatment Effects in the Kaiser Healthy Aging and Diverse Life Experience (KHANDLE) Study
Educational attainment is associated with late-life cognitive performance and dementia; few studies have examined diverse racial/ethnic groups to assess whether the association differs by race/ethnicity. We investigated whether the association between educational attainment and cognition differed between White, Black, Asian,…
Are adverse childhood experiences associated with late-life cognitive performance across racial/ethnic groups: results from the Kaiser Healthy Aging and Diverse Life Experiences study baseline
Evidence on adverse childhood experiences (ACEs) and late-life cognitive outcomes is inconsistent, with little research among diverse racial/ethnic groups. We investigated whether ACE exposures were associated with worse late-life cognition for all racial/ethnic groups and at different ages of exposure.…
Fitting a shared frailty illness-death model to left-truncated semi-competing risks data to examine the impact of education level on incident dementia
Semi-competing risks arise when interest lies in the time-to-event for some non-terminal event, the observation of which is subject to some terminal event. One approach to assessing the impact of covariates on semi-competing risks data is through the illness-death model…
Physical Performance and Cognition in a Diverse Cohort: Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study
The authors assessed the cross-sectional association of physical function measures with cognition in the Kaiser Healthy Aging and Diverse Life Experiences Cohort. Analyses included 1369 participants (24% Asian, 26% Black, 18% Latino, 32% White). Grip strength was measured using a…
Cognitive impairment in racially/ethnically diverse older adults: Accounting for sources of diagnostic bias
The Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) study enrolled Asian, Black, Latino, and White adults ages 65+ without prior dementia diagnosis (N = 1709). We evaluated the prevalence of cognitive impairment (mild cognitive impairment or dementia) accounting for potential biases.…
Physical Performance and Cognition in a Diverse Cohort: Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study
The authors assessed the cross-sectional association of physical function measures with cognition in the Kaiser Healthy Aging and Diverse Life Experiences Cohort. Analyses included 1369 participants (24% Asian, 26% Black, 18% Latino, 32% White). Grip strength was measured using a…
Sex, diabetes status and cognition: findings from the study of longevity in diabetes
Women comprise two-thirds of people with dementia, making female sex a significant dementia risk factor. Both type 1 diabetes (T1D) and type 2 diabetes (T2D) are known dementia risk factors with an increasing global incidence. Understanding whether subtle sex differences…
Elevated Depressive Symptoms and the Risk of Stroke among the Mexican Older Population
Several longitudinal studies in high-income countries suggest that depression increases stroke risk. However, few prior studies have evaluated this association in low- and middle-income countries (LMICs), where rapidly aging populations may have markedly different vascular risk profiles. Prospective cohort study.…
Recurrent diabetic ketoacidosis and cognitive function among older adults with type 1 diabetes: findings from the Study of Longevity in Diabetes
Diabetic ketoacidosis (DKA) is a serious complication of diabetes. DKA is associated with poorer cognition in children with type 1 diabetes (T1D), but whether this is the case in older adults with T1D is unknown. Given the increasing life expectancy…
Glycemic Control and Dementia: The Role of Pharmacotherapy and Vascular Complications
About 25% of people over the age of 65 are living with diabetes, with 90% of them managing type 2 diabetes. Studies have shown that older individuals with type 2 diabetes have a 51-62% higher risk of dementia than those…
5 Questions for… Paola Gilsanz
Severe Hypoglycemia and Cognitive Function in Older Adults With Type 1 Diabetes: The Study of Longevity in Diabetes (SOLID)
In children with type 1 diabetes (T1D), severe hypoglycemia (SH) is associated with poorer cognition, but the association of SH with cognitive function in late life is unknown. Given the increasing life expectancy in people with T1D, understanding the role…
Racial/Ethnic Differences in Sleep Quality among Older Adults: Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study
We assessed cross-sectional differences in sleep quality and risk factors among Asian, Black, Latino, and White participants in the Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study. KHANDLE enrolled community-dwelling adults aged ≥65 years living in northern California. Participants…
Differences in association of leisure time activities and cognition in a racially/ethnically diverse cohort of older adults: Findings from the KHANDLE study
Leisure time activity is associated with better cognitive function but has not been well studied in racially/ethnically diverse cohorts, who may have different access to activities. Frequency of participation in 10 leisure time activities (eg, reading, attending cultural events) and…
Sleep Quality and Cognitive Function in Type 1 Diabetes: Findings From the Study of Longevity in Diabetes (SOLID)
The objective was to examine the association between sleep quality and global and domain-specific cognitive function among older individuals with type 1 diabetes (T1D). We evaluated 695 individuals with T1D aged 60 years or above who participated in the baseline…
Locus of Control and Cognition in Older Adults With Type I Diabetes: Evidence For Sex Differences From the Study of Longevity in Diabetes (SOLID)
Life expectancy for individuals with type 1 diabetes mellitus (T1DM) has increased recently; however, it is unknown how diabetes care attitudes affect late-life brain health. The Study of Longevity in Diabetes (SOLID) consists of 734 older adults with T1DM, reporting…
Is it possible to overcome the ‘long arm’ of childhood socioeconomic disadvantage through upward socioeconomic mobility?
Socioeconomically disadvantaged children have worse adult health; we test if this 'long arm' of childhood disadvantage can be overcome through upward socioeconomic mobility in adulthood. Four SES trajectories (stable low, upwardly mobile, downwardly mobile and stable high) were created from…
Contributions of Educational Quality and Occupational Complexity on Racial and Ethnic Inequities in Brain Health and Alzheimer’s Disease and Related Dementia
This study utilizes a lifecourse approach to evaluate the roles of education quality and occupational complexity on dementia risk and cognitive decline and to examine if patterns of educational quality and occupational complexity across the lifecourse drive racial and ethnic…
Initiation of antidepressant medication and risk of incident stroke: using the Adult Changes in Thought cohort to address time-varying confounding
Depression strongly predicts stroke incidence, suggesting that treating depression may reduce stroke risk. Antidepressant medications, however, may increase stroke risk via direct pathways. Previous evidence on antidepressant medication and stroke incidence is mixed. We evaluated associations between antidepressant use and…
Stressors in Midlife and Risk of Dementia: The Role of Race and Education
Posttraumatic stress disorder is associated with increased dementia risk but less is known about stress because of everyday problems in diverse populations. A total of 9605 health care plan members who provided information regarding midlife stressors in 1972 to 1973…
Reproductive period and risk of dementia in a diverse cohort of health care members
Women have >50% greater lifetime risk of dementia than men but the role of female-specific endocrine milieu is not well-understood. This study evaluates associations between indicators of estrogen exposure from women's reproductive period and dementia risk in a large diverse…
Incidence of dementia after age 90 in a multiracial cohort
Little is known about dementia incidence in diverse populations of oldest-old, the age group with highest dementia incidence. Incident dementia diagnoses from 1/1/2010 to 9/30/2015 were abstracted from medical records for 2350 members of an integrated health care system in…
Posttraumatic stress disorder symptoms and television viewing patterns in the Nurses’ Health Study II: A longitudinal analysis
The relation between TV viewing and posttraumatic stress disorder (PTSD) is controversial; prior work focused exclusively on whether TV viewing of disaster events constitutes a traumatic stressor that causes PTSD. This study evaluates a possible bidirectional relation between PTSD and…
Birth in High Infant Mortality States and Dementia Risk in a Cohort of Elderly African American and White Health Care Members
Birth in areas with high infant mortality rates (IMRs) has been linked to worse long-term health outcomes, yet it is completely unknown if it impacts dementia risk. In total 6268 health care members were followed for dementia diagnosis from 1996…
Early Midlife Pulmonary Function and Dementia Risk
Poor pulmonary function (PPF) is associated with increased risk of dementia, yet it is unclear if PPF in early adulthood to midlife increases risk, independent of smoking and subsequent vascular disease. This study evaluated the association between multiple markers of…
Traumatic brain injury associated with dementia risk among people with type 1 diabetes
To examine the association between traumatic brain injury (TBI) and dementia risk among a cohort of middle-aged and elderly individuals with type 1 diabetes (T1D). We evaluated 4,049 members of an integrated health care system with T1D ≥50 years old…
Long-term Glycemic Control and Dementia Risk in Type 1 Diabetes
Individuals with type 1 diabetes have experienced an increase in life expectancy; yet, it is unknown what level of glycemic control is ideal for maintaining late-life brain health. We investigated the association of long-term glycemic control with dementia in older…
Depression in type 1 diabetes and risk of dementia
Depression afflicts 14% of individuals with type 1 diabetes (T1D). Depression is a robust risk factor for dementia but it is unknown if this holds true for individuals with T1D, who recently started living to an age conferring dementia risk.…
Diabetic Retinopathy and Dementia in Type 1 Diabetes
Retinopathy impacts over one-third of those with diabetes mellitus and is associated with impaired cognitive performance and cerebrovascular lesions in middle-aged adults with type 1 diabetes. However, the association between diabetic retinopathy (DR) and risk of dementia in type 1…
Post-traumatic stress disorder and risk of dementia among members of a health care delivery system
Post-traumatic stress disorder (PTSD) is associated with an increased risk of dementia in male veterans, but little is known in females and civilians. PTSD and comorbidities were abstracted from medical records from 1/1/1996 to 12/31/2001. Dementia incidence from 1/1/2002 to…
The Bidirectional Association Between Depression and Severe Hypoglycemic and Hyperglycemic Events in Type 1 Diabetes
Severe hyperglycemia and hypoglycemia ("severe dysglycemia") are serious complications of type 1 diabetes (T1D). Depression has been associated with severe dysglycemia in type 2 diabetes but has not been thoroughly examined specifically in T1D. We evaluated bidirectional associations between depression…
Posttraumatic stress disorder onset and inflammatory and endothelial function biomarkers in women
BACKGROUND: Research has linked posttraumatic stress disorder (PTSD) with higher circulating levels of inflammatory and endothelial function (EF) biomarkers, and effects may be bidirectional. We conducted the first investigation of new-onset PTSD and changes in inflammatory and EF biomarkers.METHODS: Data…
Female sex, early-onset hypertension, and risk of dementia
To evaluate the association of early-adulthood and mid-adulthood hypertension with dementia in men and women. We evaluated 5,646 members of a diverse integrated health care delivery system who had clinical examinations and health survey data from 1964 to 1973 (mean…
Association Between Birth in a High Stroke Mortality State, Race, and Risk of Dementia
Birth in a group of predominantly southern US states is robustly linked to increased stroke risk. Given the role of cerebrovascular disease in dementia risk, geographic patterning may also occur for dementia incidence. To determine whether birth in 9 high…
Alzheimer’s disease genetic risk variants beyondAPOEε4 predict mortality
INTRODUCTION: We hypothesized that, like apolipoprotein E (APOE), other late-onset Alzheimer's disease (LOAD) genetic susceptibility loci predict mortality.METHODS: We used a weighted genetic risk score (GRS) from 21 non-APOELOAD risk variants to predict survival in the Adult Changes in Thought…
Cross-Sectional and Longitudinal Associations of Chronic Posttraumatic Stress Disorder With Inflammatory and Endothelial Function Markers in Women
BACKGROUND: Posttraumatic stress disorder (PTSD) may contribute to heightened cardiovascular disease risk by promoting a proinflammatory state and impaired endothelial function. Previous research has demonstrated associations of PTSD with inflammatory and endothelial function biomarkers, but most work has been cross-sectional…
Posttraumatic stress disorder and accelerated aging: PTSD and leukocyte telomere length in a sample of civilian women
BACKGROUND: Studies in male combat veterans have suggested posttraumatic stress disorder (PTSD) is associated with shorter telomere length (TL). We examined the cross-sectional association of PTSD with TL in women exposed to traumas common in civilian life.METHODS: Data are from…
Post-traumatic Stress Disorder and 20-Year Physical Activity Trends Among Women
INTRODUCTION: Post-traumatic stress disorder (PTSD) may be associated with physical inactivity, a modifiable lifestyle factor that contributes to risk of cardiovascular and other chronic diseases; however, no study has evaluated the association between PTSD onset and subsequent physical activity (PA)…
Cumulative receipt of an anti-poverty tax credit for families did not impact tobacco smoking among parents
The effect of anti-poverty tax credit interventions on tobacco consumption is unclear. Previous studies have estimated short-term effects, did not isolate the effects of cumulative dose of tax credits, produced conflicting results, and used methods with limited control for some…
Neighborhood Differences in Post-Stroke Mortality
BACKGROUND: Post-stroke mortality is higher among residents of disadvantaged neighborhoods, but it is not known whether neighborhood inequalities are specific to stroke survival or similar to mortality patterns in the general population. We hypothesized that neighborhood disadvantage would predict higher…
Post-traumatic stress disorder symptom duration and remission in relation to cardiovascular disease risk among a large cohort of women
BACKGROUND: Prior studies suggest that post-traumatic stress disorder (PTSD) is associated with elevated cardiovascular disease (CVD) risk, but effects of duration and remission of PTSD symptoms have rarely been evaluated.METHOD: We examined the association of time-updated PTSD symptom severity, remission…
Validation of a theoretically motivated approach to measuring childhood socioeconomic circumstances in the Health and Retirement Study
Childhood socioeconomic status (cSES) is a powerful predictor of adult health, but its operationalization and measurement varies across studies. Using Health and Retirement Study data (HRS, which is nationally representative of community-residing United States adults aged 50+ years), we specified…
Post-traumatic stress disorder and cardiometabolic disease: improving causal inference to inform practice
Post-traumatic stress disorder (PTSD) has been declared 'a life sentence' based on evidence that the disorder leads to a host of physical health problems. Some of the strongest empirical research - in terms of methodology and findings - has shown…
Changes in Depressive Symptoms and Subsequent Risk of Stroke in the Cardiovascular Health Study
BACKGROUND AND PURPOSE: Depression is associated with stroke, but the effects of changes in depressive symptoms on stroke risk are not well understood. This study examined whether depressive symptom changes across 2 successive annual assessments were associated with incident stroke…
Childhood Psychological Distress as a Mediator in the Relationship Between Early-Life Social Disadvantage and Adult Cardiometabolic Risk: Evidence From the 1958 British Birth Cohort
OBJECTIVES:Prior research on the relationship between early adversity and adult chronic disease has often relied on retrospective reports of a limited range of exposures and has not considered childhood psychological distress as a mediator. We investigate whether distress in childhood…
Post-traumatic stress disorder symptoms and risk of hypertension over 22 years in a large cohort of younger and middle-aged women
BACKGROUND:Post-traumatic stress disorder (PTSD) has been linked to hypertension, but most research on PTSD and hypertension is cross-sectional, and potential mediators have not been clearly identified. Moreover, PTSD is twice as common in women as in men, but understanding of…
Comparing Variability, Severity, and Persistence of Depressive Symptoms as Predictors of Future Stroke Risk
OBJECTIVE: Numerous studies show that depressive symptoms measured at a single assessment predict greater future stroke risk. Longer-term symptom patterns, such as variability across repeated measures or worst symptom level, might better reflect adverse aspects of depression than a single…
Associations of Trauma Exposure and Posttraumatic Stress Symptoms With Venous Thromboembolism Over 22 Years in Women
BACKGROUND:Trauma exposure and posttraumatic stress disorder (PTSD) have been linked to myocardial infarction and stroke in women, with biological and behavioral mechanisms implicated in underlying risk. The third most common cardiovascular illness, venous thromboembolism (VTE), is a specific health risk…
Neighborhood-level social processes and substantiated cases of child maltreatment
Child maltreatment is a preventable public health problem. Research has demonstrated that neighborhood structural factors (e.g. poverty, crime) can influence the proportion of a neighborhood's children who are victims of maltreatment. A newer strategy is the identification of potentially modifiable…
Dysregulated Blood Pressure: Can Regulating Emotions Help?
Despite having identified key physiological and behavioral risk factors, the prevalence of hypertension continues to rise, affecting two thirds of American adults 60 years or older. An important condition in its own right, hypertension is also a leading risk factor…
Psychological Distress Across the Life Course and Cardiometabolic Risk: Findings From the 1958 British Birth Cohort Study
BACKGROUND:Research suggests cardiovascular and metabolic diseases are influenced by psychological distress in adulthood; however, this research is often limited to adult populations and/or a snapshot measure of distress. Given emerging recognition that cardiometabolic diseases have childhood origins, an important question…
Body mass index and cognitive function: the potential for reverse causation
OBJECTIVE:Higher late life body mass index (BMI) is unrelated to or even predicts lower risk of dementia in late life, a phenomenon that may be explained by reverse causation due to weight loss during preclinical phases of dementia. We aim…
Changes in Depressive Symptoms and Incidence of First Stroke Among Middle-Aged and Older US Adults
BACKGROUND:Although research has demonstrated that depressive symptoms predict stroke incidence, depressive symptoms are dynamic. It is unclear whether stroke risk persists if depressive symptoms remit.METHODS AND RESULTS:Health and Retirement Study participants (n=16 178, stroke free and noninstitutionalized at baseline) were…
Early life predictors of atrial fibrillation-related mortality: evidence from the health and retirement study
Prior research found that Americans born in 6 southeastern states (the AF-risk zone) had elevated risk of AF-related mortality, but no mechanisms were identified. We hypothesized the association between AF-related mortality and AF-risk zone birth is explained by indicators of…
Does the association between depressive symptoms and cardiovascular mortality risk vary by race? Evidence from the Health and Retirement Study
OBJECTIVE:To test whether the association between depressive symptoms and cardiovascular disease (CVD) mortality is stronger among Blacks than Whites.DESIGN, SETTING AND PARTICIPANTS:2,638 Black and 15,132 White participants from a prospective, observational study of community-dwelling Health and Retirement Study participants (a…
Adiposity predicts carotid intima-media thickness in healthy children and adolescents
OBJECTIVE:To examine whether anthropometric measurements, blood pressure (BP), fasting total cholesterol, and low-density lipoprotein are related to ultrasound measures of carotid intima-media thickness (CIMT) in children and teenagers with no known risk factors for cardiovascular disease.STUDY DESIGN:This cross-sectional study included…
Evaluating parent satisfaction of school nursing services
The Conceptual Model of Nursing Health Policy (CMNHP) was used to guide this study of client satisfaction as one component of an ongoing assessment of the Essential School Health Service (ESHS) Programs conducted by the Massachusetts Department of Public Health.…
