Chenkai Wu

Visit-to-Visit Blood Pressure Variability and Mortality and Cardiovascular Outcomes Among Older Adults: The Health, Aging, and Body Composition Study.

BACKGROUND Level of blood pressure (BP) is strongly associated with cardiovascular (CV) events and mortality. However, it is questionable whether mean BP can fully capture BP-related vascular risk. Increasing attention has been given to the value of visit-to-visit BP variability. METHODS We examined the association of visit-to-visit BP variability with mortality, incident myocardial infarction (MI), and incident stroke among 1,877 well-functioning elders in the Health, Aging, and Body Composition Study. We defined visit-to-visit diastolic BP (DBP) and systolic BP (SBP) variability as the root-mean-square error of person-specific linear regression of BP as a function of time. Alternatively, we counted the number of considerable BP increases and decreases (separately; 10mm Hg for DBP and 20mm Hg for SBP) between consecutive visits for each individual. RESULTS Over an average follow-up of 8.5 years, 623 deaths (207 from CV disease), 153 MIs, and 156 strokes occurred. The median visit-to-visit DBP and SBP variability was 4.96 mmHg and 8.53 mmHg, respectively. After multivariable adjustment, visit-to-visit DBP variability was related to higher all-cause (hazard ratio (HR) = 1.18 per 1 SD, 95% confidence interval (CI) = 1.01–1.37) and CV mortality (HR = 1.35, 95% CI = 1.05–1.73). Additionally, individuals having more considerable decreases of DBP (≥10mm Hg between 2 consecutive visits) had higher risk of all-cause (HR = 1.13, 95% CI = 0.99–1.28) and CV mortality (HR = 1.30, 95% CI = 1.05–1.61); considerable increases of SBP (≥20mm Hg) were associated with higher risk of all-cause (HR = 1.18, 95% CI = 1.03–1.36) and CV mortality (HR = 1.37, 95% CI = 1.08–1.74). CONCLUSIONS Visit-to-visit DBP variability and considerable changes in DBP and SBP were risk factors for mortality in the elderly.

Association of retirement age with mortality: a population-based longitudinal study among older adults in the USA

Background Retirement is an important transitional process in later life. Despite a large body of research examining the impacts of health on retirement, questions still remain regarding the association of retirement age with survival. We aimed to examine the association between retirement age and mortality among healthy and unhealthy retirees and to investigate whether sociodemographic factors modified this association. Methods On the basis of the Health and Retirement Study, 2956 participants who were working at baseline (1992) and completely retired during the follow-up period from 1992 to 2010 were included. Healthy retirees (n=1934) were defined as individuals who self-reported health was not an important reason to retire. The association of retirement age with all-cause mortality was analysed using the Cox model. Sociodemographic effect modifiers of the relation were examined. Results Over the study period, 234 healthy and 262 unhealthy retirees died. Among healthy retirees, a 1-year older age at retirement was associated with an 11% lower risk of all-cause mortality (95% CI 8% to 15%), independent of a wide range of sociodemographic, lifestyle and health confounders. Similarly, unhealthy retirees (n=1022) had a lower all-cause mortality risk when retiring later (HR 0.91, 95% CI 0.88 to 0.94). None of the sociodemographic factors were found to modify the association of retirement age with all-cause mortality. Conclusions Early retirement may be a risk factor for mortality and prolonged working life may provide survival benefits among US adults.

Prevalence and Correlates of Frailty Among Community-Dwelling Chinese Older Adults: The China Health and Retirement Longitudinal Study

Background Frailty is an age-related clinical syndrome of decreased resilience to stressors and is associated with numerous adverse outcomes. Although there is preponderance of literature on frailty in developed countries, limited investigations have been conducted in less developed regions including China-a country that has the worlds largest aging population. We examined frailty prevalence in China by sociodemographics and geographic region, and investigated correlates of frailty. Methods Participants were 5,301 adults aged ≥60 years from the China Health and Retirement Longitudinal Study. Frailty was identified by the validated physical frailty phenotype (PFP) scale. We estimated frailty prevalence in the overall sample and by sociodemographics. We identified age-adjusted frailty prevalence by geographical region. Bivariate associations of frailty with health and function measures were evaluated by chi-squared test and analysis of variance. Results We found 7.0% of adults aged 60 years or older were frail. Frailty is more prevalent at advanced ages, among women, and persons with low education. Age-adjusted frailty prevalence ranged from 3.3% in the Southeast and the Northeast to 9.1% in the Northwest, and was more than 1.5 times higher in rural versus urban areas. Frail versus nonfrail persons had higher prevalence of comorbidities, falls, disability, and functional limitation. Conclusions We demonstrated the utility of the PFP scale in identifying frail Chinese elders, and found substantial sociodemographic and regional disparities in frailty prevalence. The PFP scale may be incorporated into clinical practice in China to identify the most vulnerable elders to reduce morbidity, prevent disability, and enable more efficient use of health care resources.

A Modified Healthy Aging Index and Its Association with Mortality: The National Health and Nutrition Examination Survey, 1999–2002

Background Comorbidity indices that are based on clinically recognized disease do not capture the full spectrum of health. The Healthy Aging Index (HAI) was recently developed to describe a wider range of health and disease across multiple organ systems. We characterized the distribution of a modified HAI (mHAI) by sociodemographics in a representative sample of the U.S. population. We also examined the association of the mHAI with mortality across individuals with different levels of clinically recognizable comorbidities. Methods Data are from the National Health and Nutrition Examination Survey (1999-2000, 2001-2002) on 2,451 adults aged 60 years or older. Five mHAI components (systolic blood pressure, Digit Symbol Substitution Test, cystatin C, glucose, and respiratory problems) were scored 0 (healthiest), 1, or 2 (unhealthiest) by sex-specific tertiles or clinically relevant cutoffs and summed to construct the mHAI. Results The mean mHAI score was 4.3; 20.6% had a score of 0-2. 33.2% had a score of 3-4, 31.0% had a score of 5-6, and 15.2% had a score of 7-10. Mean mHAI scores were lower in adults who were younger, non-Hispanic whites, more educated, and married/living with partner. After multivariate adjustment, per unit higher of the mHAI was associated with higher all-cause mortality (HR = 1.19, 95% CI = 1.11-1.27) and higher cardiovascular mortality (HR = 1.23, 95% CI = 1.11-1.35). Within each comorbidity category (0, 1, 2, 3, 4+), the mHAI was still widely distributed and further stratified mortality. Conclusions Substantial variation exists in the mHAI across sociodemographic subgroups. The mHAI could provide incremental value for mortality risk prediction beyond clinically diagnosed chronic diseases among elders.

Functional Status Modifies the Association of Blood Pressure with Death in Elders: Health and Retirement Study

To examine whether grip strength, gait speed, and the combination of the two physical functioning measures modified the association of systolic BP (SBP) and diastolic BP (DBP) with mortality.

Index of Healthy Aging in Chinese Older Adults: China Health and Retirement Longitudinal Study: Chinese Healthy Aging Index

To characterize the distribution of an index of healthy aging—the Chinese Healthy Aging Index (CHAI)—in Chinese adults aged 60 and older according to sociodemographic characteristics and geographic region and to examine the association between the CHAI and mortality, disability, and functional limitation over 4 years.

Reply to: Systolic Blood Pressure and Mortality: Role of Reverse Causation

Financial Disclosure: This work was supported in part through funding from R01 HL 10741 (MAS), The Veterans Affairs Salt Lake City Geriatric Research, Education, and Clinical Center, (MAS), HHSN268200900040C (NMP), and P30 AG21332 for The Wake Forest School of Medicine Claude D. Pepper Older Americans Independence Center (JDW), National Institutes of Health Heart, Lung, and Blood Institute and National Institute on Aging. Conflict of Interest: Dr. Supiano is a member of the boards of the American Geriatrics Society and the Association of Directors of Academic Geriatric Programs and is on the Journal of the American Geriatrics Society Editorial Board. Author Contributions: All authors: concept and design, analysis and interpretation of data, manuscript writing and revision. Sponsor’s Role: The content and the views expressed in this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health, the U.S. Department of Veterans Affairs, the U.S. government, or the SPRINT Research Group.

Development, Construct Validity, and Predictive Validity of a Continuous Frailty Scale: Results From 2 Large US Cohorts

Frailty is an age-related clinical syndrome of decreased resilience to stressors. Among numerous assessments of frailty, the frailty phenotype (FP) scale proposed by Fried et al. has been the most widely used. We aimed to develop a continuous frailty scale that could overcome limitations facing the categorical FP scale and to evaluate its construct validity, predictive validity, and measurement properties. Data were from the Cardiovascular Health Study (n = 4,243) and Health and Retirement Study (n = 7,600), both conducted in the United States. Frailty was conceptualized as a continuous construct, assessed by 5 measures used in the FP scale: gait speed, grip strength, exhaustion, physical activity, and weight loss. We used confirmatory factor analysis to investigate the relationship between the 5 indicators and the latent frailty construct. We examined the association of the continuous frailty scale with mortality and disability. The unidimensional model fit the data satisfactorily; similar factor structure was observed across 2 cohorts. Gait speed and weight loss were the strongest and weakest indicators, respectively; grip strength, exhaustion, and physical activity had similar strength in measuring frailty. In each cohort, the continuous frailty scale was strongly associated with mortality and disability and continued to be associated with outcomes among robust and prefrail persons classified by the FP scale.

Abstract B26: The effect of neighborhood context on physical and mental health among ethnic minority breast cancer survivors

Background: Contextual determinants of health risk and outcomes, including physical and social environments, are increasing priority areas for health disparities research and practice. Individual-level social determinants of health among ethnic minority cancer survivors, such as education and income, have been well documented. However, little is known about the effect of neighborhood context on health among this vulnerable population. Learning more about the source and relative impact of health determinants is especially critical to public health and policy strategies to promote address health disparities and improve health equity. Purpose: This study examined the relationship between neighborhood context and patient reported outcomes. Specifically, we hypothesized that greater neighborhood stress would be significantly related to poorer physical and mental health status in post-treatment Latina (LBCS) and African-American breast cancer survivors (AABCS). Method: We used a mixed-methods recruitment approach to enroll 320 LBCS and AABCS from population-based sources. Neighborhood context was assessed using a self-rated neighborhood stress scale for the following aspects of neighborhood context: housing situation, neighborhood environment, transportation, availability of public services, crime and violence, and relation with police. Two domains of health were used: general health, measured by five-point Likert-type item along with the number of self-reported comorbidities; and mental health, assessed using the Center for Epidemiologic Studies Depression (CES-D) Scale, in conjunction with self-reported psychological difficulties. Results: Of the participants, 88 (27.5%) self-identified as African American and 232 (72.5%) self-identified as Latina. Participant age ranged from 26 to 89 years with a mean of 54.49 years (SD =11.49). LBCS were older, less educated, and more financially disadvantaged (p Conclusion: Self-reported neighborhood contextual factors were shown to be an influential predictor of physical and mental health among both AABCS and LBCS. These findings underscore the importance of taking neighborhood context into account in investigating health outcomes. The impact of contextual determinants, including neighborhood resources, on cancer-related and overall physical and mental health requires further investigations. Future studies should incorporate population level data, e.g., census tract, to obtain a fuller picture of neighborhood status and resources to better inform interventions and/or policies to improve health outcomes among lower income and vulnerable populations. Citation Format: Mayra Serrano, Kimlin Ashing, Lisa Barcelo, Chenkai Wu. The effect of neighborhood context on physical and mental health among ethnic minority breast cancer survivors. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B26.