Elena M. Andresen

Self-Rated Health: Changes, Trajectories, and Their Antecedents Among African Americans

Objective: Little is known about changes in self-rated health (SRH) among African Americans. Method: We examined SRH changes and trajectories among 998 African Americans 49 to 65 years old who we reinterviewed annually for 4 years, using multinomial logistic regression and mixed effect models. Results: Fifty-five percent had the same SRH at baseline and 4 years later, 25% improved, and 20% declined. Over time, men were more likely to report lower SRH levels, individuals with hypertension were less likely to report lower SRH levels, and those with congestive heart failure at baseline were more likely to report higher SRH levels. Lower SRH trajectory intercepts were observed for those with lower socioeconomic status, poorer health habits, disease history, and worse functional status. Those with better cognitive status had higher SRH trajectory intercepts. Discussion: The decline in SRH levels among 49- to 65-year-old African Americans is comparable to that of Whites.

Falls among adult patients hospitalized in the United States: prevalence and trends

Objectives The purpose of this study was to provide normative data on fall prevalence in U.S. hospitals by unit type and to determine the 27-month secular trend in falls before the implementation of the Centers for Medicare and Medicaid Service (CMS) rule, which does not reimburse hospitals for care related to injury resulting from hospital falls. Methods We used data from the National Database of Nursing Quality Indicators (NDNQI) collected between July 1, 2006, and September 30, 2008, to estimate prevalence and secular trends of falls occurring in adult medical, medical-surgical, and surgical nursing units. More than 88 million patient days (pd) of observation were contributed from 6100 medical, surgical, and medical-surgical nursing units in 1263 hospitals across the United States. Results A total of 315,817 falls occurred (rate = 3.56 falls/1000 pd) during the study period, of which, 82,332 (26.1%) resulted in an injury (rate = 0.93/1000 pd). Both total fall and injurious fall rates were highest in medical units (fall rate = 4.03/1000 pd; injurious fall rate = 1.08/1000 pd) and lowest in surgery units (fall rate = 2.76/1000 pd; injurious fall rate = 0.67/1000 pd). Falls (0.4% decrease per quarter, P < 0.0001) and injurious falls (1% decrease per quarter, P < 0.0001) both decreased over the 27-month study. Conclusions In this large sample, fall and injurious fall prevalence varied by nursing unit type in U.S. hospitals. Over the 27-month study, there was a small, but statistically significant, decrease in falls (P < 0.0001) and injurious falls (P < 0.0001).

Reproducibility of Physical Performance and Physiologic Assessments

We evaluate the test-retest stability of physical performance and physiologic assessments used in epidemiologic research. Method: Eighty subjects aged 50 to 65 were randomly selected from a probability sample of African Americans for test-retest assessments 5 to 45 days after baseline. Physical performance assessments included grip strength, chair stands, gait speed, and four standing-balance measures. Physiologic assessments included systolic and diastolic blood pressure, height, weight, body fat, and peak expiratory flow. Results: Intraclass correlations coefficients (ICCs) were .81 for grip strength, .72 for chair stands, .56 for gait speed, .60 for one-leg stand, .52 for semitandem stand, .58 for tandem stand with eyes closed, and .27 for tandem stand with eyes open. Except for blood pressure (ICCs of .51 and .55 for systolic and diastolic), the physiologic assessments had ICCs > .89. Discussion: Additional interviewer training may improve the reproducibility of the tandem stand with eyes open.

Health-Related Quality of Life Among Older Adults With and Without Functional Limitations

OBJECTIVES We examined factors that influence health-related quality of life (HRQOL) among individuals aged 50 years and older with and without functional limitations. METHODS We analyzed data from the 2009 Behavioral Risk Factor Surveillance System to assess associations among demographic characteristics, health care access and utilization indicators, modifiable health behaviors, and HRQOL characterized by recent physically and mentally unhealthy days in those with and those without functional limitations. We defined functional limitations as activity limitations owing to physical, mental, or emotional health or as the need for special equipment because of health. RESULTS Age, medical care costs, leisure-time physical activity, and smoking were strongly associated with both physically and mentally unhealthy days among those with functional limitations. Among those without functional limitations, the direction of the effects was similar, but the size of the effects was substantially smaller. CONCLUSIONS The availability of lower cost medical care, increasing leisure-time physical activity, and reducing rates of cigarette smoking will improve population HRQOL among older adults with and without functional limitations. These factors provide valuable information for determining future public health priorities.

Race differences in diagnosis and surgery for occupational low back injuries.

Study Design. Population-based telephone survey in Missouri. Objective. To examine the unique contribution of race to diagnosis and surgery rates in workers’ compensation claimants. Summary of Background Data. Race differences in diagnostic specificity and rates of surgery may mediate documented differences in workers’ compensation case management outcomes (treatment expenditures, disability ratings, and settlement awards) between African Americans and whites with low back injuries. Participants and Methods. African American (n = 580) and white (n = 892) workers’ compensation claimants with single-incident low back injuries were interviewed regarding diagnoses and treatments received for their injury. Participants were, on average, 21 months after settlement. Analyses examined the association of race (controlling for clinical findings, legal representation, age, gender, and socioeconomic status) with diagnosis (herniated disc vs. regional backache) and surgery. Risk ratios for race were calculated. Results. Whites were 40% more likely than African Americans to receive a herniated disc diagnosis. Of claimants with the latter diagnosis, whites were 110% more likely than African Americans to undergo surgery. Conclusions. Race differences in diagnosis and surgery may help to explain why African Americans, relative to whites, receive lower workers’ compensation medical expenditures, disability ratings, and settlement awards.

Pap, Mammography, and Clinical Breast Examination Screening Among Women with Disabilities: A Systematic Review

BACKGROUND Research has found some disparities between U.S. women with and without disabilities in receiving clinical preventive services. Substantial differences may also exist within the population of women with disabilities. The current study examined published research on Pap smears, mammography, and clinical breast examinations across disability severity levels among women with disabilities. METHODS Informed by an expert panel, we followed guidelines for systematic literature reviews and searched MEDLINE, PsycINFO, and Cinahl databases. We also reviewed in-depth four disability- or preventive service-relevant journals. Two reviewers independently extracted data from all selected articles. FINDINGS Five of 74 reviewed publications of met all our inclusion criteria and all five reported data on Pap smears, mammography, and clinical breast examination. Articles classified disability severity groups by functional and/or activity levels. Associations between disability severity and Pap smear use were inconsistent across the publications. Mammography screening fell as disability level increased according to three of the five studies. Results demonstrated modestly lower screening, but also were inconsistent for clinical breast examinations across studies. CONCLUSION Evidence is inconsistent concerning disparities in these important cancer screening services with increasing disability levels. Published studies used differing methods and definitions, adding to concerns about the evidence for screening disparities rising along with increasing disability. More focused research is required to determine whether significant disparities exist in cancer screening among women with differing disability levels. This information is essential for national and local public health and health care organizations to target interventions to improve care for women with disabilities.

Age at disability onset and self-reported health status.

BackgroundThe critical importance of improving the well-being of people with disabilities is highlighted in many national health plans. Self-reported health status is reduced both with age and among people with disabilities. Because both factors are related to health status and the influence of the age at disability onset on health status is unclear, we examined the relationship between disability onset and health status.MethodsThe U.S. 1998–2000 Behavioral Risk Factor Surveillance system (BRFSS) provided data on 11,905 adults with disability. Bivariate logistic regression analysis modeled the relationship between age at disability onset (based on self-report of duration of disability) and fair/poor self-perceived health status, adjusting for confounding variables.ResultsKey variables included demographics and other measures related to disability and general health status. Disability onset after 21 years of age showed significant association with greater prevalence of fair/poor health compared to early disability onset, even adjusting for current age and other demographic covariates. Compared with younger onset, the adjusted odds ratios (OR) were ages 22–44: OR 1.52, ages 45–64: OR 1.67, and age ≥65: OR 1.53.ConclusionThis cross-sectional study provides population-level, generalizable evidence of increased fair or poor health in people with later onset disability compared to those with disability onset prior to the age of 21 years. This finding suggests that examining the general health of people with and those without disabilities might mask differences associated with onset, potentially relating to differences in experience and self-perception. Future research relating to global health status and disability should consider incorporating age at disability onset. In addition, research should examine possible differences in the relationship between age at onset and self-reported health within specific impairment groups.

Neighbourhood environment and the incidence of depressive symptoms among middle-aged African Americans

Aim: To investigate the association between attributes of subject location and incidence of clinically relevant levels of depressive symptoms (CRLDS), and to investigate whether an association remained after adjusting for individual-level factors using data from the population-based African American Health Study. Methods: An 11-item depression scale (Center for Epidemiologic Studies Depression scale) was obtained at baseline and 3 years later through in-home evaluations. Census tract and block group deprivation indices were obtained from the 2000 census. The external appearance of the block where the subject lived was rated during sample enumeration, and the interior and exterior of the subject’s dwelling were observed during the initial in-home interview. Results: Of 998 subjects at baseline, 21.1% had CRLDS. Although 12.7% of the 672 people without CRLDS at baseline developed them by the 3-year follow-up, univariate and propensity-adjusted analyses revealed no association between the subject’s location and the incidence of CRLDS. Sensitivity analyses confirmed the robustness of the findings. Conclusion: Despite other studies showing independent effects of neighbourhood characteristics on the prevalence of CRLDS, attributes of subject location are not independent contributors to the incidence of CRLDS in middle-aged urban African Americans.

Adult Caregivers in the United States: Characteristics and Differences in Well-being, by Caregiver Age and Caregiving Status

We examined the characteristics of adults providing regular care or assistance to friends or family members who have health problems, long-term illnesses, or disabilities (ie, caregivers). We used data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) to examine caregiver characteristics, by age and caregiving status, and compare these characteristics with those of noncaregivers. Approximately 24.7% (95% confidence interval, 24.4%–25.0%) of respondents were caregivers. Compared with younger caregivers, older caregivers reported more fair or poor health and physical distress but more satisfaction with life and lower mental distress. Understanding the characteristics of caregivers can help enhance strategies that support their role in providing long-term care.

Disparities in Health Care Access and Receipt of Preventive Services by Disability Type: Analysis of the Medical Expenditure Panel Survey

OBJECTIVE To examine differences in access to health care and receipt of clinical preventive services by type of disability among working-age adults with disabilities. DATA SOURCE Secondary analysis of Medical Expenditure Panel Survey (MEPS) data from 2002 to 2008. STUDY DESIGN We conducted cross-sectional logistic regression analyses comparing people with different types of disabilities on health insurance status and type; presence of a usual source of health care; delayed or forgone care; and receipt of dental checkups and cancer screening. DATA COLLECTION We pooled annualized MEPS data files across years. Our analytic sample consisted of adults (18-64 years) with physical, sensory, or cognitive disabilities and nonmissing data for all variables of interest. PRINCIPAL FINDINGS Individuals with hearing impairment had better health care access and receipt than people with other disability types. People with multiple types of limitations were especially likely to have health care access problems and unmet health care needs. CONCLUSIONS There are differences in health care access and receipt of preventive care depending on what type of disability people have. More in-depth research is needed to identify specific causes of these disparities and assess interventions to address health care barriers for particular disability groups.