Mary McEniry

The Tide to Come Elderly Health in Latin America and the Caribbean

This article introduces a conjecture and reviews partial evidence about peculiarities in the aging of populations in Latin America and the Caribbean (LAC) that may impact future elderly health status. Using Survey on Health and Well-Being of Elders data (SABE; n = 10,902), the authors estimated effects of early childhood conditions on adult diabetes and heart disease. Using Waaler-type surfaces, the authors obtained expected mortality risks for SABE and also U.S. elderly (Health and Retirement System, n = 12,527). Expected mortality risks using Waaler-type surfaces among elderly in LAC reflected excesses supporting our conjecture. There was partial evidence of a relation between various indicators of early childhood nutritional status (knee height, waist-to-hip ratio) and diabetes and even stronger evidence of a relation between rheumatic fever and adult heart disease. There is some evidence, albeit weak, to suggest that the conjecture regarding elderly health status’ connection to early conditions has some merit.

Early Life Exposures and the Occurrence and Timing of Heart Disease Among the Older Adult Puerto Rican Population

Few studies have examined the effects of early life conditions on the timing of the onset of heart disease. We use the remarkable example of a representative sample of the population of older Puerto Ricans aged 60– 74 who lived in the countryside during childhood (n = 1,438) to examine the effects of seasonal exposures to poor nutrition and infectious diseases during late gestation on the timing of the onset and the probability of ever experiencing adult heart disease. Cox and log logistic hazard models controlling for childhood conditions (self-reported childhood health status and socioeconomic status [SES], rheumatic fever, and knee height) and adult risk factors (adult SES, obesity, smoking, texercise, and self-reported diabetes) showed that the risk of onset of heart disease was 65% higher among those born during high-exposure periods compared with unexposed individuals. However, there were no significant differences in median time of onset for those ever experiencing heart disease. As a comparison, we found that there were no significant seasonality effects for those who lived in urban areas during childhood. We conclude that early exposures in utero have important ramifications for adult heart disease among the older Puerto Rican population. We show, however, that while exposure is associated with the probability of ever experiencing adult heart disease, it is not associated with the timing of onset among those who do experience it.

A model for the treatment of cancer pain

Abstract Previous suggested protocols for the management of cancer pain have focused solely on the use of systemic analgesics. Studies of other modalities of pain management have reported the effectiveness of single methods of therapy (such as nerve blocks or surgical ablation). In response to the increasing recognition that cancer pain may be difficult to manage with any single-modality therapy, we used an expert (or consensual) panel method to propose how multiple therapies (analgesics, neuroablative procedures, and other non-drug therapies) might be combined in the management of patients with progressive pain. The product of this method is a decision tree suggesting the steps at which to consider various combined therapies dependent upon response to prior treatment. The decision tree is expected to have utility as an educational tool as well as a basis for generating testable hypotheses about the effectiveness of combined therapies for future clinical research.

The influence of early conditions on health status among elderly Puerto Ricans

Abstract The demographic origins of aging in Puerto Rican and other Latin American and Caribbean (LAC) countries may have important implications for the profile of health status and mortality of elderly people. For this article we tested a general conjecture about the relation between early childhood conditions and adult health status among Puerto Rican elderly using a rich data set recently collected through an island‐wide survey (N=4,293). We examined the association between markers of early nutritional status, self‐reports of health and on socioeconomic conditions during early childhood, and the prevalence of 3 conditions during adult ages: obesity, diabetes, and cardiovascular diseases. Although we found that obesity and diabetes are associated with markers of early malnutrition, that heart disease is associated with early deprivations and selected early childhood conditions, the evidence we were able to tease out from the data provides only fragile support for the conjecture.

Promises and Pitfalls of Anchoring Vignettes in Health Survey Research.

Data harmonization is a topic of growing importance to demographers, who increasingly conduct domestic or international comparative research. Many self-reported survey items cannot be directly compared across demographic groups or countries because these groups differ in how they use subjective response categories. Anchoring vignettes, already appearing in numerous surveys worldwide, promise to overcome this problem. However, many anchoring vignettes have not been formally evaluated for adherence to the key measurement assumptions of vignette equivalence and response consistency. This article tests these assumptions in some of the most widely fielded anchoring vignettes in the world: the health vignettes in the World Health Organization (WHO) Study on Global AGEing and Adult Health (SAGE) and World Health Survey (WHS) (representing 10 countries; n = 52,388), as well as similar vignettes in the Health and Retirement Study (HRS) (n = 4,528). Findings are encouraging regarding adherence to response consistency, but reveal substantial violations of vignette equivalence both cross-nationally and across socioeconomic groups. That is, members of different sociocultural groups appear to interpret vignettes as depicting fundamentally different levels of health. The evaluated anchoring vignettes do not fulfill their promise of providing interpersonally comparable measures of health. Recommendations for improving future implementations of vignettes are discussed.

Infant mortality, season of birth and the health of older Puerto Rican adults

The increasing prevalence of heart disease and diabetes among aging populations in low and middle income countries leads to questions regarding the degree to which endogenous early life exposures (exposures in utero) are important determinants of these health conditions. We devised a test using infant mortality (IMR) to verify if season of birth is a good indicator of early life (in utero) conditions that precipitate adult onset of disease. We linked annual IMR at the municipality (municipio) level from the late 1920s to early 1940s with individual birth year and place using a representative sample of older Puerto Rican adults (n = 1447) from the Puerto Rican Elderly: Health Conditions (PREHCO) study. We estimated the effects of season of birth on adult heart disease and diabetes for all respondents and then for respondents according to whether they were born when IMR was lower or higher, controlling for age, gender, obesity, respondents educational level, adult behavior (smoking and exercise) and other early life exposures (childhood health, knee height and childhood socioeconomic status (SES)). The pattern of effects suggests that season of birth reflects endogenous causes: (1) odds of heart disease and diabetes were strong and significant for those born during the lean season in years when IMR was lower; (2) effects remained consistent even after controlling for other childhood conditions and adult behavior; but (3) no seasonality effects on adult health for adults born when IMR was higher. We conclude that in this population of older Puerto Rican adults there is continued support that the timing of adverse endogenous (in utero) conditions such as poor nutrition and infectious diseases is associated with adult heart disease and diabetes. It will be important to test the validity of these findings in other similar populations in the developing world.

Patterns of SES Health Disparities Among Older Adults in Three Upper Middle- and Two High-Income Countries

Objectives To examine the socioeconomic status (SES) health gradient for obesity, diabetes, and hypertension within a diverse group of health outcomes and behaviors among older adults (60+) in upper middle-income countries benchmarked with high-income countries. Method We used data from three upper middle-income settings (Colombia-SABE-Bogotá, Mexico-SAGE, and South Africa-SAGE) and two high-income countries (England-ELSA and US-HRS) to estimate logistic regression models using age, gender, and education to predict health and health behaviors. Results The sharpest gradients appear in middle-income settings but follow expected patterns found in high-income countries for poor self-reported health, functionality, cognitive impairment, and depression. However, weaker gradients appear for obesity, hypertension, diabetes, and other chronic conditions in Colombia and Mexico and the gradient reverses in South Africa. Strong disparities exist in risky health behavior and in early nutritional status in the middle-income settings. Discussion Rapid demographic and nutritional transitions, urbanization, poor early life conditions, social mobility, negative health behavior, and unique country circumstances provide a useful framework for understanding the SES health gradient in middle-income settings. In contrast with high-income countries, the increasing prevalence of obesity, an important risk factor for chronic conditions and other aspects of health, may ultimately change the SES gradient for diseases in the future.

Early Life Displacement Due to Armed Conflict and Violence, Early Nutrition, and Older Adult Hypertension, Diabetes, and Obesity in the Middle-Income Country of Colombia

Objective: We examine the importance of early life displacement and nutrition on hypertension (HTN) and diabetes in older Colombian adults (60+ years) exposed to rapid demographic, epidemiological, and nutritional transitions, and armed conflict. We compare early life nutritional status and adult health in other middle- and high-income countries. Method: In Colombia (Survey of Health, Wellbeing and Aging [SABE]-Bogotá), we estimate the effects of early life conditions (displacement due to armed conflict and violence, hunger, low height, and not born in the capital city) and obesity on adult health; we compare the effects of low height on adult health in Mexico, South Africa (Study on Global Ageing and Adult Health [SAGE]), the United States, and England (Health and Retirement Study [HRS], English Longitudinal Study of Ageing [ELSA]). Results: Early life displacement, early poor nutrition, and adult obesity increase the risk of HTN and diabetes in Colombia. Being short is most detrimental for HTN in Colombian males. Discussion: Colombian data provide new evidence into how early life conditions and adult obesity contribute to older adult health.