Lesbian, Gay, and Bisexual Adults Have Higher Prevalence of Illicit Opioid Use than Heterosexual Adults: Evidence from the National Survey on Drug Use and Health, 2015-2017

Purpose: We estimated illicit opioid use prevalence among LGB and heterosexual adults. Methods: Cross-sectional National Survey on Drug Use and Health data (2015-2017) were used to estimate illicit opioid use prevalence by sexual identity, age, and gender. Results: An estimated 1.1 million LGB adults used illicit opioids in the preceding 12 months (LGB adults: 9.8%; heterosexual adults: 4.24%). Prevalence of illicit opioid use was significantly higher among LGB women aged /bisexual men (18-25 and 50 +) compared with their heterosexual counterparts. Conclusions: Interventions targeting LGB illicit opioid use should account for possible differential minority stress associated with age and gender

Do determinants of hypertension status vary between Ghana and South Africa? Study on global AGEing and adult health

Objectives: Determinants of hypertension prevalence, diagnosis and control are poorly understood in sub-Saharan Africa, including whether these determinants vary between and among countries.Methods: A cross-sectional analysis of Study on global AGEing and adult health (SAGE) data, nationally representative samples of adults aged 50+ (n=3 458 South Africa; n=4 196 in Ghana). Hypertension prevalence and status (awareness, treatment and control) were determined from directly measured blood pressure and respondents’ self-reported history of hypertension diagnosis and current treatment status. Sex-stratified, multivariable adjusted logistic regression models were used to test cross-country differences in demographic, socio-economic, environmental, and health-related determinants of hypertension prevalence and status.Results: South Africans had higher age-standardised prevalence of hypertension (Men: 76%, Women: 82%) compared to Ghana (Men: 57%, Women: 61%). Odds of hypertension prevalence varied for rural residence and education varied between country. Consistent differences in awareness of hypertension between countries included education, income, and weight status by sex; sex-specific differences between countries were also apparent. Determinants of control and management of hypertension (education) differed between countries only for women.Conclusions: Behavioural, environmental, and social determinants all influence hypertension prevalence and status for middle and older-age adults in sub-Saharan Africa, although differently between countries

Historical Differences in School Term Length and Measured Blood Pressure: Contributions to Persistent Racial Disparities among US-Born Adults

Introduction Legally mandated segregation policies dictated significant differences in the educational experiences of black and white Americans through the first half of the 20th century, with markedly lower quality in schools attended by black children. We determined whether school term length, a common marker of school quality, was associated with blood pressure and hypertension among a cohort of older Americans who attended school during the de jure segregation era. Methods National Health and Nutrition Examination Survey I and II data were linked to state level historical information on school term length. We used race and gender-stratified linear regression models adjusted for age, state and year of birth to estimate effects of term length on systolic and diastolic blood pressure (SBP and DBP) and hypertension for US-born adults. We also tested whether correcting years of schooling for term length differences attenuated estimated racial disparities. Results Among black women, 10% longer school term was associated with lower SBP, DBP and hypertension prevalence (2.1 mmHg, 1.0 mmHg, and 5.0 percentage points respectively). Associations for whites and for black men were not statistically significant. Adjustment for education incorporating corrections for differences in school term length slightly attenuated estimated racial disparities. Conclusions Longer school term length predicted better BP outcomes among black women, but not black men or whites

Historical Differences in School Term Length and Measured Blood Pressure: Contributions to Persistent Racial Disparities among US- Born Adults

IntroductionLegally mandated segregation policies dictated significant differences in the educational experiences of black and white Americans through the first half of the 20th century, with markedly lower quality in schools attended by black children. We determined whether school term length, a common marker of school quality, was associated with blood pressure and hypertension among a cohort of older Americans who attended school during the de jure segregation era.MethodsNational Health and Nutrition Examination Survey I and II data were linked to state-level historical information on school term length. We used race and gender-stratified linear regression models adjusted for age, state, and year of birth to estimate effects of term length on systolic and diastolic blood pressure (SBP and DBP) and hypertension for US-born adults. We also tested whether correcting years of schooling for term length differences attenuated estimated racial disparities.ResultsAmong black women, 10% longer school term was associated with lower SBP, DBP, and hypertension prevalence (2.1 mmHg, 1.0 mmHg, and 5.0 percentage points respectively). Associations for whites and for black men were not statistically significant. Adjustment for education incorporating corrections for differences in school term length slightly attenuated estimated racial disparities.ConclusionsLonger school term length predicted better BP outcomes among black women, but not black men or whites

Stroke-Associated Differences in Rates of Activity of Daily Living Loss Emerge Years Before Stroke Onset

To compare typical age-related changes in activities of daily living (ADL) independence in stroke-free adults to long-term ADL trajectories before and after stroke

The Disability Burden Associated With Stroke Emerges Before Stroke Onset and Differentially Affects Blacks: Results From the Health and Retirement Study Cohort

Background. Few longitudinal studies compare changes in instrumental activities of daily living (IADLs) among stroke-free adults to prospectively document IADL changes among adults who experience a stroke. We contrast annual declines in IADL independence for older individuals who remain stroke-free to those for individuals who experienced a stroke. We also assess whether these patterns differ by sex, race, or Southern birthplace. Methods. Health and Retirement Study participants who were stroke-free in 1998 (n = 17,741) were followed through 2010 (average follow-up = 8.9 years) for self- or proxy-reported stroke. We used logistic regressions to compare annual changes in odds of self-reported independence in six IADLs among those who remained stroke-free throughout follow-up (n = 15,888), those who survived a stroke (n = 1,412), and those who had a stroke and did not survive to participate in another interview (n = 442). We present models adjusted for demographic and socioeconomic covariates and also stratified on sex, race, and Southern birthplace. Results. Compared with similar cohort members who remained stroke-free, participants who developed stroke had faster declines in IADL independence and a lower probability of IADL independence prior to the stroke. After a stroke, independence declined at an annual rate similar to those who did not have a stroke. The black-white disparity in IADL independence narrowed poststroke. Conclusion. Racial differences in IADL independence are apparent long before stroke onset. Poststroke differences in IADL independence largely reflect pre stroke disparities

Elevated Depressive Symptoms and Incident Stroke in Hispanic, African-American, and White Older Americans

Although depressive symptoms have been linked to stroke, most research has been in relatively ethnically homogeneous, predominantly white, samples. Using the United States based Health and Retirement Study, we compared the relationships between elevated depressive symptoms and incident first stroke for Hispanic, black, or white/other participants (N = 18,648) and estimated the corresponding Population Attributable Fractions. The prevalence of elevated depressive symptoms was higher in blacks (27%) and Hispanics (33%) than whites/others (18%). Elevated depressive symptoms prospectively predicted stroke risk in the whites/other group (HR = 1.53; 95% CI: 1.36–1.73) and among blacks (HR = 1.31; 95% CI: 1.05–1.65). The HR was similar but only marginally statistically significant among Hispanics (HR = 1.33; 95% CI: 0.92–1.91). The Population Attributable Fraction, indicating the percent of first strokes that would be prevented if the incident stroke rate in those with elevated depressive symptoms was the same as the rate for those without depressive symptoms, was 8.3% for whites/others, 7.8% for blacks, and 10.3% for Hispanics

Does Duration of Spousal Caregiving Affect Risk of Depression Onset? Evidence from the Health and Retirement Study

To assess the association of current and long-term spousal caregiving with risk of depression in a nationally (U.S.) representative sample of older adults

Operationalizing Frailty in the Atherosclerosis Risk in Communities Study Cohort

Background: Factors that may contribute to the development of frailty in late life have not been widely investigated. The Atherosclerosis Risk in Communities (ARIC) Study cohort presents an opportunity to examine relationships of midlife risk factors with frailty in late life. However, we first present findings on the validation of an established frailty phenotype in this predominantly biracial population of older adults. Methods: Among 6,080 participants, we defined frailty based upon the Cardiovascular Health Study (CHS) criteria incorporating measures of weight loss, exhaustion, slow walking speed, low physical activity, and low grip strength. Criterion and predictive validity of the frailty phenotype were estimated from associations between frailty status and participants' physical and mental health status, physiologic markers, and incident clinical outcomes. Results: A total of 393 (6.5%) participants were classified as frail and 50.4% pre-frail, similar to CHS (6.9% frail, 46.6% pre-frail). In age-adjusted analyses, frailty was concurrently associated with depressive symptoms, low self-rated health, low medication adherence, and clinical biomarker levels (ie, cholesterol, hemoglobin A1c, white blood cell count, C-reactive protein, and hemoglobin). During 1-year follow-up, frailty was associated with falls, low physical ability, fatigue, and mortality. Conclusions: These findings support the validity of the CHS frailty phenotype in the ARIC Study cohort. Future studies in ARIC may elucidate early-life exposures that contribute to late-life frailty