Recent scholarship suggests a significant association between cross-border ties, or ties maintained with family and friends in countries and communities of origin, and the mental health of immigrants and their descendants. To date, this research has been exclusively cross-sectional, precluding conclusions about a causal association between cross-border ties and mental health outcomes. In the present study we undertake a longitudinal analysis of the relationship between cross-border ties and depression measured over a ten-year period for a sample of immigrant and U.S.-born Latinos. Data are from the Sacramento Area Latino Study on Aging (1998-2008), a population-based, prospective study of Latin American-origin adults 60 years and older. We find that cross-border ties reported at baseline were significantly associated with depression in subsequent study waves, even after controlling for the presence of depression at baseline, albeit with substantial differences by gender and nativity. Specifically, communication with family and friends in Latin America and travel to Latin America at baseline were each significantly associated with greater odds of depression for immigrant women, but with lower odds of depression for U.S.-born Latina women over the study period. Travel to Latin America at baseline was significantly associated with lower odds of depression for Latino men across the study. Across all models we control for depressive symptomatology at baseline to account for the reciprocal nature of depressive symptoms and engagement with social ties, including cross-border ties. Our findings suggest that cross-border ties may represent a unique source of both resilience and risk for the long-term mental health of immigrant Latinos and their descendants.

Objectives

A well-documented paradox is that Hispanics tend to live longer than non-Hispanic Whites (NHW), despite structural disadvantages. We evaluate whether the "Hispanic paradox" extends to more comprehensive longitudinal aging classifications and examine how lifecourse factors relate to these groupings.

Methods

We used biennial data (1998-2014) on adults aged 65 years and older at baseline from the Health and Retirement Study. We use joint latent class discrete time and growth curve modeling to identify trajectories of aging, and multinomial logit models to determine whether U.S.-born (USB-H) and Foreign-born (FB-H) Hispanics experience healthier styles of aging than non-Hispanic Whites (NHW), and test how lifecycle factors influence this relationship.

Results

We identify four trajectory classes including, "cognitive unhealthy," "high morbidity," "nonaccelerated", and "healthy." Compared to NHWs, both USB-H and FB-H have higher relative risk ratios (RRR) of "cognitive unhealthy" and "high morbidity" classifications, relative to "nonaccelerated." These patterns persist upon controlling for lifecourse factors. Both Hispanic groups, however, also have higher RRRs for "healthy" classification (vs "nonaccelerated") upon adjusting for adult achievements and health behaviors.

Discussion

Controlling for lifefcourse factors USB-H and FB-H have equal or higher likelihood for "high morbidity" and "cognitive unhealthy" classifications, respectively, relative to NHWs. Yet, both groups are equally likely of being in the "healthy" group compared to NHWs. These segregations into healthy and unhealthy groups require more research and could contribute to explaining the paradoxical patterns produced when population heterogeneity is not taken into account.

To provide national prevalence estimates of usual source of healthcare (USHC), and examine the relationship between USHC and diabetes awareness and knowledge among Latinos using a modified Andersen model of healthcare access. Three thousand eight hundred and ninety-nine Latino (18-years or older) participants of the Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic/Latino Health survey from the 48 contiguous United States. Cross-sectional, stratified, random sample telephone interviews. Self-reported healthcare service use was examined in regression models that included a past-year USHC as the main predictor of diabetes awareness and knowledge. Anderson model predisposing and enabling factors were included in additional statistical models. Significant differences in USHC between Latino groups were found with Mexican Americans having the lowest rates (59.7%). USHC was associated with significantly higher diabetes awareness and knowledge (OR=1.24; 95%CI=1.05-1.46) after accounting for important healthcare access factors. Men were significantly (OR=0.64; 95%CI=0.52-0.75) less informed about diabetes than women. We found important and previously unreported differences between Latinos with a current USHC provider, where the predominant group, Mexican Americans, are the least likely to have access to a USHC. USHC was associated with Latinos being better informed about diabetes; however, socioeconomic barriers limit the availability of this potentially valuable tool for reducing the risks and burden of diabetes, which is a major public health problem facing Latinos.

ABSTRACT Background: Caregiving for older adults is a growing public health concern because of the negative psychological effects it has on caregivers. Despite the growing Latino caregiver population, little is known regarding how the effects of acculturation on caregiver depressive symptoms might vary by caregiver age. This study aimed to examine the relationship between language acculturation and depressive symptoms in Latino caregivers, and to test whether this relationship was moderated by age. Methods: Ninety-four Latino caregivers of cognitively impaired older adults with and without dementia were identified through an ongoing epidemiological cohort study. Caregivers were interviewed in their homes, in either Spanish or English. A Poisson regression was used to analyze the caregiver characteristics associated with caregiver depressive symptoms. Results: Language acculturation was positively associated with caregiver depressive symptoms, as was age, female gender, and being married or living with someone. Those with excellent or good health and who had spent more than one year caregiving had lower depressive symptoms. Finally, the positive relationship between language acculturation and depressive symptoms was increased in older caregivers. Conclusions: Language acculturation appears to be a risk factor for depressive symptoms in Latino caregivers of cognitively impaired older adults. The relationship between language acculturation and depressive symptoms is complex such that caregiver age and health status further nuance this relationship. Future research should explore the independent and interactive effects of these variables on depressive symptoms.

Background and objectives

The evidence base on health services use and cost burdens associated with transition to severe cognitive impairment (SCI) and dementia is underdeveloped. We examine how the change in cognitive impairment status influences nursing home use, hospitalizations, and out-of-pocket (OOP) expenditures.

Research design and methods

We use prospective data from the Health and Retirement Study (2007/2008-2015/2016) on adults 70 years and older meeting research criteria for cognitive impairment not dementia (CIND) at baseline (unweighted n = 1,692) to fit 2-part models testing how reversion to normal cognition, stability (CIND maintenance), and transition into SCI/dementia influence change in yearly nursing home use, hospitalizations, and OOP expenditures.

Results

Over 8 years, 5.9% reverted, 15.9% remained CIND, 14.9% transitioned to SCI/dementia, and 63.3% died. We observed substantial increases in the propensity of any nursing home use which were particularly pronounced among those who transitioned or died during follow-up and similar but less pronounced differences in patterns of inpatient hospitalizations. Average baseline OOP spending was similar among reverters ($1156 [95% confidence interval = 832-1,479]), maintainers ($1,145 [993-1,296]), and transitioners ($1,385 [1,041-1,730]). Individuals who died during follow-up spent $2,529 (2,101-2,957). By the eighth year of follow-up, spending among reverters increased to $1,402 (869-1,934) and $2,188 (1,402-2,974) and $8,988 (5,820-12,157) for maintainers and transitioners, respectively. Average spending at the wave preceding death was $7,719 (4,345-11,094). Estimates were only partly attenuated through adjustment to covariables.

Discussion and implications

A better understanding of variations in health services use and cost burdens among individuals with mild cognitive impairment can help guide targeted care and financial planning.

Introduction

Latinos are underrepresented in brain autopsy research on Alzheimer's disease and related dementias (ADRD). The study's purpose is to identify Latinos' attitudes about brain donation (BD) to inform methods by which researchers can increase autopsy consent.

Methods

Forty Latinos (mean age: 59.4 years) completed a semi-structured interview and were presented with educational information about BD. Participants completed a questionnaire assessing their understanding of BD and willingness to donate their brain for research.

Results

Among participants, there was near unanimous support for BD to study ADRD after hearing educational information. However, prior to the information presented, participants reported a lack of knowledge about BD and demonstrated a possibility that misunderstandings about BD may affect participation.

Discussion

While nearly all study participants agree that donating is beneficial for research and for future generations, the lack of BD information must be addressed to help support positive attitudes and willingness for participation.

Background

Life-course approaches to identify and help improve modifiable risk factors, particularly in midlife, may mitigate cognitive aging.

Objective

We examined how midlife self-rated physical functioning and health may predict cognitive health in older age.

Methods

We used data from the Health and Retirement Study (1998-2016; unweighted-N = 4,685). We used survey multinomial logistic regression and latent growth curve models to examine how midlife (age 50-64 years) activities of daily living (ADL), physical function, and self-reported health affect cognitive trajectories and cognitive impairment not dementia (CIND) and dementia status 18 years later. Then, we tested for sex and racial/ethnic modifications.

Results

After covariates-adjustment, worse instrumental ADL (IADL) functioning, mobility, and self-reported health were associated with both CIND and dementia. Hispanics were more likely to meet criteria for dementia than non-Hispanic Whites given increasing IADL impairment.

Conclusion

Midlife health, activities limitations, and difficulties with mobility are predictive of dementia in later life. Hispanics may be more susceptible to dementia in the presence of midlife IADLs. Assessing midlife physical function and general health with brief questionnaires may be useful for predicting cognitive impairment and dementia in later life.

Objective

Type 2 Diabetes Mellitus (henceforth diabetes) affects roughly 35 million individuals in the US and is a major risk factor for cardiovascular and kidney disease. Serum Cystatin-C is used to monitor renal function and detect kidney damage. Recent research has focused on linking Cystatin-C to cardiovascular risk and disease, but most findings focus on small sample sizes and generalize poorly to diverse populations, thus limiting epidemiological inferences. The aim of this manuscript is to study the association between Cystatin-C, diabetes, and mortality and test for possible sex or racial/ethnic background modifications in these relationships.

Methods

We analyzed 8-years of biennial panel data from Health and Retirement Study participants 50-years and older who self-identified as White (unweighted N (uN) = 5,595), Black (uN = 867), or Latino (uN = 565) for a total of uN = 7,027 individuals. We modeled diabetes and death over 8-years as function of baseline Cystatin-C (log transformed) adjusting for covariates and tested modifications in associations by race/ethnic background and sex.

Results

Mean log Cystatin-C at visit 1 was 0.03±0.32 standard deviation. A 10% increase in Cystatin-C levels was associated with 13% increased relative risk of diabetes at baseline (11% and 9% by years 4 and 8). A 10% increase in Cystatin-C was highly associated with increased relative risk of death (28% and 31% by years 4 and 8). These associations were present even after adjusting for possible confounders and were not modified by sex or racial/ethnic background.

Conclusion

Despite differential risks for diabetes and mortality by racial/ethnic groups, Cystatin-C was equally predictive of these outcomes across groups. Cystatin-C dysregulations could be used as a risk indicator for diabetes and as a warning sign for accelerated risk of mortality.

Applying causal inference methods, such as weighting and matching methods, to a survey sampled population requires properly incorporating the survey weights and design to obtain effect estimates that are representative of the target population and correct standard errors (SEs). With a simulation study, we compared various approaches for incorporating the survey weights and design into weighting and matching-based causal inference methods. When the models were correctly specified, most approaches performed well. However, when a variable was treated as an unmeasured confounder and the survey weights were constructed to depend on this variable, only the matching methods that used the survey weights in causal estimation and as a covariate in matching continued to perform well. If unmeasured confounders are potentially associated with the survey sample design, we recommend that investigators include the survey weights as a covariate in matching, in addition to incorporating them in causal effect estimation. Finally, we applied the various approaches to the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) and found that insomnia has a causal association with both mild cognitive impairment (MCI) and incident hypertension 6-7 years later in the US Hispanic/Latino population.

Background and aims

The Ankle-Brachial index (ABI) is a well-accepted measure of peripheral artery disease (arterial stenosis and stiffness) and has been shown to be associated with cognitive function and disorders; however, these associations have not been examined in Hispanics/Latinos. Therefore, we sought to examine relationships between ABI and cognitive function among diverse middle-age and older Hispanics/Latinos.

Methods

We used cross-sectional data on n = 7991 participants aged 45-74 years, without stroke or coronary heart disease, from the Hispanic Community Health Study/Study of Latinos. Our primary outcome, global cognition (GC), was a continuous composite score of four cognitive domains (verbal learning and memory, verbal fluency, executive function, and mental status). Secondary outcomes were the individual tests representing these domains. The ABI was analyzed continuously and categorically with standard clinical cut-points. We tested associations using generalized survey regression models incrementally adjusting for confounding factors. Age, sex, hypertension, diabetes, and dyslipidemia moderations were examined through interactions with the primary exposure.

Results

In age, sex, and education adjusted models, continuous ABI had an inverse u-shape association with worse GC. We found similar associations with measures of verbal learning and memory, verbal fluency, executive function, but not with low mental status. The associations were attenuated, but not completely explained, by accounting for the confounders and not modified by age, sex, education, and vascular disease risks.

Conclusions

In addition to being a robust indicator of arterial compromise, our study suggests that abnormal ABI readings may also be useful for early signaling of subtle cognitive deficits.