scholarly journals Combined Effects of Race and Educational Attainment on Physician Visits Over 24 Years in a National Sample of Middle-Aged and Older Americans

2020 ◽  
Vol 5 (1) ◽  
pp. 17-23
Author(s):  
Shervin Assari
Keyword(s):  
Older Adults ◽  
Disease Management ◽  
Health Behaviors ◽  
Educational Attainment ◽  
Minority Groups ◽  
Middle Aged ◽  
Physician Visits ◽  
Highly Educated ◽  
Race Ethnicity

Background: The literature on Minorities’ Diminished Returns (MDRs) have shown worse than expected health of the members of racial and ethnic minority groups particularly Blacks. Theoretically, this effect can be in part due to weaker effects of educational attainment on preventive care and disease management in highly educated racial and ethnic minorities. Objectives: The current study explored the racial and ethnic differences in the effect of baseline educational attainment on % adherance to the routine physician visits among middle-aged and older adults in the US. Methods: This is a prospective study with 24 years of follow up. The Health and Retirement Study (HRS: 1992-2016) included 10880 middle-aged and older adults who were Hispanic, non-Hispanic, Black or White. The independent variable was educational attainment. The dependent variable was adherance to the routine physician visits (%). Age, gender, marital status, income, health behaviors (smoking and drinking) and health (depression, self-rated health, and chronic diseases) were the covariates. Race and ethnicity were the focal moderators. Linear regression was used for data analysis. Results: Overall, higher educational attainment was associated with higher % of adherance to the routine physician visits over the course of follow-up, net of all confounders. Race showed a significant statistical interaction with educational attainment suggesting of a smaller effect of high education attainment on % adherance to the routine physician visits for Black than White middle-aged and older adults. A similar interaction could not be found for the comparison of Hispanic and non-Hispanic middle-aged and older adults. Conclusion: Educational attainment is associated with a larger increase in preventive and disease management doctor visits for White than Black middle-aged and older adults. This is a missed opportunity to improve the health of highly educated middle-aged and older adults. It is not race/ethnicity or class that shapes health behaviors but race/ethnicity and class that shape people’s prohealth behaviors. At least some of the racial health disparities is not due to low SES but diminished returns of SES.

scholarly journals Combined Effects of Ethnicity and Education on Burden of Depressive Symptoms over 24 Years in Middle-Aged and Older Adults in the United States

2020 ◽  
Vol 10 (4) ◽  
pp. 209
Author(s):  
Shervin Assari
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Ethnic Minorities ◽  
White Americans ◽  
Middle Aged ◽  
Highly Educated ◽  
Education Levels ◽  
Nationally Representative ◽  
Hispanic White

Ethnicity and educational attainment are among the major social determinants of depression in the general population. While high education credentials protect individuals against depressive symptoms, this protection may be weaker for ethnic minority groups such as Hispanic Whites compared to the majority group (non-Hispanic Whites). Built on marginalization-related diminished returns (MDRs), the current study used 24-year follow-up data from a nationally representative sample of middle-aged and older adults to explore ethnic variation in the protective effect of education levels against the burden of depressive symptoms over time. Data for this analysis were borrowed from the Health and Retirement Study (HRS 1992–ongoing), a nationally representative longitudinal study. HRS followed 8314 middle-aged and older adults (50+ years old) for up to 24 years. From this number, 763 (9.2%) were Hispanic White, and 7551 (90.8%) were non-Hispanic White Americans. Education level was the independent variable. We had two outcomes. Firstly, using cluster analysis, individuals were categorized to low- and high-risk groups (regarding the burden of depressive symptoms over 24 years); secondly, average depressive symptoms were observed over the 24 years of follow up. Age and gender were the covariates. Ethnicity was the moderator. Linear and logistic regression were used for analysis. Logistic regression showed that, overall, high educational credentials reduced the odds of chronic depressive symptoms over the 24 years of follow-up. Linear regression also showed that higher years of education were associated with lower average depressive symptoms over time. Both models showed statistically significant interactions between ethnicity and graduation, indicating a smaller protective effect of high education against depressive symptoms over the 24 years of follow-up time among Hispanic with respect to non-Hispanic White people. In line with the MDRs, highly educated Hispanic White Americans remain at high risk for depressive symptoms, a risk that is unexpected given their education. The burden of depressive symptoms, however, is lowest for highly educated non-Hispanic White Americans. Policies that exclusively focus on equalizing educational gaps across ethnic groups may fail to eliminate the ethnic gap in the burden of chronic depressive symptoms, given the diminished marginal health return of education for ethnic minorities. Public policies must equalize not only education but also educational quality across ethnic groups. This aim would require addressing structural and environmental barriers that are disproportionately more common in the lives of ethnic minorities across education levels. Future research should test how contextual factors, residential segregation, school segregation, labor market practices, childhood poverty, and education quality in urban schools reduce the health return of educational attainment for highly educated ethnic minorities such as Hispanics.

scholarly journals Socioeconomic Status, Race/Ethnicity, and Diurnal Cortisol Trajectories in Middle-Aged and Older Adults

2016 ◽  
pp. gbw080 ◽  
Author(s):  
Laura J. Samuel ◽  
David L. Roth ◽  
Brian S. Schwartz ◽  
Roland J. Thorpe ◽  
Thomas A. Glass
Keyword(s):  
Older Adults ◽  
Socioeconomic Status ◽  
Middle Aged ◽  
Diurnal Cortisol ◽  
Race Ethnicity

scholarly journals Blacks’ Diminished Health Returns of Educational Attainment: Health and Retirement Study

2020 ◽  
Vol 4 (2) ◽  
pp. e000212
Author(s):  
Shervin Assari
Keyword(s):  
Older Adults ◽  
Educational Attainment ◽  
Black Americans ◽  
Education Level ◽  
Education Quality ◽  
White Americans ◽  
Highly Educated ◽  
Nationally Representative ◽  
Retirement Study ◽  
Hispanic White

Background: Education level reduces the risk of health problems such as poor self-rated health (SRH), high body mass index (BMI), and depressive symptoms (DS). Marginalization – related Diminished Returns (MDRs), however, refer to smaller health benefits of socioeconomic status (SES) indicators particularly educational attainment for the members of racial minority groups such as non-Hispanic Blacks compared to the majority group (non-Hispanic Whites). It is not known, however, if MDRs also hold for middle-age and older adults over a long period of time.  Aims: The current study used a nationally representative data set to explore racial variation in the predictive utility of baseline education level on protecting people against poor SRH, BMI, and DS.  Methods: Data for this analysis were borrowed from the Health and Retirement Study (HRS 1992-ongoing), a nationally representative longitudinal study that followed 10,023 middle-aged and older adults (50+ years old) for up to 26 years. From this number, 1877 (18.7%) were non-Hispanic Black Americans, and 8,146 (81.3%) were non-Hispanic White Americans. Education level was the independent variable. We used cluster analysis to categorize individuals to low and high-risk groups (outcome) based on SRH, BMI, and DS over 26 years. Age and gender were the covariates. Race was the moderator.  Results: Overall, high education level reduced the odds of poor SRH, BMI, and DS over the 26 years of follow up. Interactions were observed between race and education on all three health outcomes indicating smaller protective effects of baseline educational attainment on poor health over time, regardless of the outcome.  Conclusions: In line with the MDRs, highly educated non-Hispanic Black Americans remain at high risk for poor health across domains, a risk which is unexpected given their education. The risk of all health outcomes, however, is lowest for non-Hispanic White Americans with highest education. Policies that exclusively focus on equalizing racial gaps in SES (e.g., education) may fail to eliminate the racial and ethnic health inequalities because of the racial inequalities in the marginal health return of education. Public policies must equalize education quality and address structural and environmental barriers that are disproportionately more common in the lives of non-Hispanic Black Americans, even at high education levels. Future research should test how contextual factors, segregation, labor market practices, childhood poverty, and education quality reduces the health return of education for highly educated non-Hispanic Black Americans.

Longitudinal associations between insomnia symptoms and all-cause mortality among middle-aged and older adults: A population-based cohort study

SLEEP ◽  
2022 ◽  
Author(s):  
Asos Mahmood ◽  
Meredith Ray ◽  
Kenneth D Ward ◽  
Aram Dobalian ◽  
Sang Nam Ahn
Keyword(s):  
Older Adults ◽  
The United States ◽  
Early Morning ◽  
Time Varying ◽  
Middle Aged ◽  
Insomnia Symptom ◽  
All Cause Mortality ◽  
Longitudinal Associations ◽  
Insomnia Symptoms

Abstract To date, there is no scientific consensus on whether insomnia symptoms increase mortality risk. We investigated longitudinal associations between time-varying insomnia symptoms (difficulty initiating sleep, difficulty maintaining sleep, early-morning awakening, and non-restorative sleep) and all-cause mortality among middle-aged and older adults during 14 years of follow-up. Data were obtained from 2004 through 2018 survey waves of the Health and Retirement Study in the United States for a population-representative sample of 15,511 respondents who were ≥50 years old in 2004. Respondents were interviewed biennially and followed through the end of the 2018 survey wave for the outcome. Marginal structural discrete-time survival analyses were employed to account for time-varying confounding and selection bias. Of the 15,511 cohort respondents (mean [±SD] age at baseline, 63.7 [±10.2] years; 56.0% females), 5,878 (31.9%) died during follow-up. At baseline (2004), 41.6% reported experiencing at least one insomnia symptom. Respondents who experienced one (HR=1.11; 95% CI: 1.03–1.20), two (HR=1.12; 95% CI: 1.01–1.23), three (HR=1.15; 95% CI: 1.05–1.27), or four (HR=1.32; 95% CI: 1.12–1.56) insomnia symptoms had on average a higher hazard of all-cause mortality, compared to those who were symptom-free. For each insomnia symptom, respondents who experienced difficulty initiating sleep (HR=1.12; 95% CI: 1.02–1.22), early-morning awakening (HR=1.09; 95% CI: 1.01–1.18), and nonrestorative sleep (HR=1.17; 95% CI: 1.09–1.26), had a higher hazard of all-cause mortality compared to those not experiencing the symptom. The findings demonstrate significant associations between insomnia symptoms and all-cause mortality, both on a cumulative scale and independently, except for difficulty maintaining sleep. Further research should investigate the underlying mechanisms linking insomnia symptoms and mortality.

Yoga Education Program for Improving Memory in Older Adults: A Multicity 5-Year Follow-Up Study

2018 ◽  
Vol 39 (6) ◽  
pp. 576-587 ◽  
Author(s):  
Samta P. Pandya
Keyword(s):  
Older Adults ◽  
Education Program ◽  
Community Dwelling ◽  
Original Cohort ◽  
Cultural Variations ◽  
Highly Educated ◽  
Behavioral Memory ◽  
Community Dwelling Older Adults ◽  
State Examination

This article reports a multicity study on the effect of a yoga education program (YEP) in improving memory and cognitive functions of a nonclinical sample of community-dwelling older adults. Specifically, the intervening personal resources that bolster or hinder YEP effectiveness were examined. Of the original cohort of 918 older adults randomized into intervention and waitlist control groups, 792 remained with the study 5 years later. Results indicated that weekly YEP lessons and self-practice improved participants’ scores on the Mini-Mental State Examination (MMSE) and Rivermead Behavioral Memory Test–Third Edition (RBMT-3). Participants from Asian cities, women, Hindus and Buddhists, middle class, highly educated, retired, ever single or widowed, living alone or with children and kin, were more responsive to the YEP. Regular attendance and self-practice were strong moderators of YEP effectiveness, with self-practice having the strongest predictor effect. Some cultural variations and improvisations would lend the YEP a wider application.

scholarly journals Health Behaviors and Health Status among Middle-Aged and Older Adults with Chronic Diseases in Taiwan

2020 ◽  
Vol 17 (19) ◽  
pp. 7196
Author(s):  
Wei-Hua Tian ◽  
Joseph J. Tien
Keyword(s):  
Older Adults ◽  
Health Status ◽  
Health Behavior ◽  
Health Behaviors ◽  
Chronic Diseases ◽  
Latent Class ◽  
Healthy Diet ◽  
Lifestyle Behaviors ◽  
Middle Aged ◽  
The Relationship

Changes in lifestyle behaviors may effectively maintain or improve the health status of individuals with chronic diseases. However, such health behaviors adopted by individuals are unlikely to demonstrate similar patterns. This study analyzed the relationship between the heterogeneous latent classes of health behavior and health statuses among middle-aged and older adults with hypertension, diabetes, or hyperlipidemia in Taiwan. After selecting 2103 individuals from the 2005 and 2009 Taiwan National Health Interview Survey (NHIS), we first identified heterogeneous groups of health behaviors through latent class analysis (LCA). We further explored the relationship between each latent class of health behavior and health status through ordered logit regression. We identified the following five distinct health behavior classes: the all-controlled, exercise and relaxation, healthy diet and reduced smoking or drinking, healthy diet, and least-controlled classes. Regression results indicated that individuals in classes other than the all-controlled class all reported poor health statuses. We also found great magnitude of the coefficient estimates for individuals who reported their health status to be poor or very poor for the least-controlled class. Therefore, health authorities and medical providers may develop targeted policies and interventions that address multiple modifiable health behaviors in each distinct latent class of health behavior.

scholarly journals Social Status, Risky Health Behaviors, and Diabetes in Middle-Aged and Older Adults

2006 ◽  
Vol 61 (6) ◽  
pp. S290-S298 ◽  
Author(s):  
Linda A. Wray ◽  
Duane F. Alwin ◽  
Ryan J. McCammon ◽  
Timothy Manning ◽  
Latrica E. Best
Keyword(s):  
Older Adults ◽  
Health Behaviors ◽  
Social Status ◽  
Middle Aged ◽  
Risky Health Behaviors

Assessing Longitudinal Invariance of the Center for Epidemiologic Studies-Depression Scale Among Middle-Aged and Older Adults

2015 ◽  
Vol 23 (2) ◽  
pp. 302-314 ◽  
Author(s):  
Mulubrhan F. Mogos ◽  
Jason W. Beckstead ◽  
Kevin E. Kip ◽  
Mary E. Evans ◽  
Roger A. Boothroyd ◽  
...  
Keyword(s):  
Older Adults ◽  
Structural Equation ◽  
Factor Model ◽  
Depression Scale ◽  
Epidemiologic Studies ◽  
Equation Modeling ◽  
Middle Aged ◽  
Partial Invariance ◽  
Best Fitting

Background and Purpose: The longitudinal invariance of the Center for Epidemiologic Studies-Depression (CES-D) scale among middle-aged and older adults is unknown. This study examined the factorial invariance of the CES-D scale in a large cohort of community-based adults longitudinally. Methods: 1,204 participants completed the 20-item CES-D scale at 4 time points 1 year apart. Structural equation modeling was used to identify best fitting model using longitudinal data at baseline and at 1-, 2-, and 3-year follow-up. Results: The 4-factor model showed partial invariance over 3 years. Two of the 6 noninvariant items were consistently noninvariant at the 3 follow-up points. Conclusion: Special consideration should be given to these 2 items when using the CES-D scale in healthy adults (45–75 years old).

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