Dataset Information

Diabetes, Heart Disease, and Dementia: National Estimates of Functional Disability Trajectories.

ABSTRACT: OBJECTIVES:To estimate the associations between diabetes, heart disease, and dementia, which may increase the difficulty of self-care; model functional disability trajectories jointly with attrition (death or dropout) over 5 years. DESIGN:Population-based complex survey design. SETTING:National Health and Aging Trends Study. PARTICIPANTS:Community-dwelling Medicare beneficiaries aged 65 and older (N=7,609). MEASUREMENTS:National estimates were generated using sampling weights. Sociodemographic characteristics, self-reported physician-diagnosed chronic conditions, six activities of daily living (ADL), and cognitive status were ascertained in annual in-person interviews. A joint model using group-based trajectory modeling was used to estimate the number of ADL disabilities and attrition probability. Multinomial logistic regression with survey weights was used to estimate the association between diabetes, heart disease, and dementia and resultant trajectories of disability, with the least disabled trajectory used as a reference. RESULTS:Three functional disability trajectories were identified: 26.9 million (76.3%) individuals with no disability and a constant study attrition of 14.3%, 4.9 million (13.9%) with mild and increasing disability and 12% attrition in 2012 and 27.2% in 2015, and 3.4 million (9.7%) with severe and increasing disability and 25.4% attrition in 2012 and 35% in 2015. Persons with possible dementia, possible dementia and diabetes, or possible dementia with diabetes and heart disease had significantly greater odds of being on the mild disability trajectory than those with no disability. Persons with probable dementia, representing more than 1.5 million persons, regardless of concurrent conditions, had significantly greater odds of being on the severe disability trajectory than on the no disability trajectory. CONCLUSIONS:Methods that generate national estimates and account for attrition and for multiple chronic conditions and cognitive status may be useful for health policy-makers to make decisions on care provisions and services.

SUBMITTER: MacNeil Vroomen JL

PROVIDER: S-EPMC5906138 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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Diabetes, Heart Disease, and Dementia: National Estimates of Functional Disability Trajectories.

MacNeil Vroomen Janet L JL Han Ling L Monin Joan K JK Lipska Kasia J KJ Allore Heather G HG

Journal of the American Geriatrics Society 20180309 4

<h4>Objectives</h4>To estimate the associations between diabetes, heart disease, and dementia, which may increase the difficulty of self-care; model functional disability trajectories jointly with attrition (death or dropout) over 5 years.<h4>Design</h4>Population-based complex survey design.<h4>Setting</h4>National Health and Aging Trends Study.<h4>Participants</h4>Community-dwelling Medicare beneficiaries aged 65 and older (N=7,609).<h4>Measurements</h4>National estimates were generated using ...[more]

PMID: 29521414

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Project description:Aims/hypothesisThe aim of this study was to characterise longitudinal profiles of BMI from childhood and to examine the impact of level-independent childhood BMI trajectories on adult type 2 diabetes.MethodsThe longitudinal cohort consisted of 2449 adults (1613 white and 836 black) who had their BMI measured between four and 15 times from childhood (4-19 years) to adulthood (20-51 years) and fasting glucose measured in adulthood. Model-estimated levels and linear slopes of BMI at childhood age points were calculated in 1-year intervals using growth-curve parameters and their first derivatives, respectively.ResultsBMI from childhood to adulthood fit cubic growth curves; linear and non-linear curve parameters differed significantly between race-sex groups. BMI showed race and sex differences from 15 years onwards. Individuals with hyperglycaemia had higher long-term BMI levels than those who were normoglycaemic in race-sex groups. Linear and non-linear slope parameters of BMI differed consistently and significantly between adult hyperglycaemia groups. The OR of childhood BMI levels for ages 4-19 years was 1.45-1.83 (p < 0.001 for all) for adult hyperglycaemia after adjustment for confounders. Level-adjusted linear slopes of BMI at ages 10-19 years showed significantly positive associations with adult hyperglycaemia (OR 1.17-1.50, p < 0.01 for all). The associations of childhood BMI linear slopes with adult hyperglycaemia were not significant during the age period 5-9 years. The trends in these associations were consistent across race-sex groups.Conclusions/interpretationThese observations indicate that childhood BMI trajectories have a significant impact on adult diabetes, independent of BMI levels. The adolescence age period is a crucial window for the development of diabetes in later life, which has implications for early-life prevention.Data availabilityAll data and materials are publicly available at the National Heart, Lung, and Blood Institute (NHLBI) Biologic Specimen and Data Repository and can be accessed at https://biolincc.nhlbi.nih.gov/studies/bhs .

Project description:ObjectiveThe inter-individual variability in cognitive changes may be early indicators of major health events. We aimed to determine whether late-life cognitive trajectories were associated with incident dementia, persistent physical disability and all-cause mortality.MethodsData came from a cohort of older community-dwelling individuals aged 70 years or above in Australia and the United States. Global cognition, verbal fluency, episodic memory and psychomotor speed were assessed regularly at up to seven waves between 2010 and 2017. Dementia, disability in activities of daily living, and death were adjudicated between 2017 and 2020. Latent classes of cognitive trajectories over seven years were determined using group-based trajectory modeling. Multivariable logistic regression was used for the prospective associations between cognitive trajectories and these outcomes.ResultsCognitive trajectories were defined for 16,174 participants (mean age: 78.9 years; 56.7% female) who were alive and without incident dementia or disability by 2017, among which 14,655 participants were included in the association analysis. Between three and five trajectory classes were identified depending on the cognitive test. Cognitive trajectories were strongly associated with the risk of dementia. For example, compared to those in the highest-functioning trajectory, the worst performers of episodic memory had a 37-fold increased risk of dementia (95% CI: 17.23-82.64). The lowest trajectories of both global cognition and episodic memory also predicted increased mortality risk (OR: 1.80, 95% CI: 1.28-2.52; OR: 1.61, 95% CI: 1.09-2.36, respectively), while only slow psychomotor speed was marginally associated with physical disability (OR: 2.39, 95% CI: 0.99-5.77).ConclusionsIn older individuals, cognitive trajectories appear to be early indicators of clinically relevant health outcomes. Systematic cognitive assessments as part of routine geriatric evaluation may facilitate early identification and interventions for those individuals at highest risk.

Project description:BACKGROUND:With India preparing for the next decennial Census in 2021, we compared the disability estimates and data collection methodology between the Census 2011 and the most recent population-level survey for India and its states, to highlight the issues to be addressed to improve robustness of the disability estimates in the upcoming Census. METHODS:Data from the Census 2011 and from two complementary nationally representative household surveys that covered all Indian states with the same methodology and survey instruments-the District-Level Household Survey-4 (DLHS-4, 2012-2013) and the Annual Health Surveys (AHS three rounds, 2010-11, 2011-12 and 2012-13) were used. Data from DLHS-4 and AHS 2012-13 round were pooled to generate estimates for the year 2012-13. Data collection methodology between the sources was compared, including the review of definitions of each type of disability. The overall, mental, visual, hearing, speech, and movement disability rate (DR) per 100,000 population were compared between the sources for India and for each state, and the percent difference in the respective rates was calculated. We explored the reliability of these estimates comparing yearly data from the AHS for three successive rounds. RESULTS:Survey data were collected through proxy reporting, however, it is not entirely clear whether the data were proxy- or self-reported or a mix of both in the Census. The overall DR was 25.1% higher in the Census (2,242; 95% CI 2,241-2,243) than the survey (1,791; 95% CI 1,786-1,797) per 100,000 population, with the state-level difference ranging from -64% in Tamil Nadu to 107% in Sikkim state. Despite both sources using nearly similar definitions for overall disability and disability by type, the difference in DR was 125.5%, 54.2%, -25.7%, -19.7%, and 21.9% for hearing, speech, mental, movement, and visual DR, respectively. At the state-level, the difference in disability-specific estimates ranged from -84% to 450%. The extent of variations in the disability-specific estimates in AHS successive rounds ranged from -25% to 929% at the state-level. CONCLUSIONS:There is momentum globally towards building disability measurement that is consistent with the data required for monitoring of the Sustainable Development Goals to ensure robust estimation of disability. The current estimates from the Census and surveys seem much lower than would be expected at the population level. We make recommendations that India needs to take serious note of in order to improve the validity and reliability of India's disability estimates.

Dataset Information

Diabetes, Heart Disease, and Dementia: National Estimates of Functional Disability Trajectories.

Publications

Diabetes, Heart Disease, and Dementia: National Estimates of Functional Disability Trajectories.

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