Dataset Information

Racial Differences in Cause-Specific Mortality Between Community-Dwelling Older Black and White Adults.

ABSTRACT: OBJECTIVES:To understand which causes of death are higher in black than white community-dwelling older adults and determine whether differences in baseline risk factors explain racial differences in mortality. DESIGN:Longitudinal cohort study (Health, Aging, and Body Composition Study). SETTING:Pittsburgh, Pennsylvania; and Memphis, Tennessee. PARTICIPANTS:Black and white men and women aged 70 to 79 during recruitment (N=3,075; 48% men, 42% black) followed for a median of 13 years. MEASUREMENTS:A committee of physicians adjudicated cause of death, which was categorized as cardiovascular disease (CVD), stroke, cancer, dementia, pulmonary, infection, kidney, or other causes. Using competing risks regression, we examined whether known risk factors at baseline (demographic characteristics, smoking, body mass index, chronic diseases, physical function, cognition) could explain racial differences in cause-specific mortality risk. RESULTS:During follow-up, 1,991 (65%) participants died. Black participants died at higher rates from cancer (hazard ratio (HR)=1.36, 95% confidence interval (CI)=1.14-1.63), kidney disease (HR=2.09, 95% CI=1.16-3.74), stroke (HR=1.31, 95% CI=0.98-1.76); and CVD (HR=1.16, 95% CI=0.98-1.37). Poorer physical and cognitive performance at baseline among black participants explained most of the racial difference in risks of dying from kidney disease, stroke, and CVD but not cancer. When examining types of cancer deaths, black participants died at higher rates from multiple myeloma, pancreatic cancer, and prostate cancer, which baseline risk factors did not explain either. CONCLUSION:Factors contributing to poorer physical and cognitive performance in similarly aged black men and women could be targets to reduce excess mortality from CVD, stroke, and kidney disease. More work is needed to identify factors contributing to cancer mortality disparities.

SUBMITTER: Marron MM

PROVIDER: S-EPMC6366626 | biostudies-literature | 2018 Oct

REPOSITORIES: biostudies-literature

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Racial Differences in Cause-Specific Mortality Between Community-Dwelling Older Black and White Adults.

Marron Megan M MM Ives Diane G DG Boudreau Robert M RM Harris Tamara B TB Newman Anne B AB

Journal of the American Geriatrics Society 20180912 10

<h4>Objectives</h4>To understand which causes of death are higher in black than white community-dwelling older adults and determine whether differences in baseline risk factors explain racial differences in mortality.<h4>Design</h4>Longitudinal cohort study (Health, Aging, and Body Composition Study).<h4>Setting</h4>Pittsburgh, Pennsylvania; and Memphis, Tennessee.<h4>Participants</h4>Black and white men and women aged 70 to 79 during recruitment (N=3,075; 48% men, 42% black) followed for a medi ...[more]

PMID: 30277581

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Project description:OBJECTIVES:To investigate the relationship between warfarin treatment and different strata of all-cause mortality risk assessed using the Multidimensional Prognostic Index (MPI) based on information collected using the Standardized Multidimensional Assessment Schedule for Adults and Aged Persons (SVaMA) in community-dwelling older adults with atrial fibrillation (AF). DESIGN:Retrospective observational study. SETTING:Older community-dwelling adults who underwent a SVaMA evaluation establishing accessibility to homecare services and nursing home admission from 2005 to 2013 in the Padova Health District, Italy. PARTICIPANTS:Community-dwelling individuals with AF aged 65 and older (N = 1,827). MEASUREMENTS:Participants were classified as being at mild (MPI-SVaMA-1), moderate (MPI-SVaMA-2), or severe (MPI-SVaMA-3) risk of mortality using the MPI-SVaMA, a validated prognostic tool based on age, sex, comorbidity, cognitive status, mobility and functional disability, pressure sore risk, and social support. The association between warfarin treatment and mortality was tested using multivariate- and propensity score-adjusted Cox regression models, controlling for age, sex, all SVaMA domains, concomitant diseases, and drug treatments. RESULTS:Higher MPI-SVaMA scores were associated with lower rates of warfarin treatment and higher 3-year mortality. After adjustment for propensity score quintiles, warfarin treatment was significantly associated with lower 2-year mortality in individuals with MPI-SVaMA-1 (hazard ratio (HR) = 0.64, 95% confidence interval (CI) = 0.50-0.82), MPI-SVaMA-2 (HR = 0.68, 95% CI = 0.55-0.85), and MPI-SVaMA-3 (HR = 0.55, 95% CI = 0.44-0.67). Heterogeneity analyses confirmed that the effect of warfarin treatment was not different between MPI-SVaMA groups (P for heterogeneity = .48). CONCLUSION:Community-dwelling older adults with AF benefitted from anticoagulation in terms of lower all-cause mortality over a mean follow-up of 2 years, regardless of poor health and functional condition. Although this benefit can be ascribed to the treatment, it may also reflect better overall care.

Project description:BackgroundAlthough elevated thyrotropin (TSH) is common in older adults, controversy exists over what degree of elevation should be treated with thyroid hormone supplements. Isolated, elevated TSH in this population can be consistent with aging-related adaptations rather than indicative of primary thyroid disease, raising the possibility that thyroid hormone replacement may be harmful.ObjectivesDetermine the association between all-cause mortality and levothyroxine use among older adults.DesignLongitudinal observational study.SettingBaltimore Longitudinal Study of Aging.ParticipantsOne thousand two hundred and fifty eight community dwelling adult participants aged 65+ with an average of 9 years of follow up.MeasurementsThyroid and pituitary hormone levels and thyroid hormone supplementation were determined at each visit. Incident rate ratios (IRR) for all-cause mortality were calculated using time-dependent Poisson regression models to accommodate the varying start times. To isolate the effects of hormone replacement from its effects on TSH, the association between treatment and all-cause mortality was analyzed in participants with stable thyroid function status throughout follow-up (N = 638).ResultsThyroid hormone supplementation was not associated with a significant increase all-cause mortality in the subsequent year in the fully adjusted model (IRR = 1.40, 95% confidence interval (CI) = 0.93-2.12). In a stratified analysis of euthyroid participants, thyroid hormone use was associated with significantly greater mortality, with an adjusted IRR = 1.81 (95% CI = 1.10-2.98).ConclusionThe increased mortality associated with thyroid hormone use among the subclass of euthyroid community dwelling older adults is consistent with a model in which TSH elevation can result from a variety of underlying pathophysiologic processes, not all of which should be treated with thyroid hormone supplementation. Clinicians should consider overall clinical status when interpreting an isolated elevated TSH in older adults.

Dataset Information

Racial Differences in Cause-Specific Mortality Between Community-Dwelling Older Black and White Adults.

Publications

Racial Differences in Cause-Specific Mortality Between Community-Dwelling Older Black and White Adults.

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