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Long-term exposure to stress has been linked to multiple behavioral and biological responses that are detrimental to cardiovascular health, but the association between chronic stress and risks for acute myocardial infarction (MI) remains unknown. We examined the association between exposure to chronic stress and MI incidence from 2006 to 2016 using data from a nationally-representative prospective cohort study of adults aged 45 and older (n=15,109). Chronic stressors included ongoing issues related to personal health, social relationships, financial strain, housing, and caregiving responsibilities. Cox proportional hazards models were used to examine the association between the number of chronic stressors and MI while adjusting for confounding risk factors. More than half of the respondents reported ≥2 chronic stressors at baseline. Risks for MI increased incrementally from 1 chronic stressor (HR=1.28; 95% CI, 1.20-1.37) to ≥4 chronic stressors (HR = 2.71; 95% CI, 2.08-3.53) compared with those who reported no stressors. These risks were partly attenuated after adjustments for socioeconomic, psychosocial, behavioral, and clinical risk factors. The impact of chronic stressors was especially pronounced among adults with a history of MI (P value for interaction=.032). In adults with a prior MI, risks for a recurrent MI increased substantially from 1 chronic stressor (HR=1.31; 95% CI, 1.10-1.55) to ≥4 chronic stressors (HR = 2.92; 95% CI, 1.47-5.82) compared to those with no stressors. Chronic stress is a significant risk factor for acute coronary events in U.S. adults. More research is required to further understand the psychosocial, behavioral, and biological mechanisms underlying this association.

Massive rural-to-urban migration in China has a significant impact on caregiving arrangements among Chinese older adults. To stimulate research on the intersection of migration and caregiving, we conducted an inventory of longitudinal aging survey datasets that included older adults from mainland China. Large public available datasets that included measures related to migration and caregiving were searched and reviewed for eligibility. Key characteristics of each dataset, including study design, sample size, and measures, were extracted. Seven eligible datasets were identified, and five included national representative samples. Measures for migration varied across datasets. Some datasets included information on the migration history of older adults, whereas others focused on the migration of adult children. Similarly, caregiving was measured using different questions in each dataset. Caregiving activities were assessed with regard to their type, source, and amount. High-quality datasets exist to support research on migration and caregiving arrangements among Chinese older adults.

C-reactive protein (CRP) is a marker of inflammation linked to numerous acute and chronic conditions. Studies have not considered racial differences in elevated CRP among older adults at the national level. We investigate racial differences in elevated CRP and the socioeconomic, psychosocial, behavioral, and physiological factors that contribute to these differences overall and by gender using a nationally-representative prospective cohort of 14,700 non-Hispanic black and white participants in the Health and Retirement Study followed from 2006 to 2014. Random effects logistic regression models showed that blacks were more likely to have elevated levels of CRP than whites. In men, the racial differences in elevated CRP were attributed to a combination of socioeconomic, psychosocial, and behavioral factors. In women, the racial differences in elevated CRP were primarily attributable to physiological factors. The findings from this work have potentially important implications for clinical practice and interventions targeting vulnerable segments of the population.

Cardiovascular disease (CVD) is the leading cause of disability and death in the United States, and older adults with CVD are at a high risk of readmission after discharge. This study examined whether patients’ perceived risk of readmission at discharge was associated with actual 30-day readmissions in patients with CVD. A standardized survey and electronic health records (EHR) were used to collect sociodemographic, psychosocial, behavioral, and clinical data on patients admitted to the Duke Heart Center (n=730). Prior to discharge, patients were asked their perceived likelihood of returning to the hospital for an unplanned/emergency visit within 30-days. Logistic regression models were used to examine all-cause 30-day readmission among patients who perceived low versus high readmission risk. Nearly 1-in-3 patients (31.4%) perceived high-risk of readmission at the time of discharge. Life stressors, poor self-rated health, and ADL limitations were associated with perceptions of high-risk. Patients who perceived high-risk had significantly higher subsequent readmissions compared with low-risk (23.3% vs. 15.6% p=0.016). Among patients who perceived low-risk of readmission, those who were widowed, had inadequate health literacy, and reported difficulty accessing care exhibited a higher likelihood of being readmitted. In those perceiving a high-risk, nonwhites and those with poor self-rated health, difficulty accessing care, and prior hospitalizations in the past year were significantly more likely to be readmitted. These findings have important implications for identifying CVD patients at high risk of readmission within 30 days after discharge, particularly older adults who may lack adequate resources (e.g., social support, literacy, access to care).

We examined the dual trajectories of subjective memory impairment (SMI) and objective cognitive decline and their associated factors in U.S. older adults. We used data from the Health and Retirement Study which includes a nationally representative sample of 19,408 Americans age 65 and older from 1998 to 2016. Trajectories of SMI and objective cognitive decline were simultaneously characterized using a group-based trajectory model and multinomial logistic regressions were used to assess factors associated with the dual-trajectory typologies. Four dual-trajectories were identified: “minimal SMI and stable-low cognitive decline” (33.1% of respondents); “minimal SMI with accelerated cognitive decline” (28.2%); “significant SMI with moderate cognitive decline” (21.0%); and “moderate SMI with steady cognitive decline” (17.6%). Being male, minority, low educated, living alone, and having comorbidities were associated with trajectories featuring greater SMI or more rapid deterioration in cognition. The results suggest complex co-occurring changes in subjective memory and objective cognition in older adults.

We examined gender differences in the association between migration status (urban, rural, urban-to-urban, rural-to-urban, rural-to-rural, and urban-to-rural) and cognition among adults in China and India. We used the World Health Organization Study on global AGEing and adult health (SAGE) data that included adults age 50 + from China (N=12937) and India (N=6244). Controlling for socioeconomic status and health conditions, significant differences in cognition were found between men and women, and across migration groups. A consistent female disadvantage was found in China and India for cognition. Women who were rural residents or rural-to-rural migrants had the poorest cognition in both Chinese and Indian samples. Among males in China, rural residents had poorer cognition than urban residents, while urban-to-urban migrants had highest cognition scores; however, for male counterparts in India, rural-to-rural migrants had the poorest cognition. The results suggest that the association between migration and cognition differs by gender and country.