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We demonstrate widening socioeconomic disparities in perceived economic distress among Americans, characterized by increasing distress at the bottom and improved perceptions at the top of the socioeconomic ladder. We then assess the extent to which hardships related to the Great Recession account for the growing social disparity in economic distress. Based on the concept of loss aversion, we also test whether the psychological pain associated with a financial loss is greater than the perceived benefit of an equivalent gain. Analyses are based on longitudinal survey data from the Midlife Development in the US study. Results suggest that widening social disparities in perceived economic distress between the mid-2000s and mid-2010s are explained in part by differential exposure to hardships related to the Great Recession, the effects of which have lingered even four to five years after the recession officially ended. Yet, auxiliary analyses show that the socioeconomic disparities in economic distress widened by nearly as much (if not more) during the period from 1995-96 to 2004-05 as they did during the period in which the recession occurred, which suggests that the factors driving these trends may have already been in motion prior to the recession. Consistent with the loss aversion hypothesis, perceptions of financial strain appear to be somewhat more strongly affected by losses in income/assets than by gains, but the magnitude of the differentials are small and the results are not robust. Our findings paint a dismal portrait of a growing socioeconomic divide in economic distress throughout the period from the mid-1990s to the mid-2010s, although we cannot say whether these trends afflict all regions of the US equally. Spatial analysis of aggregate-level mortality and objective economic indicators could provide indirect evidence, but ultimately economic "despair" must be measured subjectively by asking people how they perceive their financial situations., Competing Interests: The authors have declared that no competing interests exist.

Despite myriad efforts among social scientists, epidemiologists, and clinicians to identify variables with strong linkages to mortality, few researchers have evaluated statistically the relative strength of a comprehensive set of predictors of survival. Here, we determine the strongest predictors of five-year mortality in four national, prospective studies of older adults. We analyze nationally representative surveys of older adults in four countries with similar levels of life expectancy: England (n = 6113, ages 52+), the US (n = 2023, ages 50+), Costa Rica (n = 2694, ages 60+), and Taiwan (n = 1032, ages 53+). Each survey includes a broad set of demographic, social, health, and biological variables that have been shown previously to predict mortality. We rank 57 predictors, 25 of which are available in all four countries, net of age and sex. We use the area under the receiver operating characteristic curve and assess robustness with additional discrimination measures. We demonstrate consistent findings across four countries with different cultural traditions, levels of economic development, and epidemiological transitions. Self-reported measures of instrumental activities of daily living limitations, mobility limitations, and overall self-assessed health are among the top predictors in all four samples. C-reactive protein, additional inflammatory markers, homocysteine, serum albumin, three performance assessments (gait speed, grip strength, and chair stands), and exercise frequency also discriminate well between decedents and survivors when these measures are available. We identify several promising candidates that could improve mortality prediction for both population-based and clinical populations. Better prognostic tools are likely to provide researchers with new insights into the behavioral and biological pathways that underlie social stratification in health and may allow physicians to have more informed discussions with patients about end-of-life treatment and priorities.

There are large socioeconomic disparities in adult mortality in Russia, although the biological mechanisms are not well understood. With data from the study of Stress, Aging, and Health in Russia (SAHR), we use Gompertz hazard models to assess the relationship between educational attainment and mortality among older adults in Moscow and to evaluate biomarkers associated with inflammation, neuroendocrine function, heart rate variability, and clinical cardiovascular and metabolic risk as potential mediators of that relationship. We do this by assessing the extent to which the addition of biomarker variables into hazard models of mortality attenuates the association between educational attainment and mortality. We find that an additional year of education is associated with about 5% lower risk of age-specific all-cause and cardiovascular mortality. Inflammation biomarkers are best able to account for this relationship, explaining 25% of the education-all-cause mortality association, and 35% of the education-cardiovascular mortality association. Clinical markers perform next best, accounting for 13% and 23% of the relationship between education and all-cause and cardiovascular mortality, respectively. Although heart rate biomarkers are strongly associated with subsequent mortality, they explain very little of the education-mortality link. Neuroendocrine biomarkers fail to account for any portion of the link. These findings suggest that inflammation may be important for understanding mortality disparities by socioeconomic status., Competing Interests: statement: No author has an actual or potential conflict of interest., (Copyright © 2016. Published by Elsevier Ltd.)

Recent studies have found mixed results regarding the association between leukocyte telomere length (LTL)--thought to be a marker of cellular aging--and all-cause mortality. Some studies have reported a significant inverse relationship, but others have not, perhaps in part owing to insufficient power. We examine the relationship using data from a nationally representative sample of older Taiwanese (54+ in 2000), which is larger (n = 942) than most previous studies, and which includes comprehensive information on potential confounders including white blood cell distribution and inflammatory markers. Results from a Cox hazards model demonstrate a small, but significant, association between LTL and mortality that is independent of age, sex, and lifestyle factors. White blood cell distribution, especially the proportion of neutrophils, is an important predictor of LTL; however, the association between LTL and mortality changes little controlling for white blood cell distribution. In contrast, the association between LTL and mortality weakens considerably (by 48%) after adjustment for inflammatory markers and homocysteine. Our results suggest that the relationship between short telomeres and mortality is tied to inflammation and homocysteine. Longitudinal studies are needed to explore bidirectional influences resulting from the fact that inflammation leads to shorter leukocyte telomeres, which in turn results in senescence, which exacerbates inflammation., (© The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: In light of widespread interest in the prognostic value of biomarkers, we apply three discrimination measures to evaluate the incremental value of biomarkers--beyond self-reported measures--for predicting all-cause mortality. We assess whether all three measures--area under the receiver-operating characteristic curve, continuous net reclassification improvement, and integrated discrimination improvement--lead to the same conclusions., Methods: We use longitudinal data from a nationally representative sample of older Taiwanese (n = 639, aged 54 or older in 2000, examined in 2000 and 2006, with mortality follow-up through 2011). We estimate age-specific mortality using a Gompertz hazard model., Results: The broad conclusions are consistent across the three discrimination measures and support the inclusion of biomarkers, particularly inflammatory markers, in household surveys. Although the rank ordering of individual biomarkers varies across discrimination measures, the following is true for all three: interleukin-6 is the strongest predictor, the other three inflammatory markers make the top 10, and homocysteine ranks second or third., Conclusions: The consistency of most of our findings across metrics should provide comfort to researchers using discrimination measures to evaluate the prognostic value of biomarkers. However, because the degree of consistency varies with the level of detail inherent in the research question, we recommend that researchers confirm results with multiple discrimination measures., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Background: Despite the serious biases that characterize self-rated health, researchers rely heavily on these ratings to predict mortality. Using newly collected survey data, we examine whether simple ratings of participants' health provided by interviewers and physicians can markedly improve mortality prediction., Methods: We use data from a prospective cohort study based on a nationally representative sample of older adults in Taiwan. We estimate proportional-hazard models of all-cause mortality between the 2006 interview and 30 June 2011 (mean 4.7 years' follow-up)., Results: Interviewer ratings were more strongly associated with mortality than physician or self-ratings, even after controlling for a wide range of covariates. Neither respondent nor physician ratings substantially improve mortality prediction in models that include interviewer ratings. The predictive power of interviewer ratings likely arises in part from interviewers' incorporation of information about the respondents' physical and mental health into their assessments., Conclusions: The findings of this study support the routine inclusion of a simple question at the end of face-to-face interviews, comparable to self-rated health, asking interviewers to provide an assessment of respondents' overall health. The costs of such an undertaking are minimal and the potential gains substantial for demographic and health researchers. Future work should explore the strength of the link between interviewer ratings and mortality in other countries and in surveys that collect less detailed information on respondent health, functioning, and well-being.

Background: Although sons are thought to impose greater physiological costs on mothers than daughters, sons may be advantageous for parental survival in some social contexts. The authors examined the relationship between the sex composition of offspring and parental survival in contemporary China and Taiwan. Because of the importance of sons for the provision of support to elderly parents in these populations, the authors hypothesised that sons would have a beneficial effect on parental survival relative to daughters., Methods: The authors used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) and the Taiwan Longitudinal Study of Aging (TLSA). The CLHLS sample consisted of 4132 individuals aged 65 years and over in 2002. The TLSA sample comprised two cohorts: 3409 persons aged 60 years and over in 1989 and 2193 persons aged 50-66 years in 1996. These cohorts were followed up for 3, 18 and 11 years, respectively. The Cox proportional hazards model was used to estimate the relationship between the sex composition of offspring and parental mortality., Results: Based on seven measures of sex composition, no protective effect of sons was found in either China or Taiwan. For example, in the 1989 Taiwan sample, the hazard ratio (HR) for maternal mortality associated with having an eldest son was 0.979 (95% CI 0.863 to 1.111). In Taiwan, daughters may have been more beneficial than sons in reducing mortality in recent years., Conclusion: The authors offer several explanations for these findings, including possible benefits associated with emotional and interpersonal forms of support provided by daughters and negative impacts of conflicts arising between parents and resident daughters-in-law.

The authors used data from a nationally representative survey of 933 adults aged 54 years or older (mean age = 66.2 years; standard deviation, 8.0) in Taiwan to explore whether mortality prediction at older ages is improved by the use of 3 clusters of biomarkers: 1) standard cardiovascular and metabolic risk factors; 2) markers of disease progression; and 3) nonclinical (neuroendocrine and immune) markers. They also evaluated the extent to which these biomarkers account for the female advantage in survival. Estimates from logistic regression models of the probability of dying between 2000 and 2006 (162 deaths; mean length of follow-up = 5.8 years) showed that inclusion of each of the 3 sets of markers significantly (P = 0.024, P = 0.002, and P = 0.003, respectively) improved discriminatory power in comparison with a base model that adjusted for demographic characteristics, smoking, and baseline health status. The set of disease progression markers and the set of nonclinical markers each provided more discriminatory power than standard risk factors. Most of the excess male mortality resulted from the men being more likely than women to smoke, but each of 3 markers related to disease progression or inflammation (albumin, neutrophils, and interleukin-6) explained more than 10% of excess male mortality.

Objectives: This study examined socioeconomic differentials in mortality among Hispanics in the United States, focusing on the older ages. We address previous research suggesting that social disparities in health are smaller for Hispanics than for non-Hispanic Whites and examine whether these differentials in survival are related to the mortality advantage that characterizes the older Hispanic population (i.e., the Hispanic paradox)., Methods: We used Poisson regression models based on data from the 1989 to 1994 waves of the National Health Interview Survey, with linked mortality through 1997, to estimate death rates for Hispanics and non-Hispanic Whites by age, gender, and socioeconomic status., Results: Deaths rates varied significantly (p <.05) by education and income for Whites and Hispanic subgroups defined by nativity (U.S. born and foreign born) and nationality (Mexican, Puerto Rican, and other Hispanic). However, with the exception of Puerto Ricans, the effects of education were significantly smaller for Hispanics than for Whites. The ethnic differences in mortality patterns by income were not statistically significant., Discussion: The findings reveal that the mortality advantage for Hispanics is concentrated at lower levels of socioeconomic status, with little or no advantage at higher levels. We propose several mechanisms related to immigration and assimilation patterns that may underlie these patterns of mortality.

Background: Few studies focus on "preclinical" warning signs associated with mortality. In this article, we investigate associations between all-cause mortality and two clusters of biological risk factors: (i) standard clinical measures related to cardiovascular disease and metabolic function; and (ii) nonclinical measures pertaining to hypothalamic-pituitary-adrenal axis activity, sympathetic nervous system activity, and inflammatory response., Methods: Data come from the 2000 Social Environment and Biomarkers of Aging Study, a national sample of Taiwanese persons aged 54 years or older; 1497 persons were interviewed in their homes, and 1023 participated in a hospital examination. The analysis is based on 927 respondents with complete information. Logistic regression models describe the association between biomarkers and the 3-year probability of dying., Results: Although both groups of biomarkers are significantly associated with mortality, the model with neuroendocrine and immune biomarkers has better explanatory and discriminatory power than the one with clinical measures. The association between these nonclinical measures and mortality remains strong after adjustment for the clinical markers, suggesting that the physiological effects of the nonclinical biomarkers are broader than those captured by the cardiovascular and metabolic system measures included here., Conclusions: Nonclinical markers are likely to provide warning signs of deteriorating health and function beyond what can be learned from conventional markers. Our findings are consistent with those of recent studies that (i) demonstrate the importance of neuroendocrine and immune system markers for survival, and (ii) indicate that standard clinical variables are less predictive of mortality in older than in younger populations.

We investigate whether a multi-system measure of physiological dysregulation based on 16 biological measures is associated with deterioration in physical and mental health over a 3-year period. The data come from a national survey of persons 54 and older in Taiwan that collected standard clinical markers related to cardiovascular and metabolic function and "non-clinical" measures pertaining to the immune, neuroendocrine and sympathetic nervous systems. The dysregulation score counts the number of biomarkers for which values are in the lowest or highest decile. Statistical models examine whether dysregulation predicts four health outcomes (survival, physical functioning, cognitive functioning and depressive symptoms), in the presence of extensive controls for baseline health. The estimates reveal significant associations between dysregulation and health for each outcome, although there is variability across outcomes. The associations are often attenuated in the presence of health controls, underscoring the importance of longitudinal analysis. This study extends previous research on the health consequences of physiological dysregulation by considering a broader range of outcomes and biomarkers in a non-Western population-based sample. Our analysis suggests that such dysregulation provides early warning signs of a broad range of comorbidities.

Purpose: Studies based on Western populations showed a negative relationship between dehydroepiandrosterone sulfate (DHEAS) level and mortality, but no study examined this relationship in a non-Western country. We use data from a large, nationally representative sample (n = 963) of older Taiwanese to investigate whether serum DHEAS, predicts subsequent mortality during a 3-year period (2000 to 2003) and whether an effect remains after controlling for baseline health status., Methods: Baseline data collection included an individual interview, physical examination, and blood sample. A logit model is used to test the relationship between DHEAS level and risk for mortality, controlling for age, sex, and smoking status., Results: Results show a marginally significant inverse relationship between DHEAS level and 3-year mortality risk. Participants with low DHEAS levels (<54.5 microg/dL) have 64% greater odds of dying than those with higher DHEAS levels (p < 0.06). After adjusting for various indicators of health status in 2000, the odds ratio (OR) for low DHEAS level remains substantial (OR = 1.41), but not statistically significant., Conclusions: Although the analysis is limited by the short follow-up and small number of deaths, results are consistent with the notion that DHEAS level has a sizeable effect on mortality.

Few reliable estimates have been available for assessing the impact of the COVID-19 pandemic on mortality among Native Americans. Using deidentified publicly available data on deaths and populations by age, we estimated life expectancy for the years 2019-2022 for single-race non-Hispanic Native Americans. Life expectancy in 2022 was 67.8 years, 2.3 years higher than in 2021 but a huge 4-year loss from 2019. Although our life expectancy estimates for 2022 varied under different assumptions about racial/ethnic classification and age misreporting errors, all estimates were lower than the average for middle-income countries. Estimates of losses and gains in life expectancy were consistent across assumptions. Large reductions in COVID-19 death rates between 2021 and 2022 were largely offset by increases in rates of death from unintentional injuries (particularly drug overdoses), chronic liver disease, diabetes, and heart disease, underscoring the difficulties facing Native Americans in achieving reductions in mortality, let alone returning to levels of mortality prior to the pandemic. Serious data problems have persisted for many years, but the scarcity and inadequacy of estimates during the pandemic have underscored the urgent need for timely and accurate demographic data on the Native American population. [ABSTRACT FROM AUTHOR]

COVID-19 has resulted in a staggering death toll in the United States: over 215,000 by mid-October 2020, according to the Centers for Disease Control and Prevention. Black and Latino Americans have experienced a disproportionate burden of COVID-19 morbidity and mortality, reflecting persistent structural inequalities that increase risk of exposure to COVID-19 and mortality risk for those infected. We estimate life expectancy at birth and at age 65 y for 2020, for the total US population and by race and ethnicity, using four scenarios of deaths--one in which the COVID-19 pandemic had not occurred and three including COVID-19 mortality projections produced by the Institute for Health Metrics and Evaluation. Our medium estimate indicates a reduction in US life expectancy at birth of 1.13 y to 77.48 y, lower than any year since 2003. We also project a 0.87-y reduction in life expectancy at age 65 y. The Black and Latino populations are estimated to experience declines in life expectancy at birth of 2.10 and 3.05 y, respectively, both of which are several times the 0.68-y reduction for Whites. These projections imply an increase of nearly 40% in the Black-White life expectancy gap, from 3.6 y to over 5 y, thereby eliminating progress made in reducing this differential since 2006. Latinos, who have consistently experienced lower mortality thanWhites (a phenomenon known as the Latino or Hispanic paradox), would see their more than 3-y survival advantage reduced to less than 1 y. [ABSTRACT FROM AUTHOR]

Quantification of biological aging is of interest in gerontology as a means to surveil aging rates in the population and to evaluate the effects of interventions to increase healthy life span. Analysis of proposed methods to quantify biological aging has focused on samples of midlife or mixed-age adults in the West. Research is needed to test whether quantifications of biological aging can differentiate aging rates among older adults and if quantifications of biological aging developed in Western samples can differentiate aging rates in non-Western populations. We conducted analysis of Klemera-Doubal method (KDM) Biological Age and homeostatic dysregulation measures of biological aging developed in the U.S. NHANES and tested in a sample of older Taiwanese adults in the Social Environment and Biomarkers of Aging Study. We conducted analysis of physical and cognitive function and mortality, comparing quantifications of biological aging to a biomarker index based on norms within our analysis sample and to participants' ratings of their own health. Results showed that quantifications of biological aging (a) predicted differences in physical and cognitive function and in mortality risk among Taiwanese older adults and (b) performed as well as a traditional biomarker index and participant self-rated health for prediction of these outcomes. [ABSTRACT FROM AUTHOR]

Although there is little dispute about the impact of the US opioid epidemic on recent mortality, there is less consensus about whether trends reflect increasing despair among American adults. The issue is complicated by the absence of established scales or definitions of despair as well as a paucity of studies examining changes in psychological health, especially well-being, since the 1990s. We contribute evidence using two cross-sectional waves of the Midlife in the United States (MIDUS) study to assess changes in measures of psychological distress and well-being. These measures capture negative emotions such as sadness, hopelessness, and worthlessness, and positive emotions such as happiness, fulfillment, and life satisfaction. Most of the measures reveal increasing distress and decreasing well-being across the age span for those of low relative socioeconomic position, in contrast to little decline or modest improvement for persons of high relative position. [ABSTRACT FROM AUTHOR]

This study examines whether frailty is associated with mortality independently of physiological dysregulation (PD) and, if so, which is the more accurate predictor of survival. Data come from the Social Environment and Biomarkers of Aging Study. We use Cox proportional hazard models to test the associations between PD, frailty, and 4- to 5-year survival. We use Harrell’s concordance index to compare predictive accuracy of the models. Both PD and frailty are significantly, positively, and independently correlated with mortality: Worse PD scores and being frail are associated with a higher risk of dying. The overall PD score is a more accurate predictor of survival than frailty, although model prediction improves when both measures are included. PD and frailty independently predict mortality, suggesting that the two measures may be capturing different aspects of the same construct and that both may be important for identifying individuals at risk for adverse health outcomes. [ABSTRACT FROM AUTHOR]

Telomere length has generated substantial interest as a potential predictor of aging-related diseases and mortality. Some studies have reported significant associations, but few have tested its ability to discriminate between decedents and survivors compared with a broad range of well-established predictors that include both biomarkers and commonly collected self-reported data. Our aim here was to quantify the prognostic value of leukocyte telomere length relative to age, sex, and 19 other variables for predicting five-year mortality among older persons in three countries. We used data from nationally representative surveys in Costa Rica (N = 923, aged 61+), Taiwan (N = 976, aged 54+), and the U.S. (N = 2672, aged 60+). Our study used a prospective cohort design with all-cause mortality during five years post-exam as the outcome. We fit Cox hazards models separately by country, and assessed the discriminatory ability of each predictor. Age was, by far, the single best predictor of all-cause mortality, whereas leukocyte telomere length was only somewhat better than random chance in terms of discriminating between decedents and survivors. After adjustment for age and sex, telomere length ranked between 15th and 17th (out of 20), and its incremental contribution was small; nine self-reported variables (e.g., mobility, global self-assessed health status, limitations with activities of daily living, smoking status), a cognitive assessment, and three biological markers (C-reactive protein, serum creatinine, and glycosylated hemoglobin) were more powerful predictors of mortality in all three countries. Results were similar for cause-specific models (i.e., mortality from cardiovascular disease, cancer, and all other causes combined). Leukocyte telomere length had a statistically discernible, but weak, association with mortality, but it did not predict survival as well as age or many other self-reported variables. Although telomere length may eventually help scientists understand aging, more powerful and more easily obtained tools are available for predicting survival. [ABSTRACT FROM AUTHOR]

Objective. To determine whether disease predicts weight loss in population-based studies, as this may confound the relationship between weight and mortality. Materials and methods. We used longitudinal data from the Costa Rican Longevity and Healthy Aging Study (CRELES) and the English Longitudinal Study of Ageing (ELSA). We defined two overlapping outcomes of measured weight loss between waves: >1.0 point of body mass index (BMI) and >2.0 BMI points. Logistic regression models estimated the associations with disease, adjusting for age (range 52-79), sex, smoking, and initial BMI. Results. In ELSA, onset of diabetes, cancer, or lung disease is associated with loss >2.0 points (respectively, OR=2.25 [95%CI: 1.34-3.80]; OR=2.70 [95%CI: 1.49-4.89]; OR=1.82 [95%CI: 1.02-3.26]). In CRELES, disease-onset reports are not associated with weight loss at 5% significance, but statistical power to detect associations is poor. Conclusion. Although it is known that some diseases cause weight loss, at the population level these associations vary considerably across samples. [ABSTRACT FROM AUTHOR]

Perceived stress is associated with poor health outcomes including negative affect, increased susceptibility to the common cold and cardiovascular disease; the consequences of perceived stress for mortality, however, have received less attention. This study characterizes the relationship between perceived stress and 11-year mortality in a population of Taiwanese adults aged 53+ years. Using the Survey of Health and Living Status of the Near Elderly and Elderly of Taiwan, we calculated a composite measure of perceived stress based on six items pertaining to the health, financial situation, and occupation of the respondents and their families. Proportional hazard models were used to determine whether perceived stress predicted mortality. After adjusting for sociodemographic factors only, we found that a one standard deviation increase in perceived stress was associated with a 19% increase in all-cause mortality risk during the 11-year follow-up period (hazard ratio, HR = 1.19, 95% confidence interval, CI 1.13-1.26). The relationship was greatly attenuated when perceptions of stress regarding health were excluded, and was not significant after adjusting for medical conditions, mobility limitations and depressive symptoms. We conclude that the association between perceived stress and mortality is explained by an individual's current health; however, our data do not allow us to distinguish between two possible interpretations of this conclusion: (a) the relationship between perceived stress and mortality is spurious, or (b) poor health acts as the mediator. [ABSTRACT FROM AUTHOR]

Two opposing hypotheses were proposed to explain the life course pattern in the effect of education on mortality: “cumulative advantage,” where the education effect becomes stronger with age, and “age-as-leveler,” where the effect becomes weaker in old age. Most empirical studies bring evidence for the latter hypothesis, but the observed convergence of mortality patterns could be an artifact of selective mortality due to unobserved heterogeneity. A simulation shows that unobserved heterogeneity can bias the estimated effect of education downward so that the cohort-average effect of education decreases in old age regardless of the shape of the underlying subject-specific trajectory. [ABSTRACT FROM AUTHOR]

Prospective studies that examine marital status differences in health and mortality frequently fail to update information on marital status in statistical models. The authors illustrate how the resulting misclassification of marital status can produce substantial bias in estimates of bereavement effects associated with widowhood. They use as their main source of data the Longitudinal Study of Aging (LSOA), 1984–1990, a national survey of persons aged 70 years and older. The estimates are based primarily on 3, 192 respondents who were married and cohabiting with their spouses at the time of the baseline survey and who could be matched to their spouses' records. Comparisons of widowhood status derived from matched spouse records with reported marital status recorded in LSOA interviews demonstrate that reliance on interview information leads to substantial misclassification of marital status. Resutts from survival models indicate that estimates of marital status effects are sensitive to whether and how marital status is updated after baseline interviews. For example, updating marital status in hazard models from interview information alone indicates a protective effect of widowhood, whereas classifying widowhood on the basis of spouses' death records reveals a significant bereavement effect (relative mortality risks between 1.3 and 1.4). Am J Epidemiol 1997; 145: 995–1002. [ABSTRACT FROM AUTHOR]

Measures of physical functioning are among the strongest predictors of mortality, but no previous study has assessed whether the predictive value of such measures varies by race/ethnicity, as has been done for the simple self-rated health question. The current study tests whether the relationship between two measures of physical functioning (the number of self-reported functional limitations and measured walking speed) and mortality is weaker (has a lower hazard ratio) for Latinos and blacks than for whites. Data were drawn from the 1998–2014 waves of the Health and Retirement Study, with mortality follow-up through 2016. We used Cox hazard models with household random effects to test for interactions between race/ethnicity and these measures of physical functioning and verified earlier findings for self-rated health. The number of self-reported functional limitations is significantly related to mortality for all racial/ethnic groups, but has a substantially lower hazard ratio for blacks and Latinos than for whites, as hypothesized. This hazard ratio remains lower for blacks and Latinos after adjustment for sociodemographic characteristics and health conditions. These findings suggest that the higher rates of functional limitations observed among Latinos and blacks compared with whites may reflect a history of strenuous physical work, inadequately controlled pain, lower leisure-time physical activity, or untreated/under-treated mobility problems that can lead to reduced physical performance without necessarily having a substantial effect on mortality risk. On the other hand, we do not detect significant racial/ethnic differences in the association between measured walking speed and subsequent mortality. This may be the result of the smaller sample size for the walking speed tests, the more nuanced nature of the continuous walking speed measure, or the fact that the walking speed test captures only a subset of the limitations included in the self-reports. • Physical functioning is a powerful predictor of mortality at older ages. • We investigate whether this association varies by race and ethnicity. • Functional limitations are more weakly linked to mortality for blacks and Latinos. • This may be due to racial/ethnic differences in jobs, pain, activity, or treatment. [ABSTRACT FROM AUTHOR]

Abstract: Polymorphisms of the apolipoprotein E gene (ApoE) have been associated with health and longevity. Numerous studies have linked ApoE to health outcomes including cardiovascular disease and mortality, but far fewer studies have examined the relationship of ApoE to other biological markers of health. This study investigates the relationship between ApoE and mortality, as well as ApoE and a set of biomarkers related to cardiovascular and immune function, in a population-based sample of Taiwanese adults ages 54+. ApoE ɛ2 carriers were less likely to have at-risk levels of high-density lipoprotein (HDL-C) and total cholesterol (total-C) than non-carriers (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.25–0.83 and OR 0.45, 95% CI 0.29–0.71, respectively). ApoE ɛ4 carriers were less likely to have elevated levels of C-reactive protein (CRP) than non-carriers (OR 0.62, 95% CI 0.39–0.96). ApoE genotype was not, however, associated with mortality after 8 years of follow-up. Our findings confirm the association between ApoE ɛ2 and cholesterol levels, suggesting a potential protective effect of ApoE ɛ2 on blood lipids. They also contribute to reports on the relationship between ApoE ɛ4 carrier status and lower CRP levels. [Copyright &y& Elsevier]