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Background Cardiometabolic risk (CMR) is associated with cognitive health, but the association can be affected by broader social, economic, and medical contexts. The United States and China have very different developmental and epidemiological histories, and thus CMR among older people could be linked to cognitive function differently in the 2 countries. Methods Cross-sectional and longitudinal ordinary least squares regression models were estimated for each country using nationally representative samples of populations over age 50: 7 430/4 474 Americans and 6 108/3 655 Chinese in the cross-sectional/longitudinal samples. Results In the United States, higher CMR is associated with worse cognitive function (b  = −0.08, p  < .016). Longitudinally, CMR increase is associated with worse cognitive function at a marginally significant level (b  = −0.10, p  = .055). No relationship between CMR level or change and cognitive function is observed in China. Higher education levels are linked to better cognitive function and slower cognitive decline in both countries. Unlike older Americans, relative to those with very low education levels, among older Chinese with the highest education level, a higher CMR links to better cognitive function (b  = 0.63, p  = .013) and slower cognitive decline (b  = 0.35, p  = .062); Nevertheless, a rapid increase in CMR is additionally harmful (b  = −0.54, p  = .050) for cognitive function and may lead to faster cognitive decline (b  = −0.35, p  = .079). Conclusions The significant relationship between CMR and cognitive function in the United States suggests the importance of monitoring and controlling CMR factors at older ages. The insignificant relationship in China may be explained by the high CMR among those with high education levels, highlighting the need for improving cardiometabolic health through education and promoting healthy lifestyles. [ABSTRACT FROM AUTHOR]

Objectives: This study examined differences in accelerated biological aging among non-Hispanic Blacks, Hispanics, and non-Hispanic Whites in the United States and assessed whether including life course socioeconomic conditions attenuated observed racial/ethnic differences. Methods: Data came from the Venous Blood Collection Subsample of the Health and Retirement Study. We used a comprehensive summary measure of biological age (BA-22). We determined whether key lifetime socioeconomic conditions contributed to racial/ethnic differences in biological aging. Results: Findings indicated that non-Hispanic Blacks and Hispanics have accelerated aging, and non-Hispanic Whites have decelerated aging. Racial/ethnic differences were strongly tied to educational attainment. We also observed a significant difference by birthplace for Hispanics. US-born Hispanics had accelerated biological aging, whereas foreign-born Hispanics did not. In age-stratified analyses, these racial/ethnic differences were found for adults aged 56–74, but not for adults aged 75+. Conclusions: These findings provide insight into biological differences underlying racial/ethnic disparities in health. [ABSTRACT FROM AUTHOR]

Objectives: Using comprehensive measures of biological risk, this study aims to investigate the relationship between intake of individual dietary components, overall diet quality, and biological dysregulation. Methods: We analyzed nationally representative data from 3734 older adults who participated in the Health and Retirement Study Venous Blood Study in 2016 and Health Care and Nutrition Survey in 2013. Results: Eleven out of 13 individual dietary components were associated with lower biological risk. Respondents with poor/suboptimal quality diet had higher biological risk than those with good quality diet. Discussion: Findings from this study emphasize the importance of healthy eating in improving health of older adults. Encouraging intake of fruits, greens and beans, whole grains, and fatty acids, while limiting consumption of sodium, added sugar, and saturated fat would improve overall diet quality and contribute to the prevention of chronic diseases and morbidity. [ABSTRACT FROM AUTHOR]

Objectives: The prevalence of dementia has declined in the United States; how this parallels to changes in incidence and mortality, and how improvements in educational attainment may have influences these trends, is not known. Methods: Using the Health and Retirement Study (2000–2016), we estimated logistic regression models to examine trends in dementia prevalence and incidence, and mortality for those with and without dementia. Results: The relative decline was about 2.4% per year for dementia prevalence and 1.9% for dementia incidence. Mortality declined similarly for those with and without dementia. Improved educational attainment accounted for decline in incidence, some of the decline in prevalence, and had a negligible role in mortality. Discussion: The declines in dementia incidence provide evidence that dementia prevalence should continue to decline in the near future. These declines are most likely largely driven by continued improvements in older adult education. [ABSTRACT FROM AUTHOR]

Objectives While a number of studies have documented a notable decline in age-standardized prevalence in dementia in the U.S. population, relatively little is known about how dementia has declined for specific age and race groups, and the importance of changing educational attainment on the downward trend. We assess (a) how the trends in dementia prevalence may have differed across age and race groups and (b) the role of changing educational attainment in understanding these trends. Methods This article estimates a series of logistic regression models using data from the Health and Retirement Study (2000–2014) to assess the relative annual decline in dementia prevalence and the importance of improving educational attainment for non-Hispanic Whites and non-Hispanic Blacks. Results Consistent with other studies, we found significant declines in dementia for non-Hispanic Blacks and non-Hispanic Whites across this period. Nonetheless, these declines were not uniform across age and race groups. Non-Hispanic Blacks aged 65–74 years had the steepest decline in this period. We also found that improved educational attainment in the population was fundamentally important in understanding declining dementia prevalence in the United States. Discussion This study shows the importance of improvement in educational attainment in the early part of the twentieth century to understand the downward trend in dementia prevalence in the United States from 2000 to 2014. [ABSTRACT FROM AUTHOR]

Objective: A suboptimal diet and nutritional deficiencies can have important influences on health with significant impact among older adults. This study aims to assess the presence of suboptimal dietary intake among older Americans and identify risk and protective factors influencing diet quality.Design: Cross-sectional secondary analysis.Setting: USA.Participants: A nationally representative sample of 5614 community-dwelling older adults over age 54 in the Health and Retirement Study - Health Care and Nutrition Survey.Results: Overall, only 10·7 % of respondents had a good quality diet (Healthy Eating Index score 81 and above); the majority had diets considered poor or needing improvement. Less than 50 % of respondents met dietary guidelines and nutritional goals for most individual food groups and nutrients. Respondents with low socio-economic status, fewer psychosocial resources and those who had limited access to healthy food outlets were more likely to have a diet of suboptimal quality.Conclusions: Efforts to remove identified barriers that put older adults at risk for poor nutrition and to provide resources that increase access to healthy food should be made to encourage healthy eating and enhance diet quality. [ABSTRACT FROM AUTHOR]

It is important to understand the factors motivating people to adopt recommended behavioral changes in response to the coronavirus disease 2019 (COVID-19) pandemic, and how they differ for younger and older adults. Using a nationally representative sample from the Understanding America Study (3/10-3/31/2020), we assessed how four cognitive mediators affected uptake of protective activities for younger (aged 18-34) and older adults (aged 65+) during the beginning of the COVID-19 pandemic. Confirmatory factor analysis based on Protective Motivation Theory demonstrated associations between our observed variables and the latent constructs: perceived severity and susceptibility, and response efficacy and self-efficacy. Among younger adults, coping appraisal such as perceptions of effectiveness of behaviors in protecting them from coronavirus and belief in their ability to perform recommended changes led them to adopt preventive behaviors; for older people, threat appraisal such as perception of severity was associated with behavioral responses. Younger people may rely more on their assessment of coping resources and effectiveness in their response to COVID-19; while older people base their behavioral responses on their perception of the severity of the situation, which they appraise using information from media and the severity of the epidemic in their state of residence. Different strategies are required to motivate older and younger people to adopt behavioral modifications, which are critical in reducing further spread of COVID-19. [ABSTRACT FROM AUTHOR]

Objectives We estimate life expectancy with and without dementia for Americans 65 years and older by education and race to examine how these stratification systems combine to shape disparities in later-life cognitive health. Method Based on the Health and Retirement Study (2000–2014), we use a multivariate, incidence-based life table approach to estimate life expectancy by cognitive health status for race–education groups. The models also simulate group differences in the prevalence of dementia implied by these rates. Results The life table results document notable race–education differences in dementia and dementia-free life expectancy, as well as stark differences in implied dementia prevalence. At each education level, blacks can expect to live more years with dementia and they have significantly higher rates of dementia prevalence. This distribution of disparities in the older population is anchored by 2 groups—blacks without a high school diploma and whites with some college or more. Discussion Dementia experience and dementia burden differ dramatically along race–education lines. Race and education combine to exaggerate disparities and they both have enduring effects. Future research should explicitly consider how race and education combine to influence dementia in the older American population. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate how cardiometabolic‐inflammatory risk factors are related to cognition among older adults in India and the United States. DESIGN: The Longitudinal Aging Study in India–Diagnostic Assessment of Dementia (LASI‐DAD) and the Harmonized Cognitive Assessment Protocol of the Health and Retirement Study (HRS‐HCAP) in the United States conducted an in‐depth assessment of cognition, using protocols designed for international comparison. SETTING: Cognitive tests were conducted in hospital or household settings in India and in household settings in the United States. PARTICIPANTS: Respondents aged 60 years and older from LASI‐DAD (N = 1,865) and respondents aged 65 years and older from HRS‐HCAP (N = 2,111) who provided venous blood specimen. MEASUREMENTS: We used total composite scores from the common cognitive tests administered. Cardiovascular risk was indicated by systolic and diastolic blood pressure, pulse rate, pro‐B‐type natriuretic peptide (proBNP), and homocysteine. Metabolic risk was measured by body mass index, glycosylated hemoglobin (HbA1c), high‐density lipoprotein cholesterol, and lipoprotein (a) (only in India). Inflammatory risk was indicted by white blood cell count, C‐reactive protein, albumin, and uric acid (only in India). RESULTS: The distribution of both total cognition scores and of cardiometabolic risk factors differed significantly between India and the United States. In both countries, lower cognition was associated with older age, lower education, elevated homocysteine, elevated proBNP, and lower albumin levels. The associations between HbA1c levels and cognitive measures were statistically significant in both countries, but in the opposite direction, with a coefficient of 1.5 (P <.001) in India and −2.4 (P <.001) in the United States for one percentage increase in absolute HbA1c value. CONCLUSION: Cardiometabolic‐inflammatory biomarkers are associated with cognitive functional levels in each country, but the relationships may vary across countries. J Am Geriatr Soc 68:S36‐S44, 2020. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To compare cognitive performance among Japanese and American persons, aged 68 years and older, using two nationally representative studies and to examine whether differences can be explained by differences in the distribution of risk factors or in their association with cognitive performance. DESIGN: Nationally representative studies with harmonized collection of data on cognitive functioning. SETTING: Nihon University Japanese Longitudinal Study of Aging and the US Health and Retirement Study. PARTICIPANTS: A total of 1953 Japanese adults and 2959 US adults, aged 68 years or older. MEASUREMENTS: Episodic memory and arithmetic working memory are measured using immediate and delayed word recall and serial 7s. RESULTS: Americans have higher scores on episodic memory than Japanese people (0.72 points on a 20‐point scale); however, when education is controlled, American and Japanese people did not differ. Level of working memory was higher in Japan (0.36 on a 5‐point scale) than in the United States, and the effect of education on working memory was stronger among Americans than Japanese people. There are no differences over the age of 85 years. CONCLUSION: Even with large differences in educational attainment and a strong effect of education on cognitive functioning, the overall differences in cognitive functioning between the United States and Japan are modest. Differences in health appear to have little effect on national differences in cognition. J Am Geriatr Soc 68:354–361, 2020 [ABSTRACT FROM AUTHOR]

Background: This article investigates changes in disease prevalence, incidence, and mortality among four cohorts of older persons in the Health and Retirement Study.Methods: We examine two cohorts initially aged 51 to 61, whom we call younger cohorts, and two older cohorts aged 70 to 80 at the start of observation. Each of the paired cohorts was born about 10 years apart. We follow the cohorts for approximately 10 years.Results: The prevalence of cancer, stroke, and diabetes increased in later-born cohorts; while the prevalence of myocardial infarction decreased markedly in both later-born cohorts. The incidence of heart disease, myocardial infarction, and stroke decreased among those in the later-born older cohort; while only the incidence of myocardial infarction decreased in the later-born younger cohort. On the other hand, diabetes incidence increased among those in both later-born cohorts. Death rates among those with heart disease, cancer, and diabetes decreased in the later-born cohorts. The declining incidence of three cardiovascular conditions among those who are over age 70 reflects improving population health and has resulted in stemming the increase in prevalence of people with heart disease and stroke.Discussion: While these results provide some important signs of improving population health, especially among those over 70; trends for those less than 70 in the United States are not as positive. [ABSTRACT FROM AUTHOR]

Objective: Improvements in the Black-White difference in life expectancy have been attributed to improved diagnosis and treatment of cardiovascular diseases and declines in cardiovascular disease mortality. However, it is unclear whether race differences in total cardiovascular risk and the prevalence of cardiovascular risk factors have improved in the United States since the 1990s.Design: Serial cross-sectional design.Setting: Data from the 1988-1994, 1999-2002, and 2009-2012 National Health and Nutrition Examination Survey (NHANES).Methods: We estimated total cardiovascular risk levels, the prevalence of high-risk cardiovascular risk factors and the use of antihypertensive and lipid-lowering drugs among US Black and White men and women to determine whether differential changes occurred from 1990-2010.Results: Total cardiovascular risk declined for all races from 1990-2010. The Black-White difference was only significant in 2000 and sex-specific analyses showed that trends seen in the total population were driven by changes among women. Black and White men did not differ in risk at any time during this period. Conversely, Black women had significantly higher risk than White women in 1990 and 2000; this difference was eliminated by 2010. Improved diagnosis and treatment of high blood pressure and high cholesterol reduced risk in the total population; improved blood pressure and lipid profiles among Black women and increasing obesity prevalence among White women specifically contributed to the narrowing of the Black-White difference in risk among women.Conclusion: Cardiovascular risk and racial disparities in risk declined among US Whites and Blacks due to greater use and effectiveness of lipid-lowering and antihypertensive medications. [ABSTRACT FROM AUTHOR]

Background: Relative to men, women have experienced slower improvement in mortality in the US in recent decades.Aims: We investigated 20-year trends in cardiovascular risk for men and women age 40 and over in the US to determine whether there was differential change in risk for men and women.Methods: Using the National Health and Nutrition Examination Survey (NHANES), we estimated total cardiovascular risk, the prevalence of individual risk factors, and potential factors contributing to change in risk.Results: Men showed steady reductions in cardiovascular risk over the 20 years; women experienced increased risk from 1990 to 2000, but decreased risk from 2000 to 2010. Sex differences in cardiovascular risk changed so that there was no significant difference by sex at any age over 50 in 2010. Large decreases in the prevalence of high risk lipids were important causes of reduction in risks for both sexes; changes in blood pressure were less important, except for women in the 2000-2010 period when they equaled the effect of changing lipids. Increasing medication usage and effectiveness drove improvements in blood pressure and total cholesterol for both sexes. In 2010 there was no difference between men and women in the use of antihypertensives or cholesterol-lowering medications. Metabolic risk, as indexed by obesity and HbA1c, increased over time and went against the trend in the summary measure. Diabetes, smoking, and hormone therapy use did not explain changes in high blood pressure or high total cholesterol for either gender.Conclusions: Recent decreases in cardiovascular risk may lead to future reduction in cardiovascular events and mortality among both women and men. [ABSTRACT FROM AUTHOR]

The article discusses a study which investigated international differences in the association between obesity and physiological dysregulation in the U.S., England and Taiwan. Three nationally representative samples were used in the study, including the U.S. National Health and Nutrition Examination Survey. The researchers found higher physiological dysregulation among individuals with high waist.

ABSTRACT Using the National Health and Nutrition Examination Surveys (NHANES) 1999-2004, the authors examined age patterns in oral health indicators by race/ethnicity and socioeconomic status related to edentulism, presence of root caries, and periodontal disease. Our analysis included subjects who were non-Hispanic White, Mexican American, and African American over the age of 20, and who participated in the NHANES oral health examination. African Americans experienced more oral health problems at younger ages; as age increased, so did racial disparities in oral health problems. Lower educational attainment was strongly associated with more oral health problems at all ages. These results may indicate a faster progression of oral health problems with age among African Americans, thus suggesting that the 'earlier aging' of members of racial/ethnic minorities which has been reported in prior research may also be found in oral health. [ABSTRACT FROM AUTHOR]

Life expectancy is higher in Japan than in the United States. We compared the prevalence of clinically recognized risk factors in the two countries to explore the possibility that differences in these likely precursors to disease and death are linked to the paths to higher mortality for Americans. We found that American men and women have higher levels of total biological risk than the Japanese, particularly for risk factors included in the metabolic syndrome. A significant difference between the two countries is the higher prevalence of overweight among Americans. On the other hand, measured blood pressure appears more favorable among Americans. A larger proportion of Americans use prescription drugs, which results in lowered levels of measured biological risk. There are large differences in the prevalence of a number of risk factors between American and Japanese women less than age 40; this could mean that Americans develop biological risk earlier in life or that the differences are growing larger in more recent cohorts. [ABSTRACT FROM AUTHOR]

Importance: Vital statistics are the primary source of data used to understand the mortality burden of dementia in the US, despite evidence that dementia is underreported on death certificates. Alternative estimates, drawing on population-based samples, are needed., Objective: To estimate the percentage of deaths attributable to dementia in the US., Design, Setting, and Participants: A prospective cohort study of the Health and Retirement Study of noninstitutionalized US individuals with baseline exposure assessment in 2000 and follow-up through 2009 was conducted. Data were analyzed from November 2018 to May 2020. The sample was drawn from 7489 adults aged 70 to 99 years interviewed directly or by proxy. Ninety participants with missing covariates or sample weights and 57 participants lost to follow-up were excluded. The final analytic sample included 7342 adults., Exposure: Dementia and cognitive impairment without dementia (CIND) were identified at baseline using Health and Retirement Study self- or proxy-reported cognitive measures and the validated Langa-Weir score cutoff., Main Outcomes and Measures: Hazard ratios relating dementia and CIND status to all-cause mortality were estimated using Cox proportional hazards regression models, accounting for covariates, and were used to calculate population-attributable fractions. Results were compared with information on cause of death from death certificates., Results: Of the 7342 total sample, 4348 participants (60.3%) were women. At baseline, 4533 individuals (64.0%) were between ages 70 and 79 years, 2393 individuals (31.0%) were between 80 and 89 years, and 416 individuals (5.0%) were between 90 and 99 years; percentages were weighted. The percentage of deaths attributable to dementia was 13.6% (95% CI, 12.2%-15.0%) between 2000 and 2009. The mortality burden of dementia was significantly higher among non-Hispanic Black participants (24.7%; 95% CI, 17.3-31.4) than non-Hispanic White participants (12.2%; 95% CI, 10.7-13.6) and among adults with less than a high school education (16.2%; 95% CI, 13.2%-19.0%) compared with those with a college education (9.8%; 95% CI, 7.0%-12.5%). Underlying cause of death recorded on death certificates (5.0%; 95% CI, 4.3%-5.8%) underestimated the contribution of dementia to US mortality by a factor of 2.7. Incorporating deaths attributable to CIND revealed an even greater underestimation., Conclusions and Relevance: The findings of this study suggest that the mortality burden associated with dementia is underestimated using vital statistics, especially when considering CIND in addition to dementia.

The COVID-19 pandemic has had tremendous impact on Americans' lives including their personal and social behaviors. While people of all ages are affected in some way by the pandemic, older persons have been far more likely to suffer the most severe health consequences. For this reason, how people have responded to mitigating behaviors to COVID-19 may differ by age. Using a nationally representative sample from the longitudinal data of the Understanding America Study (UAS), we examined differentials in behavioral responses to COVID-19 by age and how they changed over the first three months of the pandemic. Behavioral responses and changes in behavior over time differed by age, type of behaviors and time reference. At the beginning of the pandemic (March, 2020), older and younger people were similar in their likelihood of engaging in preventive personal behaviors when controlling for other influences. As the pandemic progressed, however, older people adopted mitigating personal behavioral changes more than younger people, such that about 1-2 months after the pandemic started, older people were more likely to comply with suggested behaviors and regulations including practicing better hygiene, quarantining, and social distancing. One month into the pandemic, older people were less likely than younger people to engage in two of four risky behaviors. The change in risky behavior over time did not differ by age; but both younger and older people were more likely to engage in risky behaviors after two months. Being female, a member of a racial/ethnic minority group, higher socioeconomic status, having more COVID-19 cases in one's state of residence, a higher perceived risk for infection and dying, and a more left-leaning political orientation were related to adopting more pandemic mitigating behaviors., Competing Interests: The authors have declared that no competing interests exist.

Objectives: This study investigates how factors related to collection, storage, transport time, and environmental conditions affect the quality and accuracy of analyses of dried blood spot (DBS) samples., Methods: Data come from the 2016 Health and Retirement Study (HRS) DBS laboratory reports and the HRS merged with the National Climatic Data Center (NCDC) Global Historical Climate Network Daily (NCDC GHCN-Daily) and the NCDC Local Climatological Data, by zip code. We ran regression models to examine the associations between assay values based on DBS for five analytes (total cholesterol, high-density lipoprotein (HDL) cholesterol, glycosylated hemoglobin (HbA1c), C-reactive protein (CRP), and cystatin C) and the characteristics of DBS cards and drops, shipping time, and temperature, and humidity at the time of collection., Results: We found cholesterol measures to be sensitive to many factors including small spots, shipping time, high temperature and humidity. Small spots in DBS cards are related to lower values across all analytes. Longer DBS transit time before freezing is associated with lower values of total and HDL cholesterol and cystatin C. Results were similar whether or not venous blood sample values were included in equations., Conclusions: Small spots, long shipping time, and exposure to high temperature and humidity need to be avoided if possible. Quality of spots and cards and information on shipping time and conditions should be coded with the data to make adjustments in values when necessary. The different results across analytes indicate that results cannot be generalized to all DBS assays., (© 2020 The Authors. American Journal of Human Biology published by Wiley Periodicals, Inc.)

Objectives: This article provides the first estimates of educational differences in age-specific prevalence, and changes in prevalence over time, of dementia by education levels in the United States. It also provides information on life expectancy, and changes in life expectancy, with dementia and cognitively healthy life for educational groups., Method: Data on cognition from the 2000 and 2010 Health and Retirement Study are used to classify respondents as having dementia, cognitive impairment without dementia (CIND), or being cognitively intact. Vital statistics data are used to estimate life tables for education groups and the Sullivan method is used to estimate life expectancy by cognitive state., Results: People with more education have lower prevalence of dementia, more years of cognitively healthy life, and fewer years with dementia. Years spent in good cognition increased for most sex-education groups and, conversely, years spent with dementia decreased for some. Mortality reduction was the most important factor in increasing cognitively healthy life. Change in the distribution of educational attainment has played a major role in the reduction of life with dementia in the overall population., Discussion: Differences in the burden of cognitive loss by education point to the significant cost of low social status both to individuals and to society.

Objectives: This study examines the similarity of cognitive assessments using 1 interview in a large population study, the Health and Retirement Study (HRS), and a subsample in which a detailed neuropsychiatric assessment has been performed (Aging, Demographics, and Memory Study [ADAMS])., Methods: Respondents are diagnosed in ADAMS as demented, cognitively impaired without dementia (CIND), or as having normal cognitive function. Multinomial logistic analysis is used to predict diagnosis using a variety of cognitive and noncognitive measures from the HRS and additional measures and information from ADAMS., Results: The cognitive tests in HRS predict the ADAMS diagnosis in 74% of the sample able to complete the HRS survey on their own. Proxy respondents answer for a large proportion of HRS respondents who are diagnosed as demented in ADAMS. Classification of proxy respondents with some cognitive impairment can be predicted in 86% of the sample. Adding a small number of additional tests from ADAMS can increase each of these percentages to 84% and 93%, respectively., Discussion: Cognitive assessment appropriate for diagnosis of dementia and CIND in large population surveys could be improved with more targeted information from informants and additional cognitive tests targeting other areas of brain function.

The incorporation of biological information in large population surveys has expanded demographic analysis to clarify the meaning of observed trends and differences in population health and mortality. Levels of measured biological risk in the population were reduced in recent years largely because of the expanded use of prescription drugs. The increased use of antihypertensives and, to a lesser extent, lipid-lowering drugs was a likely cause of significant mortality reduction. Blacks and persons with lower educational attainment experience higher levels of biological risk factors, more diseases, and more frailty; these differences are the sources of higher mortality for these groups. Hispanics are less likely to have a higher prevalence of risk factors and diseases than the non-Hispanic population, providing further understanding of the "Hispanic paradox." Almost every examined indicator of biological risk, disease, and frailty is related to higher mortality, indicating how incorporation of this information provides a fuller understanding of the morbidity process.

This article uses a demographic approach and data from the Health and Retirement Survey, a nationally representative sample of the U.S. population, to investigate sex differences in the length of life lived with heart disease and after a heart attack for persons in the United States age 50 and older. On average, women live longer than men with heart disease. At age 50 women can expect to live 7.9 years and men 6.7 years with heart disease. The average woman experiences heart disease onset three years older and heart attacks 4.4 years older than men.

Objectives: We examined biological risk profiles by race, ethnicity, and nativity to evaluate evidence for a Hispanic paradox in measured health indicators., Methods: We used data on adults aged 40 years and older (n = 4206) from the National Health and Nutrition Examination Surveys (1999-2002) to compare blood pressure, metabolic, and inflammatory risk profiles for Whites, Blacks, US-born and foreign-born Hispanics, and Hispanics of Mexican origin. We controlled for age, gender, and socioeconomic status., Results: Hispanics have more risk factors above clinical risk levels than do Whites but fewer than Blacks. Differences between Hispanics and Whites disappeared after we controlled for socioeconomic status, but results differed by nativity. After we controlled for socioeconomic status, the differences between foreign-born Hispanics and Whites were eliminated, but US-born Mexican Americans still had higher biological risk scores than did both Whites and foreign-born Mexican Americans., Conclusions: There is no Hispanic paradox in biological risk profiles. However, our finding that foreign-born Hispanics and Whites had similar biological risk profiles, but US-born Mexican Americans had higher risk, was consistent with hypothesized effects of migrant health selectivity (healthy people in-migrating and unhealthy people out-migrating) as well as some differences in health behaviors between US-born and foreign-born Hispanics.

Anthropometric measures including height provide an indication of childhood health that allows exploration of relationships between early life circumstances and adult health. Height can also be used to provide some indication of how early life health is related to selection of migrants and the Hispanic paradox in the United States. This article joins information on persons of Mexican nativity ages 50 and older in the United States collected in the National Health and Nutrition Examination Survey IV (NHANES IV 1999-2002) with a national sample of persons of the same age living in Mexico from the Mexican Health and Aging Survey (MHAS 2001) to examine relationships between height, education, migration, and late-life health. Mexican immigrants to the United States are selected for greater height and a high school, rather than higher or lower, education. Return migrants from the United States to Mexico are shorter than those who stay. Height is related to a number of indicators of adult health. Results support a role for selection in the Hispanic paradox and demonstrate the importance of education and childhood health as determinants of late-life health in both Mexico and the United States.

Objectives: This article provides estimates of the prevalence of cognitive impairment by age and sex for a nationally representative sample of the U.S. population aged 70 and over. From these estimates, years of life with and without cognitive impairment are calculated., Methods: Using data from the Assets and Health Dynamics of the Oldest Old (AHEAD) survey, the prevalence of cognitive impairment is estimated for a sample representing both the community-dwelling and institutionalized older American population. Sullivan's method is used to calculate the average number of years an elderly person can expect to live with and without cognitive impairment., Results: The prevalence of moderate to severe cognitive impairment in the total U.S. population aged 70 and over is 9.5%. At age 70, the average American can expect 1.5 years with cognitive impairment. Expected length of life with cognitive impairment is longer for women than men because of their longer life expectancy., Discussion: As total life expectancy continues to increase, the length of life with cognitive impairment for the American population will increase unless age-specific prevalence is reduced. There is great potential for improvement in future early treatment and diagnosis of this condition.

This paper examines gender differences in life with and without six major diseases, including both mortal and morbid conditions. Disease prevalence and health behavior data are from the 1993-1995 National Health Interview Surveys for the United States. Vital registration data are the source of mortality rates used in computing life expectancy. The Sullivan method is used to estimate life lived with and without disease and risky behavior for men and women at various ages. Women live more years with each of the diseases examined, and, for arthritis, the extended years with disease are greatest. Women also live more years than men free of each of these diseases with the exception of arthritis. Gender differences in life without two health-risk behaviors are also discussed. Men spend more years of their lives overweight and have fewer years during which they see a doctor.