Association between cognitive trajectories and subsequent health status, depressive symptoms, and mortality among older adults in the United States: Findings from a nationally-representative study.

BACKGROUND: Cognitive decline may be an early indicator of major health issues in older adults, though research using population-based data is lacking. Our objective was to assess the relationships between distinct cognitive trajectories and subsequent health outcomes, including health status, depressive symptoms, and mortality, using a nationally representative cohort. METHODS: Data were drawn from the National Health and Aging Trends Study. Global cognition was assessed annually between 2011 and 2018. The health status of 4,413 people, depressive symptoms in 4,342 individuals, and deaths among 5,955 living respondents were measured in 2019. Distinct cognitive trajectory groups were identified using an innovative Bayesian group-based trajectory model. Ordinal logistic, Poisson, and logistic regression models were used to examine the associations between cognitive trajectories and subsequent health outcomes. RESULTS: We identified five cognitive trajectory groups with distinct baseline values and subsequent changes in cognitive function. Compared to the group with stably high cognitive function, worse cognitive trajectories (i.e., lower baseline values and sharper declines) were associated with higher risks of poor health status, depressive symptoms and mortality, even after adjusting for relevant covariates. CONCLUSION: Among older adults, worse cognitive trajectories are strongly associated with subsequent poor health status, high depressive symptoms, and high mortality risks. Regular screening of cognitive function may help to facilitate early identification and interventions for older adults susceptible to adverse health outcomes.

Social Determinants of Health and Delivery of Rehabilitation to Older Adults During ICU Hospitalization.

Importance: Older adults with socioeconomic disadvantage develop a greater burden of disability after critical illness than those without socioeconomic disadvantage. The delivery of in-hospital rehabilitation that can mitigate functional decline may be influenced by social determinants of health (SDOH). Whether rehabilitation delivery differs by SDOH during critical illness hospitalization is not known. Objective: To evaluate whether SDOH are associated with the delivery of skilled rehabilitation during critical illness hospitalization among older adults. Design, Setting, and Participants: This cohort study used data from the National Health and Aging Trends Study linked with Medicare claims (2011-2018). Participants included older adults hospitalized with a stay in the intensive care unit (ICU). Data were analyzed from August 2022 to September 2023. Exposures: Dual eligibility for Medicare and Medicaid, education, income, limited English proficiency (LEP), and rural residence. Main Outcome and Measures: The primary outcome was delivery of physical therapy (PT) and/or occupational therapy (OT) during ICU hospitalization, characterized as any in-hospital PT or OT and rate of in-hospital PT or OT, calculated as total number of units divided by length of stay. Results: In the sample of 1618 ICU hospitalizations (median [IQR] patient age, 81.0 [75.0-86.0] years; 842 [52.0%] female), 371 hospitalizations (22.9%) were among patients with dual Medicare and Medicaid eligibility, 523 hospitalizations (32.6%) were among patients with less than high school education, 320 hospitalizations (19.8%) were for patients with rural residence, and 56 hospitalizations (3.5%) were among patients with LEP. A total of 1076 hospitalized patients (68.5%) received any PT or OT, with a mean rate of 0.94 (95% CI, 0.86-1.02) units/d. After adjustment for age, sex, prehospitalization disability, mechanical ventilation, and organ dysfunction, factors associated with lower odds of receipt of PT or OT included dual Medicare and Medicaid eligibility (adjusted odds ratio, 0.70 [95% CI, 0.50-0.97]) and rural residence (adjusted odds ratio, 0.65 [95% CI, 0.48-0.87]). LEP was associated with a lower rate of PT or OT (adjusted rate ratio, 0.55 [95% CI, 0.32-0.94]). Conclusions and Relevance: These findings highlight the need to consider SDOH in efforts to promote rehabilitation delivery during ICU hospitalization and to investigate factors underlying inequities in this practice.

Beyond Parental Wealth: Grandparental Wealth and the Transition to Adulthood.

This study considers the multigenerational consequences of wealth transmission for the transition to young adulthood. Using a wider set of outcomes than has previously been considered, and by analyzing parental and grandparental wealth simultaneously, this work underscores the salience of multiple generations of wealth as a predictor for young adult well-being. Data comes from the US Panel Study of Income Dynamics on a sample of youth followed from mid-adolescence until the age of 20. Results from linear regression models indicate that parental wealth was associated with increases in the probability of college attendance and steady employment and inversely associated with the likelihood of nonmarital birth and idleness. Grandparental wealth predicted non-educational outcomes at least as well as parental wealth did and explained more variance in young adults' outcomes when parental wealth was lower. The association between parental wealth and non-educational outcomes suggest that wealth may inform young adults' broader life course by predicting outcomes other than college attendance. Grandparental wealth may serve a compensatory function for children with low parental wealth. Results suggest that persistently low wealth across multiple generations may impede the successful transition to young adulthood.

Upward Mobility Context and Health Outcomes and Behaviors during Transition to Adulthood: The Intersectionality of Race and Sex.

This study investigates how upward mobility context affects health during transition to adulthood and its variations by race and sex. Using county-level upward mobility measures and data from the Panel Study of Income Dynamics, we apply propensity score weighting techniques to examine these relationships. Results show that low upward mobility context increases the likelihood of poor self-rated health, obesity, and cigarette use but decreases alcohol consumption probability. Conversely, high upward mobility context raises the likelihood of distress, chronic conditions, and alcohol use but reduces cigarette use likelihood. In low-opportunity settings, Black individuals have lower risks of chronic conditions and cigarette use than White men. In high-opportunity settings, Black women are more likely to experience depression and chronic conditions, and Black men are likelier to smoke than White men. Our findings emphasize the complex link between upward mobility context and health for different racial and sex groups.

Long-term exposure to wildfire smoke PM2.5 and mortality in the contiguous United States.

Despite the growing evidence on the health effects of short-term exposure to wildfire smoke fine particles (PM2.5), the impacts of long-term wildfire smoke PM2.5 exposure remain unclear. We investigated the association between long-term exposure to wildfire smoke PM2.5 and all-cause mortality and mortality from a wide range of specific causes in all 3,108 counties in the contiguous U.S., 2007-2020. Monthly county-level mortality data were collected from the National Center for Health Statistics. Wildfire smoke PM2.5 concentration was derived from a 10×10 km2 resolution spatiotemporal model. Controlling for non-smoke PM2.5, air temperature, and unmeasured spatial and temporal confounders, we found a non-linear association between 12-month moving average concentration of smoke PM2.5 and monthly all-cause mortality rate. Relative to a month with the long-term smoke PM2.5 exposure below 0.1 µg/m3, all-cause mortality increased by 0.40-1.54 and 3.65 deaths per 100,000 people per month when the 12-month moving average of PM2.5 concentration was of 0.1-5 and 5+ µg/m3, respectively. Cardiovascular, ischemic heart disease, digestive, endocrine, diabetes, mental, suicide, and chronic kidney disease mortality were all found to be associated with long-term wildfire smoke PM2.5 exposure. Smoke PM2.5 contributed to approximately 30,180 all-cause deaths/year (95% CI: 21,449, 38,910) in the contiguous U.S. Higher smoke PM2.5-related increases in mortality rates were found for people aged 65 above and racial minority populations. Positive interaction effects with extreme heat were also observed. Our study identified the detrimental effects of long-term exposure to wildfire smoke PM2.5 on a wide range of mortality outcomes, underscoring the need for public health actions and communication to prepare communities and individuals to mitigate smoke exposure.

Long-Term Exposure to Fine Particulate Matter and Academic Performance Among Children in North Carolina.

This cross-sectional study analyzes the association of exposure to fine particulate matter and academic performance among school age children in North Carolina.

Racial/ethnic disparities in PM2.5-attributable cardiovascular mortality burden in the United States.

Average ambient fine particulate matter (PM2.5) concentrations have decreased in the US in recent years, but the health benefits of this improvement among different racial/ethnic groups are unknown. We estimate the associations between long-term exposure to ambient PM2.5 and cause-specific cardiovascular disease (CVD) mortality rate and assess the PM2.5-attributable CVD deaths by race/ethnicity across 3,103 US counties during 2001-2016 (n = 595,776 county-months). A 1 µg m-3 increase in PM2.5 concentration was associated with increases of 7.16 (95% confidence interval (CI): 3.81, 10.51) CVD deaths per 1,000,000 Black people per month, significantly higher than the estimates for non-Hispanic white people (1.76 (95% CI: 1.37, 2.15); difference in coefficients: 5.40 (95% CI: 2.03, 8.77), P = 0.001). No significant difference in this association was observed between Hispanic (2.66 (95% CI: -0.03, 5.35)) and non-Hispanic white people (difference in coefficients: 0.90 (95% CI: -1.81, 3.61), P = 0.523). From 2001 to 2016, the absolute disparity in PM2.5-attributable CVD mortality burden was reduced by 44.04% between non-Hispanic Black and white people and by 2.61% between Hispanic and non-Hispanic white people. However, in 2016, the burden remained 3.47 times higher for non-Hispanic Black people and 0.45 times higher for Hispanic people than for non-Hispanic white people. We call for policies that aim to reduce both exposure and vulnerability to PM2.5 for racial/ethnic minorities.

Associations between dementia staging, neuropsychiatric behavioral symptoms, and divorce or separation in late life: A case control study.

Dementia can be difficult for married couples for many reasons, including the introduction of caregiving burden, loss of intimacy, and financial strain. In this study, we investigated the impact of dementia staging and neuropsychiatric behavioral symptoms on the likelihood of divorce or separation for older adult married couples. For this case-control study, we used data from the National Alzheimer's Coordinating Center (NACC) Uniform dataset (UDS) versions 2 and 3. This dataset was from 2007 to 2021 and contains standardized clinical information submitted by NIA/NIH Alzheimer's Disease Research Centers (ADRCs) across the United States (US). This data was from 37 ADRCs. We selected participants who were married or living as married/domestic partners at their initial visit. Cases were defined by a first divorce/separation occurring during the follow-up period, resulting in 291 participants. We selected 5 controls for each married/living as married case and matched on age. Conditional logistic regression estimated the association between overall Neuro Psychiatric Inventory (NPI) score and severity of individual symptoms of the NPI with case/control status, adjusted for education, the CDR® Dementia Staging Instrument score, living situation, symptom informant, sex, and race. Separate analyses were conducted for each symptom. Multiple comparisons were accounted for with the Hochberg method. Later stage of dementia was negatively associated with divorce/separation with an adjusted odds ratio (AOR) = 0.68 (95%CI = 0.50 to 0.93). A higher overall NPI score was positively associated with divorce/separation AOR = 1.08 (95% CI = 1.03 to 1.12,). More severe ratings of agitation/aggression, depression/dysphoria, disinhibition, and elation/euphoria were associated with greater odds of divorce/separation. Among older adults in the US, a later stage of dementia is associated with a lower likelihood of divorce or separation, while having more severe neuropsychiatric behavioral symptoms of agitation/aggression, depression/dysphoria, disinhibition, and elation/euphoria are associated with a higher likelihood of divorce or separation.

Assessment of Regional Nursing Home Preparedness for and Regulatory Responsiveness to Wildfire Risk in the Western US.

Importance: It is uncertain whether emergency preparedness and regulatory oversight for US nursing homes are aligned with local wildfire risk. Objective: To evaluate the likelihood that nursing homes at elevated risk of wildfire exposure meet US Centers for Medicare & Medicaid Services (CMS) emergency preparedness standards and to compare the time to reinspection by exposure status. Design, Setting, and Participants: This cross-sectional study of nursing homes in the continental western US from January 1, 2017, through December 31, 2019, was conducted using cross-sectional and survival analyses. The prevalence of high-risk facilities within 5 km of areas at or exceeding the 85th percentile of nationalized wildfire risk across areas overseen by 4 CMS regional offices (New Mexico, Mountain West, Pacific/Southwest, and Pacific Northwest) was determined. Critical emergency preparedness deficiencies cited during CMS Life Safety Code Inspections were identified. Data analysis was performed from October 10 to December 12, 2022. Main Outcomes and Measures: The primary outcome classified whether facilities were cited for at least 1 critical emergency preparedness deficiency during the observation window. Regionally stratified generalized estimating equations were used to evaluate associations between risk status and the presence and number of deficiencies, adjusted for nursing home characteristics. For the subset of facilities with deficiencies, differences in restricted mean survival time to reinspection were evaluated. Results: Of the 2218 nursing homes in this study, 1219 (55.0%) were exposed to elevated wildfire risk. The Pacific/Southwest had the highest percentage of both exposed (680 of 870 [78.2%]) and unexposed (359 of 486 [73.9%]) facilities with 1 or more deficiencies. The Mountain West had the largest difference in the percentage of exposed (87 of 215 [40.5%]) vs unexposed (47 of 193 [24.4%]) facilities with 1 or more deficiencies. Exposed facilities in the Pacific Northwest had the greatest mean (SD) number of deficiencies (4.3 [5.4]). Exposure was associated with the presence of deficiencies in the Mountain West (odds ratio [OR], 2.12 [95% CI, 1.50-3.01]) and the presence (OR, 1.84 [95% CI, 1.55-2.18]) and number (rate ratio, 1.39 [95% CI, 1.06-1.83]) of deficiencies in the Pacific Northwest. Exposed Mountain West facilities with deficiencies were reinspected later, on average, than unexposed facilities (adjusted restricted mean survival time difference, 91.2 days [95% CI, 30.6-151.8 days]). Conclusions and Relevance: In this cross-sectional study, regional heterogeneity in nursing home emergency preparedness for and regulatory responsiveness to local wildfire risk was observed. These findings suggest that there may be opportunities to improve the responsiveness of nursing homes to and regulatory oversight of surrounding wildfire risk.

The mobility effects hypothesis: Methods and applications.

We discuss hypotheses researchers have put forth to explain how outcomes of socially mobile and immobile individuals might differ and/or how mobility experiences are related to outcomes of interest. Next, we examine the methodological literature on this topic, culminating in the development of the diagonal mobility model (DMM, also called the diagonal reference model in some studies), the primary tool of use since the 1980's. We then discuss some of the many applications of the DMM. Although the model was proposed to examine the effects of social mobility on outcomes of interest, the estimated relationships between mobility and outcomes that researchers have called mobility effects are more appropriately regarded as partial associations. When mobility is not associated with outcomes, as is often found in empirical work, the outcomes of movers from origin o to destination d are a weighted average of the outcomes of individuals who remained in states o and d respectively, and the weights capture the relative salience of origins and destinations in the acculturation process. In light of this attractive feature of the model, we briefly develop several generalizations of the current DMM that future researchers should also find useful. Finally, we propose new estimands of mobility effects, based on the explicit notion that a unit effect of mobility is a comparison of an individual with herself under two conditions, one in which she is mobile, the other in which she is immobile, and we discuss some of the challenges in identifying such effects.

Explaining the higher COVID-19 mortality rates among disproportionately Black counties: A decomposition analysis.

Background: Why is COVID-19 mortality higher in counties with a disproportionately large (>13.4%) share of Black residents (hereafter "Black counties") relative to others ("non-Black counties")? Existing literature points to six categories of determinants: (1) social distancing, (2) COVID-19 testing, (3) socioeconomic characteristics, (4) environmental characteristics, (5) prevalence of (pre-existing) chronic health conditions, and (6) demographic characteristics. The relative importance of these determinants has not yet been thoroughly examined. Methods: We built a dataset consisting of 21 sub-indicators across the six categories of determinants for 3108 US counties and their COVID-19 mortality over the period of January 22, 2020-December 31, 2020. Applying the Gelbach's decomposition, we quantified which determinants were most (or least) associated with the COVID-19 mortality disparity between Black and non-Black counties. Results: We find that COVID-19 death rates were 26 percent higher in Black counties compared to non-Black counties. This disparity was almost completely explained by the six categories of determinants included in our model. Decomposition analyses indicate that county-level demographic and population health characteristics explained most of this disparity. Among all sub-indicators considered, the greater proportion of females and smaller proportion of rural residents in Black counties were the two largest contributors to the COVID-19 mortality gap between Black and non-Black counties. Proportions of diabetic residents, uninsured residents, and the degree of income inequality also significantly contributed to the gap in COVID-19 mortality. Conclusion: The COVID-19 mortality gap between Black and non-Black counties was largely explained by pre-pandemic differences in demographic and population health characteristics. Policies aiming to reduce the prevalence of chronic conditions and uninsured residents in Black counties would have helped narrow the COVID-19 mortality gap between Black and non-Black counties in 2020.

Explaining obesity disparities by urbanicity, 2006 to 2016: A decomposition analysis.

OBJECTIVE: A large, and potentially growing, disparity in obesity prevalence exists between large central metros and less urban United States counties. This study examines its key predictors. METHODS: Using a rich county-year data set spanning 2006 to 2016, the authors conducted a Gelbach decomposition to examine the relative importance of demographic, socioeconomic, environmental, and behavioral factors in shaping the baseline obesity gap and the growth rate over time between large central metros and other counties. RESULTS: Predictors included in this model explain almost the entire obesity gap between large central metros and other counties in the baseline year but can explain only ~32% of the growing gap. At baseline, demographic predictors explain more than half the obesity gap, and socioeconomic and behavioral predictors explain the other half. Behavioral and socioeconomic predictors explain more than half the growing gap over time whereas controlling for environmental and demographic predictors decreases the obesity gap by urbanicity over time. CONCLUSIONS: Results suggest policy makers should prioritize interventions targeting health behaviors of residents in non-large central metros to slow the growth of the obesity gap between large central metros and other counties. However, to fundamentally eliminate the obesity gap, in addition to improving health behaviors, policies addressing socioeconomic inequalities are needed.

Sibling Spillovers: Having an Academically Successful Older Sibling May be More Important for Children in Disadvantaged Families.

This paper examines causal sibling spillover effects among students from different family backgrounds in elementary and middle school. Family backgrounds are captured by race, household structure, mothers' educational attainment, and school poverty. Exploiting discontinuities in school starting age created by North Carolina school-entry laws, we adopt a quasi-experimental approach and compare test scores of public school students whose older siblings were born shortly before and after the school-entry cutoff date. We find that individuals whose older siblings were born shortly after the school-entry cutoff date have significantly higher test scores in middle school, and that this positive spillover effect is particularly strong in disadvantaged families. We estimate that the spillover effect accounts for approximately one third of observed statistical associations in test scores between siblings, and the magnitude is much larger for disadvantaged families. Our results suggest that spillover effects from older to younger siblings may lead to greater divergence in academic outcomes and economic inequality between families.

The interplay of race/ethnicity and education in fertility patterns.

This study examines the interplay between race/ethnicity and educational attainment in shaping completed fertility in the United States for women born 1961-80. Using data from the National Survey of Family Growth, 2006-17, we apply multilevel, multiprocess hazard models to account for unobserved heterogeneity and to estimate (1) cohort total fertility rates, (2) parity progression ratios, and (3) parity-specific fertility timing, for non-Hispanic white, non-Hispanic Black, and Hispanic women by educational attainment. We find that compared with their white counterparts, fertility was higher among Black and Hispanic women with less than high school education. However, among college-educated women, fertility levels were lowest among Black women and highest among Hispanic women. The difference in fertility between college-educated Black and white women is driven mainly by the smaller proportion of Black mothers having second births. We find little evidence that the observed racial/ethnic disparities in fertility levels by educational attainment are driven by differences in fertility timing.

Prediction of physical functioning and general health status trajectories on mortality among persons with cognitive impairment.

BACKGROUND: The concern posed by the confluence of aging and cognitive impairment is growing in importance as the U.S. population rapidly ages. As such, we sought to examine the predictive power of physical functioning (PF) and general health status (GHS) trajectories on mortality outcomes among persons with cognitive impairment (PCIs). METHODS: We used group-based trajectory models to identify latent group memberships for PF trajectories in 1,641 PCIs and GHS trajectories in 2,021 PCIs from the National Health and Aging Trends Survey (2011-2018) and applied logistic regressions to predict mortality using these memberships controlling for individual characteristics. RESULTS: We identified six trajectory groups for PF and four groups for GHS. Trajectory group memberships for both outcomes significantly predicted mortality. For PF, group memberships largely captured the average levels over time, and worse trajectories (i.e., lower baselines and faster declines) were associated with higher odds of death. The highest mortality risk was associated with the group experiencing a sharp decline early in its PF trajectory, although its average level across time was not the lowest. For GHS, we observed two groups with comparable average levels across time, but the one with a convex-shape trajectory had much higher mortality risks compared to the one with a concave-shape trajectory. CONCLUSIONS: Our findings highlighted that health trajectories predicted mortality among PCIs, not only because of general levels but also because of the shapes of declines. Close monitoring health deterioration of PCIs is crucial to understand the health burden of this population and to make subsequent actions.

Regional differences in intercohort and intracohort trends in obesity in the USA: evidence from the National Health Interview Survey, 1982-2018.

OBJECTIVES: Obesity in the USA is more prevalent in younger cohorts than older cohorts and also more prevalent in the South and the Midwest than other regions. However, little research has examined the intersection of cohort patterns and regional differences in obesity. We address the knowledge gap by investigating net of age and period trends, how intercohort and intracohort patterns in obesity may depend on Census regions for black and white men and women. DESIGN, SETTING AND PARTICIPANTS: A total of 1 020 412 non-Hispanic black and white respondents aged 20-69 were included from the 1982-2018 National Health Interview Survey. OUTCOME MEASURES: Obesity is defined as body mass index ≥30 kg/m2 based on participant self-reported weight and height. Obesity ORs were calculated to estimate region-specific age, period and cohort patterns for each demographic group. RESULTS: Although age and period trends in obesity were similar across regions for all demographic groups, cohort patterns depended on region of residence for white women. Specifically, for the white women cohorts born in 1955 or later, living in the South and the Midwest implied higher likelihood of obesity than their peers in other regions even after accounting for average regional differences. These cohorts' disadvantage seemed to persist and/or accumulate over the life course. Socioeconomic factors explained little average regional differences or region-specific cohort variation. CONCLUSIONS: Our findings highlight the interdependence of the temporal and geographical processes in shaping obesity disparities.

Trajectories of physical functioning among US adults with cognitive impairment.

BACKGROUND: physical functioning impairment is common among persons with cognitive impairment, but little is known about physical functioning trajectories across the US population or how trajectories may differ among persons with dementia and mild cognitive impairment (MCI). OBJECTIVE: to examine trajectories of physical functioning among persons with MCI and dementia in the USA. DESIGN: we used data from the National Health and Aging Trends study (NHATS) 2011-18. Physical functioning was assessed using the NHATS Expanded Short Physical Performance Battery. PARTICIPANTS: the 661 individuals with MCI and 980 individuals with dementia were included in this study. METHODS: we applied group-based trajectory models to identify latent groups and estimate their trajectories. Multinomial logistic regressions were applied to examine relationships between sociodemographic and health characteristics and trajectory group memberships. RESULTS: both MCI- and dementia-specific trajectories differed at baseline levels and declined at varying rates across groups. Approximately, 78.43% of persons with MCI were in trajectories with a moderate rate of decline, with only 9.75% in a trajectory with good physical function and 11.82% with poor physical function without as much change over time. Among persons with dementia, approximately 81.4% experienced moderate or fast declines, and 18.52% with virtually no functional ability remained at this same low level. Worse physical functioning trajectories were found among persons who were females, Blacks, with at least four comorbidities, and among persons who had a low socioeconomic status. CONCLUSIONS: persons with both dementia and MCI experienced steady declines in physical functioning. Socioeconomically disadvantaged groups have worse physical functioning trajectories.

Occupations and Sickness-Related Absences during the COVID-19 Pandemic.

Pandemic frontline occupations consist of disproportionately low socioeconomic status and racial minority workers. Documenting occupational health disparities is therefore crucial for understanding COVID-19-related health inequalities in the United States. This study uses Current Population Survey microdata to estimate occupational differences in sickness-related absences (SAs) from work in March through June 2020 and their contribution to educational, racial-ethnic, and nativity health disparities. We find that there has been an unprecedented rise in SAs concentrated in transportation, food-related, and personal care and service occupations. SA rates were 6 times higher in these occupations than in non-health-care professions. The greatest increases were in occupations that are unsuitable for remote work, require workers to work close to others, pay low wages, and rarely provide health insurance. Workers in these occupations are disproportionately Black, Hispanic, indigenous, and immigrants. Occupation contributes 41% of the total of Black/white differences and 54% of educational differences in SAs.

Long-term ozone exposure and cognitive impairment among Chinese older adults: A cohort study.

Ambient particulate matter pollution has been linked to impaired cognitive performance, but the effect of ambient ozone exposure on cognitive function remains largely unknown. We examined the association of long-term ozone exposure with the risk of cognitive impairment among a national representative cohort of 9,544 Chinese older adults (aged 65 years and over) with baseline normal cognition from the Chinese Longitudinal Healthy Longevity Survey (2005-2018). The ozone exposure of each participant was measured by annual mean ozone concentrations for the county of residence. Cognitive function was assessed by the Chinese version of the Mini-Mental State Examination (MMSE). We defined cognitive impairment as an MMSE score below 18 points accompanied by an MMSE score that declined ≥ 4 points from baseline. Cox proportional hazards models were applied to explore the association of ozone exposure with cognitive impairment. During the mean follow-up time of 6.5 years, 2,601 older adults developed cognitive impairment. Each 10-µg/m3 increase in annual mean ozone exposure was associated with a 10.4% increased risk of cognitive impairment. The exposure-response relationship between ozone exposure and risk of cognitive impairment showed a linear trend. Sensitivity analyses revealed the association to be robust. We found that older adults from Eastern, Central, and Southern China were particularly susceptible. Our results show that ozone is a risk factor for late-life cognitive decline. Reducing ambient ozone pollution may help delay the onset of cognitive impairment among older adults.

Trajectories of General Health Status and Depressive Symptoms Among Persons With Cognitive Impairment in the United States.

ObjectivesTo identify and examine heterogeneous trajectories of general health status (GHS) and depressive symptoms (DS) among persons with cognitive impairment (PCIs). Methods: We use group-based trajectory models to study 2361 PCIs for GHS and 1927 PCIs for DS from the National Health and Aging Trends Survey 2011-2018, and apply multinomial logistic regressions to predict identified latent trajectory group memberships using individual characteristics. Results: For both GHS and DS, there were six groups of PCIs with distinct trajectories over a 7-year period. More than 40% PCIs experienced sharp declines in GHS, and 35.5% experienced persistently poor GHS. There was greater heterogeneity in DS trajectories with 55% PCIs experiencing improvement, 16.4% experiencing persistently high DS, and 30.5% experiencing deterioration. Discussion: The GHS trajectories illustrate the heavy burden of poor and declining health among PCIs. Further research is needed to understand the factors underlying stable or improving DS despite declining GHS.