Myocardial infarction & C-reactive protein levels among Mexican adults with arthritis: Findings from the Mexican Health and Aging Study.

Background: Studies of adult populations in high-income countries have found an association between arthritis and myocardial infarction (MI) due to high levels of systemic inflammation. Our objectives were to examine the association between arthritis and MI among Mexican adults and to assess the mediating effect of C-reactive protein (CRP) on this association. Methods: Data came from the 2012, 2015, and 2018 observation waves of the Mexican Health and Aging Study. Our sample included 11,707 participants aged 50 and older with no prior MI before 2012. We used self-reported information for arthritis, joint pain, medication use, and limitations to daily activities in 2012. Logistic regression was used to model the association between arthritis and self-reported MI in 2015 or 2018. We used a sub-sample of 1602 participants to assess the mediating effect of CRP. Results: In the full sample, participants with arthritis that limited their daily activities had higher odds of MI than participants with no arthritis (OR = 1.40; 95 % CI = 1.04-1.88). In the sub-sample, arthritis that limited daily activities was associated with higher mean CRP (5.2 mg/dL; 95 % CI = 4.10-6.21) than arthritis with no limitations (3.5 mg/dL; 95 % CI = 2.93-4.01). However, CRP levels had a small mediating effect, and the relationship between arthritis with physical limitations and MI remained statistically significant. Conclusion: Mexican adults with arthritis that limits their daily activities are at an increased risk for MI. Continued research is needed to identify factors that contribute to this increased risk.

Psychosocial stressors predict lower cardiovascular disease risk among Mexican-American adults living in a high-risk community: Findings from the Texas City Stress and Health Study.

The objective of this study was to examine the link between systemic and general psychosocial stress and cardiovascular disease (CVD) risk in a group of U.S. Latinos as a function of acculturation and education within the blended guiding conceptual framework of the biopsychosocial model of the stress process plus the reserve capacity model. We analyzed data from self-identifying Mexican-origin adults (n = 396, 56.9% female, Mage = 58.2 years, 55.5% < 12 years of education, 79% U.S.-born) from the Texas City Stress and Health Study. We used established measures of perceived stress (general stress), neighborhood stress and discrimination (systemic stress) to capture psychosocial stress, our primary predictor. We used the atherosclerotic CVD calculator to assess 10-year CVD risk, our primary outcome. This calculator uses demographics, cholesterol, blood pressure, and history of hypertension, smoking, and diabetes to compute CVD risk in the next 10 years. We also created an acculturation index using English-language use, childhood interaction, and preservation of cultural values. Participants reported years of education. Contrary to expectations, findings showed that higher levels of all three forms of psychosocial stress, perceived stress, neighborhood stress, and perceived discrimination, predicted lower 10-year CVD risk. Acculturation and education did not moderate the effects of psychosocial stress on 10-year CVD risk. Contextualized within the biopsychosocial and reserve capacity framework, we interpret our findings such that participants who accurately reported their stressors may have turned to their social networks to handle the stress, thereby reducing their risk for CVD. We highlight the importance of examining strengths within the sociocultural environment when considering cardiovascular inequities among Latinos.

Fear of Falling in Older Mexican Americans: A Longitudinal Study of Incidence and Predictive Factors.

OBJECTIVES: To determine predictors of fear of falling in older Mexican Americans over time. DESIGN: Longitudinal study. SETTING: Community-dwelling residents throughout California, Colorado, New Mexico, Arizona, and Texas. PARTICIPANTS: Community-dwelling Mexican Americans aged 72 and older participating in the Hispanic Established Populations for the Epidemiologic Study of the Elderly from 2000-01 to 2010-11 (N = 1,682). MEASUREMENTS: Fear of falling was measured at baseline and at each subsequent wave. Baseline demographic and clinical variables included social support, fall history, depression symptoms, Mini-Mental State Examination (MMSE) score, activity of daily living (ADL) and instrumental ADL (IADL) limitations, and chronic health conditions. RESULTS: Nine hundred fifty three (56.7%) subjects reported fear of falling at baseline, 262 of whom reported severe fear of falling. The predictors of reporting any fear of falling over time included female sex, frequent familial interaction, depression, chronic health conditions, IADL limitations, higher MMSE score, and three or more falls in the last 12 months. Predictors of severe fear of falling included older age, female sex, married, depressive symptoms, chronic health conditions, IADL limitations, higher MMSE score, and fall history. Protective factors included frequent friend interaction and higher levels of education. CONCLUSION: Fear of falling is prevalent in older Mexican-American adults. The presence of friends nearby was shown to be protective against, whereas the presence of family nearby was shown to be predictive of fear of falling.

Chamomile Consumption and Mortality: A Prospective Study of Mexican Origin Older Adults.

PURPOSE: Approximately 20% of adults use some kind of herbal; however, little data exists from population-based study or clinical trials to support effectiveness of most herbal products. Chamomile is a commonly used herb among older adults of Mexican origin. We examined the effects of herbal chamomile consumption on mortality among older adults of Mexican origin. METHODS AND DESIGN: A sample from the Hispanic Established Populations for Epidemiologic Study of the Elderly, a population-based study of noninstitutionalized Mexican Americans aged 65 and older from five Southwestern states (Texas, California, New Mexico, Colorado, and Arizona). We included all men and women from 2000 to 2007 (n = 1,677). RESULTS: Chamomile was used by 14% of the sample. Cox proportional hazards regression analyses showed that chamomile was associated with a decreased risk of mortality in the total sample (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.55-0.92) and for women (HR 0.67, 95% CI 0.49-0.92) but not for men. In models adjusted for sociodemographic variables, health behaviors, and chronic conditions, chamomile remained significantly associated with reduced mortality in women (HR 0.72, 95% CI 0.53-0.98). IMPLICATIONS: The use of chamomile shows protective effects against mortality in this sample of older adults of Mexican origin for women. Further research is warranted in other populations to determine if these effects are consistent.

Stability in Cognitive Function Over 18 Years: Prevalence and Predictors among Older Mexican Americans.

PURPOSE: Numerous studies have examined the association of physical, behavioral and social factors with cognitive decline in older adults. Less attention has been placed on factors associated with long-term maintenance of intact cognition even into very old age. A greater understanding of those factors can inform the development of activities for maintaining cognitive strength. METHODS: Using a sample from the Hispanic Established Populations for Epidemiologic Study of the Elderly, a population-based study of non-institutionalized Mexican Americans aged 65 and older from five Southwestern states (N = 2767), latent class mixture models were developed to identify subgroups of cognitive change over time. RESULTS: Three distinct trajectories of cognitive change were identified and characterized as stable, slow decline and rapid decline. Compared to the rapid decline group, a higher proportion of the stable cognition group were women, had high school education, were married and attended church one or more times per week. Regular church attendance had a significant positive impact in the stable group (ß = 0.64, p <0.01), the slow decline group (ß = 0.84, p <0.001) and the rapid decline group (ß = 2.50, p <0.001). Activity limitations had a consistently negative association with cognition in the stable, slow decline and rapid decline groups (ß = -0.37, p <0.001; ß = -0.85, p <0.001; and ß = -1.58, p <0.001 respectively). CONCLUSION: Substantial heterogeneity exists in rates of cognitive decline among older Mexican Americans. Interventions targeting cognitive maintenance may benefit from increased focus on factors associated with continued social engagement.

Neighborhood Ethnic Composition and Problem Drinking Among Older Mexican American Men: Results from the Hispanic Established Populations for the Epidemiologic Study of the Elderly.

Ethnic enclaves may be protective for health. This study investigates the effects of neighborhood co-ethnic density on problem drinking among older Mexican American men. Probability sample of 2,086 community-dwelling Mexican Americans aged 75 or older drawn in 2004-2005 residing in communities in Arizona, California, Colorado, New Mexico and Texas. Problem drinking was found among 15.3 % of men (n = 350). For each percent increase in neighborhood percent Mexican American, men had 2 % lower odds of problem drinking [odds ratio (OR) 0.98; P < 0.05]. U.S. born men had lower odds of problem drinking (OR 0.40; P < 0.05) compared with foreign born men, while English language use was associated with greater odds of problem drinking (OR 2.14; P < 0.05). Older Mexican American men in neighborhoods with low levels of co-ethnic density, the foreign born, and those with English language facility had an increased likelihood of problem drinking.

Functional limitations and depressive symptoms: a longitudinal analysis of older Mexican American couples.

OBJECTIVES: This study extends previous work on longitudinal patterns of spousal associations between functional impairments and psychological well-being in older couples in 3 important ways: By examining Mexican Americans, by considering a broader range of functional limitations, and by assessing the role of health status, social integration, and socioeconomic resources in these associations. METHOD: Drawing on data from 6 waves of the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993-2007), we employed growth curve models to investigate the implications of the spouse's functional limitations for the respondent's age trajectories of depressive symptoms in older Mexican American couples. Models were run separately for husbands and wives. RESULTS: The spouse's functional limitations were associated with higher levels of depressive symptoms in the respondent. Personal resources can both ameliorate and intensify the adverse implications of the spouse's functional limitations for the respondent's depressive symptomatology. The interplay among these factors can vary by gender and the type of the spouse's functional impairment. DISCUSSION: Future studies would benefit by examining caregiving patterns in older couples, by distinguishing between different dimensions of social support available to them, and by considering changes in couples' marital quality and social ties over time.

Neighborhood Hispanic composition and depressive symptoms among Mexican-descent residents of Texas City, Texas.

Substantial research shows that increased Hispanic neighborhood concentration is associated with several beneficial health outcomes including lower adult mortality, better self-rated health, and fewer respiratory problems. Literature on the relationship of Hispanic composition and depressive symptoms is more equivocal. In addition, few studies have directly investigated hypothesized mechanisms of this relationship. This study uses data from a probability sample of 1238 Mexican-descent adults living in 48 neighborhoods in Texas City, Texas. Multilevel regression models investigate whether Hispanic neighborhood composition is associated with fewer depressive symptoms. This study also investigates whether social support, perceived discrimination, and perceived stress mediate or moderate the relationship, and whether results differ by primary language used at home. We find that individuals living in high Hispanic composition neighborhoods experience fewer depressive symptoms than individuals in low Hispanic composition neighborhoods. In addition, we find that these beneficial effects only apply to respondents who speak English. Social support, perceived discrimination, and perceived stress mediate the Hispanic composition-depressive symptoms relationship. In addition, discrimination and stress moderate the relationship between Hispanic composition and depressive symptoms. Our findings support theories linking higher neighborhood Hispanic composition and better mental health, and suggest that Spanish language use, social support, discrimination and stress may play important roles in the Hispanic composition-depressive symptoms relationship.

Self-reported sleep characteristics and mortality in older adults of mexican origin: results from the Hispanic established population for the epidemiologic study of the elderly.

OBJECTIVES: To determine how poor sleep affects the health of older ethnic minorities. DESIGN: Cross-sectional study involving a population-based survey. SETTING: Hispanic Established Population for the Epidemiologic Study of the Elderly (H-EPESE) survey conducted in the southwestern United States. PARTICIPANTS: Two thousand two hundred fifty-six Mexican-American men and women aged 65 and older. MEASUREMENTS: The association between self-reported sleep problems and mortality over a 15-year period in a population based sample of older Mexican Americans was examined. Using five waves of data (1993-2008) from the H-EPESE, Cox proportional hazard models stratified according to sex were used to model the risk of death as a function of chronic sleep problems. RESULTS: Having any sleeping problems during the last month was associated with greater risk of mortality (hazard ratio = 1.14, 95% confidence interval = 1.00-1.29) in unadjusted models, although the association was attenuated after accounting for covariates. CONCLUSIONS: Similar factors explained the association between sleep and mortality in men and women: health behaviors, depressive symptoms, and health conditions. These factors are related to stress, and both may lead to poor sleep quality. Research is needed to better understand the factors moderating the relationship between sleep, mortality, and sex.

Social support, stressors, and frailty among older Mexican American adults.

BACKGROUND: There is little research on the effects of stressors and social support on frailty. Older Mexican Americans, in particular, are at higher risk of medical conditions, such as diabetes, that could contribute to frailty. Given that the Mexican American population is rapidly growing in the United States, it is important to determine whether there are modifiable social factors related to frailty in this older group. METHOD: To address the influence of social support and stressors on frailty among older Mexican Americans, we utilized five waves of the Hispanic Established Populations for the Epidemiologic Study of the Elderly (Hispanic EPESE) to examine the impact of stressors and social support on frailty over a 12-year period. Using a modified version of the Fried and Walston Frailty Index, we estimated the effects of social support and stressors on frailty over time using trajectory modeling (SAS 9.2, PROC TRAJ). RESULTS: We first grouped respondents according to one of three trajectories: low, progressive moderate, and progressive high frailty. Second, we found that the effects of stressors and social support on frailty varied by trajectory and by type of stressor. Health-related stressors and financial strain were related to increases in frailty over time, whereas social support was related to less-steep increases in frailty. CONCLUSION: Frailty has been hypothesized to reflect age-related physiological vulnerability to stressors, and the analyses presented indicate partial support for this hypothesis in an older sample of Mexican Americans. Future research needs to incorporate measures of stressors and social support in examining those who become frail, especially in minority populations.

Protective neighborhoods: neighborhood proportion of Mexican Americans and depressive symptoms in very old Mexican Americans.

Research indicates that neighborhood context can have a significant effect on the health of older adults. The evidence suggests that there may be physical health benefits afforded to Mexican Americans living in ethnically homogenous neighborhoods, despite the relatively high economic risk in such neighborhoods, but few studies have considered the effect of neighborhood ethnic density on mental health outcomes in older adults. This study evaluated the association between neighborhoods with a high proportion of Mexican Americans and depressive symptoms in very old Mexican Americans. Hierarchical linear modeling was used to examine data from Wave 5 (2004/05) of the Hispanic Established Populations for the Epidemiologic Study of the Elderly. Subjects included 1,875 community-dwelling Mexican Americans aged 75 and older living in 386 neighborhoods in five states in the southwestern United States (Arizona, California, Colorado, New Mexico, Texas). Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (α=0.88). Results showed that, in very old men, there was a significant negative association between percentage of Mexican Americans in the neighborhood and depressive symptoms (P=.01). In women, the direction of the association was the same, but the effect was not significant. These findings suggest that the proportion of Mexican Americans in the neighborhood matter more for very old Mexican American men than women. Further research may inform screening and treatment for depressive symptoms based on differences in neighborhood composition. Recommendations include culturally customized programs that offer older Mexican Americans greater mobility and access to programs and opportunities in culturally identifiable neighborhoods.

The effect of acculturation on frailty among older Mexican Americans.

OBJECTIVE: To determine the effect of acculturation on becoming frail and prefrail over a 10-year period among older Mexican Americans. METHOD: A nationally representative sample of 2,049 Mexican Americans aged 67 to 108 was analyzed. Adjusted for sociodemographics and health, longitudinal multinomial mixed models examined the effects of English language and frequency of contact with Anglo-Americans on transitions among deceased, nonfrail, prefrail, and frail statuses. RESULTS: Greater English language proficiency was associated with a 10% reduced likelihood of becoming prefrail (p < .05) and marginally associated with a reduced likelihood of becoming frail (relative risk = 0.88; p = .07). Frequent contact with Anglos was significantly associated with a reduced likelihood of becoming frail (relative risk = 0.87; p < .05). DISCUSSION: Among older Mexican Americans, acculturation at baseline was protective of transitioning from a nonfrail or prefrail to a frail state. These findings suggest that increased acculturation may provide Mexican Americans with protection from health issues in old age.

Religious Involvement and Physical Functioning among Older Mexican Americans.

BACKGROUND AND PURPOSE: Examine the association between attendance at religious services and incidence of ADL disability over a period of seven years among older Mexican Americans 65 years and older. METHODS: Using data from the Hispanic Established Population for the Epidemiological Study of the Elderly (H-EPESE), logistic generalized estimation equation (GEE) models were used to analyze the contribution of attendance at religious services to the differences in incidence of ADL disability over seven years, controlling for demographics, medical conditions, and physical mobility. RESULTS: Frequent attendees at religious services had 30% lower odds of developing ADL disability over seven years compared to the non-regular attendance group. The odds were reduced to 23%, but remained significant when physical and mental health were controlled. CONCLUSIONS: In this older Mexican American population, regular attendees at religious services were less likely to develop ADL disability over a period of seven years compared to those who attended services less often.

Allostatic load among non-Hispanic Whites, non-Hispanic Blacks, and people of Mexican origin: effects of ethnicity, nativity, and acculturation.

OBJECTIVES: We investigated ethnic differences in allostatic load in a population-based sample of adults living in Texas City, TX, and assessed the effects of nativity and acculturation status on allostatic load among people of Mexican origin. METHODS: We used logistic regression models to examine ethnic variations in allostatic load scores among non-Hispanic Whites, non-Hispanic Blacks, and people of Mexican origin. We also examined associations between measures of acculturation and allostatic load scores among people of Mexican origin only. RESULTS: Foreign-born Mexicans were the least likely group to score in the higher allostatic load categories. Among individuals of Mexican origin, US-born Mexican Americans had higher allostatic load scores than foreign-born Mexicans, and acculturation measures did not account for the difference. CONCLUSIONS: Our findings expand on recent research from the National Health and Nutrition Examination Survey with respect to ethnicity and allostatic load. Our results are consistent with the healthy immigrant hypothesis (i.e., newer immigrants are healthier) and the acculturation hypothesis, according to which the longer Mexican immigrants reside in the United States, the greater their likelihood of potentially losing culture-related health-protective effects.

Neighborhood context and cognitive decline in older Mexican Americans: results from the Hispanic Established Populations for Epidemiologic Studies of the Elderly.

In previous research on cognitive decline among older adults, investigators have not considered the potential impact of contextual variables, such as neighborhood-level conditions. In the present investigation, the authors examined the association between 2 neighborhood-context variables-socioeconomic status and percentage of Mexican-American residents-and individual-level cognitive function over a 5-year follow-up period (1993-1998). Data were obtained from the Hispanic Established Populations for Epidemiologic Studies of the Elderly, a longitudinal study of community-dwelling older Mexican Americans (n = 3,050) residing in the southwestern United States. Individual records were linked with 1990 US Census tract data, which provided information on neighborhood characteristics. Hierarchical linear growth-curve models and hierarchical logistic models were used to examine relations between individual- and neighborhood-level variables and the rate and incidence of cognitive decline. Results showed that baseline cognitive function and rates of cognitive decline varied significantly across US Census tracts. Respondents living in economically disadvantaged neighborhoods experienced significantly faster rates of cognitive decline than those in more advantaged neighborhoods. Odds of incident cognitive decline decreased as a function of neighborhood percentage of Mexican-American residents and increased with neighborhood economic disadvantage. The authors conclude that neighborhood context is associated with late-life cognitive function and that the effects are independent of individual-level risk factors.

Work experience and gender differences in chronic disease risk in older Mexicans.

PURPOSE: The purpose of this study is to examine the relationship between labor force participation and gender differences in the prevalence of arthritis, diabetes, and hypertension. METHODS: The Mexican Health and Aging Survey (MHAS) data is nationally representative sample of older Mexicans 50 years and older. Binomial logistic regression models were performed to examine differences between older Mexican men and women in the prevalence of arthritis, diabetes, and hypertension. Interaction effects were also estimated between gender and occupation, length of time in the labor force, and pension eligibility. RESULTS: Older Mexican women have a significantly greater risk of having arthritis, diabetes, and hypertension. Findings from this study suggest that within the same occupational classification, women suffer from the damaging effects on health to a greater extent than men. Interaction effects show that women who work in services or in client's home are particularly susceptible to arthritis. Moreover, women who work in sales were at a significantly greater risk of hypertension than men. CONCLUSIONS: Older Mexican women are at greater risk of chronic disease and part of their vulnerability is a result of the type of work that they do.

Health related quality of life in older Mexican Americans with diabetes: a cross-sectional study.

BACKGROUND: The older Hispanic population of the U.S. is growing at a tremendous rate. While ethnic-related risk and complications of diabetes are widely-acknowledged for older Hispanics, less is known about how health related quality of life is affected in this population. METHODS: Cross-sectional study assessing differences in health related quality of life between older Mexican Americans with and without diabetes. Participants (n = 619) from the Hispanic Established Population for the Epidemiological Study of the Elderly were interviewed in their homes. The primary measure was the Medical Outcomes Study Short Form (SF-36). RESULTS: The sample was 59.6% female with a mean age of 78.3 (SD = 5.2) years. 31.2% (n = 193) of the participants were identified with diabetes. Individuals with diabetes had significantly (F = 19.35, p < .001) lower scores on the Physical Composite scale (mean = 37.50, SD = 12.69) of the SF-36 compared to persons without diabetes (mean = 43.04, SD = 12.22). There was no significant difference between persons with and without diabetes on the Mental Composite scale of the SF-36. CONCLUSION: Diabetes was associated with lower health related quality of life in older Mexican Americans. The physical components of health related quality of life uniformly differentiated those with diabetes from those without, whereas mental component scores were equivocal.

Risk of mortality related to widowhood in older Mexican Americans.

PURPOSE: To examine the risk and correlates of mortality after death of a spouse and whether mortality risk varies by sex. METHODS: Prospective cohort study (1993 to 2000) of 1693 Mexican Americans ages 65 years and older who were married at baseline. Mortality was confirmed by matching records with the National Death Index or through proxy report. Risk of death related to incidence of widowhood was estimated by using proportional hazard regression and adjusted for age, education, US nativity, financial strain, social support, health behaviors, medical conditions, disability, and depressive symptoms. RESULTS: In the unadjusted Cox hazard analysis, widowed men are significantly more likely to die (HR=2.32, CI=1.48 to 3.61), but loss of spouse has no significant effect on the subsequent risk of death for widowed women (HR=1.50, CI=0.90 to 2.49). After adjustment for covariates known to influence survival, the association between widowhood and mortality in men remained significant, but the magnitude of the association decreased by 26%, which suggests a partial mediation effect of these factors on survival. The trajectory of the survival curve shows that the risk of death associated with widowhood is highest within the first 2 years. CONCLUSIONS: Widowhood in older Mexican American men is a risk factor for mortality.

Examining the role of acculturation in health behaviors of older Mexican Americans.

OBJECTIVES: To determine if acculturation is associated with smoking, alcohol use, and physical activity among older Mexican Americans. METHODS: Multivariate analyses of data from the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (H-EPESE) were used. RESULTS: Those who were more proficient in English were more likely to be former or current smokers than nonsmokers and former or current drinkers than abstainers. In addition, those who had greater contact with Anglo-Americans were more likely to be former or current smokers than nonsmokers and former or current drinkers than abstainers. CONCLUSIONS: These results can assist health promotion programs in identifying those most at risk of engaging in negative health behaviors.

Shared health behaviors among older Mexican American spouses.

OBJECTIVE: To assess the association of health behaviors among husbands and wives. METHODS: Cohort study of 553 Mexican American couples aged 65 years or older from the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (H-EPESE). Multivariate regression analyses test the association of body mass index, smoking, and alcohol consumption among husbands and wives. RESULTS: Body mass index is positively associated among couples. Risk of smoking or drinking was higher if the partner had ever smoked or drank alcohol. CONCLUSION: Health behaviors are associated among older Mexican American couples. Intervention efforts should be directed at both spouses.