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Racial and ethnic disparities in cardiovascular disease (CVD) risk factors are well-documented. However, racial and ethnic differences in the longitudinal changes among multiple CVD risk factors are unknown. We used prospective cohort data of U.S. adults aged ≥50 in the 2006-2016 Health and Retirement Study. Group-based multi-trajectory models characterized age-related trajectories of systolic blood pressure ([BP] mmHg), non-HDL cholesterol (mg/dL), diabetes mellitus (DM), and smoking. Racial and ethnic differences in the multi-trajectory profiles were examined using multinomial logistic regression. Karlson-Holm-Breen methods were used to assess factors contributing to these associations. Among 10,292 participants (median age: 61), approximately 32% had an overall favorable profile of CVD risk factors. Compared with non-Hispanic White adults, non-Hispanic Black adults were more likely to exhibit elevated systolic BP with high risks of DM (relative risk ratio [RRR] = 3.36; 95% CI, 2.69-4.21; P < .001) and with low risks of DM (RRR = 3.23; 95% CI, 2.38-4.38; P < .001). Non-Hispanic Black adults were also more likely to exhibit high rates of smoking with and without other co-occurring risk factors. Hispanic adults were most likely to exhibit high risks of DM with elevated systolic BP (RRR = 1.74; 95% CI, 1.28-2.38; P < .001) and without elevated systolic BP (RRR = 1.90; 95% CI, 1.50-2.40; P < .001). Education, income, and country-of-origin were significantly associated with the excess CVD risks observed among racial and ethnic minority groups. Significant racial and ethnic disparities were observed in trajectories of CVD risk factors in U.S. adults. Social determinants largely contributed to these associations in non-Hispanic Black adults and Hispanic adults.

Background. Cardiovascular disease (CVD) and depression are the leading causes of disability in the U.S. Using electronic health record data, we describe the CVD burden among persons with mental illness enrolled in the Penn State Psychiatry Clinical Assessment and Rating Evaluation System (PCARES) Registry between 2015 and 2020. Methods. CVD burden assessment included prevalence of CVD conditions (any major CVD or individual CVD risk factors), indicated medication prescriptions for CVD risk factors, and mean levels of body mass index (BMI, kg/m2), glycosylated hemoglobin (HbA1C, %), glucose (mg/dl), and lipids (mg/dl). We compared the CVD burden between the PCARES sample to a representative sample of adults from the U.S. general population (NHANES 2013-2016) using one-sample chi-square/t-tests for proportions/means. The CVD burden in NHANES participants was adjusted to PCARES age, race, and sex statistics. Results. The PCARES sample (N=3556) had a mean (SE) age of 42.4 (0.3) years and comprised 63.0% women, 85.0% non-Hispanic Caucasians, and 41.0% with major depressive disorder. CVD burden was higher in the PCARES sample compared to NHANES participants for any major CVD (8.6% vs. 4.6%), diabetes (18.4% vs. 10.4%), BMI (30.3 vs. 28.3), HbA1C (6.1 vs. 5.6), cholesterol (185.6 vs. 181.7), triglycerides (153.3 vs. 136.1), and indicated antihypertensive (94.3% vs. 76.9%) and cholesterol-lowering (49.5% vs. 36.7%) medications (Bonferroni-corrected p=0.03 for each outcome). The CVD burden was lower in the PCARES sample compared to NHANES participants for hypertension (45.9% vs. 50.4%), dyslipidemia (43.2% vs. 61.9%), HDL-C (48.4 vs. 41.4), and LDL-C (107.9 vs. 112.0) (Bonferroni-corrected p=0.03 for each outcome). Glucose levels (110.9 vs. 111.9) and indicated antidiabetic medications (87.4% vs. 86.6%) were similar in the two samples (p>0.05). Conclusions. The CVD burden was higher in persons with mental illness compared to the U.S. general population. Integrated mental and physical healthcare services could reduce long-term disability among persons with mental illness.

Background Little is known about how education in later life is related to cognitive function in older adults. This study assessed whether participating in later‐life education was associated with better cognitive function over time and whether the benefits differed by sex, race/ethnicity, and prior education level in a nationally‐representative sample of U.S. older adults. Method We conducted a retrospective cohort study using six waves of data from the Health and Retirement Study ([HRS] 2008‐2018) that included adults aged ≥ 65 years with no baseline diagnosis of dementia. Cognitive function was measured at baseline and over time using a summary score (range = 0‐35). Later‐life education was measured at every wave and was categorized as attended an educational or training course “at least once a month or more” (10.3%), “not in the last month” (45.5%), or “never” (44.3%). Inverse probability weighting was applied to account for potential selection bias in who participated in later‐life education. The associations between later‐life education and trajectories of cognitive function were estimated using weighted mixed‐effects linear regression models. Result Of the 12,099 participants (median [interquartile range] age, 71[67‐77]), engaging in any later‐life education, either at least once a month (0.56 points higher, 95% CI, 0.40 to 0.73; P < .001) or not in the last month (0.55 points higher, 95% CI, 0.45 to 0.65; P < .001) was associated with significantly better cognitive function over time compared to never participating in later‐life education. The association remained constant as people aged and was only partially attenuated after adjusting for sociodemographic, psychosocial, behavioral, and health‐related factors. In addition, the benefits of engaging in any later‐life education on cognitive function were greater in women than in men (at least once a month: 0.30 points higher, 95% CI, ‐0.03 to 0.63, P = .076, not in the last month: 0.24 points higher, 95% CI, 0.04 to 0.43, P = .016) but no significant differences by race/ethnicity or prior educational attainment. Conclusion Engaging in later‐life education is beneficial for cognitive function and underscores the importance of continued learning among older adults.

•Results identified 4 distinct trajectories of hospitalization in HF patients.•Black patients had greater overall risks of hospitalizations than White patients.•Diabetes, CKD, and neighborhood disadvantage contributed to these risks. Racial and ethnic disparities in hospitalizations among heart failure (HF) patients have been well documented. However, little is known about racial and ethnic differences in the long-term trajectories of hospital admissions that follow the diagnosis of HF. We used electronic health records (EHR) of 5,606 patients with newly-diagnosed HF between January 1, 2015 and July 28, 2018 in the Duke University Health System. Patients were followed for up to 5 years (until July 28, 2023) to identify all-cause hospital admissions after their initial diagnosis of HF. Group-based trajectory models were used to identify major trajectories of hospitalization, and multinomial logistic regression models were used to identify patients’ clinical and nonclinical characteristics associated with the trajectories of admissions. In our study cohort (mean age 74.8 ± 5.8 years), we identified 4 distinct trajectories of hospitalization during follow up: 45.6% (Group 1: N = 2,556) had “low risks” of hospitalization, 36.6% (Group 2: N = 2,052) had elevated risks of admission shortly after diagnosis (“early risk” group), 9.9% (Group 3: N = 553) had elevated risks at later stages of illness (“late risk” group), and 7.9% (Group 4: N = 445) had consistently “high risks” of hospitalization. Non-Hispanic Black patients were more likely to exhibit early risks of hospitalization (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.16-1.52; P < .001), late risks of hospitalization (OR = 1.92; 95% CI, 1.58-2.34; P < .001), or consistently high risks of hospitalization (OR = 1.89; 95% CI, 1.52-2.35; P < .001) compared with non-Hispanic White patients. Diabetes, chronic kidney disease, and residence in a disadvantaged neighborhood significantly contributed to the excess risks of admissions among non-Hispanic Black patients. We found no significant differences in patterns of admissions between patients from other racial and ethnic groups compared with non-Hispanic White patients. Non-Hispanic Black patients had early, late, and consistently high risks of hospitalization following the diagnosis of HF compared with non-Hispanic White patients. These findings have important implications for targeting interventions to reduce hospitalizations during the course of HF management.

Sub-optimal diet and physical activity (PA) levels have been associated with increased risk of cardiovascular disease (CVD) mortality. The relationship between pre-cancer diagnosis diet quality and PA level on CVD mortality risk in cancer survivors is unclear. We examined the association between pre-cancer diagnosis diet quality and leisure-time PA and their interaction on CVD mortality in cancer survivors. Diet quality was characterized by the Alternative Mediterranean Diet Index (aMED). Leisure-time PA was converted to a metabolic equivalent of task hours per week (MET-h/wk). During a median of 6.3 years of follow-up of 18,533 female cancer survivors, we identified 915 CVD deaths. aMED score was not associated with CVD mortality. PA level was inversely associated with CVD mortality (HRQ1-Q4 = 0.74; 95% CI: 0.61–0.88; Ptrend = 0.0014). Compared to cancer survivors with the lowest pre-diagnosis aMED score and PA level, cancer survivors with higher aMED scores and higher MET-hrs/wk were at a 33% lower risk of CVD mortality (HR = 0.67; 95% CI: 0.52–0.87). Overall, this study shows PA to be a strong predictor of CVD mortality in female cancer survivors. Our observations support the importance of PA throughout the lifecycle in lowering CVD mortality risk.

Little is known about racial/ethnic differences in the long-term patterns of hospitalization following the diagnosis of heart failure (HF). We examined racial/ethnic differences in trajectories of hospital admissions following a diagnosis of HF and assessed the factors contributing to the long-term risks of hospitalization. We included 5,606 patients with newly-diagnosed HF between January 2015 and July 2018 in the Duke University Health System and followed them for up to five years. Group-based trajectory models were used to identify trajectories of all-cause admissions following the diagnosis of HF. Multinomial logistic regression models were used to identify patient characteristics associated with the trajectories of admissions. Approximately 45.6% (N=2,556) of HF patients had low risks of hospitalization, 36.6% (N=2,052) had elevated risks of admission shortly after diagnosis (early risk), 9.9% (N=553) had elevated risks at later stages of illness (late risk), and 7.9% (N=445) had consistently high risks of hospitalization. Non-Hispanic Black patients were more likely to exhibit early risks of hospitalization (odds ratio, [95% CI]: OR=1.33, [1.16-1.52]; P<.001), late risks of hospitalization (OR=1.92, [1.58-2.34]; P<.001), or consistently high risks of hospitalization (OR=1.89, [1.52-2.35]; P<.001) compared with non-Hispanic White patients. Diabetes, chronic kidney disease, and residence in a disadvantaged neighborhood significantly contributed to the excess risks of admissions among non-Hispanic Black patients. Overall, these findings have important implications for identifying the social and clinical factors associated with racial disparities in the timing and frequency of hospital admissions in HF patients.

The association between socioeconomic status and 30-day readmissions is well-documented in patients with heart failure (HF). However, it is less clear whether socioeconomic disadvantage has an immediate and/or lasting impact on risk of hospital admissions following the diagnosis of HF. We examined whether area-level disadvantage was associated with early and recurrent risks of hospitalizations in patients diagnosed with HF. We included 5,889 patients (ages 65-85 years) with newly diagnosed HF between January 2015 and July 2018 in the Duke University Health System and followed them for up to eight years. We assessed the association of area-level socioeconomic disadvantage (low, moderate, or high) with hospital admissions within 30-days after HF diagnosis using multivariable logistic regression models. We also assessed the risks of recurrent admissions over the entire duration of follow-up using Prentice, Williams, and Peterson models with total time. In our cohort (mean (SD) age: 75 (6) years; 51% female; 67% non-Hispanic White), 71% patients had at least one admission and 40% patients died over a median follow-up of 5.6 years. Area-level disadvantage was not associated with risks of admission within 30-days after HF diagnosis (hazard ratio [95% CI]: HR=1.09 [0.90-1.31]; P=.371). However, patients living in high-disadvantaged areas had significantly greater risks of recurrent admissions over follow-up (HR=1.11 [1.05-1.16]; P<.001). We observed similar patterns for 30-day mortality and mortality over the entire follow-up period. Overall, results from this study suggest that area-level socioeconomic disadvantage should be considered in clinical decision-making and guidelines to improve long-term outcomes in patients managing HF.

Racial/ethnic disparities in major cardiovascular disease (CVD) risk factors are well documented. However, studies have not considered racial/ethnic differences in the interrelationships among these CVD risk factors and how they vary across age. We used six waves of longitudinal data from the Health and Retirement Study ([HRS] 2006-2016; n=10,292) to examine co-occurring changes in systolic blood pressure ([BP] mmHg), non-HDL cholesterol (mg/dl), diabetes (y/n), and smoking (y/n) at ages 50-80. Group-based multi-trajectory models were used to identify age-related trajectories of CVD risk factors and multinomial logistic regression models were used to identify participant characteristics associated with the trajectories of CVD risk factors. In our cohort (mean (SD) age: 62 (7.2) years; 41% male; 66% non-Hispanic White, 17% non-Hispanic Black, 13% Hispanic, and 3% other race/ethnicity), we found eight distinct trajectories of age-related changes in CVD risk factors (37% of adults had optimal CVD levels). We also found that non-Hispanic Black and Hispanic adults were significantly more likely to exhibit elevated age-related risks related to BP, cholesterol, diabetes, and/or smoking compared with non-Hispanic White adults. The associations were differentially attenuated with the inclusion of multiple covariates and showed that education, household income, and nativity status (among Hispanics) contributed most to the excess CVD risks observed in non-Hispanic Black and Hispanic adults. Overall, our findings demonstrate the impact of social determinants on racial/ethnic disparities in age-related changes in CVD risk factors in middle-aged and older adults in the United States.

Low education in early life is a major risk factor for dementia. However, little is known about how education in later life is related to cognitive function in older adults. We assessed whether later-life learning was associated with better cognitive function over time and whether the associations differed by sex, race/ethnicity, and prior education. We used data from the 2008-2018 Health and Retirement Study, including participants aged 65+ without baseline dementia and followed for up to 6 years. Global cognition was measured using a summary score. Later-life learning was measured at every wave at least once a month or more, not in the last month, or never. Of 12 099 participants, 10.2% attended an educational or training course \"at least once a month or more,\" 45.5% reported \"not in the last month,\" and 43.3% reported \"never\" at each wave of the study. Results from adjusted mixed-effects models showed that engaging in any later-life learning, either at least once a month (0.56 points higher, 95% confidence interval [CI] = 0.40-0.73) or not in the last month (0.55 points higher, 95% CI = 0.45-0.65) was associated with better cognitive function compared to never engaging in these activities. The association remained consistent as people aged. The benefits of later-life learning on cognitive function were greater in women than in men-at least once a month versus never was 0.30 points greater in women than men (95% CI = -0.03 to 0.63,  = .0760); not in the last month versus never was 0.24 points greater in women than men (95% CI = 0.04-0.43,  = .016). There were no significant differences by race/ethnicity or prior education. Later-life learning was associated with better cognitive function over time. These findings underscore the importance of continued learning among older adults.