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Childhood socioeconomic status (cSES) is a powerful predictor of adult health, but its operationalization and measurement varies across studies. Using Health and Retirement Study data (HRS, which is nationally representative of community-residing United States adults aged 50+ years), we specified theoretically-motivated cSES measures, evaluated their reliability and validity, and compared their performance to other cSES indices. HRS respondent data (N = 31,169, interviewed 1992-2010) were used to construct a cSES index reflecting childhood social capital (cSC), childhood financial capital (cFC), and childhood human capital (cHC), using retrospective reports from when the respondent was <16 years (at least 34 years prior). We assessed internal consistency reliability (Cronbach's alpha) for the scales (cSC and cFC), and construct validity, and predictive validity for all measures. Validity was assessed with hypothesized correlates of cSES (educational attainment, measured adult height, self-reported childhood health, childhood learning problems, childhood drug and alcohol problems). We then compared the performance of our validated measures with other indices used in HRS in predicting self-rated health and number of depressive symptoms, measured in 2010. Internal consistency reliability was acceptable (cSC = 0.63, cFC = 0.61). Most measures were associated with hypothesized correlates (for example, the association between educational attainment and cSC was 0.01, p < 0.0001), with the exception that measured height was not associated with cFC (p = 0.19) and childhood drug and alcohol problems (p = 0.41), and childhood learning problems (p = 0.12) were not associated with cHC. Our measures explained slightly more variability in self-rated health (adjusted R2 = 0.07 vs. <0.06) and number of depressive symptoms (adjusted R2 > 0.05 vs. < 0.04) than alternative indices. Our cSES measures use latent variable models to handle item-missingness, thereby increasing the sample size available for analysis compared to complete case approaches (N = 15,345 vs. 8,248). Adopting this type of theoretically motivated operationalization of cSES may strengthen the quality of research on the effects of cSES on health outcomes.

Background Previous research suggests education is inversely associated with blood pressure, but little work has examined whether this relationship differs by race and gender jointly. Identifying the most vulnerable groups may inform hypertension prevention strategies. In this population-based study, we investigate the association between education and blood pressure overall and across race-by-gender subgroups. Methods Our analytic sample included participants aged 50 + to the US Health and Retirement Study data from 2006 to 2008 ( N  = 24,526). Our exposure was education, measured as self-reported years of schooling and modeled as a spline with a knot and discontinuity at 12 years representing high school diploma. We used generalized estimating equations to estimate the relationship between education and repeated measurements of two blood pressure outcomes: systolic blood pressure (SBP) and hypertension (HTN), then included race-by-gender interactions with education to evaluate differential associations. All models were adjusted for age, birthplace, parents’ education, and survey year. Results Mean age was 64.4 years, mean SBP was 129.9 mmHg, and HTN prevalence was 63.1%. Overall, below 12 years, each additional year of education was not associated with blood pressure, while twelve years of schooling was associated with lower blood pressure (b=-1.02; 95% CI: -2.04, 0.00 for SBP) and each additional year of education after 12 years was associated with lower SBP and lower odds of HTN (e.g., SBP: b=-0.75 mmHg; 95% CI: -0.88, -0.62). We observed some differential relationships by demographic subgroup such that, among Black men, 12 years of education predicted higher odds of HTN compared to White men (interaction OR = 1.60; 95% CI: 1.02, 2.52), and each additional year of education after 12 years was associated with larger SBP benefits for White, Hispanic and Black women compared to White men. Conclusions We found an overall protective relationship between more education and blood pressure/hypertension such that each additional year of college education was associated with lower blood pressure/hypertension, particularly among White and Hispanic women. However, we also found evidence of diminished benefits to high school degree attainment among Black men compared to other groups in hypertension prevalence.

Background Risk of diabetes increases exponentially with higher levels of glycosylated hemoglobin (HbA1c). Education is inversely associated with average HbA1c, however, differential associations between education and HbA1c across the HbA1c distribution have not been evaluated. Methods Health and Retirement Study data ( N  = 21,732) was used to evaluate the association between education (linear terms among those with < 12 years and ≥ 12 years of education) and first recorded HbA1c (2003–2016) at the mean using linear regression, and at the 1st-99th quantiles of the marginal outcome distribution using unconditional quantile regressions, controlling for birth year, race and ethnicity, gender, birthplace, parental education, and year of HbA1c measurement. Results Mean HbA1c was 5.9%; 16.6% of participants had HbA1c above the diabetes diagnostic threshold of 6.5%. For those with fewer than 12 years of schooling, there was no association between education and HbA1c at the mean or across the quantiles. For those with 12 or more years of schooling, an additional year of education was negatively associated with mean HbA1c (β OLS =-0.02, 95% confidence interval (CI) -0.03,-0.02); a one-year increase in mean education was associated with lower HbA1c across the distribution, but the magnitude was larger at higher quantiles (β q50 =-0.02, 95%CI -0.02,-0.01; β q90 =-0.06, 95%CI -0.09,-0.04). Conclusions Educational attainment is inversely associated with HbA1c among those with 12 or more years of schooling, with larger point estimates for those in the high-risk tail of the HbA1c distribution.

Education is a strong predictor of cognitive aging, but little work has evaluated the relationship between early childhood education (ECE) specifically and cognition in midlife and beyond. Using data from the National Longitudinal Survey of Youth 1979 Cohort (n = 7,129), we examined the relationship between attending preschool, Head Start (federally-funded free ECE targeted for low-income families), or no ECE, and midlife global cognition. We defined midlife global cognition based on immediate and delayed word recall, serial 7 subtraction, and backwards counting. We used multivariable linear regression models to estimate overall associations and associations among groups more likely eligible for Head Start, and to evaluate heterogeneities by sex, race and ethnicity, and family socioeconomic status (SES). Overall, preschool, but not Head Start, was associated with better midlife cognition compared to no ECE in some models. Among families more likely eligible for Head Start, we found not only that preschool (β = 0.26; 95% CI: 0.01, 0.51) was associated with better midlife cognition, but also directionally positive evidence that Head Start (β = 0.09; 95% CI: -0.08, 0.27) was associated with better midlife cognition. Associations varied; Head Start was associated with higher midlife cognition for Black and Hispanic men and people with higher family SES marginalization compared to other groups. This study provides initial evidence suggesting that early childhood education may be associated with better cognition more than 40 years later, especially for Black and Hispanic men and people who faced greater socioeconomic marginalization.

The Korean War GI Bill provided economic benefits for veterans, thereby potentially improving their health outcomes. However potential spillover effects on veteran wives have not been evaluated. Data from wives of veterans eligible for the Korean War GI Bill (N = 128) and wives of non-veterans (N = 224) from the Health and Retirement Study were matched on race and coarsened birth year and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78) were assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale. Regression analyses were stratified into low (mother < 8 years schooling / missing data, N = 95) or high (mother ≥ 8 years schooling, N = 257) childhood socio-economic status (cSES) groups, and were adjusted for birth year and childhood health, as well as respondent's educational attainment in a subset of analyses. Husband's Korean War GI Bill eligibility did not predict depressive symptoms among veteran wives in pooled analysis or cSES stratified analyses; analyses in the low cSES subgroup were underpowered (N = 95, β = -0.50, 95% Confidence Interval: (-1.35, 0.35), p = 0.248, power = 0.28). We found no evidence of a relationship between husband's Korean War GI Bill eligibility and wives' mental health in these data, however there may be a true effect that our analysis was underpowered to detect.

Socioeconomically disadvantaged children have worse adult health; we test if this 'long arm' of childhood disadvantage can be overcome through upward socioeconomic mobility in adulthood. Four SES trajectories (stable low, upwardly mobile, downwardly mobile and stable high) were created from median dichotomized childhood socioeconomic status (SES; childhood human and financial capital) and adult SES (wealth at age 67) from Health and Retirement Study respondents (N = 6669). Healthy ageing markers, in tertiles, were walking speed, peak expiratory flow (PEF), and grip strength measured in 2008 and 2010. Multinomial logistic regression models, weighted to be nationally representative, controlled for age, gender, race, birthplace, outcome year and childhood health and social capital. Upwardly mobile individuals were as likely as the stable high SES group to be in the best health tertile for walking speed (OR = 0.81; 95% CI: 0.63, 1.05; P = 0.114), PEF (OR = 0.97; 95% CI: 0.78, 1.21; P = 0.810) and grip strength (OR = 0.97; 95%CI: 0.74, 1.27; P = 0.980). Findings suggest the 'long arm' of childhood socioeconomic disadvantage can be overcome for these markers of healthy ageing through upward socioeconomic mobility.

BackgroundDiscrimination in health care settings is associated with poor health outcomes and may be especially harmful to individuals with chronic conditions, who need ongoing clinical care. Although efforts to reduce discrimination are growing, little is known about national trends in discrimination in health care settings.MethodsFor Black, White, and Hispanic respondents with chronic disease in the 2008–2014 Health and Retirement Study (N = 13,897 individuals and 21,078 reports), we evaluated trends in patient-reported discrimination, defined based on frequency of receiving poorer service or treatment than other people from doctors or hospitals (“never” vs. all other). Respondents also reported the perceived reason for the discrimination. In addition, we evaluated whether wealth predicted lower prevalence of discrimination for Blacks or Whites. We used generalized estimating equation models to account for dependency of repeated measures on individuals and wave-specific weights to represent the US non-institutionalized population aged 54+ .ResultsThe estimated prevalence of experiencing discrimination in health care among Blacks with a major chronic condition was 27% (95% CI: 23, 30) in 2008 and declined to 20% (95% CI: 17, 22) in 2014. Reports of receiving poorer service or treatment were stable for Whites (17%, 95% CI: 16, 19 in 2014). The Black–White difference in reporting any health care discrimination declined from 8.2% (95% CI: 4.5, 12.0) in 2008 to 2.5% (95% CI: −1.1, 6.0) in 2014. There was no clear trend for Hispanics. Blacks reported race and Whites reported age as the most common reason for discrimination.ConclusionsFindings suggest national declines in patient-reported discrimination in health care among Blacks with chronic conditions from 2008 to 2014, although reports of discrimination remain common for all racial/ethnic groups. Our results highlight the critical importance of monitoring trends in reports of discrimination in health care to advance equity in health care.

BackgroundAdverse childhood socioeconomic status (cSES) predicts higher late-life risk of memory loss and dementia. Veterans of U.S. wars are eligible for educational and economic benefits that may offset cSES disadvantage. We test whether cSES disparities in late-life memory and dementia are smaller among veterans than non-veterans.MethodsData came from US-born men in the 1995–2014 biennial surveys of the Health and Retirement Study (n=7916 born 1928–1956, contributing n=38 381 cognitive assessments). Childhood SES was represented by maternal education. Memory and dementia risk were assessed with brief neuropsychological assessments and proxy reports. Military service (veteran/non-veteran) was evaluated as a modifier of the effect of maternal education on memory and dementia risk. We employed linear or logistic regression models to test whether military service modified the effect of maternal education on memory or dementia risk, adjusted for age, race, birthplace and childhood health.ResultsLow maternal education was associated with worse memory than high maternal education (β = −0.07 SD, 95% CI −0.08 to –0.05), while veterans had better memory than non-veterans (β = 0.03 SD, 95% CI 0.02 to 0.04). In interaction analyses, maternal education disparities in memory were smaller among veterans than non-veterans (difference in disparities = 0.04 SD, 95% CI 0.01 to 0.08, p = 0.006). Patterns were similar for dementia risk.ConclusionsDisparities in memory by maternal education were smaller among veterans than non-veterans, suggesting military service and benefits partially offset the deleterious effects of low maternal education on late-life cognitive outcomes.

Background Past research shows that spousal death results in elevated mortality risk for the surviving spouse. However, most prior studies have inadequately controlled for socioeconomic status (SES), and it is unclear whether this 'widowhood effect' persists over time. Methods Health and Retirement Study participants aged 50+ years and married in 1998 (n = 12 316) were followed through 2008 for widowhood status and mortality (2912 deaths). Discrete-time survival analysis was used to compare mortality for the widowed versus the married. Results Odds of mortality during the first 3 months post-widowhood were significantly higher than in the continuously married (odds ratio (OR) for men = 1.87, 95% CI: 1.27, 2.75; OR for women = 1.47, 95% CI: 0.96, 2.24) in models adjusted for age, gender, race and baseline SES (education, household wealth and household income), behavioral risk factors and co-morbidities. Twelve months following bereavement, men experienced borderline elevated mortality (OR = 1.16, 95% CI: 1.00, 1.35), whereas women did not (OR = 1.07, 95% CI: 0.90, 1.28), though the gender difference was non-significant. Conclusion The 'widowhood effect' was not fully explained by adjusting for pre-widowhood SES and particularly elevated within the first few months after widowhood. These associations did not differ by sex.

In July 2009, an international committee announced a new diagnostic criterion for diabetes based on hemoglobin Ale A|c(HbA1C) values. Our objective was to estimate how the new diabetes diagnostic criterion will affect the prevalence of diabetes among different race, age, and gender subpop-ulations, compared to the previously used fasting plasma glucose (FPG) criterion. We analyzed nationally representative data from The National Health and Nutrition Examination Survey (NHANES), aggregated from 1999 to 2006. We estimated the prevalence of known diabetes (prevalence static across either diagnostic criterion), unknown, and no diabetes (prevalence variable by criterion). We tested statistical significance of prevalence differences for unknown diabetes between the prior diagnostic criterion—FPG of at least 126 mg/dL—and the new diagnostic criterion—HbA1c of at least 6.5%—using conditional logistic regression. We further tested the association of these differences with demographic factors. The new HbAicdiagnostic criterion differentially affects different racial/ethnic groups. For non-Hispanic whites, the prevalence of undiagnosed diabetes was more than halved from 2.6% (95% confidence interval [CI], 2.2-3.1) with FPG diagnosis to 1.3% (95% CI, 1.0-1.7), P <.001 with HbAic diagnosis. For Hispanics and non-Hispanic blacks, the differences in prevalence by the 2 criteria were smaller and nonsignificant. Racial differences by diagnostic criteria were most pronounced among people aged over 55 years. Overall, the new definition of diabetes differentially affects ethnic groups, especially for older people. If the new criterion is widely adopted, over time, we may see an apparent widening of racial/ethnic disparities in diabetes prevalence.