Chicago Health Research Articles

Neuroticism, physical activity, and cognitive functioning in a population-based cohort of older adults

BackgroundLittle is known about how physical activity influences the relationship between neuroticism and cognitive function and cognitive decline.MethodsData from the Chicago Health and Aging Project (CHAP) was utilized to conduct this study. CHAP is a population-based cohort study of chronic conditions in older adults. Participants completed in-home interviews cycles of three years from 1993–2012. Mixed effects regression models were conducted to test the associations between physical activity, neuroticism, and the interaction between neuroticism and physical activity on outcomes: global cognitive function, global cognitive decline, episodic memory, decline in episodic memory, perceptual speed, and decline in perceptual speed. Stratified mixed effects regression models by physical activity level were conducted to test the associations between neuroticism and global cognitive function and global cognitive decline.ResultsA total of 7,685 participants were eligible for this study. Participants were 62% female and 64% African American. We found statistically significant associations for the interaction of high physical activity and neuroticism on baseline global cognitive function (β = 0.017 (SE = 0.007), p = .010) and on the interaction of neuroticism and high physical activity on baseline episodic memory (β = 0.020 (SE = .009), p = .021) and on decline in episodic memory over time (β = -0.003 (SE = .001), p = .039).ConclusionHigher physical activity lessened the association between higher neuroticism and poor cognitive outcomes.

Serum total tau, neurofilament light, and glial fibrillary acidic protein are associated with mortality in a population study.

Total tau (t-tau), neurofilament light (NfL), and glial fibrillary acidic protein (GFAP) are neuronal cytoskeletal biomarkers that may indicate greater risk of poor outcomes in age-related conditions, including mortality. Health disparities experienced by some racial minority subgroups may influence biomarker expression and effects on longevity. We aimed to examine (a) associations of serum t-tau, NfL, and GFAP with overall and cardiovascular mortality and (b) differences in associations by racial background. Data came from 1327 older participants from the Chicago Health and Aging Project (CHAP), a longitudinal population-based study. Cox proportional hazards regression models were used to examine associations between concentrations of serum t-tau, NfL, and GFAP biomarker(s) and mortality (overall/cardiovascular mortality based on age at death). Interaction terms were used to examine differences between African-American and European-American participants. Models were adjusted for age, sex, education, the APOE-ε4 allele, body mass index, chronic health conditions, and cognitive and physical functioning. Models showed that fivefold higher concentrations of t-tau (HR = 1.46, 95% CI: 1.27, 1.68), NfL (HR = 2.13, 95% CI: 1.76, 2.58), and GFAP (HR = 1.43, 95% CI: 1.08, 1.90) were separately associated with increased risk of overall mortality, with higher risk in African Americans in t-tau or NfL. In models with all biomarkers, NfL (HR = 2.17, 95% CI: 1.65, 2.85) was associated with risk of overall mortality, with racial differences in t-tau. Higher concentrations of t-tau (HR = 1.32, 95% CI: 1.02, 1.70), NfL (HR = 1.95, 95% CI: 1.40, 2.72), and GFAP (HR = 1.87, 95% CI: 1.18, 2.98) were separately associated with risk of cardiovascular mortality, with racial differences in t-tau, NfL, or GFAP. In combined models, NfL (HR = 1.73, 95% CI: 1.08, 2.78) was associated with cardiovascular mortality. Serum t-tau, NfL, and GFAP may be early indicators for mortality outcomes among older adults, with racial differences among associations.

Cardiovascular health and cognitive outcomes: Findings from a biracial population-based study in the United States.

The aim of this study was to evaluate the association of cardiovascular health (CVH) with cognitive outcomes, including incident Alzheimer's dementia, rate of cognitive decline, and measures of brain injury and structure. This study consisted of 1702 Black or African American and White participants living in the south side of Chicago, Illinois, and enrolled in the Chicago Health and Aging Project, a population-based cohort since 1993. CVH was based on seven risk factors, including diet, physical activity, body mass index, smoking, dyslipidemia, hypertension, and diabetes. In a multivariable-adjusted model, CVH was associated with a lower risk of Alzheimer's dementia. The hazard ratio per 1 additional point in CVH score was 0.84 (95% CI 0.76, 0.94). CVH was also associated with a slower rate of cognitive decline and less volume (injury) in white matter hyperintensities. Promoting CVH in communities with Black residents may lower the future risk of Alzheimer's dementia.

Prevalence of Alzheimer's disease dementia in the 50 US states and 3142 counties: A population estimate using the 2020 bridged-race postcensal from the National Center for Health Statistics.

This study estimates the prevalence and number of people living with Alzheimer's disease (AD) dementia in 50 US states and 3142 counties. We used cognitive data from the Chicago Health and Aging Project, a population-based study, and combined it with the National Center for Health Statistics 2020 bridged-race population estimates to determine the prevalence of AD in adults ≥65 years. A higher prevalence of AD was estimated in the east and southeastern regions of the United States, with the highest in Maryland (12.9%), New York (12.7%), and Mississippi (12.5%). US states with the highest number of people with AD were California, Florida, and Texas. Among larger counties, those with the highest prevalence of AD were Miami-Dade County in Florida, Baltimore city in Maryland, and Bronx County in New York. The state- and county-specific estimates could help public health officials develop region-specific strategies for caring for people with AD.

UChicago Medicine Grows Through Partnership Synergies.

University of Chicago Health System-UChicago Medicine-recently joined forces with AdventHealth's Great Lakes Region to expand access to services, treatment options, and clinical trials to residents in Chicago's western suburbs. Other organizations may want to follow that approach in developing and maintaining a high-quality and integrated healthcare ecosystem-one that not only increases access to care for underserved populations but also responds to changing consumer preferences and behavior. Building partnerships with other systems that possess similar values and complementary strengths is an effective way to provide patients with convenient, high-quality care closer to home. Early results of the joint venture show promising synergies and benefits.

Subjective memory complaints, white matter hyperintensities, and cognitive decline in a population‐based cohort study

AbstractBackgroundSubjective memory complaints (SMCs) are associated with a faster cognitive decline and dementia; whether this relationship results from irreversible structural brain alterations, such as white matter hyperintensities (WMH), requires investigation. We aimed to determine the association of SMCs with WMH and cognitive decline and investigate the role of WMH on the relationship between SMCs and cognitive decline.MethodWe studied 917 participants (63% African Americans and 60% women) from the population‐based Chicago Health and Aging Project (CHAP), who responded to questions about SMCs, underwent magnetic resonance imaging of the brain, and had valid cognitive data on two or more visits during the follow‐up period. SMCs were obtained by self‐report questionnaire, and based on frequency and severity of concerns, we categorized participants into three groups: not concerned, moderately concerned, and very concerned.ResultOf 917 participants eligible for the study, 158 (17.2%) had no SMCs concerns, 671 (73.2%) had moderate concerns, and 88 (9.6%) were very concerned. SMCs were associated with larger WMH volumes and faster cognitive decline. Compared to participants with no concerns, those very concerned had 0.833 (95%CI 0.203, 1.463) units higher WMH volumes and 174% faster cognitive decline (‐0.049; 95%CI ‐0.076, ‐0.022). The association between SMCs and cognitive decline was statistically significant only among individuals with large WMH volumes; that is, very concerned individuals with large WMH volumes had 428% faster cognitive decline annually (‐0.077; 95%CI ‐0.144, ‐0.011) than participants with no concerns. In participants with low volumes of WMH, SMCs were not associated with a faster cognitive decline (P‐value = 0.595).ConclusionOur study suggests that SMCs, frequently reported by the elderly, are an important sign of cognitive impairment, especially in people with brain atrophies, such as large WMH volumes.

White matter hyperintensity, neurofilament light chain, and cognitive decline

AbstractBackgroundWhite matter hyperintensity (WMH), assessed by magnetic resonance imaging (MRI), is a marker of cerebrovascular disease. Neurofilament light chain (NFL), assessed in the blood, is a biomarker of neurodegeneration. While both measures, WMH and NFL, are associated with cognitive impairment, we aimed to evaluate which of the two measurements is most advantageous in determining the risk of cognitive impairment.MethodWe conducted this investigation in Chicago Health and Aging Project (CHAP), a prospective population‐based cohort study in the United States. The study included 1,323 participants with data on NFL serum concentrations and 923 who underwent an MRI scan and had data on WMH volumes. NFL was measured using an ultrasensitive immunoassay, single‐molecule array technology. MRI scans of the brain were acquired using 1.5‐T systems. Global cognitive function was created as a composite measure of 4 neuropsychological tests, standardized and averaged to z‐scores. Linear mixed‐effects models were used to examine associations of the NFL, WMH, and cognitive decline adjusting for age, sex, race, education, and APOE e4.ResultOf 1,323 participants, 808 (61%) were African Americans, and 38% were men, with an average age of 78.5 years. WMH and NFL were associated with faster cognitive decline in a multivariable‐adjusted model. Individuals in the third tertile of WMH had a faster cognitive decline by 0.029 (95%CI ‐0.052, ‐0.006) units per year compared to the first tertile. Also, compared to the first tertile of NFL, individuals in the third tertile had a faster cognitive decline by 0.029 (95%CI ‐0.046, ‐0.011) units per year. The stratified analysis by the tertiles of WMH showed that NFL was associated with a cognitive decline only in participants in the lowest tertile of WMH (‐0.089; 95%CI ‐0.159, ‐0.02). Similarly, when we stratified analysis by the tertiles of the NFL, we found a significant association of WMH with cognitive decline only participants in the lowest tertile of the NFL (‐0.052; 95%CI ‐0.008, ‐0.024).ConclusionWhile both biomarkers, NFL and WMH, are associated with cognitive decline, our findings suggest that within individuals with low values of NFL, WMH may identify people with a faster rate of decline in cognitive functioning.

Serum total tau, neurofilament light, and glial fibrillary acidic protein are associated with overall and cardiovascular mortality in a biracial longitudinal population‐based cohort

AbstractBackgroundSerum cytoskeletal biomarkers may indicate greater risk of poor outcomes in age‐related conditions, including mortality. Total tau (t‐tau), neurofilament light (Nf‐L) and glial fibrillary acidic protein (GFAP) are neuronal cytoskeletal biomarkers that are measurable in biofluids. Our objective is to examine separate and combined associations of serum t‐tau, Nf‐L, and GFAP with overall and cardiovascular mortality in a biracial population‐based sample.MethodData came from 1,327 older participants who were either of Black or White racial background from the Chicago Health and Aging Project (CHAP), a longitudinal population‐based study of chronic conditions of aging. An ultrasensitive immunoassay was used to measure the concentration of t‐tau, Nf‐L, and GFAP in blood serum. Mortality based on age at death included overall mortality and cardiovascular mortality. A series of Cox proportional hazard regression models were used to examine associations between biomarker(s) and outcomes (overall and cardiovascular mortality), adjusting for age, gender, education, the APOE‐e4 allele, global cognitive function, and physical functioning.ResultIn univariate models, 5‐fold higher concentrations of serum t‐tau (HR = 1.46, 95% CI: 1.28, 1.68), Nf‐L (HR = 2.14, 95% CI: 1.79, 2.57), and GFAP (HR = 1.39, 95% CI: 1.07, 1.81) were separately associated with increased risk of overall mortality, with higher risk in participants of Black race versus White in models with t‐tau or Nf‐L. In combined models with all three biomarkers, t‐tau (HR = 1.38, 95% CI: 1.09, 1.75) and Nf‐L (HR = 3.05, 95% CI: 2.35, 3.95) were associated with risk of overall mortality, with racial differences in t‐tau only. In univariate models, higher concentrations of t‐tau (HR = 1.32, 95% CI: 1.03, 1.68), Nf‐L (HR = 2.11, 95% CI: 1.56, 2.88), and GFAP (HR = 1.74, 95% CI: 1.13, 2.69) were separately associated with risk of cardiovascular mortality, with racial differences in t‐tau or Nf‐L. In combined models, only Nf‐L was associated with cardiovascular mortality (HR = 2.84, 95% CI: 1.84, 4.38).ConclusionSerum t‐tau, Nf‐L, and GFAP were associated with increased risk of overall and cardiovascular mortality, with racial differences among associations, in a biracial population‐based sample. Our findings suggest that serum t‐tau, Nf‐L, and GFAP may serve as a potential biomarker for overall and cardiovascular mortality among older adults.

Vitamin D intake and cognitive decline in African Americans and European Americans: The role of diet and supplements

AbstractBackgroundVitamin D intake and supplementation has received considerable interest in dementia research because the prevalence of vitamin D deficiency is higher among older adults, particularly among older African Americans and cognitively impaired individuals. We prospectively examined the role of vitamin D intake, from both diet and supplements, in association with cognitive decline in African Americans and European Americans.MethodUtilizing data from the population‐based Chicago Health and Aging Project, we studied 2,061 African Americans and 1,329 European Americans with dietary vitamin D data and cognitive testing over 18 years of follow‐up. Multivariable linear mixed‐effects models adjusted for age, sex, education, APOE e4, body mass index, late‐life cognitive activities, physical activity, comorbidities, total energy intake, and their respective interactions with follow‐up time were used to determine the association of vitamin D intake with cognitive decline.ResultOn average, the vitamin D intake was lower in African Americans than European Americans (210.2 IU/d vs. 348.7 IU/d). In African Americans, participants in the highest tertile had a slower cognitive decline of 0.019 units/year (95%CI 0.009, 0.030) compared to those in the lowest tertile of dietary intake. The use of vitamin D supplementation was not associated with cognitive decline in African Americans (β 0.004, 95%CI ‐0.006, 0.013). In European Americans, vitamin D intake was not associated with cognitive decline.ConclusionDietary vitamin D may help slow the rate of cognitive decline in African Americans as they age.

Loneliness and cognitive decline in the community: Examining demographic and APOE4 status differences

AbstractBackgroundLimited information exists regarding patterns of loneliness and relationships among subgroups of older adults in the community. We evaluated demographic and APOE4 status differences in associations between loneliness and cognitive decline in older adults.MethodParticipants (N = 7,696) were selected from the Chicago Health and Aging Project (CHAP), a longitudinal population‐based study, who completed at least two measurement time points of neuropsychological testing, including individual tests of episodic memory, perceptual speed, and the Mini‐Mental State Examination (MMSE). The mean of individual test scores was taken to calculate composite global cognitive function. Loneliness was measured using an item from the Center for Epidemiologic Studies‐Depression Scale (modified). Mixed effects regression models evaluated associations between loneliness and decline in global cognitive function and individual tests, by race, sex, and APOE4 (one or more copies of e4 allele (any) vs. none). Modeling included adjustments such as sex, race, age, education, chronic conditions, cognitive activities, statin prescription, and interactions with time for each.ResultA higher percentage of participants that were female (74% vs. 61%), African American compared to Non‐Hispanic White (72% vs. 63%), with older mean age (74 vs. 72 years) reported loneliness. The prevalence of loneliness was similar across APOE4 status. The interaction/ synergy of loneliness with time had statistically significant associations with global cognition (β = ‐0.010, p = 0.005), episodic memory (β = ‐0.010, p = 0.017), and MMSE (β = ‐0.015, p = 0.000) for women. This interaction was statistically significant in associations with global cognition (β = ‐0.012, p = 0.001), episodic memory (β = ‐0.011, p = 0.012), and MMSE (β = ‐0.018, p = 0.000) among African American participants. This interaction also showed the following statistically significant associations by APOE4 status: any (β = ‐0.012, p = 0.034) and none (β = ‐0.007, p = 0.049) for global cognition, none (β = ‐0.009, p = 0.039) for episodic memory, and any (β = ‐0.017, p = 0.009) and none (β = ‐0.011, p = 0.004) for MMSE.ConclusionLoneliness is differentially associated with global cognitive decline based on race and sex but not APOE4 status. More research is needed to understand relationships between loneliness and biological mechanisms and how to best account for demographic characteristics when intervening on loneliness.

Depressive Symptoms, Glial Fibrillary Acid Protein Concentrations, and Cognitive Decline in a Cohort Study.

Little is known about how depressive symptoms and glial fibrillary acid protein (GFAP) concentrations taken together may influence cognitive functioning. Understanding this relationship may inform strategies for screening and early intervention to decrease the rate of cognitive decline. This study sample includes 1 169 participants from the Chicago Health and Aging Project (CHAP), consisting of 60% Black participants and 40% White participants, and 63% female participants and 37% male participants. CHAP is a population-based cohort study of older adults with a mean age of 77 years. Linear mixed-effects regression models tested the main effects of depressive symptoms and GFAP concentrations and their interactions on baseline cognitive function and cognitive decline over time. Models included adjustments for age, race, sex, education, chronic medical conditions, body mass index, smoking status, alcohol use, and their interactions with time. The interaction of depressive symptomology and GFAP (β = -0.105 [standard error = 0.038], p = .006) on global cognitive function was statistically significant. Participants with depressive symptoms including and above the cutoff and high log of GFAP concentrations had more cognitive decline over time, followed by participants with depressive symptoms below the cutoff and high log of GFAP concentrations, depressive symptom scores including and above the cutoff and low log of GFAP concentrations, and depressive symptom scores below the cutoff and low log of GFAP concentrations. Depressive symptoms have an additive effect on the association between the log of GFAP and baseline global cognitive function.

Predictive Modeling of Lapses in Care for People Living with HIV in Chicago: Algorithm Development and Interpretation.

Reducing care lapses for people living with HIV is critical to ending the HIV epidemic and beneficial for their health. Predictive modeling can identify clinical factors associated with HIV care lapses. Previous studies have identified these factors within a single clinic or using a national network of clinics, but public health strategies to improve retention in care in the United States often occur within a regional jurisdiction (eg, a city or county). We sought to build predictive models of HIV care lapses using a large, multisite, noncurated database of electronic health records (EHRs) in Chicago, Illinois. We used 2011-2019 data from the Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN), a database including multiple health systems, covering the majority of 23,580 people with an HIV diagnosis living in Chicago. CAPriCORN uses a hash-based data deduplication method to follow people across multiple Chicago health care systems with different EHRs, providing a unique citywide view of retention in HIV care. From the database, we used diagnosis codes, medications, laboratory tests, demographics, and encounter information to build predictive models. Our primary outcome was lapses in HIV care, defined as having more than 12 months between subsequent HIV care encounters. We built logistic regression, random forest, elastic net logistic regression, and XGBoost models using all variables and compared their performance to a baseline logistic regression model containing only demographics and retention history. We included people living with HIV with at least 2 HIV care encounters in the database, yielding 16,930 people living with HIV with 191,492 encounters. All models outperformed the baseline logistic regression model, with the most improvement from the XGBoost model (area under the receiver operating characteristic curve 0.776, 95% CI 0.768-0.784 vs 0.674, 95% CI 0.664-0.683; P<.001). Top predictors included the history of care lapses, being seen by an infectious disease provider (vs a primary care provider), site of care, Hispanic ethnicity, and previous HIV laboratory testing. The random forest model (area under the receiver operating characteristic curve 0.751, 95% CI 0.742-0.759) revealed age, insurance type, and chronic comorbidities (eg, hypertension), as important variables in predicting a care lapse. We used a real-world approach to leverage the full scope of data available in modern EHRs to predict HIV care lapses. Our findings reinforce previously known factors, such as the history of prior care lapses, while also showing the importance of laboratory testing, chronic comorbidities, sociodemographic characteristics, and clinic-specific factors for predicting care lapses for people living with HIV in Chicago. We provide a framework for others to use data from multiple different health care systems within a single city to examine lapses in care using EHR data, which will aid in jurisdictional efforts to improve retention in HIV care.

Factors Associated With Readmission for Postpartum Preeclampsia [ID: 1378401

INTRODUCTION: Factors associated with preeclampsia with severe features (PSF) diagnosed on postpartum readmission are understudied, although important. METHODS: Patients were identified using ICD-9/10 codes of PSF diagnosed antenatally or postnatally between 2010 and 2019. We collected background and pregnancy characteristics via electronic medical records and used the Chicago Health Atlas to assign zip code-based socioeconomic hardship and education scores. Descriptive statistics and logistic regressions evaluated whether individual, pregnancy, and neighborhood factors predicted odds of readmission. Model 1 included age, body mass index (BMI), fetal growth restriction, urine protein, preterm delivery, and cesarean section. Model 2 added neighborhood factors, number of hypertensive medications at discharge, and length of delivery inpatient stay. RESULTS: Seven hundred forty-seven participants with PSF were identified, and 108 (14.8%) were diagnosed on postnatal readmission. Our sample was 68.8% Black, aged 29.0±6.8 years, with a mean BMI of 34.7±9.7 kg/m2. In model 1, older age was associated with an increased risk for readmission (adjusted odds ratio [aOR] 1.07, 95% CI 1.03–1.11) while the presence of proteinuria (aOR 0.38, 95% CI 0.24–0.61) and preterm birth (aOR 0.52, 95% CI 0.30–0.91) were associated with decreased risk for readmission. In model 2, older age (aOR 1.09, 95% CI 1.04–1.14) remained significantly associated with increased risk of readmission while the presence of proteinuria (aOR 0.24, 95% CI 0.12–0.45), more hypertensive medications given at discharge (aOR 0.44, 95% CI 0.24–0.82), and longer inpatient stay (aOR 0.60, 95% CI 0.40–0.92) showed decreased odds of readmission. No other studied factors were associated with readmission. CONCLUSION: Older mothers were consistently more at risk for readmission, while more intensive hypertensive treatment (higher number of medications, longer inpatient stay at delivery) protected against readmission.

79. Treatment of chlamydia and gonorrhea in a Chicago health system: Observations of treatment

79. Treatment of chlamydia and gonorrhea in a Chicago health system: Observations of treatment

Serum neurofilament light chain, brain infarcts, and the risk of stroke: a prospective population-based cohort study.

Neurofilament light chain (NfL), a neuron-specific protein, has been related to several neurodegenerative diseases. In addition, elevated levels of NfL have also been observed in patients admitted to the hospital for stroke, suggesting that NfL as a biomarker may extend well beyond neurodegenerative diseases. Therefore, using data from the Chicago Health and Aging Project (CHAP), a population-based cohort study, we prospectively investigated the association of serum NfL levels with incident stroke and brain infarcts. During a follow-up of 3603 person-years, 133 (16.3%) individuals developed incident stroke, including ischemic and hemorrhagic. The HR (95%CI) of incident stroke was 1.28 (95%CI 1.10-1.50) per 1 standard deviation (SD) increase of log10 NfL serum levels. Compared to participants in the first tertile of NfL (i.e., lower levels), the risk of stroke was 1.68 times higher (95%CI 1.07-2.65) in those in the second tertile and 2.35 times higher (95%CI 1.45-3.81) in those in the third tertile of NfL. NfL levels were also positively associated with brain infarcts; 1-SD in log10 NfL levels was associated with 1.32 (95%CI 1.06-1.66) higher odds of one or more brain infarcts. These results suggest that NfL may serve as a biomarker of stroke in older adults.

Impact of steroid injections on hip joint integrity

1University of Chicago NorthShore Family Medicine Residency Program, Chicago, IL 2University of Chicago Hospitals and Health System: The University of Chicago Medicine, Chicago, IL The corresponding author is Priya Veda Nagarajan; [email protected] The authors have no conflicts of interest to declare.

154. Treatment of Chlamydia and Gonorrhea in a Chicago Health System: Observations of Treatment Practices Before and After Updated CDC Guidelines

154. Treatment of Chlamydia and Gonorrhea in a Chicago Health System: Observations of Treatment Practices Before and After Updated CDC Guidelines

The Impact of Neighborhood Disadvantage on Asthma Prevalence in a Predominantly African-American, Chicago-Based Cohort.

This study aimed to investigate the joint effect of neighborhood disadvantages on asthma prevalence and evaluate whether individual-level variables protect residents against neighborhood disadvantages. Data from the Chicago Multiethnic Prevention and Surveillance Study (from 2013-2020) were analyzed. Eight neighborhood characteristics were measured using the Chicago Health Atlas, including neighborhood unsafety, limited access to healthy food, neighborhood alienation, severe rent burden, vacant housing, single-parent household, neighborhood poverty, and unemployment. A structured questionnaire measured asthma diagnosis (childhood or adulthood) and individual-level variables including sex, age, income, education, and race. Weighted quantile sum (WQS) regression was used to evaluate the impact of neighborhood disadvantages. Stratified analysis was performed by income and education. A total of 6,592 participants (mean age = 53.5 (standard deviation, 11.1) years) were included. Most of the study population were non-Hispanic Black (82.5%) and reported an annual household income less than $15,000 (53%). Asthma prevalence was 23.6%. The WQS index, which represents the overall neighborhood disadvantages, was associated with asthma prevalence (odds ratio= 1.14, 95% confidence interval: 1.07, 1.22) when adjusted for individual-level confounders. Neighborhood poverty contributed 40.8% to the overall impact, followed by vacant housing (23.1%) and neighborhood alienation (22.9%). When stratified by individual-level income or education, no difference was observed for the association between WQS index and asthma prevalence.

Personal network size and social accompaniment: Protective or risk factor for momentary loneliness, and for whom?

Personal networks yield important health benefits for individuals, in part by providing more opportunities to be in the company of others throughout daily life. Social accompaniment is generally believed to protect against momentary feelings of loneliness, although this hypothesis remains understudied. We examine how personal network size shapes older adults' experiences of momentary loneliness and whether this association varies by momentary social accompaniment. We use three waves of ecological momentary assessments (EMA; N = 12,359) and personal network data from 343 older adults in the Chicago Health and Activity in Real-Time study. Older adults with large personal networks experienced more intense momentary loneliness compared to those with smaller social networks when they were momentarily alone. This association was more pronounced among men. We discuss how research approaches that bridge global and momentary measures of social connectedness can reveal important nuances of our understanding of how interpersonal factors influence later-life well-being over time.

Race and Apolipoprotein E-e4 Allele Status Differences in the Association Between Loneliness and Cognitive Decline.

This study aimed to examine race and apolipoprotein E-e4 allele (APOE-e4) status differences in the longitudinal associations between loneliness and cognitive decline. The study sample is composed of participants ( N = 7696, 64% Black participants and 36% White participants) from the Chicago Health and Aging Project, a population-based cohort study. Mixed-effects regression models were conducted to examine the longitudinal associations between loneliness on global cognitive function and individual tests of cognitive function. Models were also stratified by race and APOE-e4. A greater percentage of Black participants (17%) reported loneliness at baseline visit compared with White participants (12%). Black and White participants who were lonely individuals had a similar rate of decline in global cognitive function at 0.075 (95% confidence interval [CI] = -0.082 to -0.068) standard deviation unit (SDU) per year for Black participants and at 0.075 (95% CI = -0.086 to -0.063) SDU per year for White participants. Lonely participants with APOE-e4 had a higher rate of global cognitive decline at -0.102 (95% CI = -0.115 to -0.088) SDU per year than for lonely participants without APOE-e4 at -0.052 (95% CI = -0.059 to -0.045) SDU per year. The burden of loneliness and its relation to cognitive decline is higher among participants with APOE-e4 compared with those without APOE-e4. Loneliness is associated with cognitive decline in both Black and White participants.