Disparities In Trajectories Research Articles

Disparate trajectories of cognitive aging among American Indian and Alaskan Native people with and without HIV.

This study describes trajectories of cognitive aging among American Indian/Alaskan Native (AI/AN) adults with and without HIV and the role of immunosenescence longitudinally. We characterized trajectories of cognitive aging in a sample of 333 AI/AN and 309 non-Hispanic White (NHW) adults who were followed longitudinally for up to 20 years by the HIV Neurobehavioral Research Program (HNRP) across six U.S. research sites. We used growth curve modeling with autoregressive Lag-1 structures and heterogeneous residual variances to assess the role of ethnoracial identity and HIV grouping upon decline in trajectories of cognitive aging. HIV- AI/AN adults demonstrated earlier and steeper decline in normative trajectories of cognitive aging on tasks of processing speed, timed tasks of attention/working memory, executive function, and psychomotor speed in comparison to HIV- NHW adults. Accentuated trajectories of cognitive aging were evident in both HIV+ and HIV+ immunosuppressed groups in comparison to HIV- peers and were primarily driven by the role of immunosenescence. AI/AN disparities in trajectories of cognitive aging are evident and are likely explained by the interplay of biopsychosociocultural factors, including immunosenescence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

COVID-19 and Youth Mental Health Disparities: Intersectional Trends in Depression, Anxiety and Suicide Risk-Related Diagnoses

ObjectivesMental health disparities were prevalent among racially and ethnically minoritized youth prior to the COVID-19 pandemic. As complete datasets from 2022 become available, we can estimate the extent to which the pandemic further magnified existing inequities. Our objective was to quantify disparities in trajectories of depression, anxiety, and suicide risk-related diagnoses in youth before and after the start of the COVID-19 pandemic, using an intersectional lens of race, ethnicity and gender. MethodsUsing electronic medical record data from one mid-Atlantic health care system (2015–2022), we evaluated changes in annual rates of depression, anxiety and suicide risk-related diagnoses in 29,117 youths, aged 8–20 years, using graphical analysis, comparison of adjusted mean differences (AMD) and adjusted mixed multilevel logistic regression. ResultsAlmost all racial and gender subgroups had significantly higher rates of depression and anxiety after the start of COVID-19 compared to the years prior, with the greatest changes observed in Hispanic and Asian females. Suicide risk-related diagnoses significantly increased among all female subgroups, with the largest increase among Asian females (AMD 4.8, 95% CI 0.2–9.3) and Black females (AMD 4.6, 95% CI 2.2–6.9). ConclusionsRates of depression, anxiety, and suicidal thoughts and/or behaviors in young people continued to increase in the post-pandemic period. Many pre-existing disparities between subgroups, especially females, significantly widened, highlighting the importance of using an intersectional lens. Urgent action is warranted, including universal screening of pediatric patients for suicide risk, broadening effective treatment and support options in minoritized patients, and increasing support services to patients and families.

Abstract 073: Blood Pressure Trajectories Among Young Veterans: Differences By Sex, Race, And Ethnicity

Background: Veteran status (~6% of U.S. population) is an independent risk factor for cardiovascular disease (CVD). High blood pressure (BP) increases CVD risk for older Veterans. Less is known about BP levels and trajectories for younger Veterans. Objective: Assess sex- and racial/ethnic differences in longitudinal BP trajectories for young Veterans accessing the Veterans Affairs (VA) healthcare system. Methods: We used national 2001-2016 Veterans Health Administration data for Veterans who served in conflicts in Afghanistan and Iraq. Systolic (SBP) and diastolic (DBP) BP were collected from the first to most recent outpatient visit. Linear mixed effects models estimated annual rate of change in BP. Models adjusted for sociodemographic, behavioral, and clinical factors included a time*sex, time*race/ethnicity interaction term. Results: We included 764,652 Veterans (13% women; median age 29.5 years) with 14,788,864 BP measurements over a mean of 6.1 years. There was a significant interaction by sex and race/ethnicity ( P <0.0001). In sex-stratified models, women vs. men had lower initial SBP (113.3 vs 120.9) and DBP (70.1 vs 73.0), but women had a markedly rapid BP increase over time (SBP rate of change= 0.36 vs 0.10 mmHg/year; DBP = 0.46 vs 0.31; Figure ). For women, Non-Hispanic (NH) Black women had the highest initial BP and annual rate of change (SBP/DBP: 0.46/0.50). Conclusion: Younger Veterans’ have normal BP when ending military service, but there are sex, racial, and ethnic differences in BP patterns over time. NH Black women Veterans show the greatest rate of BP increase. Targeted interventions may be needed to reduce disparities in trajectories to reduce future CVD risk.

Disparities in trajectories of cigarette and E-cigarette use across sexual orientation groups of young adult men and women in the US

IntroductionLimited research has examined differences in cigarette/e-cigarette use trajectories among specific subgroups of sexual minority (SM) young adult (SMYA) men and women. MethodsRepeated measures latent profile analyses (RMLPAs) examined past 6-month cigarette and e-cigarette use trajectories across 5 waves of data (2018–2020) among men (n = 1235; Mage = 25.56, SD = 4.85; 8.0% bisexual, 12.7% gay; 36.4% racial/ethnic minority) and women (n = 1574; Mage = 24.64, SD = 4.72; 23.8% bisexual, 5.9% lesbian; 35.3% racial/ethnic minority) residing in 6 US metropolitan statistical areas. Multinomial logistic regressions examined associations among sexual orientation (bisexual, gay/lesbian, heterosexual) and tobacco use trajectories among men and women, separately. ResultsRMLPAs yielded a 6-profile solution: stable low-level cigarette and e-cigarette use (66.6%), stable low-level cigarette and high-level e-cigarette use (12.2%), stable low-level cigarette and decreasing e-cigarette use (6.2%), stable mid-level cigarette and low-level e-cigarette use (6.2%), stable high-level cigarette and low-level e-cigarette use (4.5%), and stable high-level cigarette and e-cigarette use (4.2%). Gay (vs. heterosexual) men were less likely to display stable low-level cigarette and stable high-level e-cigarette use. Bisexual (vs. heterosexual) women were more likely to display stable low-level cigarette and stable high-level e-cigarette use, stable low-level cigarette and decreasing high-level e-cigarette use, and stable high-level cigarette and stable low-level e-cigarette use. ConclusionsBisexual women were at greatest risk for displaying several problematic cigarette and e-cigarette use trajectories, whereas few differences emerged for men. Tailored interventions and campaigns are needed to curtail ongoing tobacco use disparities among SMYA men and women, particularly bisexual women.

Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans

IntroductionMultimorbidity, the presence of multiple chronic health conditions, generally starts in middle and older age but there is considerable heterogeneity in the trajectory of morbidity accumulation. This study aimed to clarify the number of distinct trajectories and the potential associations between race/ethnicity and socioeconomic status and these trajectories. MethodsData from 13,699 respondents (age ≥51) in the Health and Retirement Study between 1998 and 2016 were analyzed with growth mixture models. Nine prevalent self-reported morbidities (arthritis, cancer, cognitive impairment, depressive symptoms, diabetes, heart disease, hypertension, lung disease, stroke) were summed for the morbidity count. ResultsThree trajectories of morbidity accumulation were identified: low [starting with few morbidities and accumulating them slowly (i.e., low intercept and low slope); 80% of sample], increasing (i.e., low intercept and high slope; 9%), and high (i.e., high intercept and low slope; 11%). Compared to non-Hispanic (NH) White adults in covariate-adjusted models, NH Black adults had disadvantages while Hispanic adults had advantages. Our results suggest a protective effect of education for NH Black adults (i.e., racial health disparities observed at low education were ameliorated and then eliminated at increasing levels of education) and a reverse pattern for Hispanic adults (i.e., increasing levels of education was found to dampen the advantages Hispanic adults had at low education). Compared with NH White adults, higher levels of wealth were protective for both NH Black adults (i.e., reducing or reversing racial health disparities observed at low wealth) and Hispanic adults (i.e., increasing the initial health advantages observed at low wealth). ConclusionThese findings have implications for addressing health disparities through more precise targeting of public health interventions. This work highlights the imperative to address socioeconomic inequalities that interact with race/ethnicity in complex ways to erode health.

Race Inequity in School Attendance Across the Jim Crow South and Its Implications for Black-White Disparities in Trajectories of Cognitive Function Among Older Adults.

Although education is a key determinant of cognitive function, its role in determining Black-White disparities in cognitive function is unclear. This may be due, in part, to data limitations that have made it difficult to account for systemic educational inequities in the Jim Crow South experienced by older cohorts, including differences in the number of days Black students attended school compared to their White counterparts or Black peers in better-funded southern states. We determine if accounting for differential rates of school attendance across race, years, and states in the Jim Crow South better illuminates Black-White disparities in trajectories of cognitive function. We linked historical state-level data on school attendance from the 1919/1920 to 1953/1954 Biennial Surveys of Education to the Health and Retirement Study, a nationally representative, longitudinal study of U.S. adults older than age 50. We restricted our sample to Black and White older adults who attended school in the Jim Crow South and began primary school in/after 1919/1920 and completed primary/secondary school by 1953/1954 (n = 4,343). We used linear mixed models to estimate trajectories of total cognitive function, episodic memory, and working memory. Self-reported years of schooling explained 28%-33% of the Black-White disparity in level of cognitive function, episodic memory, and working memory. Duration of school, a measure that accounted for differential rates of school attendance, explained 41%-55% of the Black-White disparity in these outcomes. Our study highlights the importance of using a more refined measure of schooling for understanding the education-cognitive health relationship.

Current and Future Directions in Minority Aging: Embracing Interdisciplinary Models

Racial/ethnic disparities in health among older adults are well-documented. More research is needed to clarify the complex and multifactorial mechanisms underlying these associations. This symposium will feature research that employs innovative theoretical and methodological approaches to understand the biopsychosocial mechanisms that underlie racial/ethnic disparities in older adults’ health and determine sources of within-group heterogeneity in minority aging. Dr. Forrester will integrate stress biology and intersectionality to demonstrate the importance of stress and resilience (e.g., John Henryism) with biological aging within Black adults participating in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Dr. Brown Hughes will present innovative research using data from the African American United Memory and Aging Project (AA-UMAP) on the importance of Alzheimer’s disease-specific knowledge and perceptions among Black older adults. Dr. Gamaldo will employ a within-race approach to understand how knowledge and perceptions of Alzheimer’s disease and related dementias (ADRD) shape cognitive performance among Black older adults in the AA-UMAP study. Dr. Mitchell will use Health and Retirement Study data to explore the role of midlife stress exposure in accounting for racial disparities in trajectories of cognitive functioning. Drs. Thierry and Farmer will use HRS data to examine how psychosocial resilience (e.g., mastery) affects the relationship between perceived neighborhood conditions (e.g., disorder) and cognition among Black older adults. This work highlights the importance of applying an interdisciplinary lens to move the study of minority aging forward and ultimately, to reduce the unnecessary burden of morbidity and mortality among minoritized groups.

The Disparities in Mental Health between Gay and Bisexual Men Following Positive HIV Diagnosis in China: A One-Year Follow-Up Study.

This study aimed to determine the change in mental health (depression and anxiety) among HIV-positive gay and bisexual men (GBM) one year after diagnosis and the disparities in trajectories of mental health between them. The potential factors contributing to the disparities were also investigated. This was a one-year follow-up study focusing on the mental health of newly diagnosed HIV-positive individuals. Participants rated their depression, anxiety, stress, and social support levels at baseline and one year later. Information on the utilization of mental healthcare and the initiation of antiretroviral therapy (ART) after diagnosis was collected at one-year follow-up. A total of 171 and 87 HIV-positive gay and bisexual men, respectively, completed two-time points surveys in this study. The depressive and anxiety symptoms experienced by HIV-positive GBM improvement one year after diagnosis. These improvements tended to be smaller in gay participants. Other factors including mental health care utilization and ART status during the one-year follow-up period, changes in social stress scores and objective social support scores were also associated with the changes in depression and anxiety, and all these factors, except for change in objective support, were found to be statistically different between HIV-positive GBM. Special attention should be given to the mental health of HIV-positive gay men. Promoting HIV-positive gay men to assess to mental health services and ART may be important for these populations to improve mental health. Enhancing social support and reducing stress levels may also be necessary for the vulnerable HIV-positive sexual minority groups.

Disparities in trajectories of changes in the unhealthy food environment in New York City: A latent class growth analysis, 1990–2010

Disparities in availability of food retailers in the residential environment may help explain racial/ethnic and socio-economic differences in obesity risk. Research is needed that describes whether food environment dynamics may contribute to equalizing conditions across neighborhoods or to amplifying existing inequalities over time. This study improves the understanding of how the BMI-unhealthy food environment has evolved over time in New York City. We use longitudinal census tract-level data from the National Establishment Time-Series (NETS) for New York City in the period 1990–2010 and implement latent class growth analysis (LCGA) to (1) examine trajectories of change in the number of unhealthy food outlets (characterized as selling calorie-dense foods such as pizza and pastries) at the census tract-level, and (2) examine how trajectories are related to socio-demographic characteristics of the census tract. Overall, the number of BMI-unhealthy food outlets increased between 1990 and 2010. We summarized trajectories of evolutions with a 5-class model that indicates a pattern of fanning out, such that census tracts with a higher initial number of BMI-unhealthy food outlets in 1990 experienced a more rapid increase over time. Finally, fully adjusted logistic regression models reveal a greater increase in BMI-unhealthy food outlets in census tracts with: higher baseline population size, lower baseline income, and lower proportion of Black residents. Greater BMI-unhealthy food outlet increases were also noted in the context of census tracts change suggestive of urbanization (increasing population density) or increasing purchasing power (increasing income).

Racial, Socioeconomic, and Attitudinal Disparities in Trajectories of Young Women's Willingness to Refuse Unwanted Sex

PurposeWe identify trajectories of young women's willingness to refuse unwanted sex, assess racial, socioeconomic, and attitudinal variation across trajectory groups, and describe the sexual and relationship behaviors of different trajectory groups. MethodsPanel data from the Relationship Dynamics and Social Life study facilitate a latent class analysis identifying trajectories of women's willingness to refuse unwanted sex, followed by bivariate analyses illuminating demographic, attitudinal, experiential, and behavioral correlates of each trajectory. ResultsThree trajectories emerge confident (stable high), moderate (slightly declining moderate), and reluctant (low-U). Socially advantaged women were most likely to follow a confident trajectory. Black women, socially disadvantaged women, women with early sexual debut, women with early births, and women who adhere to rape myths were most likely to follow a reluctant trajectory. Women whose trajectory was moderate spent the most time in relationships and had sex most often. ConclusionsHow much young women are willing to refuse unwanted sex and how this willingness changes during the transition to adulthood vary with key characteristics of their demographic background, earlier sexual experiences, and perceptions of rape. The trajectories by which this willingness evolves further correspond with sexual and relationship behaviors during the transition to adulthood. Greater research on whether willingness to refuse unwanted sex affects behavior and/or vice versa is needed to more fully understand the diversity of women's sexual experiences and to develop effective interventions for improving women's willingness to refuse unwanted sex.

INTERSECTIONALITY BETWEEN SEX AND RACE ON SEMANTIC MEMORY TRAJECTORIES OF BLACK AND NON-HISPANIC WHITE OLDER ADULTS

Previous research has demonstrated differences in cognitive trajectories leading to Alzheimer's disease (AD) across racial/ethnic groups, as well as sex groups; however, very few studies have examined how race/ethnicity and sex intersect to affect cognitive trajectories of older adults. The purpose of this study was to examine how race/ethnicity and sex jointly and simultaneously determine semantic memory trajectories among Black and NHW female and male older adults who participated in the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS). Non-Hispanic White (NHW; n=5,034) and Black (BLK; n=865) female and male NACC participants age 65 and older who were non-demented at baseline were included in the current analyses. BLK participants had lower levels of educational attainment and were significantly younger at baseline compared to NHW participants. Age-and education-corrected semantic memory scores were derived from immediate and delayed trials of the Logical Memory subtest and Animal and Vegetable Naming Semantic Fluency subtests. Growth mixture models (GMMs) with multiple groups were used to estimate semantic memory trajectories over five years for each racial group. Growth factors were regressed on the binary variable sex to assess whether race moderated the relationship between sex and semantic memory over time. Three latent trajectory classes were identified, representing High-Stable (n = 1,999, 34%), Low-Stable (n = 2,675, 46%), and Decliner (n = 1,168, 20%). Participants in the BLK group tended to have lower initial semantic memory scores across classes; however, BLK participants in the Decliner class demonstrated a slower rate of decline over time compared to NHW Decliners. Being female was associated with higher baseline scores across racial groups. For the BLK decliner class, female sex was associated with more rapid decline in semantic memory over time. Failure to examine the relationship between sex and race/ethnicity on cognitive trajectories raises the potential of obscuring important differences in the onset and course of dementia. The current study takes an important step in understanding racial/ethnic disparities in trajectories to dementia. Future research can build from the current findings and determine how biological and socio-cultural risk factors shape cognitive trajectories over time.

준고령층의 소득계층에 따른 건강 및 의료비 지출 차이에 대한 종단연구

준고령층의 소득계층에 따른 건강 및 의료비 지출 차이에 대한 종단연구

Adolescent Neighborhood Environments and Latino Intraethnic Disparities in Trajectories of Serious Violent Behaviors.

The purpose of this study was to describe the longitudinal trajectories of risk for serious violent behaviors among Latinos of different ancestry in the United States and to examine the impact of neighborhood perceptions, socioeconomic status (SES), and racial/ethnic and immigrant concentration during adolescence in long-term risk. Guided by sociological theories and life-course frameworks, we utilized data from Mexican (n = 755), Cuban (n = 182), Puerto Rican (n = 219), and other Latino (n = 289) respondents who participated in all waves of the National Longitudinal Study of Adolescent to Adult Health. Stratified, weighted, multilevel growth curve models were conducted in Stata 14 MP to determine unadjusted and adjusted trajectories between 13 and 32 years of age for each ancestry group by sex. Violent behaviors decreased over time, and were lower among females of all groups. Puerto Ricans and Cubans had higher risk than Mexicans or other Latinos. Neighborhood factors did not have consistent effects across groups. Neighborhood satisfaction reduced risk among most groups, while social cohesion increased violent behaviors among Mexicans. Neighborhood economic well-being (SES) and proportion of non-Latino Whites had no impact among any group. Living in predominantly Black neighborhoods during adolescence reduced the risk into adulthood among Puerto Ricans, but increased it among other Latinos. Higher neighborhood immigrant concentration was related to higher risk among other Latinos. Initial and long-term risk for violent behaviors differed across Latino ancestry, with slower decreases among Puerto Ricans and Cubans. The impact of neighborhood perceptions, SES, and racial/ethnic and immigrant composition was inconsistent.

Do gender and racial/ethnic disparities in sleep duration emerge in early adulthood? Evidence from a longitudinal study of U.S. adults

ObjectiveGender and racial/ethnic disparities in sleep duration are well documented among the U.S. adult population, but we know little about how these disparities are shaped during the early course of adult life, a period marked by substantial changes in social roles that can influence time for sleep. MethodsProspective data was used from the National Longitudinal Survey of Youth 1997 (NLSY97), a U.S.-based representative sample of persons born between 1980 and 1984, who were first interviewed in 1997. Sleep duration was assessed in 2002, 2007/2008, 2009, 2010, and 2011. Random-coefficient models were estimated to examine gender and racial/ethnic disparities in trajectories of sleep duration across early adulthood as a function of educational experiences, employment, and family relationships. ResultsSleep duration declined during early adulthood. Women reported shorter sleep than men from age 18 to 22, but slept longer than men by age 28. Black Young adults reported sleep durations similar to those of White young adults until age 24, after which blacks slept less than whites. Educational experiences and employment characteristics reduced gender and racial/ethnic disparities, but family relationships exacerbated them. ConclusionThis study is the first to establish the emergence of gender and racial/ethnic disparities in sleep duration during early adulthood.

Racial disparities in trajectories of dental caries experience.

This study charted the trajectories of dental caries, including decayed teeth, missing teeth and filled teeth among older Americans over a 5-year period. In particular, it focused on racial differences in the levels of and rates of change in dental caries experience. Data came from the Piedmont Dental Study. The sample included 810 older Americans who were dentate at the baseline with up to 4 repeated observations between 1988 and 1994. Hierarchical linear models were employed in depicting intrapersonal and interpersonal differences in dental caries experience. Different measures of caries outcomes exhibited distinct trajectories. On average, the number of decayed teeth decreased over time, whereas missing teeth increased. In contrast, the number of filled teeth remained stable during a 5-year period. Relative to their white counterparts, older black Americans had more decayed teeth and missing teeth but fewer filled teeth. Blacks and whites differed in the levels of dental caries but not in their rates of change except for missing teeth. Even when demographic and socioeconomic attributes were adjusted, racial variations in dental caries experience remained significant. Although significantly correlated, various dental caries outcomes move along different paths over time. In view of the persistent racial disparities in dental caries trajectories, future interventions to minimize such variations among older Americans in the levels of and the rates of change in dental caries experience are clearly warranted.

Racial disparities in trajectories of dental caries experience

Racial disparities in trajectories of dental caries experience

Socioeconomic disparities in trajectories of adiposity across childhood.

Socioeconomic inequalities in obesity are consistently observed in high-income countries. The development of such inequalities across childhood; however, has not been studied using longitudinal data. Using data from the Avon Longitudinal Study of Parents and Children (participants were born 1991/2 in South-West England), we modelled trajectories of ponderal index (PI) (N=12 246) from birth to 2 years and body mass index (BMI) (N=11 380) from 2 to 10 years. Individual trajectories were estimated using mixed-effects models, and differences in trajectories by socioeconomic position (measured by maternal education) were investigated. There was little socioeconomic patterning of PI from birth to 2 years. Socioeconomic differences in BMI began to emerge by 4 years old, and widened with increasing age. Amongst girls there was a clear gradient across all categories of maternal education by age 8, with daughters of more educated women being less adipose. Amongst boys, sons of degree-educated women had lower BMI but there was little difference between the lower maternal education categories. By 10 years old the mean BMI difference between the highest and lowest maternal education category was 0.38 kg/m(2) for boys and 0.89 kg/m(2) for girls. The results imply that interventions to prevent inequalities in childhood obesity should begin in pre-school years.

P19 Socioeconomic disparities in trajectories of adiposity across childhood

ObjectiveSocioeconomic inequalities in obesity are consistently observed in high-income countries, with lower socioeconomic groups tending to be more adipose amongst both adults and children. The development of such inequalities across...

Social disparities in BMI trajectories across adulthood by gender, race/ethnicity and lifetime socio-economic position: 1986-2004.

The prevalence of obesity and overweight is rapidly increasing in industrialized countries, with long-term health and social consequences. There is also a strong social patterning of obesity and overweight, with a higher prevalence among women, racial/ethnic minorities and those from a lower socio-economic position (SEP). Most of the existing work in this area, however, is based on cross-sectional data or single cohort studies. No national studies to date have examined how social disparities in obesity and overweight differ by age and historical period using longitudinal data with repeated measures. We used panel data from the nationally representative Monitoring the Future Study (1986-2004) to examine social disparities in trajectories of body mass index (BMI) over adulthood (age 18-45). Self-reported height and weight were collected in this annual US survey of high-school seniors, followed biennially since 1976. Using growth curve models, we analysed BMI trajectories over adulthood by gender, race/ethnicity and lifetime SEP (measured by parents' education and respondent's education). BMI trajectories exhibit a curvilinear rate of change from age 18 to 45, but there was a strong period effect, such that weight gain was more rapid for more recent cohorts. As a result, successive cohorts become overweight (BMI>25) at increasingly earlier points in the life course. BMI scores were also consistently higher for women, racial/ethnic minority groups and those from a lower SEP. However, BMI scores for socially advantaged groups in recent cohorts were actually higher than those for their socially disadvantaged counterparts who were born 10 years earlier. Results highlight the importance of social status and socio-economic resources for maintaining optimal weight. Yet, even those in advantaged social positions have experienced an increase in BMI in recent years.