Epidemiologic Studies Of The Elderly Research Articles

Sex Differences in the Relationship Between Subthreshold Depression and Mortality in a Community Sample of Older Adults

The authors investigated the increased risk of mortality from subthreshold depression and examined differences in risk by gender. Data from the Duke University Established Populations for Epidemiologic Studies of the Elderly (EPESE) longitudinal study of 4,162 community-dwelling adults age 65 or older were used for these analyses. Depression was measured with a modified version of the Center for Epidemiologic Studies Depression Scale (CES-D). Three follow-up periods were assessed, 1986-1989, 1989-1992, and 1992-1996. Using logistic regression, they determined the odds of mortality from both CES-D depression (> or =9 symptoms) and subthreshold depression (6-8 symptoms) by sex for each follow-up period, controlling for sociodemographic factors, physical and cognitive health and functioning, and health behaviors. CES-D depression was not associated with mortality in either men or women. Subthreshold depression was also not associated with mortality in men; in women, however, subthreshold depression was negatively related to mortality (OR=0.60; p=0.002) across the three periods. Subthreshold depression may result in different outcomes in women, possibly mediating against mortality.

The Life-Course Trajectory toward Living Alone

Objectives: Dramatic increases in living alone in late life have been associated with higher incomes and better health, obscuring the risk to subgroups living alone with diminished health and socioeconomic resources. This study describes race differences in the stability and life-course antecedents of living alone. Method: The prospective cohort study used data from the Established Populations for Epidemiologic Studies of the Elderly at Duke University ( n = 4,132) to estimate 10-yearprevalence, incidence, and predictors of living alone among Black and White elders. Results: New episodes of living alone were equally likely. Black elders’lower prevalence of living alone was a function of their 80 percent greater probability of a new coresident episode. Home ownership, residential tenure, and perceived good health were lower among Blacks living alone, compared to Whites, who had fewer living children. Stressful life events had similar effects on household size. Discussion: Race differences in late life household size were primarily dependent on decisions embedded in midlife.

Access to Health Care and Self-Rated Health Among Community-Dwelling Older Adults

Objective: This study examined the relationship between access to health care and self-rated health among community-dwelling persons aged 65 years and older. Data Source: The analyses were based on a sample of 2,982 participants from the Duke Established Populations for Epidemiologic Studies of the Elderly. Study Design: This study was a secondary data analysis using longitudinal data collected in 1987 and again in 1990. Logistic regression was used to determine change to poor self-rated health from excellent, good, or fair self-rated health. Principal Finding: In a multivariate model, one of the seven access to health care indicators was found to be significantly related to reporting poor self-rated health. Controlling for demographics and other potential confounders, the odds of reporting poor self-rated health were approximately 87% higher among those without private health coverage.

Screening mammography: Is it suitably targeted to older women who are most likely to benefit?

To determine whether screening mammography is suitably targeted to older women who are most likely to benefit. Prospective cohort study. New Haven County, Connecticut. Eight hundred forty-four community-dwelling older women were interviewed as part of the 1990 New Haven Established Populations for the Epidemiologic Study of the Elderly (EPESE) program. Mammography use was ascertained from Medicare Part B claims data. A four-level prognostic mortality index was developed using items previously shown to be predictive of mortality. Mammography use and all-cause mortality were evaluated by prognostic stage over a 5-year period, January 1, 1991, to December 31, 1995. Five-year mortality increased steadily with each prognostic stage (12% to 68%, P = .001), whereas the 5-year mammography use rate declined (48% to 7%, P = .001). Over half the women (53%) in the most favorable prognostic group did not receive a mammogram, whereas 13% in the two worst prognostic groups received at least one mammogram. Screening mammography may be underutilized among older women who are the most likely to benefit and overutilized among those who are unlikely to benefit.

Accuracy of self-reported stroke among elderly veterans

The objective was to use secondary analysis of prevalence data from a prospective cohort study to ascertain the accuracy of self-reported stroke among veterans. The study comprised a community-dwelling population of 88 elderly veterans (from five counties in the Northern Piedmont of North Carolina, USA) who received health care at the local Veterans Health Administration (VHA) medical center and were respondents at the North Carolina site of the NIH-funded Established Populations for Epidemiologic Studies of the Elderly (EPESE) project. Self-report of stroke from the baseline interview of the EPESE project; and occurrence of stroke as verified by the national VHA hospital discharge database and the patients' medical records was measured. Results showed that self-report of stroke had a sensitivity of 86% and a specificity of 100%; the predictive value of a positive report was 100%. Veterans' self-reports of stroke are sufficiently accurate to use in preliminary epidemiological studies and health services research of cerebrovascular disease.

Toward a threshold for subthreshold depression: an analysis of correlates of depression by severity of symptoms using data from an elderly community sample.

The prevalence of depressive symptoms in elderly adults is high, yet the criteria to identify clinically significant depression may leave many elders undiagnosed and untreated. We explored the demographic and risk factor profiles of two groups, one with more severe depression and one with less severe depression. The data come from the Duke University Established Populations for Epidemiologic Studies of the Elderly (EPESE) baseline survey of 4,162 community-dwelling adults aged 65 or older. The prevalence of depression meeting criteria of the Center for Epidemiologic Studies-Depression scale (CES-D) and sub-threshold depression was 9.1% and 9.9%, respectively. In ordinal logistic regression, both CES-D and subthreshold depression were associated with impairment in physical functioning, disability days, poorer self-rated health, use of psychotropic medications, perceived low social support, female gender, and being unmarried. Depression appears to exist along a continuum, with demographic and social and physical health predictors of subthreshold depression similar to predictors of depression as defined by the CES-D scale.

Blood pressure and mortality risk in older people: comparison between African Americans and whites.

To determine the risk from hypertension for all-cause mortality in a racially mixed sample of community-dwelling older adults. Baseline blood pressure was assessed between 1985 and 1986 in a sample of persons 65 years of age and older from five counties of the Piedmont of North Carolina (N = 4,162). All-cause mortality was monitored annually over the subsequent 6 years as part of the Established Populations for Epidemiologic Studies of the Elderly (EPESE) sponsored by the National Institute on Aging. Eighteen percent of all respondents in the sample had a systolic blood pressure of > 160 (17% for whites and 18% for African Americans) and 16% had a diastolic blood pressure of >90 (14% for whites and 20% for African Americans). During the 6 years of follow-up, 29% of the sample died (with no difference in mortality rates between whites and African Americans). 4,000 community-dwelling people age 65 years and older; 1,846 were white and 2,154 were African American. Systolic and diastolic blood pressure and all-cause mortality. Systolic blood pressure positively related to mortality during the 6 years of follow-up (relative risk = 1.05). Among whites the relationship of diastolic pressure to mortality was nonlinear, with those at the upper and lower ends of the distribution at increased risk. Among African Americans, diastolic pressure was unrelated to mortality. The analyses were controlled for age; gender; education; body mass index (BMI); smoking history; taking a medication to manage blood pressure; a history of cancer, diabetes mellitus, heart attack, or stroke; poor subjective health; impaired functional status; and cognitive impairment. The findings confirm that among older adults there is a significant relationship overall between systolic blood pressure and mortality over 6 years of follow-up in both whites and African Americans. Diastolic pressure was a risk factor for whites only.

Self-reported walking ability predicts functional mobility performance in frail older adults.

To determine how self-reported physical function relates to performance in each of three mobility domains: walking, stance maintenance, and rising from chairs. Cross-sectional analysis of older adults. University-based laboratory and community-based congregate housing facilities. Two hundred twenty-one older adults (mean age, 79.9 years; range, 60-102 years) without clinical evidence of dementia (mean Folstein Mini-Mental State score, 28; range, 24-30). We compared the responses of these older adults on a questionnaire battery used by the Established Populations for the Epidemiologic Study of the Elderly (EPESE) project, to performance on mobility tasks of graded difficulty. Responses to the EPESE battery included: (1) whether assistance was required to perform seven Katz activities of daily living (ADL) items, specifically with walking and transferring; (2) three Rosow-Breslau items, including the ability to walk up stairs and walk a half mile; and (3) five Nagi items, including difficulty stooping, reaching, and lifting objects. The performance measures included the ability to perform, and time taken to perform, tasks in three summary score domains: (1) walking ("Walking," seven tasks, including walking with an assistive device, turning, stair climbing, tandem walking); (2) stance maintenance ("Stance," six tasks, including unipedal, bipedal, tandem, and maximum lean); and (3) chair rise ("Chair Rise," six tasks, including rising from a variety of seat heights with and without the use of hands for assistance). A total score combines scores in each Walking, Stance, and Chair Rise domain. We also analyzed how cognitive/ behavioral factors such as depression and self-efficacy related to the residuals from the self-report and performance-based ANOVA models. Rosow-Breslau items have the strongest relationship with the three performance domains, Walking, Stance, and Chair Rise (eta-squared ranging from 0.21 to 0.44). These three performance domains are as strongly related to one Katz ADL item, walking (eta-squared ranging from 0.15 to 0.33) as all of the Katz ADL items combined (eta-squared ranging from 0.21 to 0.35). Tests of problem solving and psychomotor speed, the Trails A and Trails B tests, are significantly correlated with the residuals from the self-report and performance-based ANOVA models. Compared with the rest of the EPESE self-report items, self-report items related to walking (such as Katz walking and Rosow-Breslau items) are better predictors of functional mobility performance on tasks involving walking, stance maintenance, and rising from chairs. Compared with other self-report items, self-reported walking ability may be the best predictor of overall functional mobility.

Consequences of driving cessation: decreased out-of-home activity levels.

Increasing age, socioeconomic factors, and declining function and health have been linked to driving cessation, but little is known about the consequences of stopping driving. This study was designed to test the hypothesis that driving cessation leads to a decline in out-of-home activity levels. In 1989 a survey of driving practices was administered to surviving noninstitutionalized members of the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) cohort. Of 1,316 respondents, 502 were active drivers as of 1988, 92 had stopped driving between 1982 and 1987, and 722 never drove or stopped before 1982. Information on sociodemographic and health-related variables came from in-home EPESE interviews in 1982, 1985, and 1988, and from yearly phone interviews. Activity was measured at all three in-home interviews, and an activity measure was created based on self-reported participation in nine out-of-home activities. A repeated measures random-effects model was used to test the effect of driving cessation on activity while controlling for potential confounders. Driving cessation was strongly associated with decreased out-of-home activity levels (coefficient-1.081, standard error 0.264, p < .001) after adjustment for sociodemographic and health-related factors. The potential consequences of driving limitations or cessation should be taken into account when advising older drivers and developing alternative transportation strategies to help maintain their mobility.

Characteristics of Nondisabled Older Persons Who Perform Poorly in Objective Tests of Lower Extremity Function

It has been suggested that nondisabled older persons with poor performance of lower extremity function are ideal targets for interventions of disability prevention. However, health-related factors associated with poor performance are largely unknown. Using data from a representative sample of nondisabled older persons, this study identifies the diseases and biological markers that characterize this group of the population. A total of 3,381 persons aged 71 or older, interviewed and administered a battery of physical performance tests at the sixth annual follow-up of the Established Populations for Epidemiologic Studies of the Elderly (EPESE), who reported no need for help in walking 1/4 mile or climbing stairs. Lower extremity performance was measured using a short battery of tests including assessment of standing balance, a timed 2.4-m walk, and timed test of rising 5 times from a chair. Chronic conditions were ascertained as self-report of a physician diagnosis. Data on previous hospitalizations were obtained from the Medicare database. Nonfasting blood samples were obtained and processed with standard methods. In a multivariate analysis, older age, female gender, higher BMI, history of hip fracture and diabetes, one or more hospital admissions for acute infection in the last 3 years, lower levels of hemoglobin and albumin, and higher leukocytes and gamma-glutamyl transferase were all associated independently with poor performance. Screening for older patients who are not disabled but have poor lower extremity performance selects a subgroup of the population with a high percentage of women, high prevalence of diabetes and hip fracture, and high levels of biological markers of inflammation. This group represents about 10% of the US population 70 to 90 years old. These findings should be considered in planning specifically tailored interventions for disability prevention in this subgroup.

Test of item-response bias in the CES-D scale: experience from the New Haven EPESE Study

We present results of item-response bias analyses of the exogenous variables age, gender, and race for all items from the Center for Epidemiologic Studies Depression (CES-D) scale using data ( N = 2340) from the New Haven component of the Established Populations for Epidemiologic Studies of the Elderly (EPESE). The proportional odds of blacks responding higher on the CES-D items “people are unfriendly” and “people dislike me” were 2.29 (95% confidence interval: 1.74, 3.02) and 2.96 (95% confidence interval: 2.15, 4.07) times that of whites matched on overall depressive symptoms, respectively. In addition, the proportional odds of women responding higher on the CES-D item “crying spells” were 2.14 (95% confidence interval: 1.60, 2.82) times that of men matched on overall depressive symptoms. Our data indicate the CES-D would have greater validity among this diverse group of older men and women after removal of the crying item and two interpersonal items.

Does religious attendance prolong survival? A six-year follow-up study of 3,968 older adults.

A probability sample of 3,968 community-dwelling adults aged 64-101 years residing in the Piedmont of North Carolina was surveyed in 1986 as part of the Established Populations for the Epidemiologic Studies of the Elderly (EPESE) program of the National Institutes of Health. Attendance at religious services and a wide variety of sociodemographic and health variables were assessed at baseline. Vital status of members was then determined prospectively over the next 6 years (1986 1992). Time (days) to death or censoring in days was analyzed using a Cox proportional hazards regression model. During a median 6.3-year follow-up period, 1,777 subjects (29.7%) died. Of the subjects who attended religious services once a week or more in 1986 (frequent attenders), 22.9% died compared to 37.4% of those attending services less than once a week (infrequent attenders). The relative hazard (RH) of dying for frequent attenders was 46% less than for infrequent attenders (RH: 0.54, 95% CI 0.48-.0.61), an effect that was strongest in women (RH 0.51, CI 0.434).59) but also present in men (RH 0.63, 95% CI 0.52-0.75). When demographics, health conditions, social connections, and health practices were controlled, this effect remained significant for the entire sample (RH 0.72, 95% CI 0.64-.81), and for both women (RH 0.65, 95% CI 0.554-.76, p<.0001) and men (RH 0.83, 95% CI 0.69-1.00, p=.05). Older adults, particularly women, who attend religious services at least once a week appear to have a survival advantage over those attending services less frequently.

Current and remote blood pressure and cognitive decline.

Previous studies raise the possibility that blood pressure (BP) in middle age predicts later cognitive decline. To examine prospectively the relationship of BP with level of and change in cognitive function in the elderly. Longitudinal, population-based study comprising subjects enrolled in the East Boston component of the Established Populations for the Epidemiologic Study of the Elderly (EPESE) (1982-1983) and the Hypertension Detection and Follow-Up Program (HDFP) (1973-1974). East Boston, Mass. Of the 3657 participants in the EPESE with baseline BP measurements, 2068 also participated in the HDFP. Subjects were aged 65 to 102 years at baseline in the EPESE and had mental status and memory assessed at baseline and 3 and 6 years. Numbers of errors on the Short Portable Mental Status Questionnaire and the East Boston Memory Test and rates of change in these numbers of errors. Subjects had BP measured both at baseline in the EPESE and 9 years before, as part of the HDFP. In analyses adjusted for age, sex, and education, there was no strong linear association between BP and cognition. The associations found were fairly small in magnitude, and varied according to which test was used to measure cognition. There was little evidence for an effect of BP on change in cognitive function with either test, or for an effect on level of function on the memory test. In analyses of level of mental status questionnaire performance, however, elevated systolic BP (> or =160 mm Hg) 9 years before baseline was associated with a 14% (95% confidence interval [CI], 4%-25%) increase in error rate, relative to the referent (130-139 mm Hg). Baseline systolic BP had a U-shaped association with the number of errors; error rates were 9% higher compared with the referent group among those with systolic BP lower than 130 mm Hg (95% CI, 1%-17%) and 7% greater (95% CI, 0%-15%) among those with elevated systolic BP. Diastolic BP 9 years before baseline also had a U-shaped association with errors on the mental status questionnaire. The findings do not suggest a linear association of BP with cognitive decline, but they are consistent with a more complex relationship between BP and cognition than previously appreciated.

Association of interleukin-6 and other biologic variables with depression in older people living in the community.

The prevalence of depression increases with age, as does the prevalence of higher levels of the cytokine interleukin-6 (IL-6). This analysis was performed to determine the association between increased levels of this cytokine and depression in a population-based sample. Cross-sectional cohort study. Rural and urban counties in North Carolina. Community-dwelling older people. The association between IL-6 and other biologic variables with self-report depression was examined in 1686 persons aged 70 years and older in the third in-person survey wave (1991) of the Duke Established Population for Epidemiologic Studies of the Elderly (EPESE). Bivariate associations were established by the Spearman correlation, adjusted for age. A stepwise linear logistic regression model was used to derive a final model to assess multivariable effects on CES-D scores. Depression was correlated with IL-6 (P = .011), D-Dimer (P = .017), alpha-1-globulin (P = .023), alpha-2-globulin (P = .002), and beta globulin (P = .012). After controlling for age, race, and gender, IL-6 levels remained the only biologic variable significantly associated with depression (P = .035). These data suggest that the inflammatory marker, IL-6, is associated with depression in older people in this cross-sectional study. These results are compatible with the hypothesis of cytokine (IL-6) stimulation in geriatric depression as part of an overall immunoendocrine dysregulation.

Depressive Symptoms and Mortality in Older Mexican Americans

PURPOSE: We examined the prevalence of comorbid depressive symptomatology and leading chronic medical conditions, and their influence on death rates in older Mexican Americans. METHODS: Data from the Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE) were used. Differences in death rates across sociodemographics, self-ratings of health, and health conditions were examined with analysis of variance statistics. Logistic regression models were used to examine main effects and interaction effects of each medical condition separately and in conjunction with depressive symptomatology. RESULTS: Bivariate analyses indicated that death rates were substantially higher when a high level of depressive symptoms was comorbid with diabetes (OR = 3.84, 95% CI = 2.55–5.78), cardiovascular disease (OR = 4.04, 95% CI = 2.36–6.91), hypertension (OR = 2.27, 95% CI = 1.57–3.27), stroke (OR = 3.00, 95% CI = 1.44–6.15), and cancer (OR = 4.46, 95% CI = 2.48–8.01). Multivariate analyses indicated a synergistic effect for comorbid diabetes and depressive symptoms such that the odds of having died among diabetics with high levels of depressive symptoms (OR = 4.03, 95% CI = 2.67–6.11) were three times that of diabetics without high levels of depressive symptoms (OR = 1.36, 95% CI = 0.89–2.06). CONCLUSIONS: High levels of depressive symptoms concomitant with major chronic medical conditions elevate the risk for death among older Mexican Americans. Given the fact that depression is often unrecognized and undertreated in the elderly, awareness of the potential for loss of life as well as the potential for treatment may help to improve this situation not only for older Mexican Americans, but for older adults in general.

Equivalence of two screens of cognitive functioning: the Short Portable Mental Status Questionnaire and the Orientation-Memory-Concentration test.

To determine the equivalence of two screens of cognitive functioning: the Short Portable Mental Status Questionnaire (SPMSQ) and the Orientation-Memory-Concentration (OMC) test. The design was cross-sectional and longitudinal. Four rural and one urban county in the Piedmont region of North Carolina (n = 3210). A stratified random cluster sample (n = 3210) of people 68 years of age and older. SPMSQ and OMC at the fourth wave of the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE); disability, depression, and death measurements from the fourth through seventh waves of EPESE; demographic characteristics. On the SPMSQ and the OMC (r = .80), 15.3% and 38.4%, respectively, of those tested were rated cognitively impaired. Poorer scores were associated with older age, black race, and less education. These associations were attenuated on the dichotomized SPMSQ but not on the OMC. Both measures predicted disability and depressive symptomatology currently and 3 years hence and death. The SPMSQ and OMC, although highly correlated, are not equivalent. Association with race and education are greater for the OMC, whereas an association with age exists for both measures. The milder level of impairment identified by the OMC increases predictive capacity.

Lower Body Functioning as a Predictor of Subsequent Disability Among Older Mexican Americans

Disability measures among elderly non-Hispanic White populations have traditionally been associated with activities of daily living (ADLs) and instrumental activities of daily living (IADLs). More recently, performance-based measures have increasingly been used to predict the onset of disability in initially nondisabled elderly populations. We used data from two waves (1993-94 and 1995-96) of the Hispanic Established Populations for the Epidemiologic Studies of the Elderly (EPESE) to assess the degree with which lower mobility performance measures predict future disability in a representative sample of older Mexican Americans from the Southwestern United States. Performances on an 8-foot walk, repeated chair stands, and standing balance among nondisabled subjects at baseline were significantly associated with the onset of ADL and lower body disability 2 years later, controlling for age, gender, and the presence of medical conditions. The results were significant for each performance measure and for a measure combining all three. This study offers further evidence that performance-based measures of lower body function are able to predict future disability in older Mexican Americans, as has been found with other elderly populations. These measures were able to detect changes over a relatively short period of time (2 years). In addition, the study found that the short (8-foot) walk was the most sensitive measure in predicting future disability.

The relationship between religious activities and cigarette smoking in older adults.

The objective of this study was to examine the relationship between religious activities and cigarette smoking in community-dwelling older adults. Cigarette smoking and religious activities were assessed in a probability sample of 3968 persons age 65 years or older participating in the Duke Populations for Epidemiologic Studies of the Elderly (EPESE) survey. Participants were asked if they currently smoked, if they ever smoked, and how many cigarettes per day they smoked. Attendance at religious services, participation in private religious activities (prayer or Bible study), and use of religious media (religious TV or radio) were also assessed. Data were available for Waves I-III of the survey (1986, 1989, and 1992). Analyses were controlled for age, race, sex, education, alcohol use, physical health, and in the longitudinal analyses, smoking status at prior waves. Cross-sectional analyses revealed that participants who frequently attended religious services were significantly less likely to smoke cigarettes at all three waves. Likewise, elders frequently involved in private religious activity were less likely to smoke (Waves II and III). Total number of pack-years smoked was also inversely related to both attendance at religious services and private religious activities. Watching religious TV or listening to religious radio, on the other hand, was not related to smoking at Waves I and II nor to total pack-years smoked, but was positively related to current smoking at Wave III. Among those who smoked, number of cigarettes smoked was inversely related to frequency of attendance at religious services (Wave I), private religious activities (Wave III), and religious TV/radio (Waves II and III). Retrospective and prospective analyses revealed that religiously active persons were less likely to ever start smoking, not more likely to quit smoking. Religiously active persons are less likely to smoke cigarettes, and if they do smoke, smoke fewer cigarettes. Given the association between smoking and disease, and the widespread prevalence of both smoking and religious activity, this finding has implications for public health.

The Prevalence and 3-Year Incidence of Dementia in Older Black and White Community Residents

Objective: To determine the prevalence and 3-year incidence of dementia in Blacks and Whites age 65 and older in a five-county Piedmont area of North Carolina. Design: Stratified random sample of members of the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE) (baseline n = 4,136; 55% Black; weighted n ≈ 28,000). Prevalence study members were differentially selected on the basis of score on the Short Portable Mental Status Questionnaire at the second in-person Duke EPESE wave. Incidence study members included all persons with obvious cognitive decline over a 3-year period, and a 10% sample of the remainder. Measurements: Self- and informant report on health history, functional status, and memory. Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) Neuropsychology Battery administered to all subjects, and CERAD Clinical Battery to those with impaired memory. Clinical consensus to determine presence and type of dementia. Results: Prevalence of dementia for persons ⩾68 years old was 0.070 (95% confidence interval = 0.021–0.119) for Blacks and 0.072 (0.022–0.122) for Whites. Rates for Black men (0.078, 0.001–0.155) exceeded those for Black women (0.066, 0.003–0.129), but gender rates for Whites were reversed (men: 0.044, 0.000–0.103), (women: 0.087, 0.015–0.160). Neither race nor gender differences were significant. Prevalence of dementia increased through age 84 and tapered off thereafter. Three-year incidence of dementia was 0.058 (0.026–0.090) for Blacks and 0.062 (0.027–0.097) for Whites. Neither race nor gender differences were significant. Incidence increased through age 84, but moderated thereafter for all but Black men. The proportional representation of different types of dementia varied little by race. Conclusion: Prevalence, 3-year incidence, and types of dementia are comparable in Black and White elderly in the Piedmont area of North Carolina.

Attendance at religious services, interleukin-6, and other biological parameters of immune function in older adults.

First, to examine and explain the relationship between religious service attendance and plasma Interleukin-6 (IL-6) levels, and second, to examine the relationship between religious attendance and other immune-system regulators and inflammatory substances. During the third in-person interview (1992) of the Establishment of Populations for Epidemiologic Studies of the Elderly (EPESE) project, Duke site, 1718 subjects age sixty-five or over had blood drawn for analysis of immune regulators and inflammatory factors, including IL-6 measurements. IL-6 was examined both as a continuous variable and at a cutoff of 5 pg/ml. Information on attendance at religious services was available from the 1992 interview and two prior interviews (1986 and 1989). Religious attendance was inversely related to high IL-6 levels (> 5 pg/ml), but not to IL-6 measured as a continuous variable. Bivariate analyses revealed that high religious attendance in 1989 predicted a lower proportion of subjects with high IL-6 in 1992 (beta-.10, p = .01) High religious attendance in 1992 also predicted a lower proportion of subjects with high IL-6 levels in 1992 (beta-.14, p = .0005). When age, sex, race, education, chronic illnesses, and physical functioning were controlled, 1989 religious attendance weakened as a predictor of high IL-6 (beta-.07, p = .10), but 1992 religious attendance retained its effect (beta-.10, p = .02). When religious attenders were compared to non- attenders, they were only about one-half as likely to have IL-6 levels greater than 5 ng/ml (OR 0.58, 95% CI 0.40-0.84, p < .005). Religious attendance was also related to lower levels of the immune-inflammatory markers alpha-2 globulin, fibrin d-dimers, polymorphonuclear leukocytes, and lymphocytes. While controlling for covariates weakened most of these relationships, adjusting analyses for depression and negative life events had little effect. There is a weak relationship between religious attendance and high IL-6 levels that could not be explained by other covariates, depression, or negative life events. This finding provides some support for the hypothesis that older adults who frequently attend religious services have healthier immune systems, although mechanism of effect remains unknown.