Latent Growth Mixture Modeling Research Articles

Resilient phenotypes among bereaved youth: a comparison of trajectory, relative, and cross-domain approaches

BackgroundBereavement is a common traumatic event associated with adverse health outcomes across the life course. Despite these risks, not all bereaved individuals experience these negative effects. Limited scientific consensus exists on how to define resilience in individuals who have experienced the death of a loved one.MethodsUsing a sample of N = 3766 youth from the Avon Longitudinal Study of Parents and Children birth cohort, we identified bereavement of a family member between ages 7 and 8.5. We derived and compared three different approaches to assess resilience among bereaved youth. Trajectory-based psychological resilience identified sub-groups with similar psychological symptom profiles between ages 6 and 16 using latent growth mixture models. Relative psychological resilience at age 16 leveraged standardized residuals from a model regressing psychological symptoms on bereavement to determine better-than-expected psychological functioning relative to bereavement status. Relative cross-domain resilience around age 16 was a sum score of the residuals approach applied to eight unique domains of health. Predictive validity of each approach was assessed using depressive symptoms at age 17.5ResultsOverall, N = 877 (23%) youth were bereaved of a family member between ages 7 and 8.5. Using latent growth mixture models, a three-class solution described 84% of bereaved youth with low and stable psychological symptoms over time, 8% with worsening symptoms, and 8% with improving yet elevated symptoms. Each relative resilience score was largely concordant with the trajectory-based approach in identifying individuals as resilient or not, though relative psychological resilience demonstrated a stronger degree of concordance than the cross-domain score. Relative psychological and cross-domain resilience exhibited moderate to low correlation, depending on the domains included (r = 0.14–0.43). For each approach, resilience significantly predicted lower depressive symptoms at age 17.5, highlighting predictive validity of these measures.ConclusionsPsychological symptom trajectories among bereaved youth aligned with those previously identified among bereaved adults. The residual-based approach to defining resilience exhibited limited utility in the context of bereavement. When identifying risk and resilience after bereavement, researchers and clinicians must address the interplay across psychosocial and physical health domains, as bereaved youth considered resilient from a mental health perspective may benefit from intervention in other domains.

A Person-Centered Investigation Into the Co-Development of Perceived Stress and Internalizing Symptoms Among Post-Secondary Students.

The early post-secondary years are regarded as a period of heightened vulnerability for stress and internalizing symptoms among emerging adults. However, there is a lack of research examining variability in stress and internalizing symptoms among students, the co-occurrence of stress and internalizing symptoms, or predictors of distinct profiles of stress and internalizing symptoms. To address these gaps in the literature, 1125 ethnically diverse first-year students (71% female; Mage = 17.96 years, SD = 0.69; 55% East or South Asian, 21% Caucasian, 24% other ethnicity) were surveyed three times across the first year of university. Latent growth mixture models revealed four distinct profiles (i.e., high distress, moderate increasing distress, low distress, high decreasing distress), in which patterns of perceived stress and internalizing symptoms co-occurred. Higher levels of exposure to stressful life events, identifying as female and/or LGBQ+ were associated with increasing and high distress profiles. The findings underscore variability in distress among students, as well as the strong associations between stressful experiences, perceived stress, and internalizing symptoms.

Trajectories of Learned Helplessness in Maintenance Haemodialysis Patients and Their Predictive Effects on Self-Management: A Latent Growth Mixture Modeling Approach.

Learned helplessness (LH) is an essential psychological factor influencing maintenance haemodialysis (MHD) patients' health behaviour and is closely related to prognosis of the disease. This study aimed to identify potential trajectories of LH in MHD patients and assess their predictive role in self-management. This study was conducted in strict compliance with national laws, the Declaration of Istanbul, and the Declaration of Helsinki. A total of 347 MHD patients at a blood purification centre in Hunan Province, China, were selected as the study population. Four longitudinal surveys (baseline and second/fourth/sixth month after baseline) were conducted using the General Information Questionnaire for MHD patients, the Chinese version of the Learned Helplessness Scale for MHD patients, and the Self-Management Scale for Haemodialysis. Latent growth mixture model (LGMM) analysis was used to identify LH trajectories, and their predictors were analysed using multinomial logistic regression. The predictive role of LH trajectory on self-management was analysed using linear regression. This study identified three LH trajectories in MHD patients, named the "high-decreasing group" (57.9%), "low-increasing group" (21.3%), and "low-stability group" (20.7%). The results of the univariate analysis showed that sex (χ2=33.777, P < 0.001), age (χ2=10.605, P<0.05), and subjective social status (SSS) (χ2=12.43, P<0.01) were associated with LH trajectory classes. Multinomial logistic regression further demonstrated that gender, age, and SSS were predictors of different LH trajectories. The intercept and slope of the overall LH trajectory were negatively correlated with self-management (β=-0.273, P<0.001; β=-0.234, P<0.01). MHD patients show three different LH trajectories. The initial level and developmental rate of LH can negatively predict future self-management. It is necessary to screen MHD patients' LH and develop targeted interventions for them with different LH trajectories at specific stages.

Joint Developmental Trajectories of Likability and Popularity: Associations with Social Behavior among Chinese Adolescents.

The beginning of secondary school is a critical time point of adolescents' development as they entered a new peer context in which social status was re-established. As the key indicators of social status, likability and popularity co-occur but also display distinct developmental trajectories over time. Nevertheless, little is known about the joint developmental trajectories of likability and popularity among adolescents and how identified trajectories are associated with important social behavior. The current study examined the joint developmental trajectories of likability and popularity among Chinese adolescents and their associations with social behavior (prosocial behavior, aggression, and peer victimization) over time. A total of 1509 Chinese 7th grade students (53.6% male, Mage = 13.1, SD = 0.67) participated in self-report and peer nomination assessments on three occasions at 6-month intervals. Parallel process latent growth mixture models revealed four distinct trajectories of likability and popularity: social status decreasing, average, high social status, and social status increasing. The high social status group showed the highest levels of prosocial behavior, the lowest levels of peer victimization, and higher aggression than the average group. The social status decreasing group and social status increasing group exhibited the lower prosocial behavior as well as the higher aggression and peer victimization compared to the average group over time. The findings highlight the co-occurrence but diversity of developmental patterns of likability and popularity in adolescence.

Baseline and longitudinal trajectories of body-mass index and all-cause mortality among patients with type 2 diabetes

AimTo investigate the associations of baseline body mass index (BMI) and longitudinal BMI trajectories with all-cause mortality among patients with type 2 diabetes mellitus (T2DM). Methods,We used data from the diabetes surveillance system of Yinzhou Health Information System with T2DM patients registered from 2010 to 2015. Participants aged ≥ 40 years were included and were followed up until September 30, 2021. The latent class growth mixture model was used to identify different changing patterns in BMI for 5 years from registration. Cox proportional hazards models were used to examine the associations of baseline BMI and 5-year BMI trajectories with all-cause mortality. ResultsWe observed a nonlinear association between baseline BMI and all-cause mortality (P for nonlinearity < 0.001), with an increased risk of death for low but not high BMI. However, compared with participants with medium-stable BMI for 5 years from baseline, individuals with increasing BMI had higher mortality, with adjusted hazard ratios (95% confidence intervals) 1.21 (1.02;1.43) for early-increasing and 1.47 (1.19;1.80) for late-sharp increasing groups. ConclusionThese findings suggest that while obesity itself may not be associated with an increased risk for mortality, weight gain, and in particular rapid weight gain, is a risk factor for mortality among patients with T2DM.

1174 THE ROLE OF HIP FRACTURE IN TRAJECTORIES OF DEPRESSIVE SYMPTOMS AMONG OLDER ADULTS: ANALYSIS FROM THE ENGLISH LONGITUDINAL STUDY

Abstract Introduction Older adults experience ‘Late life depression’. Hip fractures may negatively influence trajectories of depressive symptoms in older adults. This study aimed to determine trajectories of depressive symptoms among older adults in England, overall and for those after hip fracture, and identify characteristics defining trajectory membership. Methods Analysis of adults aged 60 years or more (n=7,050), including a hip fracture subgroup (n = 384), from the English Longitudinal Study of Ageing. Latent class growth mixture modelling was completed. Depressive symptom prevalence was estimated at baseline. Chi-squared tests were completed to compare baseline characteristics across trajectories. Results Three trajectory groups were identified overall and for those with hip fracture: no-, mild-, and moderate-severe- symptoms. The moderate-severe group comprised 13.7% and 7% of participants for overall and hip fracture populations respectively. Overall, the proportion of participants with depressive symptoms were 0.4%, 12.4% and 65.4% for no-, mild-, and moderate-severe- symptom groups, respectively. For the hip fracture subgroup, these proportions were 0.7%, 28.8%, and 85.2%. Depressive symptoms were stable over time, with a weak trend towards increasing severity for the moderate-severe group. Individuals with moderate-severe trajectories were older, more likely to be female, live alone and had worse health outcomes (p &amp;lt; 0.001). Conclusions Older adults, and those after hip fracture, follow one of three trajectories of depressive symptoms which are broadly stable over time. The prevalence of depressive symptoms was lower for those with hip fracture however, when present, the symptoms were more severe than the overall population. Results suggest a role of factors including age, gender, and marital status in depressive symptoms trajectories.

Muscle strength trajectories and their association with postoperative health-related quality of life in patients undergoing coronary artery bypass grafting surgery: a prospective cohort study

BackgroundPatients with sarcopenia have a higher risk of poor recovery after coronary artery bypass grafting (CABG). Little is known about the impact of changes in muscle strength (the primary indicator for sarcopenia) on health-related quality of life (HR-QoL). This study aimed to (1) identify subgroups with different muscle strength trajectories, (2) identify differences in preoperative risk factors among trajectory group membership, and (3) explore their prognostic value on postoperative HR-QoL in patients undergoing CABG.MethodsIn this prospective observational study 131 patients undergoing elective CABG completed grip strength tests and HR-QoL questionnaires. Latent Class Growth Mixture Modelling (LCGMM) was used to identify clinically relevant trajectories (> 5% of study population) for weight-normalised grip strength, measured at admission, 3 days, and 6 months after surgery. Differences between trajectory group membership at baseline were evaluated. The impact of trajectory group membership on postoperative HR-QoL was evaluated with multiple linear regression models.ResultsDue to low numbers (n = 15), female patients were excluded from LCGMM and subsequent statistical analyses. In males (n = 116), we identified two main weight-normalised grip strength trajectories: a “stable average” trajectory with a slight decline immediately post-surgery and recovery to preoperative levels (n = 85) and a “high” trajectory with a considerable immediate decline after surgery but followed towards a higher level of recovery compared to preoperative level (n = 27). The “stable average” patients were older (68 vs. 57 years; P = 0.003), had more diabetes (27% vs. 4%; P = 0.01) and had a higher BMI (27.8 vs. 24.8; P = 0.005) compared to the “high” group. After correction for age, diabetes, and baseline HR-QoL, group trajectory membership was not associated with postoperative HR-QoL, yet an increase in individual change scores of weight-normalised grip strength was associated with a better postoperative HR-QoL. We also identified one small trajectory group (n = 4, ≤ 5%).ConclusionsThis study showed two relevant weight-normalised grip strength trajectories in male patients undergoing CABG, varying in important preoperative risk factors. While change scores of grip strength per weight did predict postoperative HR-QoL, the trajectory subgroups could not predict postoperative HR-QoL. Future research should focus on female patients, reacting potentially different on CABG and/or rehabilitation treatment.Trial registration NCT03774342, 12-12-2018.

In utero exposure to perfluoroalkyl substances and early childhood BMI trajectories: A mediation analysis with neonatal metabolic profiles

BackgroundIn utero perfluoroalkyl substances (PFAS) exposure has been associated with childhood adiposity, but the mechanisms are poorly known. ObjectiveTo investigate the potential mediating role of neonatal metabolites in the relationship between prenatal PFAS exposure and childhood adiposity trajectories in the first four years of life. MethodsWe analyzed the data for 1671 mother-child pairs from the Shanghai Birth Cohort study. We included those with PFAS exposure information in early pregnancy, neonatal metabolites data and at least three child anthropometric measurements at 6, 12, 24 and/or 48 months. Body mass index (BMI) z-score trajectories were identified using latent class growth mixture modeling. The associations between PFAS concentrations and trajectory classes were assessed using multinomial logistic regression. Screening and penalization-based selection was used to identify neonatal amino acids and acylcarnitines with significant mediation effects. ResultsThree BMI z-score trajectories in early childhood were identified: a persistent increase trajectory (Class 1, 2.2 %), a stable trajectory (Class 2, 66 %), and a transient increase trajectory (Class 3, 32 %). Increased odds of being in Class 1 were observed in association with one log-unit increase in concentrations of perfluorooctane sulfonate (odds ratio [OR], 1.76 [95 % CI, 0.96–3.23], Class 2 as reference; OR, 2.36 [95 % CI, 1.27–4.40], Class 3 as reference), perfluorononanoic acid (OR, 1.90 [95 % CI, 0.97–3.72], Class 2 as reference; OR, 2.23 [95 % CI, 1.12–4.42], Class 3 as reference) and perfluorodecanoic acid (OR, 1.95 [95 % CI, 1.12–3.38], Class 2 as reference; OR, 2.14 [95 % CI, 1.22–3.76], Class 3 as reference). The effect of prenatal PFAS exposure on being in Class 1 was significantly but partly mediated by octanoylcarnitine (2.64 % for perfluorononanoic acid and 3.70 % for sum of 10 PFAS). ConclusionsIn utero PFAS exposure is a risk factor for persistent growth in BMI z-score in early childhood. The alteration of neonatal acylcarnitines suggests a potential molecular pathway.

Characterizing the individual course of health-related quality of life after subarachnoid haemorrhage: Latent growth mixture modelling

BackgroundSurvivors of aneurysmal subarachnoid haemorrhage (SAH) show heterogeneous profiles of health-related quality of life (HrQoL). The aim of this study was to characterize individual differences in the course of HrQoL following SAH using latent growth mixture modelling (LGMM). MethodsA longitudinal study with 113 incident cases of aneurysmal SAH was performed in order to evaluate clinical outcome (Hunt and Hess scale, Barthel-Index, Beck Depression Inventory) and HrQoL data (EQ-5D) at baseline, 6 and 12 months. The heterogeneity in HrQoL courses after SAH was analysed using LGMM. ResultsFour subgroups (classes) of different patterns of HrQoL course after SAH were identified. Two of these classes (1 and 3) comprised patients with considerably reduced initial HrQoL, which was associated with more severe symptoms of SAH. Class 1 showing the worst EQ5D-index values during the entire study period. Class 3 experiencing a considerable improvement in HrQoL values. In comparison to classes 1 and 3, class 2 and 4 were characterized by less severe SAH and better functional outcome. An important difference in the disease course between classes 2 and 4 was a temporary increase in depression scores at the 6-month time point in class 4, which was associated with a considerable reduction in HrQoL.The specific clinical parameters characterizing differences between classes, such as severity of SAH, functional outcome, cognitive impairment and post-stroke depression, were identified and the influence of their potential improvement on HrQoL was estimated. ConclusionBy means of LGMM we could classify the course of HrQoL after SAH in four different patterns, which are relevant for the clinical decisions. Clinical parameters, which can be modified in order to improve the course of HrQoL were identified and could help to develop individual therapeutic strategies for the rehabilitation after SAH.

Population heterogeneity in developmental trajectories of internalising and externalising mental health symptoms in childhood: differential effects of parenting styles.

Multiple studies have connected parenting styles to children's internalising and externalising mental health symptoms (MHS). However, it is not clear how different parenting styles are jointly influencing the development of children's MHS over the course of childhood. Hence, the differential effects of parenting style on population heterogeneity in the joint developmental trajectories of children's internalising and externalising MHS were examined. A community sample of 7507 young children (ages 3, 5 and 9) from the Growing Up in Ireland cohort study was derived for further analyses. Parallel-process linear growth curve and latent growth mixture modelling were deployed. The results indicated that the linear growth model was a good approximation of children's MHS development (CFI = 0.99, RMSEA = 0.03). The growth mixture modelling revealed three classes of joint internalising and externalising MHS trajectories (VLMR = 92.51, p < 0.01; LMR = 682.19, p < 0.01; E = 0.86). The majority of the children (83.49%) belonged to a low-risk class best described by a decreasing trajectory of externalising symptoms and a flat low trajectory of internalising MHS. In total, 10.07% of the children belonged to a high-risk class described by high internalising and externalising MHS trajectories, whereas 6.43% of the children were probable members of a mild-risk class with slightly improving yet still elevated trajectories of MHS. Adjusting for socio-demographics, child and parental health, multinomial logistic regressions indicated that hostile parenting was a risk factor for membership in the high-risk (OR = 1.47, 95% CI 1.18-1.85) and mild-risk (OR = 1.57, 95% CI 1.21-2.04) classes. Consistent (OR = 0.75, 95% CI 0.62-0.90) parenting style was a protective factor only against membership in the mild-risk class. In short, the findings suggest that a non-negligible proportion of the child population is susceptible to being at high risk for developing MHS. Moreover, a smaller proportion of children was improving but still displayed high symptoms of MHS (mild-risk). Furthermore, hostile parenting style is a substantial risk factor for increments in child MHS, whereas consistent parenting can serve as a protective factor in cases of mild-risk. Evidence-based parent training/management programmes may be needed to reduce the risk of developing MHS.

Latent Growth Mixture Modeling to Estimate Differential PTSD Trajectories and Associated Risk Factors in Psychiatric Staff Following Workplace Violence

Latent Growth Mixture Modeling to Estimate Differential PTSD Trajectories and Associated Risk Factors in Psychiatric Staff Following Workplace Violence

Posttraumatic stress disorder symptom trajectories in a 16-month COVID-19 pandemic period.

COVID-19 pandemic presents an unheralded opportunity to better understand trajectories of posttraumatic stress disorder (PTSD) symptoms across a prolonged period of social disruption and stress. We tracked PTSD symptoms among trauma-exposed individuals in the United States and sought to identify population-based variability in PTSD symptom trajectories and understand what, if any, early pandemic experiences predicted membership in one trajectory versus others. As part of a longitudinal study of U.S. residents during the pandemic, participants who reported at least one potentially traumatic experience in their lifetime (N = 1,206) at Wave 1 (April 2020) were included in the current study. PTSD symptoms were assessed using the PCL-5 at four time points extending to July 2021. Latent growth mixture modeling was used to identify heterogeneous symptom trajectories. Trajectory membership was regressed on experiences from the early stage of the pandemic as measured using the Epidemic-Pandemic Impacts Inventory in a model that controlled for variables with documented associations to PTSD trajectories, including age, sex, income, and trauma history. Four trajectories were identified, categorized as resilient (73.0%), recurring (13.3%), recovering (8.3%), and chronic (5.5%). Emotional and physical health problems and positive changes associated with the early phase of the pandemic were each significant predictors of trajectory membership over and above all other variables in the model. Predictors primarily differentiated the resilient trajectory from each of the other three trajectories. Distinct PTSD symptom trajectories during the COVID-19 pandemic suggest a need for targeted efforts to help individuals at most risk for ongoing distress.

Longitudinal trajectory of acidosis and mortality in acute kidney injury requiring continuous renal replacement therapy

BackgroundAcidosis frequently occurs in severe acute kidney injury (AKI), and continuous renal replacement therapy (CRRT) can control this pathologic condition. Nevertheless, acidosis may be aggravated; thus, monitoring is essential after starting CRRT. Herein, we addressed the longitudinal trajectory of acidosis on CRRT and its relationship with worse outcomes.MethodsThe latent growth mixture model was applied to classify the trajectories of pH during the first 24 hours and those of C-reactive protein (CRP) after 24 hours on CRRT due to AKI (n = 1815). Cox proportional hazard models were used to calculate hazard ratios of all-cause mortality after adjusting multiple variables or matching their propensity scores.ResultsThe patients could be classified into 5 clusters, including the normally maintained groups (1st cluster, pH = 7.4; and 2nd cluster, pH = 7.3), recovering group (3rd cluster with pH values from 7.2 to 7.3), aggravating group (4th cluster with pH values from 7.3 to 7.2), and ill-being group (5th cluster, pH < 7.2). The pH clusters had different trends of C-reactive protein (CRP) after 24 hours; the 1st and 2nd pH clusters had lower levels, but the 3rd to 5th pH clusters had an increasing trend of CRP. The 1st pH cluster had the best survival rates, and the 3rd to 5th pH clusters had the worst survival rates. This survival difference was significant despite adjusting for other variables or matching propensity scores.ConclusionsInitial trajectories of acidosis determine subsequent worse outcomes, such as mortality and inflammation, in patients undergoing CRRT due to AKI.

LATER-LIFE TRAJECTORIES OF MARITAL QUALITY FOR WOMEN AND MEN

Abstract It is essential to better understand older adults’ marital dynamics, as marital quality is consequential for older adults’ physical and mental health, relationships with other social network members, and risk of divorce. Although numerous studies examine marital quality during the early life course, much less is known about later life trajectories. Earlier work suggested marital quality followed a U-shaped curve, characterized by a later-life upswing, but more recent research finds patterns of stability or decline over time. Gender differences in marital quality are well established, but it is less clear whether older men and women experience different marital quality trajectories during later life. We use nationally-representative data from a sample of continuously-married adults over age 50 in the Health and Retirement Study (n=2,175) with measures of both positive and negative marital quality at three time points (2006, 2010, and 2014). Latent growth mixture models in Mplus estimate trajectories of marital quality over the eight-year time period. Results show small declines in both positive (b = -0.016, p &amp;lt; 0.05) and negative (b = -0.028, p &amp;lt; 0.05) marital quality over the observation period, but the declines in positive marital quality are limited to those in remarriages. Women have lower initial positive marital quality and higher initial negative marital quality than men, but there are no significant gender differences in change over time. Results support the stability and continuous-decline patterns of marital quality over the life course rather than a U-shaped curve, and suggest persistence of gender differences over time.

FRAILTY TRAJECTORIES AMONG WORLD TRADE CENTER GENERAL RESPONDERS

Abstract As the WTC cohort ages, it is important to examine whether there are differences in frailty trajectories over time in the cohort and examine clinical risk profiles of subpopulations with different trajectories. We used longitudinal data collected annually from the WTC data center and included all individuals with 3+ Clinical Frailty Index (FI) measurements after 9/11 to examine frailty trajectories using latent class growth mixture models. These patterns of change of Clinical-FI all showed an increasing trend over time, but there were three distinct patterns with different rates of increase. These were associated with distinct profiles of characteristics including sociodemographic, occupational and exposure level. WTC responders with higher age, working in construction, and higher-intermediate WTC level of exposure had higher rate of increase of Clinical-FI over time. While WTC responders with younger age, working in protective environment, and with higher education had lower rate of increase of Clinical-FI over time.

Multiple pathways of integration: Acculturative change and associations with school adjustment in immigrant-origin adolescents.

Tracing developmental pathways of immigrant-origin adolescents, this 3-year longitudinal study (2012-2015) examined within-person changes in cultural orientations and their consequences for school adjustment. Multivariate latent growth mixture modeling confirmed multiple pathways of integration, revealing variable acculturative changes along dual trajectories of heritage and mainstream orientations among European-origin (N=592, Mage =14.45, 55.1% boys) and Turkish- and Moroccan-origin adolescents (N=1269, Mage =14.70, 53.1% boys). Two trajectories for European-origin adolescents differed in heritage orientations (high decreasing and low increasing); for Turkish- and Moroccan-origin adolescents, three trajectories differed in mainstream orientations (high stable, low increasing, and high decreasing). Acculturative change affected aspects of later school adjustment: European-origin adolescents in high heritage orientation trajectories reported more belonging and emotional engagement; Turkish- and Moroccan-origin adolescents in high mainstream orientation trajectories reported more behavioral engagement.

Modelling trajectories of change in psychopathology and well-being during eating disorder outpatient treatment

Objective: There are considerable differences in how eating disorder (ED) patients respond to treatment. This study aimed to identify change trajectories of mental health during treatment. Method: Longitudinal data of 442 patients was used with five time points during a year of outpatient treatment. ED psychopathology and well-being were used as primary measures. A series of latent growth mixture models were applied to model trajectories of change. Results: Three latent classes were found for ED psychopathology and well-being. For ED psychopathology, a high baseline severity and slow recovery class (55.9% of the patients), a high baseline severity followed by a substantial recovery class (19.9%) and a moderate baseline severity and no significant recovery class (24.2%) were found. For well-being, a low baseline followed by a slow growth class (44.6%), a low baseline and substantial growth class (9.5%) and a moderate and stable well-being class (45.9%) was found. General psychopathology, early symptom change, hope for recovery, intrinsic motivation and the ED type were predictive of class membership in either ED psychopathology or well-being. Conclusions: This study shows variability in ED psychopathology and well-being change trajectories, modelled in meaningful latent recovery classes. These results may have clinical implications, such as adjusting patients’ treatment based on change trajectories.

Associations between household solid fuel use and activities of daily living trajectories: A nationwide longitudinal study of middle and older adults in China

BackgroundMore studies focus on reporting the effects of ambient air pollution on physical activity while ignoring the hazards of indoor air pollution caused by household solid fuel use. Moreover, the impact of individual cognitive and depressive status on the health effects of air pollution is often overlooked. ObjectiveWe examined the association between household solid fuel and activities of daily living (ADL) trajectories, and further examined this association in homogeneous subgroups of cognitive or depressive trajectories. MethodsParticipants were from the China Health and Retirement Longitudinal Study, which conducted four waves of surveys from 2011 to 2018. We collected information on participants' household fuel use, then the ADL, cognitive and depressive performances were assessed in each wave. The latent growth mixture model (LGMM) was used to identify the optimal trajectory class for ADL, cognition, and depression. Then, the multinomial logistic regression was used to assess the association between solid fuel use and ADL trajectories in total population, as well as subgroups with different cognitive or depression trajectories. Furthermore, we examined the association between switching household fuel types and ADL trajectories across the four-wave survey. ResultsThe study sample included 7052 participants. We identified three ADL trajectory classes in total population: “Low-stable”, “Moderate-anterior rise”, and “Moderate-posterior rise”. The multinomial logistic regression results showed that solid fuel use was associated with elevated odds for the adverse ADL trajectories, and this association was still shown in homogeneous subgroups of cognitive or depressive trajectories, while some effects were less significant. In addition, the risk of adverse ADL trajectories generally increases with the times of solid fuel use across the four-wave survey. ConclusionsFor middle and older adults in China, household solid fuel use was not conducive to physical activity development, which inspires that a further transformation to cleaner fuels is an important intervention.

Head and Neck Symptom Severity (HNSS) and Health-Related Quality of Life (HRQL) Trajectories during and after Chemoradiotherapy (CRT) for HPV-Associated Oropharyngeal Cancer (HPVOPC): A TROG 12.01 Secondary Analysis

<h3>Purpose/Objective(s)</h3> This secondary analysis aimed to identify HNSS and HRQL trajectories during and following CRT for HPVOPC. <h3>Materials/Methods</h3> All 182 evaluable TROG 12.01 patients were included. HNSS was assessed with the MDASI-HN (range 0-10) at baseline (BL), weekly during CRT (weeks (w) 1-7) and then 1, 3, 5, 9 and 13w and 6, 12 and 24 months (m) post CRT. HRQL was assessed using the FACT-G (range 0-108) at BL, and 7w, 6m, 12m and 24m post CRT. Latent class growth mixture modelling (LCMM) was performed to identify trajectories. Mean estimates and 95% confidence intervals (CI) were calculated at each time point. <h3>Results</h3> The HNSS model identified 4 trajectory classes (HNSS1-4) distinguished by differences in HNSS at BL, during the peak of treatment symptoms (w7 CRT/1w post CRT) and during early (1w to 9w post CRT) and intermediate recovery (9w to 12m post CRT). The trajectories of all 4 classes were stable beyond 12m. The reference trajectory (HNSS4, n=74) score was 0.1 (CI 0.1-0.2) at BL, peaking at 4.6 (CI 4.2-5.0), with rapid early recovery (1.1, CI 0.8-2.2) and gradual improvement to 12m (0.6, CI 0.5-0.8). HNSS2 ("high BL", n=30) reported higher BL scores (1.4, CI 0.8-2.0) but was otherwise similar, HNSS3 ("low acute", n=53) reported reduced acute symptoms (2.5, CI 2.2-2.9) with stable scores beyond 9w post CRT (1.1, CI 0.9-1.4). HNSS1 ("slow recovery", n=25) had slower recovery from an acute peak of 4.9 (CI 4.3-5.6) to 0.9 (CI 0.6-1.3) at 12m. Compared to HNSS4, the high BL group were younger (mean 53.6 vs 57.4), with fewer ECOG0 (87 vs 99%) or with higher degree (38 vs 69%), and higher baseline anxiety (HADS, mean 6.8 vs 4.4). The low acute group were older (mean 60.1), had fewer ECOG0 patients (87%) and were more likely to have received cetuximab (68% vs 43%). The slow recovery group had fewer with a higher degree (52%). The HRQL model included 2 trajectory classes. The reference trajectory (HRQL2, n=156) scores were 90 (CI 88-92) at BL, similar 7w post CRT (88, CI 85-90) with slow but clinically meaningful improvement to 12m (98, CI 96-100). HRQL1 (n=26) had lower BL mean scores (80, CI 74-86), with a significant decline at 7w post CRT (57, CI 50-63) and a slower recovery to BL scores over 12m (83, CI 72-94). Both trajectories were flat beyond 12m. The slow recovery group were older (mean 61.1 vs 56.8), with worse BL anxiety (mean 6.5 vs 4.4) and depression (mean 4.5 vs 2.1). In addition, LCMM identified 4 trajectories for head and neck symptom interference, 3 for anxiety and 4 for depression, which will be presented. <h3>Conclusion</h3> LCMM identified distinct trajectories of HNSS and HRQL during and after CRT. These and their associations with variations in HPVOPC patients' characteristics and treatment factors provide clinically relevant insights into identifying patients who may require increased support during and after CRT.

BMI Trends for Veterans Up to 10 Years After VA Enrollment Following Military Discharge.

BackgroundObesity (body mass index [BMI]≥30kg/m2) among US adults has tripled over the past 45 years, but it is unclear how this population-level weight change has occurred.ObjectiveWe sought to identify distinct long-term BMI trajectories and examined associations with demographic and clinical characteristics.DesignThe design was latent trajectory modeling over 10 years of a retrospective cohort. Subgroups were identified via latent class growth mixture models, separately by sex. Weighted multinomial logistic regressions identified factors associated with subgroup membership.ParticipantsParticipants were a retrospective cohort of 292,331 males and 62,898 females enrolled in VA.Main MeasuresThe main outcome measure was 6-month average VA-measured BMI over the course of 10 years. Additional electronic health record measures on demographic, clinical, and services utilization characteristics were also used to characterize latent trajectories.Key ResultsFour trajectories were identified for men and for women, corresponding to standard BMI categories “normal weight” (BMI <25), “overweight” (BMI 25-29.99), and “with obesity” (BMI ≥30): “normal weight” and increasing (males: 28.4%; females: 22.8%), “overweight” and increasing (36.4%; 35.6%), “with obesity” and increasing (33.6%; 40.0%), and “with obesity” and stable (males: 1.6%) or decreasing (females: 1.6%). Race, ethnicity, comorbidities, mental health diagnoses, and mental health service utilization discriminated among classes.ConclusionsBMI in the 10 years following VA enrollment increased modestly. VA should continue prioritizing weight management interventions to the large number of veterans with obesity upon VA enrollment, because the majority remain with obesity.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-022-07818-5.