Middle-aged Adults Research Articles

Public perceptions of brain health in young and middle-aged adults in Cuba: Opportunities for intervention.

Understanding brain health is increasingly important, particularly in light of growing public health challenges related to neurological and psychiatric conditions. These include the rising prevalence of mental health disorders, such as depression and anxiety, as well as neurodegenerative diseases like Alzheimer's and Parkinson's. Lifestyle factors, including stress, poor diet, and insufficient physical activity, also significantly impact cognitive function. Exploring the perceptions and awareness of brain health among young and middle-aged adults is crucial to developing effective educational programs and awareness campaigns tailored to their specific needs. This study aimed to examine the perceptions and awareness of brain health among Cuban youth, focusing on the factors that shape their understanding and attitudes toward brain well-being. A cross-sectional online survey was conducted, with 1,049 participants voluntarily completing the questionnaire. Using "The Global Brain Health Survey," we assessed participants' conceptions of brain health and analyzed associations between demographic variables and brain health knowledge through logistic regression. Our findings revealed that the social environment was viewed as the most significant factor influencing brain health. Other factors, such as profession, genetics, income, and nutrition, were considered important but to a lesser degree. While participants were generally aware of conditions like Alzheimer's disease and depression, there was a notable gap in understanding the cognitive implications of chronic diseases such as hypertension and diabetes, which are prevalent in Cuba. These insights highlight the need for targeted public health initiatives and educational campaigns that promote healthier behaviors and community support, particularly among young adults.

Retrospective observational study of the association between changes in physical activity and frailty in middle-aged and older adults: evidence from the Korean Longitudinal Study of Aging (2006–2022)

ObjectivesThis study aimed to investigate the relationship between changes in physical activity and frailty among middle-aged and older adults in Korea, using panel data from the 2006–2022 Korean Longitudinal Study...

The association between functional social support, marital status and memory in middle-aged and older adults: An analysis of the canadian longitudinal study on aging.

Although several studies have reported positive associations between functional social support (FSS) and memory, few have explored how other social variables, such as marital status, may affect the magnitude and direction of this association. We examined whether marital status modifies the association between FSS and memory in a sample of community-dwelling, middle-aged and older adults. Data at three timepoints, spanning six years, were analyzed from the Tracking Cohort of the Canadian Longitudinal Study on Aging (n = 10,318). Linear mixed models were used to regress memory onto FSS across all three timepoints, adjusting for multiple covariates. The moderating effect of marital status was assessed by adding its interaction with FSS in the model. Separate regression models were built for overall FSS and four subtypes (positive interactions, affectionate, emotional/informational, and tangible support). We found significant and positive adjusted associations for overall FSS (β: 0.07; 95 % CI: 0.01, 0.13), positive interactions (β: 0.06; 95 % CI: 0.01, 0.11), and affectionate support (β: 0.05; 95 % CI: 0.00, 0.11) with memory. However, the interaction between marital status and FSS (overall and subtypes) was not statistically significant (likelihood ratio test p-value = 0.75), indicating that FSS does not have differing effects on memory depending on marital status. Our findings do not provide evidence to suggest that marital status affects the association between FSS and memory in middle-aged and older adults. Nonetheless, policymakers and practitioners should take a comprehensive approach when exploring how various dimensions of social relationships may uniquely influence cognitive trajectories.

A META analysis and systematic review of the effects of exercise interventions on middle-aged and elderly patients with depression.

This study sought to conduct a meticulous systematic review, delving into the efficacy of exercise interventions on depressive symptoms among middle-aged and older adults. Additionally, we aimed to scrutinize the nuanced influence of various intervention factors on the intricate relationship between exercise and depressive symptoms within this demographic. Our investigation involved an extensive search across multiple databases, including PubMed, Embase, Web of Science, and the Cochrane Library, spanning from the inception of these repositories to December 2023. Following a rigorous screening process, we identified and included 12 papers, encompassing a total of 994 subjects. The meta-analysis unveiled a compelling overall effect size of exercise interventions on depressive symptoms in middle-aged and older individuals, represented by SMD = -0.41, with a 95% confidence interval of [-0.60, -0.22], and P < 0.0001. This statistical evidence underscores the significant and positive impact of exercise interventions on ameliorating depressive symptoms in this demographic. However, a degree of heterogeneity among studies was observed, with I2 = 48% and P = 0.03. The comprehensive synthesis of outcomes elucidates the pronounced positive effect of exercise interventions in enhancing depressive symptoms among middle-aged and older adults. Specifically, the gentle and balanced exercise series emerges as particularly efficacious in mitigating depression. Furthermore, individual exercises stand out as more effective, with optimal results noted for moderate exercise sessions lasting 30 to 60 minutes. Our findings also highlight the superiority of short-term interventions, followed by medium- and long-term exercise interventions, in terms of efficacy. Nevertheless, recognizing the inherent heterogeneity and potential limitations of our study, we advocate for future large-scale, comprehensive investigations to validate these findings. Additionally, optimizing exercise intervention protocols necessitates a more nuanced understanding, urging further research endeavors to refine strategies aimed at improving depressive symptoms in middle-aged and older adults.

Trends in functional limitations among middle-aged and older adults in the Asia-Pacific: survey evidence from 778,507 observations across six countries.

There are few studies comparing health status trends among middle-aged and older adults in countries currently experiencing a rapid demographic and economic transition in the Asia-Pacific, relative to their high-income regional counterparts. This study investigates trends in functional limitations among individuals aged 45 years and above in six major Asia-Pacific countries, ranging from middle- to high-income, from 2001 to 2019 and examines disparities across socioeconomic and demographic sub-groups. Data on 778,507 individuals from seven surveys in three high-income countries (Australia, Japan, South Korea) and three middle-income countries (China, Indonesia, and India) were used. Activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility measures served as indicators of functional limitations. Age-standardized prevalence was used to assess prevalence trends in functional limitations and their distribution across sex and age. Multivariate linear probability models were used to examine whether the patterns still hold when controlling for birth cohorts and socioeconomic and demographic factors. People aged 45 years and above in Australia, Japan, and South Korea experienced declines in functional limitations, whereas increases were observed in India and Indonesia. The findings for China were unclear and varied depending on the indicator. Changes in prevalence of functional limitations over time were more pronounced among people aged over 60 years. Higher prevalence of functional limitations was observed for respondents with lower education and among those are not currently married across countries. Study findings highlight the potential for cross-national learning to address functional limitations among older populations in low- and middle-income countries. Not applicable.

A web-based tool for cancer risk prediction for middle-aged and elderly adults using machine learning algorithms and self-reported questions.

From a global perspective, China is one of the countries with higher incidence and mortality rates for cancer. Our objective is to create an online cancer risk prediction tool for middle-aged and elderly Chinese adults by leveraging machine learning algorithms and self-reported data. Drawing from a cohort of 19,798 participants aged 45 and above from the China Health and Retirement Longitudinal Study (2011 - 2018), we employed nine machine learning algorithms (LR: Logistic Regression, Adaboost: Adaptive Boosting, SVM: Support Vector Machine, RF: Random Forest, GNB: Gaussian Naive Bayes, GBM: Gradient Boosting Machine, LGBM: Light Gradient Boosting Machine, XGBoost: eXtreme Gradient Boosting, KNN: K - Nearest Neighbors), which are mainly used for classification and regression tasks, to construct predictive models for various cancers. Utilizing non-invasive self-reported predictors encompassing demographic, educational, marital, lifestyle, health history, and other factors, we focused on predicting "Cancer or Malignant Tumour" outcomes. The types of cancers that can be predicted mainly include lung cancer, breast cancer, cervical cancer, colorectal cancer, gastric cancer, esophageal cancer, and other rare cancers. The developed tool, MyCancerRisk, demonstrated significant performance, with the Random Forest algorithm achieving an AUC of 0.75 and ACC of 0.99 using self-reported variables. Key predictors identified include age, self-rated health, sleep patterns, household heating sources, childhood health status, living conditions, and smoking habits. MyCancerRisk aims to serve as a preventative screening tool, encouraging individuals to undergo testing and adopt healthier behaviours to mitigate the public health impact of cancer. Our study also sheds light on unconventional predictors, such as housing conditions, offering valuable insights for refining cancer prediction models.

Prevalence and risk factors of the most common multimorbidity among Canadian adults.

The number of persons living with multimorbidity-defined as the co-occurrence of at least two chronic conditions in the same individual-is growing globally, especially in developed countries. Traditionally, this increase has been attributed to a growing aging population, sedentary lifestyle, obesity, low socioeconomic status, and individual genetic susceptibility. To investigate the prevalence and associated risk factors of the most common multimorbidity (MCM) among Canadian middle-aged and older adults. Relevant data on all 30,097 middle-aged and older Canadian adults (aged 45 to 85 years) from the Canadian Longitudinal Study on Aging were used for this study. To identify the specific sociodemographic risk factors associated with the MCM, we used survey-specific logistic regression. Overall, co-occurrence of osteoarthritis and hypertension was identified as the MCM among Canadian adults aged 45+ with an estimated prevalence of 16.5%. The results from multivariate analysis showed that seven factors were significantly associated with increased odds of the MCM, which included increasing age, being retired from work (retired vs not retired), poorer rating of perceived health, (very good, good, poor vs excellent), increasing problems with sleep quality (satisfied, dissatisfied vs neutral), and abnormal body-mass index (underweight, overweight, obese vs normal). Also, residents in other urban centres had significantly lower odds than those in urban core. Persons living in Atlantic Canada, Ontario and Quebec were at increased odds of having the MCM compared to those in British Columbia. The odds of the MCM associated with increasing age was significantly higher among Females (OR = 1.12, 95% CI = 1.11-1.13) than Males (OR = 1.08, 95% CI = 1.07-1.10). Multimorbidity is a common feature among Canadian adults. The identification of the most prevalent patterns and associated risk factors in this study provides fresh insights into the etiology, progression, and possible prevention of the MCM among Canadian adults.

Association between informal caregiving and changes in cardiovascular-related health behaviors among middle-aged and older adults in Japan: A 15-year panel survey

BackgroundStudies have shown that informal caregiving is associated with an increased risk of cardiovascular diseases. However, there is limited evidence on the mechanisms involved. To fill this knowledge gap, we investigated the association of informal caregiving with changes in health-related behaviors.MethodsWe analyzed a nationally representative sample aged 50-59 years as of 2005 using fifteen waves of the Longitudinal Survey of Middle-Aged and Older Adults, conducted between 2005-2019. We investigated the association between the change in informal caregiving status and the change in health-related behaviors, including (1) heavy drinking, (2) smoking, (3) no exercise habits, and (4) no attendance at annual health checkups. We used multivariable logistic regression models with correlated random effects, adjusting for individual-level time-invariant characteristics.ResultsAmong 268,165 observations from 30,530 participants (median age 55 [interquartile range 52-57] at baseline; 51.6% women), 32,164 (12.0%) observations from 10,224 individuals provided informal care. After adjusting for potential confounders, informal caregiving was associated with higher probabilities of deteriorating health-related behaviors, including heavy drinking (adjusted odds ratio [aOR] 1.16; 95% confidence interval [CI] 1.03-1.32; adjusted p=0.032) and no exercise habits (aOR 1.09; 95%CI 1.04-1.15; adjusted p<0.001). We observed similar patterns for smoking (aOR 1.12; 95%CI 1.001-1.26; adjusted p=0.053) and no attendance at health checkups (aOR 1.05; 95%CI 0.999-1.10; adjusted p=0.053).ConclusionThis study showed that the transition into informal caregiving was associated with deteriorating cardiovascular-related health behaviors in Japan. These findings highlighted the importance of continued efforts to prevent the deterioration of caregivers' health-related behaviors.

Middle-aged females are resistant to LPS-induced learning deficits: Sex comparison

Preclinical data have repeatedly shown learning and memory disruption following administration of the bacterial endotoxin lipopolysaccharide (LPS). Normal aging is reported to enhance vulnerability to LPS-induced cognitive impairments. However, a limitation is the primary use of male subjects. Recent evidence indicates sex-related differences in vulnerability to LPS-induced cognitive deficits [1,2], with young females showing resilience. Whether middle-aged females are susceptible to LPS-induced cognitive impairment is unknown. The current experiment compared associative learning in young and middle-aged male and female C57BL/6J mice following a systemic LPS challenge. While LPS impaired acquisition of the two-way active avoidance conditioning task in adult and middle-aged males, females’ learning was unaffected. The sex difference in LPS-induced cognitive impairments appears unrelated to responsivity to LPS, as males and females mount a comparable sickness-like response. Additionally, relative to males, females produce higher brain levels of interleukin-6 (IL-6) and comparable splenic IL-6 levels following LPS. These data demonstrate that female resilience to LPS-induced learning deficits persists into middle age, whereas males are vulnerable as both young and middle-aged adults. Our findings confirm the importance of considering sex as a biological variable and extend the existing literature by evaluating sex-related responsivity to LPS in middle-aged males and females

Association of anthropometric and obesity indices with abnormal blood lipid levels in young and middle-aged adults.

Obesity is a known risk factor for dyslipidemia. We aimed to evaluate the association between nine obesity indices and various types of abnormal lipid levels in the young and middle-aged. From July to November 2022, we distributed health survey questionnaires to the target population in the hospital and collected their biochemical and anthropometric data. Multivariate regression models and Receiver operating characteristic (ROC) curve analysis were used for data analyzing. We collected a total of 1174 complete samples. Among the five blood lipid indexes tested in this study, TG (triglyceride) is most closely related to various body measurements (P<0.05). WC (Waist circumference) has the greatest risk for abnormal TG levels (OR, 2.61; P<0.001) and high-density lipoprotein cholesterol (HDL-C) levels(OR, 1.96; P<0.001).WHR has the greatest risk of abnormal low-density lipoprotein cholesterol (LDL-C) levels (OR, 1.35; P<0.05) and non-high-density lipoprotein cholesterol levels(OR, 1.59; P<0.001). ROC curve analyses revealed that all the tested variables gave the highest area under the curve (AUC) values for predicting high TG in comparison to other plasma lipid abnormalities. The AUC of WC, AVI and BMI were 0.81, 0.80 and 0.79 respectively. Specific obesity-related anthropometric measurements, including WC, AVI, and WHR, show improved predictive accuracy in identifying abnormal lipid levels across diverse types. This study supports their effectiveness in early dyslipidemia screening among young and middle-aged individuals.

Trends in prescribing montelukast in patients with asthma in real-life: Results from the Turkish adult asthma registry.

Montelukast, a leukotriene receptor antagonist (LTRA) approved for the treatment of asthma and allergic rhinitis, is widely used, though real-world data on its application in asthma management remain limited. This registry-based study evaluated the use of montelukast in adult asthma patients, examining demographic and disease characteristics, asthma control status, asthma phenotypes, presence of atopy, and treatment regimens. Among 2053 patients analyzed, 61.76% (n = 1268; mean age: 46.2 ± 14.3 years), predominantly females (~76%), received montelukast. Montelukast users showed higher rates of allergic rhinitis (P < 0.001), hypersensitivity to nonsteroidal anti-inflammatory drugs (NSAIDs) (P = 0.008), and chronic rhinosinusitis (P = 0.008). Montelukast group also had higher atopy and total IgE levels and tended to be more eosinophilic. Montelukast was commonly preferred in allergic, eosinophilic, NSAID-exacerbated respiratory disease, and severe asthma phenotypes (P < 0.001). Patients receiving Steps 4 and 5 treatments are more likely to be prescribed montelukast (P < 0.001). Montelukast usage was higher among patients with uncontrolled asthma [ACT< 20 (OR:1.29, 95%CI:1.052-1.582, P = 0.014)]. In addition, logistic regression analyses identified the main factors associated with increased montelukast use as; female gender (OR:1.33, 95%CI:1.041-1.713, P = 0.02), presence of atopy (OR:1.46, 95%CI:1.157-1.864, P = 0.002), comorbid allergic rhinitis (OR:2.12, 95%CI:1.679-2.293, P < 0.001), and severe asthma (OR:2.18, 95%CI:1.712-2.784, P < 0.001). These findings reveal that montelukast use is prevalent among asthma patients, particularly in females, middle-aged adults, and those with comorbid allergic rhinitis, uncontrolled asthma, or specific asthma phenotypes, underscoring the factors that influence its prescription in asthma management.

Baseline Estimates for Companion Animals Living in Households in Hawai'i: Associated Socio-Demographic, and Select Health Variables, as Measured by a Household Survey.

Information on companion animals in Hawai'i is lacking. The Hawai'i Department of Health's Hawai'i Health Survey, collected data on adults and households by telephone interview. National estimates of companion animals range from 50-67%. However, the estimate from Hawai'i was lower with 39% of households in Hawai'i having a companion animal that spends part or all of the day indoors, including 29.5% of households with dogs and 14.7% with cats. There may be multiple reasons the count is lower for Hawai'i and possible factors are identified. There were significant differences in companion animals by ethnicity with Whites having the highest percentage of cats (25.8%) and Japanese the highest percentage of dogs (33.8%). Differences were observed between Asian ethnicities and Native Hawaiians. Specifically, individuals of Japanese ethnicity were more likely to have dogs, while Native Hawaiians were more likely to have cats compared to other Asian and Other Pacific Island ethnicities. Furthermore, companion animals were associated with counties other than Honolulu, lower poverty, ownership of a car or home, women, education, and middle-aged adults. Thus, many households in Hawai'i may not have the resources for a companion animal. Adults who rated their general health excellent had the highest association with having a cat(s). Asthma was higher for women living with dogs than women without cats or dogs. Asthma was lowest for men with cats compared to other groups for men and women. This study contributes to the understanding of complex interrelationships of humans, animals, and their environment which is gaining momentum under the umbrella of "One Health" by supporting increased collaboration and new data sources.

Number of teeth and incidence of hip fracture in older adults aged ≥75 years: the OHSAKA study

Several studies reported an association between the number of teeth and the incidence of hip fractures in observational studies, mainly in middle-aged adults. This retrospective cohort study aimed to clarify the association between the number of teeth and the incidence of hip fractures. In this retrospective cohort study, a total of 256,772 participants aged 75 years or older who underwent public dental checkups in Japan were evaluated. Exposure in this study was the number of teeth, with a maximum number of 28, excluding third molars. Outcome measures were the incidence of hip fractures needing surgery, using the Japanese procedure codes in medical claims. A total of 190,998 participants met the inclusion criteria and were available for analysis. Adjusted Fine and Gray models identified a significant association between the number of teeth, including sound, filled, and decayed teeth, and the incidence of hip fractures among women but not for men. The continuous net reclassification improvement (NRI) of the sound and filled teeth count model increased by 0.078 compared with that of the sound, filled, and decayed teeth count model among women. The number of sound and filled teeth predicted the risk of hip fractures in women, whereas no association was observed between the number of teeth and hip fractures in men.

The impact of sex and the cheese matrix on cholesterol metabolism in middle-aged adults.

The impact of sex and the cheese matrix on cholesterol metabolism in middle-aged adults.

Physical Activity Habits and Incident First-Ever Stroke in Middle-Aged Adults-A Prospective Cohort Study.

Lifestyle affects the risk of cardiovascular events such as myocardial infarction and stroke. Several lifestyle factors, such as physical activity (PA), are modifiable, and in this study, we examined the association between leisure-time PA habits and the risk of a first-ever stroke. This prospective study included residents in Västerbotten, Sweden, who participated in the Västerbotten Intervention Programme at 40, 50, and 60years of age. Altogether, 31,855 individuals (50.5% women, mean age: 42.6 [6.9] y at baseline) participated between 1989 and 2016. Leisure-time PA was categorized as irregular (never/now and then) or regular (once a week/2 or 3 times a week/more than 3 times a week). Changes in PA were compared between examinations (10y apart). Cases of stroke were validated according to World Health Organization MONICA (Monitoring Trends and Determinants of Cardiovascular Disease) criteria. The risk related to changes in leisure-time PA was estimated using a multivariable Cox regression model. During an average follow-up of 9.8years (4.4), 609 incident first-ever stroke cases occurred (1.9%). A multivariable model showed that, compared with individuals with irregular PA at both examinations, those reporting regular PA over time had a lower risk of stroke (hazard ratio: 0.78, 95% CI, 0.61-0.99). Middle-aged adults who maintained regular PA during their leisure time over 10years had a lower risk of a first-ever stroke. This association is probably partly mediated by lower body mass index and a reduced risk of hypertension and diabetes.

Incense Use and the Risk of Chronic Limb-Threatening Ischemia Among Middle-Aged and Older Adults in the Singapore Chinese Health Study.

Epidemiologic studies have shown that daily exposure to incense smoke is associated with greater risk of cardiovascular mortality, which suggests that chronic exposure to incense could be linked to atherosclerosis. We studied the association between home incense use and the risk of chronic limb-threatening ischemia (CLTI), the most severe outcome of peripheral arterial disease. We used data from the Singapore Chinese Health Study, which recruited 63,257 Chinese participants 45-74 years old from 1993-1998. Data were collected via in-person interviews conducted at the participants' homes by trained interviewers. Linkage to the nationwide hospital discharge database was used to determine incident cases, defined as participants who underwent revascularization or lower extremity amputation for CLTI. Association between use of incense and risk of CLTI was examined using multivariable Cox proportional hazards regression models, adjusted for demographics and cardiovascular risk factors. In this cohort, 76.9% were current users of incense at recruitment, and 92.6% of those used incense daily at home. During a mean 18.8 years of follow-up, 1,097 participants developed CLTI. Compared to never or former users, current users had a 22% higher risk of CLTI [hazard ratio ; 95% confidence interval (CI): 1.04, 1.43]. The risk was greater with chronicity of use, and the HR was highest and statistically significant in participants who had used incense daily for years [ (95% CI: 1.06, 1.46)]. The results did not differ by sex, history of diabetes, or smoking status. Daily exposure to incense in the home environment for more than 40 years was associated with a greater risk of developing CLTI. https://doi.org/10.1289/EHP14674.

Patterns of use of heated tobacco products: a comprehensive systematic review

Relative or absolute safety of heated tobacco products (HTP) remains unknown, while independent literature suggests that these products do not favour tobacco control. We conducted a comprehensive systematic review and meta-analysis to evaluate HTP usage patterns and the effect of HTP use on conventional tobacco smoking (use transitions). We used Pubmed/MEDLINE, Embase and the Cochrane Library to identify all articles published up to February 2022 on HTP use. For the present review, we included all representative cross-sectional studies dealing with HTP use, and all prospective cohort studies or cross-sectional studies on conventional tobacco smoking transitions due to HTP use. From 610 non-duplicate articles, 76 were eligible (71 cross-sectional and 5 prospective cohort studies). Compared with young adults, HTP use was less frequent among middle-aged (pooled odds ratio, OR=0.59; 95% confidence interval, CI: 0.48-0.74; number of studies, n=15) and older adults (OR=0.17; 95%-CI: 0.07-0.38; n=12). HTP use was more frequent among former (OR=2.73; 95%-CI: 1.03-7.25; n=6) and current smokers (OR=14.53; 95%-CI: 6.34-33.31; n=12). Overall, 68.3% of HTP users were dual users (n=26). Eight studies (including 5 cohorts) showed that HTP users were more likely than non-users to start conventional cigarette smoking (OR=6.31; 95%-CI: 4.13-9.65; n=2), whereas current cigarette smokers using HTPs were less likely to quit (OR=0.84; 95%-CI: 0.80-0.89; n=4). We found that HTPs are specifically popular among young generations. More than two out of three HTP users are dual users. Prospective studies consistently show that in real life HTPs are not effective smoking cessation tools.

Psychological profiles associated with mental, cognitive and brain health in middle-aged and older adults

Psychological characteristics are associated with varying dementia risk and protective factors. To determine whether these characteristics aggregate into psychological profiles and whether these profiles differentially relate to aging health, we conducted a cross-sectional investigation in two independent middle-aged (51.4 ± 7.0 years (mean ± s.d.); N = 750) and older adult (71.1 ± 5.9 years; N = 282) cohorts, supplemented by longitudinal analyses in the former. Using a person-centered approach, three profiles emerged in both cohorts: those with low protective characteristics (profile 1), high risk characteristics (profile 2) and well-balanced characteristics (profile 3). Profile 1 showed the worst objective cognition in older age and middle age (at follow-up), and most rapid cortical thinning. Profile 2 exhibited the worst mental health symptomology and lowest sleep quality in both older age and middle age. We identified profile-dependent divergent patterns of associations that may suggest two distinct paths for mental, cognitive and brain health, emphasizing the need for comprehensive psychological assessments in dementia prevention research to identify groups for more personalized behavior-change strategies.

The dynamic association between emotional functioning, quality of life, and subjective cognitive concerns in a large community-based sample of middle-aged and older adults

The dynamic association between emotional functioning, quality of life, and subjective cognitive concerns in a large community-based sample of middle-aged and older adults

Racial and ethnic disparities in longitudinal trajectories of cardiovascular risk factors in U.S. middle-aged and older adults.

Racial and ethnic disparities in cardiovascular disease (CVD) risk factors are well-documented. However, racial and ethnic differences in the longitudinal changes among multiple CVD risk factors are unknown. We used prospective cohort data of U.S. adults aged ≥50 in the 2006-2016 Health and Retirement Study. Group-based multi-trajectory models characterized age-related trajectories of systolic blood pressure ([BP] mmHg), non-HDL cholesterol (mg/dL), diabetes mellitus (DM), and smoking. Racial and ethnic differences in the multi-trajectory profiles were examined using multinomial logistic regression. Karlson-Holm-Breen methods were used to assess factors contributing to these associations. Among 10,292 participants (median age: 61), approximately 32% had an overall favorable profile of CVD risk factors. Compared with non-Hispanic White adults, non-Hispanic Black adults were more likely to exhibit elevated systolic BP with high risks of DM (relative risk ratio [RRR] = 3.36; 95% CI, 2.69-4.21; P < .001) and with low risks of DM (RRR = 3.23; 95% CI, 2.38-4.38; P < .001). Non-Hispanic Black adults were also more likely to exhibit high rates of smoking with and without other co-occurring risk factors. Hispanic adults were most likely to exhibit high risks of DM with elevated systolic BP (RRR = 1.74; 95% CI, 1.28-2.38; P < .001) and without elevated systolic BP (RRR = 1.90; 95% CI, 1.50-2.40; P < .001). Education, income, and country-of-origin were significantly associated with the excess CVD risks observed among racial and ethnic minority groups. Significant racial and ethnic disparities were observed in trajectories of CVD risk factors in U.S. adults. Social determinants largely contributed to these associations in non-Hispanic Black adults and Hispanic adults.