Suchergebnisse

AbstractWe consider a broad set of variables used by social scientists and clinicians to identify the leading predictors of five‐year survival among American adults. We address a question not considered in earlier research: Do the strongest predictors of survival vary by age, sex or race/ethnicity? The analysis uses hazard models with 30 well‐established predictors to examine five‐year survival in the National Health and Nutrition Examination Survey. We find that the simple measure of self‐assessed health and self‐reported measures of functional ability and disability are the strongest predictors in all demographic groups, and are generally ranked considerably higher than biomarkers. Among the biomarkers, serum albumin is highly ranked in most demographic groups, whereas clinical measures of cardiovascular and metabolic function are consistently among the weakest predictors. Despite these similarities, there is substantial variation in the leading predictors across demographic groups, most notably by race and ethnicity

The proliferation of biosocial surveys has increased the importance of weighing the costs and benefits of adding biomarker collection to population‐based surveys. A crucial question is whether biomarkers offer incremental value beyond self‐reported measures, which are easier to collect and impose less respondent burden. We use longitudinal data from a nationally representative sample of older Taiwanese (aged 54+ in 2000, examined in 2000 and 2006 with mortality follow‐up through 2011) to address that question with respect to predicting all‐cause mortality. A summary measure of biomarkers improves mortality prediction (as measured by the area under the receiver operating characteristic curve) compared with self‐reports alone, but individual biomarkers perform better than the summary score. We find that incorporating change in biomarkers over a six‐year period yields a small improvement in mortality prediction compared with one‐time measurement. But, is the incremental value worth the costs?

SummaryData from a national representative sample of 1023 elderly and near-elderly Taiwanese were used to explore whether allostatic load is associated with health outcomes and mediates the association between socioeconomic status and health in a non-Western population. The information collected included: demographic characteristics; allostatic load scores; socioeconomic status, measured by education and income; health behaviours; health-related variables, including self-rated health, basic activities of daily living difficulties, instrumental activities of daily living difficulties, and physical activity difficulties. The adjusted prevalent odds ratios of higher allostatic load level were 1·25 (95% CI: 1·00, 1·56) for reporting one level worse in self-rated health and 1·43 (95% CI: 1·14, 1·82) for reporting one more physical activity difficulty. There were significant associations of lower education or less income with worse self-rated health and more difficulties with physical functioning. The associations between education, income and health status are not mediated by the conventional ten-point measure of allostatic load in older Taiwanese adults.

The social environment and exposure to life challenge affect a person's physical and emotional well-being. The present research uses a population-based study of the elderly in Taiwan to elaborate the cumulative physiological costs – as reflected in biological markers of risk factors known to have adverse consequences for health – of challenge and unfavourable position in social hierarchies and networks. Overall, biological markers of risk among the elderly are similar in Taiwan and the United States. However, male and female Taiwanese elderly are at lower risk for illness associated with
indicators of DHEA-S, while women are at higher risk for illness associated with elevated blood pressure, and men at lower risk for illness associated with total/HDL cholesterol, and glycosylated haemoglobin. There are strong and statistically significant effects of position in social hierarchy (education) and challenge (recent widowhood and a perception of high demands) on an index of cumulative risk (allostatic load). Membership in social networks and participation in social activities have expected, but not statistically discernible, effects.