@article {9008, title = {Association of Retail Environment and Neighborhood Socioeconomic Status with Mortality among Community-dwelling Older Adults in the US: Cardiovascular Health Study.}, journal = {J Gerontol A Biol Sci Med Sci}, year = {2021}, month = {2021 Oct 20}, abstract = {

BACKGROUND: Few studies have examined the association of neighborhood environment and mortality among community-dwelling older populations. Geographic Information Systems (GIS)-based measures of neighborhood physical environment may provide new insights on the health effects of the social and built environment.

METHODS: We studied 4,379 community-dwelling older adults in the US aged >=65 years from the Cardiovascular Health Study. Principal component analysis was used to identify neighborhood components from 48 variables assessing facilities and establishments, demographic composition, socio-economic status, and economic prosperity. We used a Cox model to evaluate the association of neighborhood components with five-year mortality. Age, sex, race, education, income, marital status, body mass index, smoking status, disability, coronary heart disease, and diabetes were included as covariates. We also examined the interactions between neighborhood components and sex and race (Black vs. white or other).

RESULTS: We identified five neighborhood components, representing facilities and resources, immigrant communities, community-level economic deprivation, resident-level socio-economic status and residents{\textquoteright} age. Communities{\textquoteright} economic deprivation and residents{\textquoteright} socio-economic status were significantly associated with five-year mortality. We did not find interactions between sex or race and any of the five neighborhood components. The results were similar in a sensitivity analysis where we used ten-year mortality as the outcome.

CONCLUSIONS: We found that communities{\textquoteright} economic status but not facilities in communities was associated with mortality among older adults. These findings revealed the importance and benefits living in a socio-economically advantaged neighborhood could have on health among older residents with different demographic backgrounds.

}, issn = {1758-535X}, doi = {10.1093/gerona/glab319}, author = {Zhang, Kehan and Lovasi, Gina S and Odden, Michelle C and Michael, Yvonne L and Newman, Anne B and Arnold, Alice M and Kim, Dae Hyun and Wu, Chenkai} } @article {8616, title = {Associations between neighborhood greenspace and brain imaging measures in non-demented older adults: the Cardiovascular Health Study.}, journal = {Soc Psychiatry Psychiatr Epidemiol}, year = {2021}, month = {2021 Jan 03}, abstract = {

PURPOSE: Greater neighborhood greenspace has been associated with brain health, including better cognition and lower odds of Alzheimer{\textquoteright}s disease in older adults. We investigated associations between neighborhood greenspace and brain-based magnetic resonance imaging (MRI) measures and potential effect modification by sex or apolipoprotein E genotype (APOE), a risk factor for Alzheimer{\textquoteright}s disease.

METHODS: We obtained a sample of non-demented participants 65~years or older (n = 1125) from the longitudinal, population-based Cardiovascular Health Study (CHS). Greenspace data were derived from the National Land Cover Dataset. Adjusted multivariable linear regression estimated associations between neighborhood greenspace five years prior to the MRI and left and right hippocampal volume and 10-point grades of ventricular size and burden of white matter hyperintensity. Interaction terms tested effect modification by APOE genotype and sex. CHS data (1989-1999) were obtained/analyzed in 2020.

RESULTS: Participants were on average 79~years old [standard deviation (SD) = 4], 58\% were female, and 11\% were non-white race. Mean neighborhood greenspace was 38\% (SD = 28\%). Greater proportion of greenspace in the neighborhood five years before MRI was borderline associated with lower ventricle grade (estimate: -~0.30; 95\% confidence interval: -~0.61, 0.00). We observed no associations between greenspace and the other MRI outcome measures and no evidence of effect modification by APOE genotype and sex.

CONCLUSION: This study suggests a possible association between greater greenspace and less ventricular enlargement, a measure reflecting global brain atrophy. If confirmed in other longitudinal cohort studies, interventions and policies to improve community greenspaces may help to maintain brain health in older age.

}, issn = {1433-9285}, doi = {10.1007/s00127-020-02000-w}, author = {Besser, Lilah M and Lovasi, Gina S and Michael, Yvonne L and Garg, Parveen and Hirsch, Jana A and Siscovick, David and Hurvitz, Phil and Biggs, Mary L and Galvin, James E and Bartz, Traci M and Longstreth, W T} } @article {9737, title = {Associations between toxicity-weighted concentrations and dementia risk: Results from the Cardiovascular Health Cognition Study.}, journal = {Sci Total Environ}, volume = {945}, year = {2024}, month = {2024 Oct 01}, pages = {173706}, abstract = {

BACKGROUND: Air pollution is a modifiable risk factor for dementia. Yet, studies on specific sources of air pollution (i.e., toxic chemical emissions from industrial facilities) and dementia risk are scarce. We examined associations between toxicity-weighted concentrations of industrial pollution and dementia outcomes among a large, multi-site cohort of older adults.

METHODS: Participants (n~=~2770) were~>=~65~years old (Mean~=~75.3, SD~=~5.1~years) from the Cardiovascular Health Cognition Study (1992-1999). Toxicity-weighted concentrations were estimated using the Risk Screening Environmental Indicator (RSEI) model which incorporates total reported chemical emissions with toxicity, fate, and transport models. Estimates were aggregated to participants{\textquoteright} baseline census tract, averaged across 1988-1992, and log2-transformed. Dementia status was clinically adjudicated in 1998-1999 and categorized by subtype (Alzheimer{\textquoteright}s, vascular, mixed). We assessed whether RSEI-estimated toxicity-weighted concentrations were associated with 1) odds of prevalent dementia and 2) incident dementia risk by subtype.

RESULTS: After adjusting for individual and census-tract level covariates, a doubling in toxicity-weighted concentrations was associated with 9~\% higher odds of prevalent dementia (OR~=~1.09, 95~\% CI: 1.00, 1.19). In discrete-time survival models, each doubling in toxicity-weighted concentrations was associated with a 16~\% greater hazard of vascular dementia (HR~=~1.16, 95~\% CI: 1.01, 1.34) but was not significantly associated with all-cause, Alzheimer{\textquoteright}s disease, or mixed dementia (p{\textquoteright}s~>~0.05).

DISCUSSION: Living in regions with higher toxicity-weighted concentrations was associated with higher odds of prevalent dementia and a higher risk of incident vascular dementia in this large, community-based cohort of older adults. These findings support the need for additional studies to examine whether toxic chemical emissions from industrial and federal facilities may be a modifiable target for dementia prevention.

}, keywords = {Aged, Aged, 80 and over, Air Pollutants, Air Pollution, Dementia, Environmental Exposure, Female, Humans, Male, Risk Factors}, issn = {1879-1026}, doi = {10.1016/j.scitotenv.2024.173706}, author = {Crane, Breanna M and Moored, Kyle D and Donahue, Patrick T and Corrigan, Anne E and Curriero, Frank C and Shields, Timothy M and Desjardins, Michael R and Richards, Emily A and Rosso, Andrea L and Lovasi, Gina S and Odden, Michelle C and Lopez, Oscar L and Biggs, Mary Lou and Newman, Anne B and Andrews, Ryan M and Carlson, Michelle C} } @article {9901, title = {Associations of neighbourhood food retail with disability and death in older adults: Cardiovascular Health Study.}, journal = {BMJ Nutr Prev Health}, volume = {7}, year = {2024}, month = {2024}, pages = {e000646}, abstract = {

BACKGROUND: A healthier diet is associated with lower chronic disease burden, but the impact of neighbourhood food environments on disability and death in older adults is not known.

METHODS: In the Cardiovascular Health Study, a cohort study of adults aged 65+, we calculated study years until death (years of life (YOL)), study years without activities of daily living (ADL) difficulty (years of able life; YoAL) and percent of study years without ADL difficulty (compression of disability). Linear regression quantified associations of food establishments within 5 km of baseline home address (as a z-score) with each outcome, adjusted for sociodemographic characteristics. Sensitivity analyses considered adjustment for risk factors and comorbidities, multiple imputation, alternate neighbourhood definitions (1-km radial buffer, census tract) and restriction on residential stability.

RESULTS: We included 4298 participants followed for up to 26 years. All food retail establishments were associated with 6 months higher YoAL per SD in the main model (beta, 0.50 years; 95\% CI 0.01, 0.98; p=0.046), with similar findings across sensitivity analyses except when restricting on residential stability. Supermarkets and produce markets were associated with compression of disability (beta, 2.31; 95\% CI, 0.04, 4.57) and when using 1-km buffers with YOL (beta, 0.23 years; 95\% CI 0.03, 0.43) and YoAL (beta, 0.21 years; 95\% CI 0.01, 0.41). Non-supermarket food stores were associated with YoAL (beta, 0.67 years; 95\% CI, 0.07, 1.27) and compression of disability (beta, 3.03; 95\% CI 0.44, 5.62), but significance was not consistent across sensitivity analyses. Fast-food restaurants did not reach statistical significance in any model.

CONCLUSION: All food retail was associated with YOL without impairment. Neighbourhood food retail access and type may both have roles in extending YOL and years of able life among older adults, but the findings were sensitive to decisions made during measurement and modelling.

}, issn = {2516-5542}, doi = {10.1136/bmjnph-2023-000646}, author = {Bhatia, Roma and Hernandez, Mark A and Platt, Jonathan and Newman, Anne B and Siscovick, David S and Mukamal, Kenneth J and Lovasi, Gina S} } @article {9904, title = {Association between spatial social polarisation and high blood pressure in older adults.}, journal = {J Epidemiol Community Health}, year = {2025}, month = {2025 Mar 24}, abstract = {

BACKGROUND: Using data from the Cardiovascular Health Study (CHS) and the REasons for Geographic And Racial Differences in Stroke (REGARDS) study, we investigate the association between socioeconomic polarisation and blood pressure outcomes in black and white adults. We also validate previous findings that joint racial/ethnic and income measures of spatial social polarisation (SSP) outperform single domain measures.

METHODS: We conducted a cross-sectional analysis using a retrospective cohort combining CHS (recruited 1989-1990 and 1992-1993) and REGARDS (recruited 2003-2007). The study included 5888 CHS participants aged >=65 years and 30 183 REGARDS participants aged >=45 years. SSP was measured using the Index of Concentration at the Extremes for education, race/ethnicity, income, home ownership, and joint race/ethnicity and income at ZIP code, census tract and county levels. The SSP measures were modelled against the presence of high blood pressure and systolic blood pressure.

RESULTS: The sample had a mean age of 66 (SD: 9), was majority female (56\%), white/other (63\%), and at least high school graduates (85\%). A total of 26\% had high blood pressure, with a mean systolic blood pressure of 129 mm Hg (SD: 18). Census tract-level models showed low-income black areas had 25\% (95\% CI 11\%-40\%) higher odds of high blood pressure and 1.8 mm Hg (95\% CI 1.0-2.5) higher mean systolic blood pressure than high-income White areas.

CONCLUSION: Greater SSP is associated with a higher risk of high blood pressure and higher systolic blood pressure. Further investigating and reducing polarisation could help mitigate cardiovascular health disparities, improving outcomes for socioeconomically deprived communities.

}, issn = {1470-2738}, doi = {10.1136/jech-2024-223191}, author = {Abdel Magid, Hoda S and Jaros, Samuel and Lovasi, Gina S and Rosso, Andrea L and Tan, Annabel X and Rehkopf, David H and Nelson, Lorene M and Carlson, Michelle and Judd, Suzanne E and Odden, Michelle C} }