Person: Glymour, Maria
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Glymour
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Maria
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Glymour, Maria
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Publication The Health Effects of US Unemployment Insurance Policy: Does Income from Unemployment Benefits Prevent Cardiovascular Disease?(Public Library of Science, 2014) Walter, Stefan; Glymour, Maria; Avendano, MauricioObjective: Previous studies suggest that unemployment predicts increased cardiovascular disease (CVD) risk, but whether unemployment insurance programs mitigate this risk has not been assessed. Exploiting US state variations in unemployment insurance benefit programs, we tested the hypothesis that more generous benefits reduce CVD risk. Methods: Cohort data came from 16,108 participants in the Health and Retirement Study (HRS) aged 50–65 at baseline interviewed from 1992 to 2010. Data on first and recurrent CVD diagnosis assessed through biennial interviews were linked to the generosity of unemployment benefit programmes in each state and year. Using state fixed-effect models, we assessed whether state changes in the generosity of unemployment benefits predicted CVD risk. Results: States with higher unemployment benefits had lower incidence of CVD, so that a 1% increase in benefits was associated with 18% lower odds of CVD (OR:0.82, 95%-CI:0.71–0.94). This association remained after introducing US census regional division fixed effects, but disappeared after introducing state fixed effects (OR:1.02, 95%-CI:0.79–1.31).This was consistent with the fact that unemployment was not associated with CVD risk in state-fixed effect models. Conclusion: Although states with more generous unemployment benefits had lower CVD incidence, this appeared to be due to confounding by state-level characteristics. Possible explanations are the lack of short-term effects of unemployment on CVD risk. Future studies should assess whether benefits at earlier stages of the life-course influence long-term risk of CVD.Publication Social Integration and Reduced Risk of Coronary Heart Disease in WomenNovelty and Significance(Ovid Technologies (Wolters Kluwer Health), 2017) Chang, Shun-Chiao; Glymour, Maria; Cornelis, Marilyn; Walter, Stefan; Rimm, Eric; Tchetgen Tchetgen, Eric; Kawachi, Ichiro; Kubzansky, LauraRATIONALE: Higher social integration is associated with lower cardiovascular mortality; however, whether it is associated with incident coronary heart disease (CHD), especially in women, and whether associations differ by case fatality are unclear. OBJECTIVES: This study sought to examine the associations between social integration and risk of incident CHD in a large female prospective cohort. METHODS AND RESULTS: Seventy-six thousand three hundred and sixty-two women in the Nurses' Health Study, free of CHD and stroke at baseline (1992), were followed until 2014. Social integration was assessed by a simplified Berkman-Syme Social Network Index every 4 years. End points included nonfatal myocardial infarction and fatal CHD. Two thousand three hundred and seventy-two incident CHD events occurred throughout follow-up. Adjusting for demographic, health/medical risk factors, and depressive symptoms, being socially integrated was significantly associated with lower CHD risk, particularly fatal CHD. The most socially integrated women had a hazard ratio of 0.55 (95% confidence interval, 0.41-0.73) of developing fatal CHD compared with those least socially integrated (P for trend <0.0001). When additionally adjusting for lifestyle behaviors, findings for fatal CHD were maintained but attenuated (P for trend =0.02), whereas the significant associations no longer remained for nonfatal myocardial infarction. The inverse associations between social integration and nonfatal myocardial infarction risk were largely explained by health-promoting behaviors, particularly through differences in cigarette smoking; however, the association with fatal CHD risk remained after accounting for these behaviors and, thus, may involve more direct biological mechanisms. CONCLUSIONS: Social integration is inversely associated with CHD incidence in women, but is largely explained by lifestyle/behavioral pathways.Publication Changes in Depressive Symptoms and Incidence of First Stroke Among Middle-Aged and Older US Adults(Wiley Blackwell, 2015) Gilsanz, Paola; Walter, Stefan; Tchetgen, Eric; Patton, Kristen; Moon, James; Capistrant, Benjamin; Marden, Jessica Rachel; Kubzansky, Laura D; Kawachi, Ichiro; Glymour, MariaBACKGROUND: Although research has demonstrated that depressive symptoms predict stroke incidence, depressive symptoms are dynamic. It is unclear whether stroke risk persists if depressive symptoms remit. METHODS AND RESULTS: Health and Retirement Study participants (n=16 178, stroke free and noninstitutionalized at baseline) were interviewed biennially from 1998 to 2010. Stroke and depressive symptoms were assessed through self-report of doctors' diagnoses and a modified Center for Epidemiologic Studies - Depression scale (high was ≥3 symptoms), respectively. We examined whether depressive symptom patterns, characterized across 2 successive interviews (stable low/no, onset, remitted, or stable high depressive symptoms) predicted incident stroke (1192 events) during the subsequent 2 years. We used marginal structural Cox proportional hazards models adjusted for demographics, health behaviors, chronic conditions, and attrition. We also estimated effects stratified by age (≥65 years), race or ethnicity (non-Hispanic white, non-Hispanic black, Hispanic), and sex. Stroke hazard was elevated among participants with stable high (adjusted hazard ratio 2.14, 95% CI 1.69 to 2.71) or remitted (adjusted hazard ratio 1.66, 95% CI 1.22 to 2.26) depressive symptoms compared with participants with stable low/no depressive symptoms. Stable high depressive symptom predicted stroke among all subgroups. Remitted depressive symptoms predicted increased stroke hazard among women (adjusted hazard ratio 1.86, 95% CI 1.30 to 2.66) and non-Hispanic white participants (adjusted hazard ratio 1.66, 95% CI 1.18 to 2.33) and was marginally associated among Hispanics (adjusted hazard ratio 2.36, 95% CI 0.98 to 5.67). CONCLUSIONS:In this cohort, persistently high depressive symptoms were associated with increased stroke risk. Risk remained elevated even if depressive symptoms remitted over a 2-year period, suggesting cumulative etiologic mechanisms linking depression and stroke.Publication Body mass index and cognitive function: the potential for reverse causation(Nature Publishing Group, 2015) Suemoto, C K; Gilsanz, Paola; Mayeda, E R; Glymour, MariaBackground/Objective: Higher late life body mass index (BMI) is unrelated to or even predicts lower risk of dementia in late-life, a phenomenon that may be explained by reverse causation due to weight loss during pre-clinical phases of dementia. We aim to investigate the association of baseline BMI and changes in BMI with dementia in a large prospective cohort, and to examine whether weight loss predicts cognitive function. Methods: Using a national cohort of adults average age 58 at baseline in 1994 (n=7,029), we investigated the associations between baseline BMI in 1994 and memory scores from 2000 to 2010. We also examined the association of BMI change from 1994 to 1998 with memory scores from 2000 to 2010. Lastly, to investigate reverse causation, we examined whether memory scores in 1996 predicted BMI trajectories from 2000 to 2010. Results: Baseline overweight predicted better memory scores 6 to 16 years later (β=0.012, 95%CI=0.001; 0.023). Decline in BMI predicted lower memory scores over the subsequent 12 years (β= -0.026, 95%CI= -0.041; -0.011). Lower memory scores at mean age 60 in 1996 predicted faster annual rate of BMI decline during follow-up (β= -0.158 kg/m2 per year, 95% CI= -0.223;-0.094). Conclusion: Consistent with reverse causation, greater decline in BMI over the first four years of the study was associated with lower memory scores over the next decade and lower memory scores was associated with a decline in BMI. These findings suggest that pre-clinical dementia predicts weight loss for people as early as their late 50s.Publication Elevated Depressive Symptoms and Incident Stroke in Hispanic, African-American, and White Older Americans(Springer US, 2011) Glymour, Maria; Yen, Jessica J.; Kosheleva, Anna; Moon, J. Robin; Capistrant, Benjamin; Patton, Kristen K.Although depressive symptoms have been linked to stroke, most research has been in relatively ethnically homogeneous, predominantly white, samples. Using the United States based Health and Retirement Study, we compared the relationships between elevated depressive symptoms and incident first stroke for Hispanic, black, or white/other participants (N = 18,648) and estimated the corresponding Population Attributable Fractions. The prevalence of elevated depressive symptoms was higher in blacks (27%) and Hispanics (33%) than whites/others (18%). Elevated depressive symptoms prospectively predicted stroke risk in the whites/other group (HR = 1.53; 95% CI: 1.36–1.73) and among blacks (HR = 1.31; 95% CI: 1.05–1.65). The HR was similar but only marginally statistically significant among Hispanics (HR = 1.33; 95% CI: 0.92–1.91). The Population Attributable Fraction, indicating the percent of first strokes that would be prevented if the incident stroke rate in those with elevated depressive symptoms was the same as the rate for those without depressive symptoms, was 8.3% for whites/others, 7.8% for blacks, and 10.3% for Hispanics.Publication Migraine and Cognitive Decline Among Women: Prospective Cohort Study(BMJ Publishing Group Ltd., 2012) Rist, Pamela; Kang, Jae Hee; Buring, Julie; Glymour, Maria; Grodstein, Francine; Kurth, TobiasObjective: To evaluate the association between migraine and cognitive decline among women. Design Prospective cohort study. Setting Women’s Health Study, United States. Participants 6349 women aged 65 or older enrolled in the Women’s Health Study who provided information about migraine status at baseline and participated in cognitive testing during follow-up. Participants were classified into four groups: no history of migraine, migraine with aura, migraine without aura, and past history of migraine (reports of migraine history but no migraine in the year prior to baseline). Main outcome measures Cognitive testing was carried out at two year intervals up to three times using the telephone interview for cognitive status, immediate and delayed recall trials of the east Boston memory test, delayed recall trial of the telephone interview for cognitive status 10 word list, and a category fluency test. All tests were combined into a global cognitive score, and tests assessing verbal memory were combined to create a verbal memory score. Results: Of the 6349 women, 853 (13.4%) reported any migraine; of these, 195 (22.9%) reported migraine with aura, 248 (29.1%) migraine without aura, and 410 (48.1%) a past history of migraine. Compared with women with no history of migraine, those who experienced migraine with or without aura or had a past history of migraine did not have significantly different rates of cognitive decline in any of the cognitive scores: values for the rate of change of the global cognitive score between baseline and the last observation ranged from −0.01 (SE 0.04) for past history of migraine to 0.08 (SE 0.04) for migraine with aura when compared with women without any history of migraine. Women who experienced migraine were also not at increased risk of substantial cognitive decline (worst 10% of the distribution of decline). When compared with women without a history of migraine, the relative risks for the global score ranged from 0.77 (95% confidence interval 0.46 to 1.28) for women with migraine without aura to 1.17 (0.84 to 1.63) for women with a past history of migraine. Conclusion: In this prospective cohort of women, migraine status was not associated with faster rates of cognitive decline.Publication Timing of Onset of Cognitive Decline: Results from Whitehall II Prospective Cohort Study(BMJ Publishing Group Ltd., 2012) Singh-Manoux, Archana; Kivimaki, Mika; Glymour, Maria; Elbaz, Alexis; Berr, Claudine; Ebmeier, Klaus P; Ferrie, Jane E; Dugravot, AlineObjectives: To estimate 10 year decline in cognitive function from longitudinal data in a middle aged cohort and to examine whether age cohorts can be compared with cross sectional data to infer the effect of age on cognitive decline. Design: Prospective cohort study. At study inception in 1985-8, there were 10 308 participants, representing a recruitment rate of 73%. Setting: Civil service departments in London, United Kingdom. Participants: 5198 men and 2192 women, aged 45-70 at the beginning of cognitive testing in 1997-9. Main outcome measure: Tests of memory, reasoning, vocabulary, and phonemic and semantic fluency, assessed three times over 10 years. Results: All cognitive scores, except vocabulary, declined in all five age categories (age 45-49, 50-54, 55-59, 60-64, and 65-70 at baseline), with evidence of faster decline in older people. In men, the 10 year decline, shown as change/range of test×100, in reasoning was −3.6% (95% confidence interval −4.1% to −3.0%) in those aged 45-49 at baseline and −9.6% (−10.6% to −8.6%) in those aged 65-70. In women, the corresponding decline was −3.6% (−4.6% to −2.7%) and −7.4% (−9.1% to −5.7%). Comparisons of longitudinal and cross sectional effects of age suggest that the latter overestimate decline in women because of cohort differences in education. For example, in women aged 45-49 the longitudinal analysis showed reasoning to have declined by −3.6% (−4.5% to −2.8%) but the cross sectional effects suggested a decline of −11.4% (−14.0% to −8.9%). Conclusions: Cognitive decline is already evident in middle age (age 45-49).Publication Can Social Policy Influence Socioeconomic Disparities? Korean War GI Bill Eligibility and Markers of Depression(Elsevier BV, 2016-02) Vable, Anusha M.; Canning, David; Kawachi, Ichiro; Jimenez, Marcia P.; Subramanian, Subu V.; Glymour, MariaPurpose: The Korean War GI Bill provided socioeconomic benefits to veterans; however, its association with health is unclear; we hypothesize GI Bill eligibility is associated with fewer depressive symptoms and smaller disparities.Methods: Data from 246 Korean War GI Bill eligible veterans and 240 nonveterans from the Health and Retirement Study were matched on birth year, southern birth, race, height, and childhood health using coarsened exact matching. Number of depressive symptoms in 2010 (average age = 78 years) was assessed using a modified, validated Center for Epidemiologic Studies-Depression Scale, dichotomized to reflect elevated depressive symptoms. Regression analyses were stratified into low (at least one parent < 8 years schooling/missing data, n = 167) or high (both parents > 8 years schooling, n = 319) childhood socioeconomic status (cSES) groups.Results: Korean War GI Bill eligibility predicted fewer depressive symptoms among individuals from low cSES backgrounds = 0.64, 95% confidence interval (CI) = (-1.18, 0.09), P =.022]. Socioeconomic disparities were smaller among veterans than nonveterans for number of depressive symptoms [0 = 0.76, 95% CI = (-1.33, 0.18), P =.010] and elevated depressive symptoms [0 = 11.7, 95% CI = (-8.2, 22.6), P =.035].Conclusions: Korean War GI Bill eligibility predicted smaller socioeconomic disparities in depression markers.