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Background: Retirement represents a crucial transitional period for many adults with possible consequences for cognitive aging. We examined trajectories of cognitive change before and after retirement in Black and White adults. Methods: Longitudinal examination of up to 10 years (mean = 7.1 ± 2.2 years) using data from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study–a national, longitudinal study of Black and White adults ≥45 years of age. Data were from 2226 members of the REGARDS study who retired around the time when an occupational ancillary survey was administered. Cognitive function was an average of z‐scores for tests of verbal fluency, memory, and global function. Results: Cognitive functioning was stable before retirement (Estimate = 0.05, p = 0.322), followed by a significant decline after retirement (Estimate = −0.15, p < 0.001). The decline was particularly pronounced in White (Estimate = −0.19, p < 0.001) compared with Black (Estimate = −0.07, p = 0.077) participants, twice as large in men (Estimate = −0.20, p < 0.001) compared with women (Estimate = −0.11, p < 0.001), highest among White men (Estimate = −0.22, p < 0.001) and lowest in Black women (Estimate = −0.04, p = 0.457). Greater post‐retirement cognitive decline was also observed among participants who attended college (Estimate = −0.14, p = 0.016). While greater work complexity (Estimate = 0.92, p < 0.05) and higher income (Estimate = 1.03, p < 0.05) were related to better cognitive function at retirement, neither was significantly related to cognitive change after retirement. Conclusion: Cognitive functioning may decline at an accelerated rate immediately post‐retirement, more so in White adults and men than Black adults and women. Lifelong structural inequalities including occupational segregation and other social determinants of cognitive health may obscure the role of retirement in cognitive aging. [ABSTRACT FROM AUTHOR]

Background: The work environment can contribute to the risk of cardiovascular diseases (CVD) including stroke. Our objective was to identify occupations with elevated risk of stroke within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Methods: We analyzed incident stroke outcomes (ischemic and hemorrhagic strokes) from 2003 to 2020 and employment characteristics of 13,659 adults aged ≥45 years enrolled in a national population‐based cohort study. Using a modified Poisson regression approach, we estimated the relative risks (RRs) and the associated 95% confidence intervals (CI) of stroke in relation to years of employment within each occupation coded using the US Census two‐digit Standard Occupation Code. Models were adjusted for Framingham Stroke Risk Score, region, race, age, and body mass index. We conducted stratified analysis by sex, employment time period (pre‐1975 vs. post‐1975), and region. Results: Workers in the following occupations had a greater risk of stroke with longer duration of employment (per decade): protective service (RR: 2.35, 95% CI: 1.11, 4.97), food preparation and service (RR: 1.51, 95% CI: 1.05, 2.19), and transportation and material moving (RR: 1.30, 95% CI: 1.00, 1.69). The stroke risk in these occupations was disproportionately elevated in men, and differed by region and employment time period. Conclusions: Longer employment in protective service, food preparation and serving, and transportation and materials moving occupations may increase the risk of stroke. Surveillance may uncover specific work‐related risk factors in these occupations, leading to interventions to reduce the burden of stroke among US workers. [ABSTRACT FROM AUTHOR]

Purpose: We previously described the magnitude of rural‐urban differences in the prevalence of stroke risk factors and stroke mortality. In this report, we sought to extend the understanding of rural‐urban differences in the prevalence of stroke risk factors by using an enhanced definition of rural‐urban status and assessing the impact of neighborhood socioeconomic status (nSES) on risk factor differences. Methods: This analysis included 28,242 participants without a history of stroke from the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort. Participants were categorized into the 6‐level ordinal National Center for Health Statistics Urban‐Rural Classification Scheme. The prevalence of stroke risk factors (hypertension, diabetes, smoking, atrial fibrillation, left ventricular hypertrophy, and heart disease) was assessed across the rural‐urban scale with adjustment for demographic characteristics and further adjustment for nSES score. Findings: Hypertension, diabetes, and heart disease were more prevalent in rural than urban regions. Higher odds were observed for these risk factors in the most rural compared to the most urban areas (odds ratios [95% CI]: 1.25 [1.11‐1.42] for hypertension, 1.15 [0.99‐1.33] for diabetes, and 1.19 [1.02‐1.39] for heart disease). Adjustment for nSES score partially attenuated the odds of hypertension and heart disease with rurality, completely attenuated the odds of diabetes, and unmasked an association of current smoking. Conclusions: Some of the higher stroke mortality in rural areas may be due to the higher burden of stroke risk factors in rural areas. Lower nSES contributed most notably to rural‐urban differences for diabetes and smoking. [ABSTRACT FROM AUTHOR]

Socioeconomic status (SES) is a well‐established determinant of health. Disparities in stress are thought to partially account for SES‐health disparities. We tested whether multiple indicators of SES show similar associations with psychological stress and whether race, sex, and geographic region moderate associations. Participants (n = 26,451) are from a well‐characterized national cohort of Black and White US adults aged 45 years or older. Psychological stress was measured using the 4‐item perceived stress scale. Income was assessed as annual household income and education as highest level of education completed. Occupation was assessed during a structured interview and subsequently coded hierarchically. For all sex‐race‐region groups, the largest SES‐stress associations were for income and the smallest were for occupation. Race moderated SES‐stress associations, such that income and education were more closely associated with stress in Black adults than White adults. Additionally, education was more strongly associated with stress in individuals living in the stroke belt region. Black Americans with lower income and education reported greater psychological stress and may be at higher risk for disease through stress‐related pathways. Thus, which SES indicator is examined and for whom may alter the magnitude of the association between SES and psychological stress. [ABSTRACT FROM AUTHOR]

Background: The Mediterranean‐DASH Intervention for Neurodegenerative Delay (MIND) diet (high in nuts, seeds, vegetables, berries and low in meat, dairy, and butter) has been associated with reduced risk of dementia. However, no studies have examined the role of the MIND diet in a racially diverse population nor have there been studies that have examined the association of the MIND diet with dementia mortality. Method: We examined data from Black and White adults (age 45‐98) in the US‐based REGARDS cohort. Dietary and covariate data were collected at baseline (2002‐2007). MIND diet score was created as described by other cohort studies (Table footnote). The primary outcome was dementia‐related mortality through December 31, 2020 from the National Death Index using ICD‐10 codes F00‐F03, G30, G31.0‐G31.1, and R54. Cox proportional hazards regression was used to model MIND diet score (in tertiles and as a continuous variable) and time to dementia death. To ensure robust association across sub‐groups, we tested for interactions of MIND diet with sex, race, age, obesity, history of stroke, and baseline cognitive impairment and adjusted for competing risks. Result: A total of 18,277 participants (mean age 64.9) had dietary data available to calculate the MIND diet score. MIND diet score was higher among females compared with males, White compared with Black participants, and college graduates. There were no differences in accordance by age. After a median of 12 years, participants with the highest MIND diet scores had the lowest risk of dementia death HR = 0.78 {95% CI; (0.66, 0.94)} comparing the 3rd tertile with the 1st tertile and after adjustment for age, race, sex, income, education, total energy, and other medical conditions (Table). This association was attenuated slightly when a competing risk analysis was considered HR = 0.84 {95%CI; (0.70, 1.00)}. There were no significant interactions observed. Conclusion: The MIND diet score is associated with dementia death in a large bi‐racial cohort in the US. This association is robust across race, age, and sex groups. Dietary interventions using the MIND diet may further clarify whether this association is causal and whether MIND diet may be an important tool in reducing rates of dementia. [ABSTRACT FROM AUTHOR]

Objective: This study examined whether metabolic health status is associated with risk of cancer mortality and whether this varies by body mass index (BMI) category.Methods: A prospective study of 22,514 participants from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort was performed. Metabolically unhealthy status was defined as having three or more of the following: (1) elevated fasting glucose, (2) high triglycerides, (3) dyslipidemia, (4) hypertension, and (5) elevated waist circumference. Participants were categorized into normal weight (BMI 18.5-24.9 kg/m2 ), overweight (BMI 25.0-29.9 kg/m2 ), and obesity (BMI ≥ 30 kg/m2 ) groups. Cox proportional hazards regression was performed to estimate hazards ratios (HRs) and 95% confidence intervals (CIs) for cancer mortality during follow-up.Results: Among participants with normal weight, participants who were metabolically unhealthy had an increased risk of cancer mortality (HR: 1.65; 95% CI: 1.20-2.26) compared with metabolically healthy participants. The overall mortality risk for participants who were metabolically unhealthy and had normal weight was stronger for obesity-related cancers (HR: 2.40; 95% CI: 1.17-4.91). Compared with participants with normal weight, those who were metabolically healthy and overweight were at a reduced risk of any cancer mortality (adjusted HR: 0.79; 95% CI: 0.63-0.99).Conclusions: There was an increased risk of overall and obesity-related cancer mortality among metabolically unhealthy participants with normal weight. [ABSTRACT FROM AUTHOR]

Marked racial differences exist in dietary patterns and obesity, as well as cancer mortality. This study aims to assess whether dietary patterns are associated with cancer mortality overall and by race. We identified 22,041 participants from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Dietary patterns were categorized into: Convenience (Chinese and Mexican foods, pasta, pizza), Plant-based (fruits, vegetables), Southern (added fats, fried foods, sugar-sweetened beverages), Sweets/Fats (sugary foods) and Alcohol/Salads (alcohol, green-leafy vegetables, salad dressing). Using Cox regression, we examined the association between quartiles of dietary patterns and cancer mortality, adjusted for potential confounders, overall among all participants and stratified by race. A total of 873 cancer deaths were observed over the 10-year observation period: 582 (66.7%) in Whites and 291 (33.3%) in Blacks. Greater adherence to the Southern dietary pattern was associated with an increased risk of cancer mortality (4th vs. 1st quartile HR: 1.67; 95% CI: 1.32-2.10) overall, especially among Whites (4th vs. 1st quartile HR: 1.59; 95% CI: 1.22-2.08). The convenience (HR: 0.73; 95% CI: 0.56-0.94) and Plant-based (HR: 0.72; 95% CI: 0.55-0.93) dietary patterns were associated with up to a 28% reduced risk of cancer mortality, but only among Whites. Greater adherence to the Southern dietary pattern increased the risk of cancer mortality, while greater adherence to the convenience and Plant-based diets reduced the risk of cancer mortality among Whites. Racial differences were observed in the association between dietary patterns and cancer mortality, but warrant further study. [ABSTRACT FROM AUTHOR]

Objective: State-level estimates of obesity based on self-reported height and weight suggest a geographic pattern of greater obesity in the Southeastern US; however, the reliability of the ranking among these estimates assumes errors in self-reporting of height and weight are unrelated to geographic region. Design and Methods: Regional and state-level prevalence of obesity (body mass index ≥ 30 kg m−2) for non-Hispanic black and white participants aged 45 and over were estimated from multiple sources: self-reported from the behavioral risk factor surveillance system (BRFSS 2003-2006) ( n = 677,425), self-reported and direct measures from the National Health and Nutrition Examination Study (NHANES 2003-2008) ( n = 6,615 and 6,138, respectively), and direct measures from the REasons for Geographic and Racial Differences in Stroke (REGARDS 2003-2007) study ( n = 30,239). Results: Data from BRFSS suggest that the highest prevalence of obesity is in the East South Central Census division; however, direct measures suggest higher prevalence in the West North Central and East North Central Census divisions. The regions relative ranking of obesity prevalence differs substantially between self-reported and directly measured height and weight. Conclusions: Geographic patterns in the prevalence of obesity based on self-reported height and weight may be misleading, and have implications for current policy proposals. [ABSTRACT FROM AUTHOR]

Objective: Examine whether long- and short-term sunlight radiation is related to stroke incidence. Methods: Fifteen-year residential histories merged with satellite, ground monitor, and model reanalysis data were used to determine sunlight radiation (insolation) and temperature exposure for a cohort of 16,606 stroke and coronary artery disease-free black and white participants aged ≥45 years from the 48 contiguous United States. Fifteen-, 10-, 5-, 2-, and 1-year exposures were used to predict stroke incidence during follow-up in Cox proportional hazard models. Potential confounders and mediators were included during model building. Results: Shorter exposure periods exhibited similar, but slightly stronger relationships than longer exposure periods. After adjustment for other covariates, the previous year's monthly average insolation exposure below the median gave a hazard ratio (HR) of 1.61 (95% confidence interval [CI], 1.15-2.26), and the previous year's highest compared to the second highest quartile of monthly average maximum temperature exposure gave an HR of 1.92 (95%, 1.27-2.92). Interpretation: These results indicate a relationship between lower levels of sunlight radiation and higher stroke incidence. The biological pathway of this relationship is not clear. Future research will show whether this finding stands, the pathway for this relationship, and whether it is due to short- or long-term exposures. ANN NEUROL 2013 [ABSTRACT FROM AUTHOR]

The article focuses on the study conducted to examine disparities in stroke incidence contributing to disparities in stroke mortality. It states that black-white and regional disparities of stroke mortality rates in the U.S. contributes the disparities in stroke incidence. It concludes that the national patterns of black-white and regional differences in stroke incidence and stroke mortality are similar.

Background Cystic fibrosis (CF) patients have chronic pancreatic insufficiency leading to malabsorption of fat-soluble vitamins, including vitamin D which can contribute to poor skeletal health and respiratory function. Objective This study evaluated the prevalence of vitamin D insufficiency and its impact on bone and respiratory health in adults with CF. Design and measurements This was a retrospective study in which data were collected from medical records over a 2-year period. Data included patient demographics, lung function, biochemical data, bone mineral densities, X-rays and ascertainment of use of vitamin supplements. Data were collected from medical records at a single accredited CF Center. Serum 25-hydroxyvitamin D [25(OH)D] levels and bone mineral density studies were also collected. Patients A total of 185 adults with CF were identified with a mean age of 29 ± 9 years. Results The prevalence of vitamin D insufficiency [25(OH)D < 75 nmol/l] was 76%. Mean serum 25(OH)D concentrations were 58·8 ± 30 nmol/l. Use of specific vitamin D supplementation was protective against vitamin D insufficiency whereas use of multivitamins was not. There was a small, but significant, positive association between serum 25(OH)D and FEV1 per cent predicted after controlling for age, gender, BMI and race ( R2 = 0·30, P < 0·001). A high prevalence (27%) of vertebral fractures was detected on lateral chest X-ray. Conclusions The prevalence of vitamin D insufficiency and poor skeletal health is high in the US CF population. Vitamin D status appears to be positively associated with lung function. Prospective studies to examine the impact of correction of vitamin D insufficiency on skeletal and lung health in adult CF are warranted. [ABSTRACT FROM AUTHOR]

The article presents a study on the association of ratio indices of anthropometric measures to obesity in a stunted population from Guatemala. Results showed that for all evaluated indices, the derived exponents differed with one and differed between men and women. It mentions that the derived indices were not merely strongly correlated with obesity than were simple unexponentiated ratios.

Background: It is unknown how blood pressure (BP) relates to stroke risk across levels of hypertension daily dose (HDD)-quantified antihypertensive medication intensity., Methods and Results: The REGARDS (Reasons for Geographic and Racial Differences in Stroke) study enrolled 30 239 participants from the 48 contiguous US states in 2003 to 2007 with in-person follow-up in 2013 to 2016 (Visit 2). We included those without prior stroke at Visit 2, treating this visit as T 0 . Biannual phone calls and medical record review ascertained incident stroke events. Cox proportional hazard models estimated the hazard ratio (HR) of incident stroke by treatment intensity defined by systolic BP stages and HDD groupings. There were 344 stroke events over a median 5.5 years. Relative to systolic BP <120 mm Hg and no antihypertensive medications, the stroke HR was 2.86 (95% CI, 1.68-4.85) for systolic BP 140 to 159 mm Hg and HDD tertile 2, 2.33 (1.37-3.97) for systolic BP 140 to 159 mm Hg and HDD tertile 3, 3.08 (1.20-7.88) for systolic BP ≥160 mm Hg and HDD tertile 2, and 3.66 (1.61-8.30) for systolic BP ≥160 mm Hg and HDD tertile 3. Stroke risk was similar across HDD levels for people with systolic BP <140 mm Hg., Conclusions: Among adults without prior stroke, systolic BP ≥140 mm Hg and HDD tertile ≥2 was associated with greater stroke risk. For adults with BP <140 mm Hg, stroke risk was similar despite cumulative dose of antihypertensive medications used. These findings support the practice of BP-lowering medications to mitigate stroke risk.