Estimating Dementia from Self-Reports of Diagnoses Among Adults Aged 65 and Over: United States, 2019

Prior research shows that, overall, about 10% of the population aged 65 and over in the U.S. has dementia. Estimating the prevalence of dementia from nationally representative surveys can be accomplished by asking respondents about a diagnosis, by administering a cognitive assessment, or, if available, by examining linked medical claims data. In 2019 for the first time, the National Health Interview Survey (NHIS) added “dementia, including Alzheimer’s disease” to the questions asking about doctor-diagnosed health conditions. Although estimates derived from doctor-diagnosed questions usually underestimate the true prevalence of a condition, and estimating dementia from self-reports presents additional challenges, they are still useful for many surveillance and research objectives. Early diagnosis of dementia is encouraged to allow patients and their families to plan for future needs. The objective of this research is to describe the noninstitutionalized population aged 65 and over who have a dementia diagnosis, by selected socio-demographic, health, and healthcare utilization characteristics. Point estimates, standard errors, and 95% confidence intervals for percentages are calculated using NHIS adult sample weights and adjusted for the complex sample design of NHIS. Preliminary analyses show that, overall, 4% of the 65 and over noninstitutionalized population has a diagnosis of dementia. About 8% of respondents with less than a high school education reported a dementia diagnosis compared with 2% of those with more than a high school education. Those with a dementia diagnosis were more likely to report depression than those without a dementia diagnosis (44% vs. 14%).

Measuring Childlessness Among Middle-Aged and Older Americans

Existing literature on childlessness among middle-aged and older Americans is sparse, and measuring childlessness is not straightforward for those with complex family histories. To address this knowledge gap, we examined data on 19,929 respondents age ≥50 from the 2016 Health and Retirement Study. All analyses accounted for complex sample design to generate nationally representative estimates. The proportion of respondents without children differed significantly depending on how “childless” was defined: 1) 14.9% (95% confidence interval [CI]: 13.9-15.9%) having no biological children, versus 2) 10.4% (95% CI: 9.5-11.3%) having no children/step-children that were living and in-contact. When measured based on absence of biological children, the prevalence of childlessness was higher in younger cohorts (17.7%, 13.2%, and 9.0% for age 50-64, 65-74, and ≥75 years, respectively, p<0.001) and among more educated individuals (17.4%, 12.3%, and 9.6% for more than high school, high school, and less than high school education, respectively, p<0.001). The prevalence of childlessness was also higher among men (16.7%) than women (13.2%) (p<0.001) and among non-Hispanic whites (16.0%) than Hispanics (9.8%) (p<0.001). Similar patterns, but lower prevalence, were observed when measuring childlessness based on absence of children/step-children that were living and in-contact. Although non-Hispanic whites (16.0%) were more likely than non-Hispanic blacks (13.0%) to have no biological children (p=0.007), a similar proportion of them had no children/step-children that were living and in-contact (10.8% versus 10.6%, p=0.06). Given fertility decline and growing family complexity, these findings help inform the structure of social support and long-term care needs of middle-aged and older Americans.

Contribution of Dairy Foods to Energy and Nutrient Intake in Infants’ and Toddlers’ Diets, 4–23 Months of Age: An Analysis of NHANES 2013–2016 Data

Objectives The objective of this study was to determine the contribution of total dairy, milk, cheese, and yogurt to energy and nutrient intake in infants’ and toddlers’ diets, age 4–23 months, using the most recent data from the National Health and Nutrition Examination Survey (NHANES) 2013–2016. Methods Data from NHANES 2013–2014 and 2015–2016 for subjects 4 months to less than 24 months of age was used with exclusions for consumers of human milk and those with incomplete data. Nutrient intakes from total dairy, milk (milk, flavored milk, dairy drinks, and substitutes), cheese, and yogurt were determined using the USDA databases. Separate analyses were done for age groups: 4–6 months (n = 136), 7–11 months (n = 226), 12–17 months (n = 200) and 18–23 months (n = 196) after adjusting for complex sample design of NHANES. Results Conclusions Contribution of dairy foods for energy and most nutrients was 1% or less for infants 4–6 months, 16% or less for ages 7–11months and more than 25% for age 12–17 months and 18–23 months; and milk was always the main contributor of energy and most nutrients. Funding Sources National Dairy Council.

Effects of Physical Activity on the Stress and Suicidal Ideation in Korean Adult Women with Depressive Disorder

Depressive disorder is common in many adult women in the world. It was found that depressive disorder was related to stress and suicidal ideation in Korean adult women with depressive disorder. Physical activities were effective to solve this mental disorder. Thus, the purpose of the study was to investigate the effects of physical activity (PA) on the stress and suicidal ideation of Korean adult women with depressive disorder. A sample of 1315 Korean adult women who have depressive disorder was collected, and the Korea National Health and Nutrition Examination Survey (KNHANES) was used to determine this purpose of the study. The complex samples in frequency analysis were used to identify the characteristics of the participants. The logistic regression in the complex sample design was conducted to investigate the effects of PA on the stress and suicidal ideation in Korean adult women with depressive disorder. The effects of flexibility exercise on the stress in Korean adult women with depressive disorder showed the odds ratio (OR) value of 1.434 (OR = 1.434, 95% CI = 1.043–1.973, p < 0.05). The effects of flexibility exercise on the suicidal ideation in Korean adult women with depressive disorder presented the OR value of 0.682 (OR = 0.682, 95% CI = 0.496–0.937, p < 0.05). Based on the results, the participants who did flexibility exercises were likely to have less stress and suicidal ideation than the Korean adult women with depressive disorder who did not participate in flexibility exercise. In conclusion, the flexibility exercise has played an important role in reducing and preventing stress and suicidal ideation in Korean adult women with depressive disorder.

The Utilization of Long-Acting Reversible Contraception and Associated Factors Among Women in Indonesia

Long-acting reversible contraceptives (LARCs), consist of IUD and implats, were effective and efficient methods in preventing the pregnancy. However, the used of these methods in Indonesia was still low. This study sought to explore LARC utilization trends and the factors influencing LARC used among reproductive women in Indonesia. This research analyzed data from the Indonesia Demographic and Health Survey 2017. Respondents in this study were women who currently used modern contraceptive methods. A total of 20,409 women who used modern methods were included in the analysis. Descriptive analysis was performed using chi-square and percentages. Logistic regression with complex sample design was used to determine the associated factors in LARC utilization. Among women in reproductive age who currently used modern contraception, IUDs and implants were viewed particularly unfavorably which only 16.5% of women used LARC. Findings highlighted that higher LARC use among reproductive age women in Indonesia correlated with higher parity, older women, higher education, working women, desire to limit the pregnancy in the future and more visited by fieldworkers in the last 12 months. This study underscored that even though only 4% of respondents were visited by fieldworkers, the utilize of LARC was higher among women who visited by fieldworkers. This study suggests that communication skills among fieldworker need to be enhanced to do counselling and work closely with the community member.

CHARACTERISTICS AND LIVING ARRANGEMENTS OF CHILDLESS ELDERLY AMERICANS

Despite a growing number of Americans without children, information on characteristics of childless older adults and their living arrangements is sparse and often outdated. To address this knowledge gap, we examined data from the 2014 Health and Retirement Study (HRS) on childless Americans age ≥65 years (N=760) and compared with childless elders in 2004 HRS (N=830). All analyses accounted for complex sample design of HRS to generate nationally representative estimates. The proportion of elderly Americans without any living biological or step children increased from 8.1% in 2004 to 9.4% in 2014. Compared to childless elders in 2004, those in 2014 were younger (mean age=76.8 years versus 73.8 years, p&lt;0.01) with a higher proportion completing college education (20.7% versus 37.5%, p&lt;0.01) or were cognitively intact (64.6% versus 73.6%, p&lt;0.01). However, childless elders in 2014 had more chronic conditions than those in 2004 (mean=2.5 versus 2.3, p&lt;0.01). The proportion of childless elders living independently (alone or with a spouse) (81.6% in 2004 versus 82.6% in 2014) or living with others (10.0% in 2004 versus 13.5% in 2014) remained relatively stable, whereas the proportion living in nursing homes declined significantly from 8.4% in 2004 to 4.0% in 2014 (adjusted odds ratio [OR]=0.07, p&lt;0.01). A sensitivity analysis limited to childless elders without biological children showed that they accounted for 9.9% of the elderly population in 2004 versus 11.9% in 2014, while other results were generally similar. These findings can help inform long term care needs of childless elders.

kg_nchs: A command for Korn–Graubard confidence intervals and National Center for Health Statistics’ Data Presentation Standards for Proportions

In August 2017, the National Center for Health Statistics (NCHS), part of the U.S. Federal Statistical System, published new standards for determining the reliability of proportions estimated using their data. These standards require one to take the Korn–Graubard confidence interval (CI), CI widths, sample size, and degrees of freedom to assess reliability of a proportion and determine whether it can be presented. The assessment itself involves determining whether several conditions are met. In this article, I present kg_nchs, a postestimation command that is used following svy: proportion. It allows Stata users to a) calculate the Korn–Graubard CI and associated statistics used in applying the NCHS presentation standards for proportions and b) display a series of three dichotomous flags that show whether the standards are met. I provide empirical examples to show how kg_nchs can be used to easily apply the standards and prevent Stata users from needing to perform manual calculations. While developed for NCHS survey data, this command can also be used with data that stem from any survey with a complex sample design.

How to use replicate weights in health survey analysis using the National Nutrition and Physical Activity Survey as an example

Objective:To conduct nutrition-related analyses on large-scale health surveys, two aspects of the survey must be incorporated into the analysis: the sampling weights and the sample design; a practice which is not always observed. The present paper compares three analyses: (1) unweighted; (2) weighted but not accounting for the complex sample design; and (3) weighted and accounting for the complex design using replicate weights.Design:Descriptive statistics are computed and a logistic regression investigation of being overweight/obese is conducted using Stata.Setting:Cross-sectional health survey with complex sample design where replicate weights are supplied rather than the variables containing sample design information.Participants:Responding adults from the National Nutrition and Physical Activity Survey (NNPAS) part of the Australian Health Survey (2011–2013).Results:Unweighted analysis produces biased estimates and incorrect estimates of se. Adjusting for the sampling weights gives unbiased estimates but incorrect se estimates. Incorporating both the sampling weights and the sample design results in unbiased estimates and the correct se estimates. This can affect interpretation; for example, the incorrect estimate of the OR for being a current smoker in the unweighted analysis was 1·20 (95 % CI 1·06, 1·37), t= 2·89, P = 0·004, suggesting a statistically significant relationship with being overweight/obese. When the sampling weights and complex sample design are correctly incorporated, the results are no longer statistically significant: OR = 1·06 (95 % CI 0·89, 1·27), t = 0·71, P = 0·480.Conclusions:Correct incorporation of the sampling weights and sample design is crucial for valid inference from survey data.

A Permutation Test on Complex Sample Data

Permutation tests are a distribution-free way of performing hypothesis tests. These tests rely on the condition that the observed data are exchangeable among the groups being tested under the null hypothesis. This assumption is easily satisfied for data obtained from a simple random sample or a controlled study after simple adjustments to the data, but there is no general method for adjusting survey data collected using a complex sample design to allow for permutation tests. In this article, we propose a general method for performing a pseudo-permutation test that accounts for the complex sample design. The proposed method is not a true permutation test in that the new values do not come from the set of observed values in general but of an expanded set of values satisfying a random-effects model on the clustered residuals of a design-consistent estimating equation. We provide a set of conditions under which this procedure leads to consistent test results. Tests using a simulated population and an application analyzing US Bureau of Labor Statistics consumer expenditure data comparing the performance of the proposed method to permutation tests that ignore the sample design demonstrate that it is necessary to account for the design features in order to obtain reasonable p value estimates.

Caries prevalence among Brazilian indigenous population of urban areas based on the 2010 National Oral Health Survey

It is important to have an epidemiological understanding of oral diseases among indigenous persons, in order to contribute with the organization of health services for these populations. The SB Brasil 2010 database was used to compare the prevalence of dental caries among 308 self-identified indigenous and 37,211 non-indigenous individuals from urban areas, in the following age/age-groups: 5, 12, 15-19, 35-44, 65-74. The study also analyzed the effect of the complex sample design and the sample weight in the outcomes. Kruskal-Wallis, Wilcoxon Scores (Rank Sums), logistic and multiple linear regressions were used for statistical analysis. The mean dmft index for indigenous and non-indigenous children aged five were 4.02 ± 4.01 and 2.41 ± 3.35, respectively, and 46% of non-native and 30.8% of native children were caries-free. The mean DMFT for indigenous and non-indigenous were 10.90 ± 11.69 and 10.93 ± 11.58, respectively, for all age groups when not taking into account the sample weight effect. When considering the complex sample design and the sample weight effect, the study found a statistical significant difference. The results lend credence to suspicions that in Brazil there are disparities in the patterns of caries between self-identified indigenous and non-indigenous individuals.