Fredric D Wolinsky1, Padmaja Ayyagari2, Theodore K Malmstrom3, J Phillip Miller4, Elena M Andresen5, Mario Schootman6, Douglas K Miller7. 1. Department of Health Management and Policy, College of Public Health, The University of Iowa. fredric-wolinsky@uiowa.edu. 2. Department of Health Management and Policy, College of Public Health, The University of Iowa. 3. Department of Neurology & Psychiatry, School of Medicine, Saint Louis University, Missouri. 4. Department of Biostatistics, Washington University in St. Louis, Missouri. 5. Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland. 6. Department of Epidemiology, School of Public Health, Saint Louis University, Missouri. 7. Center for Aging Research, Indiana University & the Regenstrief Institute, Indianapolis.
Abstract
BACKGROUND: We addressed two understudied issues in estimating lower extremity functional trajectories in older adults-incorporating the effect of mortality and evaluating heterogeneity among African Americans. METHODS: Data were taken from the 998 participants in the African American Health cohort. A highly reliable and valid 8-item lower extremity function scale was used at baseline and at the 1-, 2-, 3-, 4-, 7-, and 9-year follow-up interviews. Semiparametric (ie, discrete) group-based mixture modeling identified the trajectories, and multinomial logistic regression identified risk factors for differential trajectory groups. RESULTS: When treating mortality as informative censoring, six discrete trajectories were observed with 45% of the participants belonging to three stable trajectories (good, fair, or poor function), and the remainder belonging to three declining trajectories (very high function with minimal improvement then minimal decline, very good function with a slow and modest decline, and very good function with a large and quick decline). CONCLUSION: Substantial heterogeneity in lower extremity function trajectories exists in the African American Health cohort, after appropriately treating mortality as informative censoring.
BACKGROUND: We addressed two understudied issues in estimating lower extremity functional trajectories in older adults-incorporating the effect of mortality and evaluating heterogeneity among African Americans. METHODS: Data were taken from the 998 participants in the African American Health cohort. A highly reliable and valid 8-item lower extremity function scale was used at baseline and at the 1-, 2-, 3-, 4-, 7-, and 9-year follow-up interviews. Semiparametric (ie, discrete) group-based mixture modeling identified the trajectories, and multinomial logistic regression identified risk factors for differential trajectory groups. RESULTS: When treating mortality as informative censoring, six discrete trajectories were observed with 45% of the participants belonging to three stable trajectories (good, fair, or poor function), and the remainder belonging to three declining trajectories (very high function with minimal improvement then minimal decline, very good function with a slow and modest decline, and very good function with a large and quick decline). CONCLUSION: Substantial heterogeneity in lower extremity function trajectories exists in the African American Health cohort, after appropriately treating mortality as informative censoring.
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