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1.  Dynamics of Constructs in Successful Aging of Korean Elderly: Modified Rowe and Kahn’s Model 
This study examined components in Rowe and Kahn’s successful aging model to investigate their hierarchical order and led to a modification of the previous hierarchical order.
To examine the hierarchical order of components, we constructed a structural equation model and verified those paths that have discrepancies in studies and/or potential inclusion or omission errors in the model. For this purpose, we analyzed 556 cases out of stratified and purposively sampled 600 elderly people living in the city of Jeonju during the study period (2011).
The paths with inclusion errors such as H3 [self-reported health → productive activity (SRH → PA)]: the effect of SRH on PA, and H6 [social network (SN) → PA]: the effect of SN on PA, were not directly but indirectly supported. The path with discrepancy, H4 [SN → physical–cognitive function (PCF)]: the effect of SN on PCFs, was statistically significant. The path with inclusion error and discrepancy, H8 (PCF → PA): the effect of PCF on PA, was not directly but indirectly supported. Also the path with the omission error, H2 [SRH → psychological trait (PT)]: the effect of SRH on PT, was statistically significant. The other paths in the hierarchical order of the model reported in previous studies were statistically significant.
We verified new dynamics of constructs involved in successful aging, which would provide better understanding of Rowe and Kahn’s successful aging model for Korean elderly people living in a medium-sized city.
PMCID: PMC3738711  PMID: 24159505
productive activity; physical–cognitive function; psychological trait; social network; self-reported health
2.  Prevalence of Successful Aging in the Elderly in Western Mexico 
Objectives. The aim of this paper is to estimate the prevalence of successful aging in the elderly in Western Mexico and to analyze its variability by age, sex, education, marital status, and pension. Methods. This study employs data from the Health, Wellbeing, and Aging Study (SABE) in Jalisco and Colima, Mexico. Successful aging was operationalized in accordance with no important disease, no disability, physical functioning, cognitive functioning, and being actively. There were a total of 3116 elderly. Results. 12.6% of older adults were “successful” aging. The old-old is a lower proportion of successful aging people; it ranges from 18.9% among people aged 60–69 years to 3.9% in the 80–89 years and up to 1% in people 90 and older. There were also differences according to sex (P = .000), with a higher proportion of successful aging men (18.4% compared with 9.2% of women). There were differences in educational level (P = .000); those higher with education were found to be more successful aging, and also there were differences in marital status for married people (P = .000). Discussion. A small number of older adults meet the criteria definition of successful aging, suggesting the need to analyze in depth the concept and the indicators.
PMCID: PMC3463158  PMID: 23049550
3.  Recent trends in chronic disease, impairment and disability among older adults in the United States 
BMC Geriatrics  2011;11:47.
To examine concurrent prevalence trends of chronic disease, impairment and disability among older adults.
We analyzed the 1998, 2004 and 2008 waves of the Health and Retirement Study, a nationally representative survey of older adults in the United States, and included 31,568 community dwelling adults aged 65 and over. Measurements include: prevalence of chronic diseases including hypertension, heart disease, stroke, diabetes, cancer, chronic lung disease and arthritis; prevalence of impairments, including impairments of cognition, vision, hearing, mobility, and urinary incontinence; prevalence of disability, including activities of daily living (ADLs) and instrumental activities of daily living (IADLs).
The proportion of older adults reporting no chronic disease decreased from 13.1% (95% Confidence Interval [CI], 12.4%-13.8%) in 1998 to 7.8% (95% CI, 7.2%-8.4%) in 2008, whereas the proportion reporting 1 or more chronic diseases increased from 86.9% (95% CI, 86.2%-89.6%) in 1998 to 92.2% (95% CI, 91.6%-92.8%) in 2008. In addition, the proportion reporting 4 or more diseases increased from 11.7% (95% CI, 11.0%-12.4%) in 1998 to 17.4% (95% CI, 16.6%-18.2%) in 2008. The proportion of older adults reporting no impairments was 47.3% (95% CI, 46.3%-48.4%) in 1998 and 44.4% (95% CI, 43.3%-45.5%) in 2008, whereas the proportion of respondents reporting 3 or more was 7.2% (95% CI, 6.7%-7.7%) in 1998 and 7.3% (95% CI, 6.8%-7.9%) in 2008. The proportion of older adults reporting any ADL or IADL disability was 26.3% (95% CI, 25.4%-27.2%) in 1998 and 25.4% (95% CI, 24.5%-26.3%) in 2008.
Multiple chronic disease is increasingly prevalent among older U.S. adults, whereas the prevalence of impairment and disability, while substantial, remain stable.
PMCID: PMC3170191  PMID: 21851629
chronic disease; impairment; disability; prevalence trends
4.  How “Successful” Do Older Europeans Age? Findings From SHARE 
We estimate comparable prevalence estimates of “successful aging” for 14 European countries and Israel, adding a new cross-nationally comparative perspective to recently published findings for the United States.
Measures for a variety of specific successful aging criteria were derived from baseline interviews of respondents aged 65+ who participated in the Survey of Health, Ageing, and Retirement in Europe (n = 21,493). A multivariate logistic model was run for our global successful aging measure.
Our analysis revealed substantial cross-country variation around a mean value of 8.5%: Although as many as 21.1% of older Danes meet our successful aging criteria, the respective proportion in Poland is only 1.6%. Age, gender, and socioeconomic status are shown to bear highly significant associations with individuals’ odds of successful aging.
The observed cross-national variation in successful aging—which continues to exist if population composition is controlled for—highlights the importance of taking into consideration structural factors at the societal level. It also suggests a potential for policy interventions supporting individuals’ opportunities for successful aging.
PMCID: PMC3041975  PMID: 21135069
Cross-national research; Population aging; SHARE; Successful aging
5.  Successful Aging in Older Adults with Schizophrenia: Prevalence and Associated Factors 
This study contrasts the prevalence of successful aging in older adults with schizophrenia with their age peers in the community, and examines variables associated with successful aging in the schizophrenia group.
The schizophrenia group consisted of 198 community-dwelling persons aged ≥55 years who developed schizophrenia before age 45. A community comparison group (N = 113) was recruited using randomly selected block-groups. The three objective criteria proposed by Rowe and Kahn were operationalized using a 6-item summed score. The association of 16 predictor variables with the successful aging score in the schizophrenia group was examined.
The community group had significantly higher successful aging scores than the schizophrenia group (4.3 vs. 3.0; t =8.36, df =309, p< .001). Nineteen percent of the community group met all 6 criteria on the Successful Aging Score versus 2% of the schizophrenia group. In regression analysis, only two variables –fewer negative symptoms and a higher quality of life index—were associated with the successful aging score within the schizophrenia group.
Older adults with schizophrenia rarely achieve successful aging, and do so much less commonly than their age peers. Only two significant variables were associated with successful aging, neither of which are easily remediable. The elements that comprise the components of successful aging, especially physical health, may be better targets for intervention.
PMCID: PMC2946512  PMID: 20808093
successful aging; social integration; schizophrenia
6.  Trends in ADL and IADL Disability in Community-Dwelling Older Adults in Shanghai, China, 1998–2008 
We investigated trends in activities of daily living (ADL) and instrumental activities of daily living (IADL) disability from 1998 to 2008 among elder adults in Shanghai, China.
Our data came from 4 waves of the Shanghai Longitudinal Survey of Elderly Life and Opinion (1998, 2003, 2005, and 2008). ADL and IADL disabilities were recorded dichotomously (difficulty vs. no difficulty). The major independent variable was survey year. Covariates included demographics, socioeconomic conditions, family and social support, and other health conditions. Nested random-effect models were applied to estimate trends over time, referenced to 1998.
In comparison with the baseline year (1998), older adults in 2008 had lower odds of being ADL disabled, though the effect was no longer statistically significant when other health conditions were taken into account. Elders in 2003, 2005, and 2008 were 20%–26%, 17%–38%, and 53%–64% less likely to be IADL disabled than those in 1998, respectively, depending on the set of covariates included in the model.
Shanghai elders experienced substantial improvements in both ADL and IADL disability prevalence over the past decade. The trend toward improvement in IADL function is more consistent and substantial than that of ADL function.
PMCID: PMC3627657  PMID: 23525547
Activity of daily living (ADL); Disability trend; Instrumental activity of daily living (IADL); Shanghai; China.
7.  Incidence of Self-Reported Diabetes in New York City, 2002, 2004, and 2008 
Prevalence and incidence of diabetes among adults are increasing in the United States. The purpose of this study was to estimate the incidence of self-reported diabetes in New York City, examine factors associated with diabetes incidence, and estimate changes in the incidence over time.
We used data from the New York City Community Health Survey in 2002, 2004, and 2008 to estimate the age-adjusted incidence of self-reported diabetes among 24,384 adults aged 18 years or older. Multiple logistic regression analysis was performed to examine factors associated with incident diabetes.
Survey results indicated that the age-adjusted incidence of diabetes per 1,000 population was 9.4 in 2002, 11.9 in 2004, and 8.6 in 2008. In multivariable-adjusted analysis, diabetes incidence was significantly associated with being aged 45 or older, being black or Hispanic, being overweight or obese, and having less than a high school diploma.
Our results suggest that the incidence of diabetes in New York City may be stabilizing. Age, black race, Hispanic ethnicity, elevated body mass index, and low educational attainment are risk factors for diabetes. Large-scale implementation of prevention efforts addressing obesity and sedentary lifestyle and targeting racial/ethnic minority groups and those with low educational attainment are essential to control diabetes in New York City.
PMCID: PMC3457762  PMID: 22698175
8.  Memory Decline and Depressive Symptoms in a Nationally Representative Sample of Older Adults: The Health and Retirement Study (1998–2004) 
Inconsistencies in the relationship between depression and cognitive decline may exist because the expected cognitive domains at-risk have not been specified in previous study designs.
To examine the relationship between depressive symptoms and verbal episodic memory functioning over time.
Prospective cohort study (Health and Retirement Study HRS; 1998–2004), a multistage probability sample of adults 51 years and over in 1998, was analyzed.
Contiguous 48 United States
Nationally representative sample of older adults (51+ years) in 1998 (N=18,465)
Main Outcomes
Verbal learning and memory of a ten-word list learning task.
Main Predictor
Depressive symptoms (Center for Epidemiologic Studies—Depression Scale; (CES-D)
Depressive symptoms were associated with significantly lower Immediate (−0.05; p<0.001) and Delayed (−0.06; p<0.001) word list recall scores after controlling for demographics and baseline and time-varying cardiovascular disease risks and diseases.
In this U.S. national study of older adults, elevated depressive symptoms were associated with declines in episodic learning and memory over time. These associations were little affected by demographic or medical conditions considered in this study. The results suggest that learning and memory decline may be a long-term feature associated with depressive symptoms among the nation’s older adult population.
PMCID: PMC2292399  PMID: 18270489
depression; cognitive decline; older adults; learning; memory
9.  Changes in the Prevalence of Cognitive Impairment Among Older Americans, 1993–2004: Overall Trends and Differences by Race/Ethnicity 
American Journal of Epidemiology  2011;174(3):274-283.
The authors used data from 6 waves of the Health and Retirement Study to evaluate changes in the prevalence of cognitive impairment among adults 70 years of age or older from 1993 to 2004. Having sampling weights for each wave enabled the authors to create merged waves that represented cross-sections of the community-dwelling older population for that year. Logistic regression analyses with year as the predictor were used to estimate trends and determine the contribution of sociodemographic and health status variables to decreasing trends in the prevalence of cognitive impairment over time (score ≤8 on a modified Telephone Interview Cognitive Screen). Results showed an annual decline in the prevalence of cognitive impairment of 3.4% after adjustment for age, gender, and prior test exposure (odds ratio (OR) = 0.966, 95% confidence interval (CI): 0.941, 0.992). The addition of socioeconomic variables to the model attenuated the trend by 72.1%. The annual percentage of decline in impairment was larger for blacks (OR = 0.943, 95% CI: 0.914, 0.973) and Hispanics (OR = 0.954, 95% CI: 0.912, 0.997) than for whites (OR = 0.971, 95% CI: 0.936, 1.006), although the differences were not statistically significant. Linear probability models used in secondary analyses showed larger percentage-point declines for blacks and Hispanics. Improvements in educational level contributed to declines in cognitive impairment among older adults—particularly blacks and Hispanics—in the United States.
PMCID: PMC3202156  PMID: 21622948
African Americans; aged; aged, 80 and over; cognition disorders; health status disparities; Hispanic Americans; prevalence; socioeconomic factors
10.  The Prevalence of Cognitive Impairment in Older Adults with Heart Failure 
Our understanding of the prevalence of cognitive impairment (CI) in older adults with heart failure (HF) in a nationally-representative sample is limited.
We used a national probability sample to determine the prevalence of CI in older adults with HF.
Cross-sectional analysis of the 2004 wave of the nationally representative Health and Retirement Study linked to 2002–04 Medicare administrative claims
United States, community-dwelling
6,189 respondents ≥ 67 years old.
An algorithm was developed using a combination of self- and proxy-report of a heart problem and the presence of ≥ 1 Medicare claim in administrative files using standard HF diagnostic codes. On the basis of the algorithm, 3 categories were created to characterize the likelihood of a HF diagnosis: 1) High or Moderate Probability of HF; 2) Low Probability of HF; and 3) Not a HF case. Cognitive function was assessed using a screening measure of cognitive function or by proxy rating. Age-adjusted prevalence estimates of CI were calculated for the high-moderate probability HF group, the low probability HF group, and the non-HF cases.
The prevalence of CI consistent with dementia in older adults with HF was 15%; while the prevalence of mild CI was 24%. The odds of dementiain those with HF was significantly increased, even after adjustment for age, education level, net worth and prior stroke (OR: 1.52; 95% CI: 1.14 – 2.02).
CI is common in older adults with HF and is independently associated with an increased risk for dementia. A cognitive assessment should be routinely incorporated into HF-focused models of care.
PMCID: PMC3445700  PMID: 22882000
Heart failure; aged; cognitive impairment; Medicare claims data
11.  Trends in the Prevalence and Mortality of Cognitive Impairment in the United States: Is There Evidence of a Compression of Cognitive Morbidity? 
Recent medical, demographic, and social trends may have had an important impact on the cognitive health of older adults. To assess the impact of these multiple trends, we compared the prevalence and 2-year mortality of cognitive impairment (CI) consistent with dementia in the United States in 1993-1995 and 2002-2004.
We used data are from the Health and Retirement Study (HRS), a nationally representative population-based longitudinal survey of U.S. adults. Individuals aged 70 or older from the 1993 (N=7,406) and 2002 (N=7,104) waves of the HRS were included. CI was determined using a 35-point cognitive scale for self-respondents, and assessments of memory and judgment for respondents represented by a proxy. Mortality was ascertained using HRS data verified by the National Death Index.
12.2% of those aged 70 or older in 1993 had CI compared to 8.7% in 2002 (P<.001). CI was associated with a significantly higher risk of 2-year mortality in both years. The risk of death for those with moderate / severe CI was greater in 2002 compared to 1993 (unadjusted hazard ratio [HR] 4.12 in 2002 vs. 3.36 in 1993 [P=.08]; age- and sex- adjusted HR 3.11 in 2002 vs. 2.53 in 1993 [P=.09]). Education was protective against CI, but among those with CI, more education was associated with higher 2-year mortality.
These findings suggest a compression of cognitive morbidity between 1993 and 2004, with fewer older Americans reaching a threshold of significant CI, and a more rapid decline to death among those who did. Societal investment in building and maintaining cognitive reserve through formal education in childhood, and continued cognitive stimulation during work and leisure in adulthood, may help limit the burden of dementia among the growing number of older adults worldwide.
PMCID: PMC2390845  PMID: 18631957
12.  Partner Caregiving in Older Cohabiting Couples 
Despite the rapidly increasing prevalence of cohabitation among older adults, the caregiving literature has exclusively focused on formally married individuals. Extending prior work on intra-couple care, this study contrasts frail cohabitors’ patterns of care receipt from a partner to that of frail spouses.
Using nationally representative panel data from the Health and Retirement Study (2000, 2002, 2004, and 2006), we estimate random effects cross-sectional times series models predicting frail cohabitors’ likelihood of receiving partner care compared with their married counterparts’. Conditional on the receipt of intra-couple care, we also examine differences in marital and nonmarital partners’ caregiving hours and caregiving involvement relative to other helpers.
Net of sociodemographic, disability, and comorbidity factors, we find that cohabitors are less likely to receive partner care than married individuals. However, caregiving nonmarital partners provide as many hours of care as spouses while providing a substantially larger share of disabled respondents’ care than marital partners.
Cohabitation and marriage have distinct implications for older adults’ patterns of partner care receipt. This study adds weight to a growing body of research emphasizing the importance of accounting for older adults’ nontraditional union forms and of examining the ramifications of cohabitation for older adults’ well-being.
PMCID: PMC3078761  PMID: 21482588
Caregiving; Disability; Intra-couple care; Older cohabitors
13.  Use of Other Tobacco Products among U.S. Adult Cigarette Smokers: Prevalence, Trends and Correlates 
Addictive behaviors  2007;33(3):472-489.
This paper examines the trends in concurrent use of cigarettes and other tobacco and sociodemographic variables associated with concurrent use among adult cigarette smokers in the United States. Data from the 1995/96, 1998, 2000, and 2001/02 Tobacco Use Supplements to the Current Population Survey were used to estimate concurrent use of tobacco among cigarette smokers among adults ages 18 years and older (n for all 4 survey groups = 552,804). Concurrent use of tobacco fluctuated over the survey periods for current smokers and ranged from 3.7% in 1995/96 to 7.9% in 1998. Results from the multivariate logistic regression indicate that male current, daily, and intermittent smokers had substantially higher odds of concurrent use (OR = 12.9, 11.7, 17.2, respectively) than their female counterparts. Age, race/ethnicity, geographic region, income, and survey years were significantly associated with concurrent use among current and daily smokers; for intermittent smokers, these variables and occupation were significantly associated with concurrent use. The strongest correlates for multiple tobacco use among cigarettes smokers were being male and Non-Hispanic White. These factors should be considered when planning tobacco prevention and control efforts. In addition, surveillance efforts should continue to monitor changes in concurrent use and further investigate the increased risk of cancer among smokers who also use other forms of tobacco.
PMCID: PMC2277213  PMID: 18053653
cigarette smokers; multiple tobacco use cigar; pipe; snuff; chewing tobacco; trends
14.  Trends in adult current asthma prevalence and contributing risk factors in the United States by state: 2000–2009 
BMC Public Health  2013;13:1156.
Current asthma prevalence among adults in the United States has reached historically high levels. Although national-level estimates indicate that asthma prevalence among adults increased by 33% from 2000 to 2009, state-specific temporal trends of current asthma prevalence and their contributing risk factors have not been explored.
We used 2000–2009 Behavioral Risk Factor Surveillance System data from all 50 states and the District of Columbia (D.C.) to estimate state-specific current asthma prevalence by 2-year periods (2000–2001, 2002–2003, 2004–2005, 2006–2007, 2008–2009). We fitted a series of four logistic-regression models for each state to evaluate whether there was a statistically significant linear change in the current asthma prevalence over time, accounting for sociodemographic factors, smoking status, and weight status (using body mass index as the indicator).
During 2000–2009, current asthma prevalence increased in all 50 states and D.C., with significant increases in 46/50 (92%) states and D.C. After accounting for weight status in the model series with sociodemographic factors, and smoking status, 10 states (AR, AZ, IA, IL, KS, ME, MT, UT, WV, and WY) that had previously shown a significant increase did not show a significant increase in current asthma prevalence.
There was a significant increasing trend in state-specific current asthma prevalence among adults from 2000 to 2009 in most states in the United States. Obesity prevalence appears to contribute to increased current asthma prevalence in some states.
PMCID: PMC3878893  PMID: 24325173
Current asthma; Smoking; Obesity; Trend; The United States
15.  Prevalence of Cognitive Impairment without Dementia in the United States 
Annals of internal medicine  2008;148(6):427-434.
Cognitive impairment without dementia is associated with increased risk for disability, increased health care costs, and progression to dementia. There are no population-based prevalence estimates of this condition in the United States.
To estimate the prevalence of cognitive impairment without dementia in the United States and determine longitudinal cognitive and mortality outcomes.
Longitudinal study from July 2001 to March 2005.
In-home assessment for cognitive impairment.
Participants in ADAMS (Aging, Demographics, and Memory Study) who were age 71 years or older drawn from the nationally representative HRS (Health and Retirement Study). Of 1770 selected individuals, 856 completed initial assessment, and of 241 selected individuals, 180 completed 16- to 18-month follow-up assessment.
Assessments, including neuropsychological testing, neurologic examination, and clinical and medical history, were used to assign a diagnosis of normal cognition, cognitive impairment without dementia, or dementia. National prevalence rates were estimated by using a population-weighted sample.
In 2002, an estimated 5.4 million people (22.2%) in the United States age 71 years or older had cognitive impairment without dementia. Prominent subtypes included prodromal Alzheimer disease (8.2%) and cerebrovascular disease (5.7%). Among participants who completed follow-up assessments, 11.7% with cognitive impairment without dementia progressed to dementia annually, whereas those with subtypes of prodromal Alzheimer disease and stroke progressed at annual rates of 17% to 20%. The annual death rate was 8% among those with cognitive impairment without dementia and almost 15% among those with cognitive impairment due to medical conditions.
Only 56% of the nondeceased target sample completed the initial assessment. Population sampling weights were derived to adjust for at least some of the potential bias due to nonresponse and attrition.
Cognitive impairment without dementia is more prevalent in the United States than dementia, and its subtypes vary in prevalence and outcomes.
PMCID: PMC2670458  PMID: 18347351
16.  Socioeconomic inequality in domains of health: results from the World Health Surveys 
BMC Public Health  2012;12:198.
In all countries people of lower socioeconomic status evaluate their health more poorly. Yet in reporting overall health, individuals consider multiple domains that comprise their perceived health state. Considered alone, overall measures of self-reported health mask differences in the domains of health. The aim of this study is to compare and assess socioeconomic inequalities in each of the individual health domains and in a separate measure of overall health.
Data on 247,037 adults aged 18 or older were analyzed from 57 countries, drawn from all national income groups, participating in the World Health Survey 2002-2004. The analysis was repeated for lower- and higher-income countries. Prevalence estimates of poor self-rated health (SRH) were calculated for each domain and for overall health according to wealth quintiles and education levels. Relative socioeconomic inequalities in SRH were measured for each of the eight health domains and for overall health, according to wealth quintiles and education levels, using the relative index of inequality (RII). A RII value greater than one indicated greater prevalence of self-reported poor health among populations of lower socioeconomic status, called pro-rich inequality.
There was a descending gradient in the prevalence of poor health, moving from the poorest wealth quintile to the richest, and moving from the lowest to the highest educated groups. Inequalities which favor groups who are advantaged either with respect to wealth or education, were consistently statistically significant in each of the individual domains of health, and in health overall. However the size of these inequalities differed between health domains. The prevalence of reporting poor health was higher in the lower-income country group. Relative socioeconomic inequalities in the health domains and overall health were higher in the higher-income country group than the lower-income country group.
Using a common measurement approach, inequalities in health, favoring the rich and the educated, were evident in overall health as well as in every health domain. Existent differences in averages and inequalities in health domains suggest that monitoring should not be limited only to overall health. This study carries important messages for policy-making in regard to tackling inequalities in specific domains of health. Targeting interventions towards individual domains of health such as mobility, self-care and vision, ought to be considered besides improving overall health.
PMCID: PMC3364884  PMID: 22429978
17.  Physical Disability Trajectories in Older Americans With and Without Diabetes: The Role of Age, Gender, Race or ethnicity, and Education 
The Gerontologist  2010;51(1):51-63.
Purpose: This research combined cross-sectional and longitudinal data to characterize age-related trajectories in physical disability for adults with and without diabetes in the United States and to investigate if those patterns differ by age, gender, race or ethnicity, and education. Design and Methods: Data were examined on 20,433 adults aged 51 and older from the 1998 to 2006 Health and Retirement Study. Multilevel models and a cohort-sequential design were applied to quantitatively depict the age norm of physical disability after age 50. Results: Adults with diabetes not only experience greater levels of physical disability but also faster rates of deterioration over time. This pattern is net of attrition, time-invariant sociodemographic factors, and time-varying chronic disease conditions. Differences in physical disability between adults with and without diabetes were more pronounced in women, non-White, and those of lower education. The moderating effects of gender and education remained robust even after controlling for selected covariates in the model. Implications: This study highlighted the consistently greater development of disability over time in adults with diabetes and particularly in those who are women, non-White, or adults of lower education. Future studies are recommended to examine the mechanisms underlying the differential effects of diabetes on physical disability by gender and education.
PMCID: PMC3018868  PMID: 20713455
Cohort-sequential design (accelerated longitudinal design); Multilevel model (hierarchical linear model); Disablement process model; Life course; Health and retirement study (HRS)
PMCID: PMC1657332  PMID: 18741269
23.  Kahn Test Difficulties 
British Medical Journal  1950;1(4663):1205.
PMCID: PMC2037793
24.  Comparison of the Wassermann and Kahn Reactions 
British Medical Journal  1950;1(4652):524.
PMCID: PMC2037324  PMID: 20787768

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