Estimating dementia prevalence using remote diagnoses and algorithmic modelling: a population-based study of a rural region in South Africa.

Background: Dementia is a leading cause of global death and disability. High-quality data describing dementia prevalence and burden remain scarce in sub-Saharan Africa. Health and Aging in Africa: A Longitudinal Study in South Africa (HAALSI) fills evidence gaps with longitudinal data on cognition, biomarkers, and everyday function in a population-based cohort of Black South Africans, aged 40 years and older, in a rural subdistrict.

Mid-life employment trajectories and subsequent memory function and rate of decline in rural South Africa, 2000-22.

Aim: To investigate mid-life employment trajectories in relation to later-life memory function and rate of decline in rural South Africa.

Methods: Data from the Agincourt Health and Socio-Demographic Surveillance System were linked to the 'Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa' (HAALSI) in rural Agincourt, South Africa (N = 3133). Employment was assessed every 4 years over 2000-12 as being employed (0, 1, 2 and ≥3 time points), being employed in a higher-skill occupation (0, 1, 2 and ≥3 time points) and dynamic employment trajectories identified using sequence analysis.

Associations between cohort derived dementia and COVID-19 serological diagnosis among older Black adults in rural South Africa.

Objectives: This study investigates the association between cohort derived dementia and serologically confirmed SARS-CoV-2 infection, an underexplored phenomena in low-and middle-income countries. Examining this relationship in a rural South African community setting offers insights applicable to broader healthcare contexts.

Methods: Data were collected from Black South Africans in the Mpumalanga province who participated in the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa.

The Effect of Family Wealth on Physical Function Among Older Adults in Mpumalanga, South Africa: A Causal Network Analysis.

The aging of the South African population could have profound implications for the independence and overall quality of life of older adults as life expectancy increases. While there is evidence that lifetime socio-economic status shapes risks for later function and disability, it is unclear whether, and how, the wealth of family members shapes these outcomes. We investigated the relationship between outcomes activities of daily living (ADL), grip strength, and gait speed, and the household wealth of non-coresident family members.

Employee Cardiometabolic Risk Following a Cluster-Randomized Workplace Intervention From the Work, Family and Health Network, 2009-2013.

To examine whether workplace interventions to increase workplace flexibility and supervisor support and decrease work-family conflict can reduce cardiometabolic risk. We randomly assigned employees from information technology (n = 555) and long-term care (n = 973) industries in the United States to the Work, Family and Health Network intervention or usual practice (we collected the data 2009-2013). We calculated a validated cardiometabolic risk score (CRS) based on resting blood pressure, HbA (glycated hemoglobin), HDL (high-density lipoprotein) and total cholesterol, height and weight (body mass index), and tobacco consumption.

Quantifying the Contribution of Work Characteristics to Educational Disparities in Health-Induced Work Limitations.

Objectives: To quantify how poor health and inhospitable working conditions each contribute to educational disparities in work disability in midlife and old age.

Methods: We used the Health and Retirement Study (2006-2016) to examine educational disparities in reporting "any impairment or health problem that limits the kind or amount of paid work" in ages 51-80.

Results: We found disparities to be profound and persistent over time.

Are loneliness and social isolation equal threats to health and well-being? An outcome-wide longitudinal approach.

The detrimental effects of loneliness and social isolation on health and well-being outcomes are well documented. In response, governments, corporations, and community-based organizations have begun leveraging tools to create interventions and policies aimed at reducing loneliness and social isolation at scale. However, these efforts are frequently hampered by a key knowledge gap: when attempting to improve specific health and well-being outcomes, decision-makers are often unsure whether to target loneliness, social isolation, or both.

Telomere Length, Health, and Mortality in a Cohort of Older Black South African Adults.

Telomere length (TL) may be a biomarker of aging processes as well as age-related diseases. However, most studies of TL and aging are conducted in high-income countries. Less is known in low- and middle-income countries (LMICs) such as South Africa, where life expectancy remains lower despite population aging.

Towards a consensus definition of allostatic load: a multi-cohort, multi-system, multi-biomarker individual participant data (IPD) meta-analysis.

Background: Allostatic load (AL) is a multi-system composite index for quantifying physiological dysregulation caused by life course stressors. For over 30 years, an extensive body of research has drawn on the AL framework but has been hampered by the lack of a consistent definition.

Methods: This study analyses data for 67,126 individuals aged 40-111 years participating in 13 different cohort studies and 40 biomarkers across 12 physiological systems: hypothalamic-pituitary-adrenal (HPA) axis, sympathetic-adrenal-medullary (SAM) axis, parasympathetic nervous system functioning, oxidative stress, immunological/inflammatory, cardiovascular, respiratory, lipidemia, anthropometric, glucose metabolism, kidney, and liver.

Feasibility of an online consensus approach for the diagnosis of cognitive impairment and dementia in rural South Africa.

Introduction: We describe the development and feasibility of using an online consensus approach for diagnosing cognitive impairment and dementia in rural South Africa.

Methods: Cognitive assessments, clinical evaluations, and informant interviews from Cognition and Dementia in the Health and Aging in Africa Longitudinal Study (HAALSI Dementia) were reviewed by an expert panel using a web-based platform to assign a diagnosis of cognitively normal, mild cognitive impairment (MCI), or dementia.

Results: Six hundred thirty-five participants were assigned a final diagnostic category, with 298 requiring adjudication conference calls.

Long-term household material socioeconomic resources and cognitive health in a population-based cohort of older adults in rural northeast South Africa, 2001-2015.

Material resources owned by households that affect daily living conditions may be salient for cognitive health during aging, especially in low-income settings, but there is scarce evidence on this topic. We investigated relationships between long-term trends in household material resources and cognitive function among older adults in a population-representative study in rural South Africa. Data were from baseline interviews with 4580 adults aged ≥40 in "Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa" (HAALSI) in 2014/2015 linked to retrospective records on their household material resources from the Agincourt Health and Socio-Demographic Surveillance System (HDSS) from 2001 to 2013.

Association Between New-Onset Medicaid Home Care and Family Caregivers' Health.

Importance: More than 17 million people in the US provide uncompensated care for adults with physical or cognitive limitations. Such caregiving is associated with worse mental and physical health, yet little research has investigated how publicly funded home care might ameliorate these harms.

Objective: To investigate the association between Medicaid home care services and family caregivers' health.

Producing Change to Understand the Social Determinants of Health: The Promise of Experiments for Social Epidemiology.

In this commentary, invited for the 100th anniversary of the Journal, we discuss the addition of randomized experiments, along with natural experiments that emulate randomized trials using observational data, as designs in the social epidemiologist's toolbox. These approaches transform the way we define and ask questions about social exposures. They compel us to ask questions about how well-defined interventions change a social exposure that might lead to changes in health.

The double-edged role of accessed status on health and well-being among middle- and older-age adults in rural South Africa: The HAALSI study.

Background: Social capital theory conceptualizes accessed status (the socioeconomic status of social contacts) as interpersonal resources that generate positive health returns, while social cost theory suggests that accessed status can harm health due to the sociopsychological costs of generating and maintaining these relationships. Evidence for both hypotheses has been observed in higher-income countries, but not in more resource-constrained settings.We therefore investigated whether the dual functions of accessed status on health may be patterned by its interaction with network structure and functions among an older population in rural South Africa.

Eight-Year Depressive Symptom Trajectories and Incident Stroke: A 10-Year Follow-Up of the HRS (Health and Retirement Study).

Background: Evidence suggests a link between depressive symptoms and risk of subsequent stroke. However, most studies assess depressive symptoms at only one timepoint, with few examining this relationship using repeatedly measured depressive symptoms. This study aimed to examine the relationship between depressive symptom trajectories and risk of incident stroke.

Childhood eviction and cognitive development: Developmental timing-specific associations in an urban birth cohort.

Eviction upends children's lives and exacerbates deprivation; it remains largely unexamined as a determinant of cognitive development. We assess whether children evicted in infancy, early childhood, and middle childhood exhibit lower scores on four cognitive assessments (measuring executive function, mathematical reasoning, written language skills, and vocabulary skills) at age 9. Using linear regression and selection weights, we analyze longitudinal data from the Fragile Families and Child Wellbeing Study, a national, urban birth cohort (N = 1724 for eviction during infancy, 2126 for early childhood, 1979 for middle childhood).

Subjective social position and cognitive function in a longitudinal cohort of older, rural South African adults, 2014-2019.

Background: The relationship between subjective social position (SSP) and cognitive ageing unclear, especially in low-income settings. We aimed to investigate the relationship between SSP and cognitive function over time among older adults in rural South Africa.

Methods: Data were from 3771 adults aged ≥40 in the population-representative 'Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa' from 2014/2015 (baseline) to 2018/2019 (follow-up).

Work Redesign for the 21st Century: Promising Strategies for Enhancing Worker Well-Being.

Work is a key social determinant of population health and well-being. Yet, efforts to improve worker well-being in the United States are often focused on changing individual health behaviors via employer wellness programs. The COVID-19 health crisis has brought into sharp relief some of the limitations of current approaches, revealing structural conditions that heighten the vulnerability of workers and their families to physical and psychosocial stressors.

Association of Social Support With Brain Volume and Cognition.

Importance: Cognitive resilience refers to the general capacity of cognitive processes to be less susceptible to differences in brain structure from age- and disease-related changes. Studies suggest that supportive social networks reduce Alzheimer disease and related disorder (ADRD) risk by enhancing cognitive resilience, but data on specific social support mechanisms are sparse.

Objective: To examine the association of individual forms of social support with a global neuroanatomical measure of early ADRD vulnerability and cognition.

Socioeconomic disparities and risk of hypertension among older Americans: the Health and Retirement Study.

Background: Reducing hypertension represents a critical point of intervention to lower the burden of cardiovascular disease worldwide. Although the relationship between lower socioeconomic status and higher rates of hypertension is well documented, most of the evidence comes from prevalence studies involving young adult population.

Aim: To investigate the independent association of wealth, education and income with incident hypertension among older adults living in the United States.

Do You See What Eye See? Measurement, Correlates, and Functional Associations of Objective and Self-Reported Vision Impairment in Aging South Africans.

Our study investigates measurement, correlates, and functional associations of vision impairment (VI) in an aging population in rural South Africa. 1582 participants aged 40-69 reported on near (NVI) and distance vision impairment (DVI) and completed objective vision tests. Logistic and linear regression were used to evaluate sociodemographic, health, and psychosocial correlates of VI and assess relationships between VI and cognitive and physical function.

Incidence of Cognitive Impairment during Aging in Rural South Africa: Evidence from HAALSI, 2014 to 2019.

Introduction: Despite rapid population aging, there are currently limited data on the incidence of aging-related cognitive impairment in sub-Saharan Africa. We aimed to determine the incidence of cognitive impairment and its distribution across key demographic, social, and health-related factors among older adults in rural South Africa.

Methods: Data were from in-person interviews with 3,856 adults aged ≥40 who were free from cognitive impairment at baseline in the population-representative cohort, "Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa" (HAALSI), in Agincourt sub-district, Mpumalanga province, South Africa (2014-19).