Cross-sectional and short-term cohort studies have demonstrated an association between urinary incontinence and dementia, as well as lower performance on cognitive testing. The Health and Retirement ...Study, a longitudinal study of community-dwelling older adults, offers an opportunity to assess the temporal association between these conditions because it included an assessment of incontinence symptoms and biennial assessments of cognitive function.
This study aimed to evaluate if urinary incontinence before the age of 70 years had an effect on changes in cognitive function among women participating in the Health and Retirement Study.
This secondary analysis included data from female respondents in the Health and Retirement Study aged 58 to 67 years with ≥2 cognitive assessments. Urinary incontinence was defined as any involuntary loss of any urine in the preceding 12 months. A control group without incontinence was reweighted for better comparability using coarsened exact matching for age and comorbidities. Validated methods, including neuropsychological test data, estimated a memory score and dementia probability for each participant biennially. Coprimary outcomes were the changes in memory score and dementia probability. Linear regression models were used to estimate the association of urinary incontinence with change in memory score and dementia probability, adjusting for baseline demographics and comorbidities. A subgroup analysis was performed to assess the effects of urinary incontinence frequency on these outcomes. The infrequent subgroup reported <15 days of leakage per month and the frequent subgroup reported ≥15 days of leakage per month.
Among eligible female respondents, 40.6% reported urinary incontinence between the ages of 58 and 69 years. Baseline memory scores and dementia probability were similar between those with urinary incontinence (n=1706) and controls (n=2507). Memory score declined significantly in both cohorts, indicating poorer memory over time (−0.222 among those with incontinence 95% confidence interval, −0.245 to −0.199 vs −0.207 in controls 95% confidence interval, −0.227 to −0.188). The decline of memory score was not statistically significantly different between cases and controls (mean difference, −0.015; 95% confidence interval, −0.045 to 0.015). Dementia probability increased significantly in both groups, indicating a greater probability of developing dementia by 0.018 among those with incontinence (95% confidence interval, 0.015–0.020) and by 0.020 among controls (95% confidence interval, 0.017–0.022). The change in dementia probability was not significantly different between groups (mean difference, −0.002; 95% confidence interval, −0.006 to 0.002). Frequent urinary incontinence was reported in 105 of 1706 (6%) of those with urinary incontinence. Memory score declined and dementia probability increased with time (P<.001) in frequent and infrequent urinary incontinence subgroups. There was no dose–response relationship.
Measures of cognitive performance declined during approximately 10 years of observation. The changes in performance were not associated with the presence of urinary incontinence in the participants’ younger years.
Family planning programs are believed to have substantial long-term benefits for women's health and well-being, yet few studies have established either extent or direction of long-term effects. The ...Matlab, Bangladesh, maternal and child health/family planning (MCH/FP) program afforded a 12-y period of well-documented differential access to services. We evaluate its impacts on women's lifetime fertility, adult health, and economic outcomes 35 y after program initiation. We followed 1,820 women who were of reproductive age during the differential access period (born 1938-1973) from 1978 to 2012 using prospectively collected data from the Matlab Health and Demographic Surveillance System and the 1996 and 2012 Matlab Health and Socioeconomic Surveys. We estimated intent-to-treat single-difference models comparing treatment and comparison area women. MCH/FP significantly increased contraceptive use, reduced completed fertility, lengthened birth intervals, and reduced age at last birth, but had no significant positive impacts on health or economic outcomes. Treatment area women had modestly poorer overall health (+0.07 SD) and respiratory health (+0.12 SD), and those born 1950-1961 had significantly higher body mass index (BMI) in 1996 (0.76 kg/m
) and 2012 (0.57 kg/m
); fewer were underweight in 1996, but more were overweight or obese in 2012. Overall, there was a +2.5 kg/m
secular increase in BMI. We found substantial changes in lifetime contraceptive and fertility behavior but no long-term health or economic benefits of the program. We observed modest negative health impacts that likely result from an accelerated nutritional transition among treated women, a transition that would, in an earlier context, have been beneficial.
In this dissertation, I study how public and private programs affect health and human capital accumulation over the lifecycle. In "Who Benefits Most From a Same-Race Mentor? Evidence From a ...Nationwide Youth Mentoring Program,'' my co-authors, Zachary Szlendak and Corey Woodruff, and I identify the impacts of assigning a mentor of the same race/ethnicity on youths' social, emotional and academic growth which are key inputs for their non-cognitive development. We find that Black and Hispanic youth assigned a same-race/ethnicity mentor had slightly faster growth in self-perceived school ability and risk attitudes relative to cross-race matches. Cross-race matched Hispanic youth had improvements in course grades and Black youth were more likely to report having a "special adult'' in their life. We do not find improvements in grades or expectations for future educational attainment.In "Early Childhood Health and Family Planning: Long-Term and Intergenerational Effects on Human Capital,'' Tania Barham, Gisella Kagy, Jena Hamadani and I examine the long-term and intergenerational effects of an early child health and family planning program in Bangladesh on the human capital of adults who were eligible as children and of their children. Improving the health and nutrition of young children can improve both immediate well-being and also reduce poverty in the long-run through improved human capital. There may also be intergenerational transfers of endowments and investments from improved health and nutrition that augment the human capital of the next generation. We find sustained impacts on height and education into adulthood for the adult generation, and improved height and cognition for daughters in the next generation.In "Mental Health Parity and Depression,'' I estimate the impacts of mental healthcare on individual depression. Depression is one of the most common mental illnesses and, although treatable, access to care is limited. I use the passage of state mental health parity laws which mandated higher levels of coverage to identify the effect of increased access to mental health services. I find that privately insured individuals living in states with parity mandates showed no improvements in depression compared to their counterparts in non-parity states.
The Current Population Survey (CPS) is the most widely cited source for estimates on Medicaid enrollment. However, previous literature has shown the CPS underreports enrollment by 30-40% in ...comparison to state-level records. The question then is how to correct the Medicaid enrollment gap brought on by the CPS. Gross adjustments for the discrepancy may be made, but only if the true amount of enrollees is known. In years when administrative records are delayed or incomplete this is not possible. To date, the methods for correcting underreporting require access to the state-level data which is usually infeasible or unpublishable due to privacy issues. Redesigning the CPS questionnaire itself might alleviate a good part of the undercount but doing so is well beyond the scope of most researchers. A better correction would rely only on the CPS count of Medicaid enrollees so as to avoid privacy concerns and time delays. We propose using stochastic frontier analysis to shrink the gap between the CPS count of Medicaid enrollees and the state records by adjusting the CPS counts to be closer to the state records.
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