How Does Surviving War Age the Body and Mind? An Analysis of - PowerPoint PPT Presentation

How Does Surviving War Age the Body and Mind? An Analysis of Subjective Age in Vietnam VHAS Kim Korinek, University of Utah Jefferson Schmidt, University of Utah Eleanor Brindle, University of Washington Tran Khanh Toan, Hanoi Medical University Yvette Young, University of Utah Zachary Zimmer, Mount Saint Vincent University This research was supported by the National Institutes of Health/National Institute on Aging (R01AG052537)

Background: Biological, Social and Contextual Underpinnings of Subjective Age • Recent research advances biomedical perspective on SA SA correlates with lower grip strength, lower PEF, higher waist circumference, – Older S higher Albumin, Cystatin C 1,2,3,4 – Younger S SA correlates with faster gait speed, higher ADL/IADL functioning; and lower 2 levels of C-reactive protein, Cystatin C 5,6 • Few studies of SA in non-western or LMICs, where often uniquely adverse contexts affect aging – China studies 7,8,9 ; Israeli veteran studies 10,11,12 • Interpreting SA: intersection of life course, social context, & biology – Past research: stress exposure in SA-inflammation association6; ageism & SA2 – Famine, war stress, military service à psychosocial & biological correlates of SA

Dependent “I know that you are currently__ years old. People sometimes feel younger or older than their age. Do you feel younger, older Variable or about your age?” Subjective Age in VHAS Sample 50 3 45 45 40 42 35 30 25 % 20 15 10 13 5 (N=306) (N=986) (N=1057) 0 Younger than Chron Age Same as Chron Age Older than Chron Age

Dependent “I know that you are currently__ years old. People sometimes feel younger or older than their age. Do you feel younger, older Variable or about your age?” Subjective Age in VHAS & HRS Samples 80 4 70 74.9 60 50 45 40 VHAS, 2018 % 42 HRS, 2016 30 20 10 14.3 13 10.8 (N=306) (N=986) (N=1057) 0 Younger than Chron Age Same as Chron Age Older than Chron Age

Hypotheses 1.Subjective age will be INCREASED among individuals with greater exposure to wartime stressors during their early adulthood. 5 2.Individuals with biomarkers and self-assessed outcomes indicative of poor functional and physical health will perceive their subjective age as OLDER than their chronological age; 3.Indicators of nutritional deficiency, as indicated by periods of severe hunger in childhood, low hematocrit & underweight BMI, will correlate will OLDER SA

Vietnam H Health & & A Aging Study, 2 2018 • N=2,447 adults age 60+ Omnibus survey; dimensions of • war stressors, health, aging 11 • ‘American War’ cohort • Multi-stage probability sampling 6 in 4 purposively selected districts; • Biomarker data – Collected by HMU staff in 12 CHCs – Anthropometrics – Hair sample – cortisol – Finger prick capillary blood sample; CBC & A1c by POCTs, stored samples for ELISA & multiplex assays

Key Covariates Earl rly L Life & & W War S r Stre ress E Exposure res Mean/% Std Dev Biomarkers & & S Self-re reported H Health Severe Childhood Hunger – once or 46.0 --- multiple episodes of 1+ months (%) Mean Std Dev Served in formal military 26.1 ---- ADL Limitations (0-5) 0.92 1.68 Served in militia 40.3 --- Chronic Conditions (0-8) 1.72 1.23 Wartime Combat/Death Index (0-11) 2.6 3.2 7 Peak Expiratory Flow 288.3 98.9 Wartime Malevolent Environment Index 1.4 1.5 (L/min; max of 3) (0-5) Grip Strength – avg of 2 tests on 20.54 8.17 each (kg) Recent P Psychological D Distre ress Calf Circumference (cm) 30.04 3.35 Mean/% Std Dev BMI 21.68 3.09 Psych. Distress Score (SRQ) (0-7) 2.02 1.79 Waist-height ratio 0.51 0.06 Hematocrit %tile (assessed by QBC 41.87 4.26 Distressing Life Events within past 2-3 0.89 1.01 Star centrifugal hematology system) years (0-5)

Crosstabs: Severe childhood hunger, by sex, and health/biomarker covariates ADLS PEF Grip Strength Calf Circ. BMI

Crosstabs: Wartime malevolent environment exposures, by sex, and health/biomarker covariates Chron. Conds. ADLS PEF Grip Strength Calf Circ.

Analytical approach Survey-adjusted multinomial logistic regression; adjusted for commune- level clustering Outcome variable: Subjective Age (SA) Feeling Older vs. Feeling about the same as chronological age Feeling younger vs. Feeling about the same as chronological age 10 Independent variable groups: Early life stress exposures Biomarkers & self-assessed health outcomes Psychological distress Control variables: chronological age, sex, educational attainment, main occupation, marital status, district of residence Analytical N = 2,126 (proxies & missing data; missing coded as ‘9’ in categorical variable where feasible)

Multinomial Logit – Feeling older than CA (RRRs, ref: Feeling One’s CA) 1.6 Life Course Stress Covariates Life Course Stress + HEALTH/BIO Life Course Stress + PSYCH Full Model 1.4 (w/ Sociodemog. Controls) Covariates (w/ Sociodemog. Controls) DISTRESS Covariates (w/ Sociodemog. Controls) t n.s. n.s. n.s. 1.2 Relative Risk Ratio (RRR) 11 * n.s. n.s. n.s. 1 0.8 * * ** *** 0.6 0.4 Severe Childhood Hunger - Mult times (vs None) # Malevolent Environ Stressors Served in Formal Military (vs No Mil Service)

Multinomial Logit – Feeling older than CA (RRRs, ref: Feeling One’s CA) 1.6 *** *** ** * * 1.4 * ** ** ** * ** 1.2 12 * * 1 0.8 n.s. n.s. * Life Course Stress + HEALTH/BIO Life Course Stress + PSYCH DISTRESS Full Model Covariates (w/ Sociodemog. Controls) Covariates (w/ Sociodemog. Controls) 0.6 # ADLS # Chron Conds Calf Circ - Below Threshold BMI - Underweight WHR-Ab Adiposity 0.4

Multinomial Logit – Feeling younger than CA (RRRs, ref: Feeling One’s CA) 1.4 1.3 Life Course Stress Covariates Life Course Stress + HEALTH/BIO Life Course Stress + PSYCH Full Model (w/ Sociodemog. Controls) Covariates (w/ Sociodemog. Controls) DISTRESS Covariates (w/ 1.2 Sociodemog. Controls) 1.1 Relative Risk Ratio (RRR) n.s. n.s. 13 * * 1 0.9 0.8 0.7 0.6 0.5 * * * * 0.4 Severe Childhood Hunger - One (vs None) # Combat/Death Stress Exposures

Multinomial Logit – Feeling younger than CA (RRRs, ref: Feeling One’s CA) 1.6 1.4 * 1.2 Relative Risk Ratio (RRR) Life Course Stress + HEALTH/BIO Life Course Stress + PSYCH DISTRESS Full Model 14 Covariates (w/ Sociodemog. Controls) Covariates (w/ Sociodemog. Controls) * * * 1 0.8 n.s. * * 0.6 * * * Grip Strength - weakest quartile Underweight BMI Hematocrit %tile 0.4

Discussion • Undernutrition (childhood hunger, low Hct, underweight) à feeling older • Malevolent war environment stressors ‘age’ survivors 15 • Military veterans & combat- stressed: more youthful SA – survivor ‘resilience’ &/or benefits of military service? • Biomarkers of aging/frailty correlate with older SA – Life course stressors partially expressed through biomarkers

Limitations – Selective survival influences observed associations between war stress exposure & aging, including subjective age – Limited ability to assess inflammation & other biological processes linking stress exposure & SA; additional biomarkers in stored blood will paint a fuller picture 16 – Categorical measure of subjective age along a singular dimension Looking a ahead – One of many cross-sectional studies; modeling techniques & Wave II data to assess bi-directionality, longitudinal associations