Investigating pathogen burden in relation to a cumulative deficits index in a representative sample of US adults.

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2018-06-14

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Abstract

Pathogen burden is a construct developed to assess the cumulative effects of multiple, persistent pathogens on morbidity and mortality. Despite the likely biological wear and tear on multiple body systems caused by persistent infections, few studies have examined the impact of total pathogen burden on such outcomes and specifically on preclinical markers of dysfunction. Using data from two waves of the National Health and Nutrition Examination Survey, we compared three alternative methods for measuring pathogen burden, composed of mainly persistent viral infections, using a cumulative deficits index (CDI) as an outcome: single pathogen associations, a pathogen burden summary score and latent class analyses. We found significant heterogeneity in the distribution of the CDI by age, sex, race/ethnicity and education. There was an association between pathogen burden and the CDI by all three metrics. The latent class classification of pathogen burden showed particularly strong associations with the CDI; these associations remained after controlling for age, sex, body mass index, smoking, race/ethnicity and education. Our results suggest that pathogen burden may influence early clinical indicators of poor health as measured by the CDI. Our results are salient since we were able to detect these associations in a relatively young population. These findings suggest that reducing pathogen burden and the specific pathogens that drive the CDI may provide a target for preventing the early development of age-related physiological changes.

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10.1017/s095026881800153x

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Noppert, GA, AE Aiello, AM O'Rand and HJ Cohen (2018). Investigating pathogen burden in relation to a cumulative deficits index in a representative sample of US adults. Epidemiology and infection. pp. 1–9. 10.1017/s095026881800153x Retrieved from https://hdl.handle.net/10161/17277.

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Scholars@Duke

O'Rand

Angela M. O'Rand

Professor Emeritus of Sociology

My major research interests focus on patterns of inequality across the life span, with a special interest in the temporal diversity of life transitions, their consequences for later life, and the impact of institutions on these transitions over time. Over forty years I have examined workplace policies related to wage and benefit structures and the impact of workers' educational, work and family histories on socioeconomic outcomes. The changing employment relationship and the re-organization of retirement institutions (especially pensions) have been other central concerns of my research. Most recently, I have turned to the cumulative impact of economic adversity on early-, mid- and later-life health risks, such as heart attack. This research has uncovered the persistent effects of childhood adversity on adult heart attack risk, especially among women. I am expanding this focus over the next few years to examine the more general question of "life course risks" and increased economic and social inequalities in life course trajectories of health and wealth across birth cohorts and race-ethnic groups (including the role of debt as a stressor). And, from 2014-2020 I was the Principle Investigator on Duke's NIH P30 Center grant  in the Demography and Economics of Aging awarded to the “Center for Population Health and Aging;” Scott Lynch is the current PI appointed for 2020-25.  Over the same period I was the Director of the Duke University Population Research Institute.

Cohen

Harvey Jay Cohen

Walter Kempner Distinguished Professor of Medicine, in the School of Medicine

Dr. Cohen's research program includes clinical research relating to aspects of the pathways to functional decline and reilience with aging, geriatric assessment, and cancer and anemia in the elderly.

Pathways to functional decline are being explored through the NIA funded Claude Pepper Older Americans Independence Center, and includes studies of the contributions of age related physiologic change, in particular changes in inflammatory parameters, comorbid diseases and conditions, environment, genetics, and the interactionas among them. Data are derived from several current studies as well as previously collected data sets from the Established Populations for Epidemiologic Studies of the Elderly (EPESE), National Long Term Care Survey, and the Chinese Longevity Study (with Dr. Zeng Yi). Previous work has demonstrated the important contributions of age related inflammation and coagulation activation to functional status. He is Co-PI of the Pepper Center Physical Performance Across the LifeSpan (PALS) study, which is a longitudinal cohort study of community dwelling adults from age 30-90+and includes functional measures and biomarkers on inflammation and metabolism.
 
Geriatric assessment approaches have been studied in a number of randomized and controlled studies and work is now concentrating on the application of Comprehensive Geriatric Assessment tools to the evaluation and treatment of elderly patients with cancer. This is an extension and continuation of a long standing interest in geriatric oncology. Previous studies have elucidated age-related patterns of disease presentation, treatment approaches, clinical trials, survivorship, quality of life, impact of comrobidities and functional outcomes. Dr. Cohen was co-chair, and now member of the Cancer in the Older Adult Committee of the Alliance for Clinical Trials in Oncology (ALLIANCE). A number of active studies and ongoing data bases aree being utilized to address these questions.


Anemia in the older adult is being addressed through an NIA funded U01 consortium (Dr. Cohen Co-PI). the current main study is an observational study followed by a pragmatic treatment trial for anemia in older adults with CHF, in collaboration with the Cardiovascular Research Network (CVRN) of the Health services research network (HSRN) 


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