Puerto Rico is aging more rapidly than almost any country, with 2020 estimates placing its population share of adults older than 65 as being the 10 th highest in the world. Unlike most locales, Puerto Rico's aging is driven by both a) the culmination of long-running fertility and mortality trends, and b) high levels of outmigration of working-age adults, which contributes both directly (removal of young people) and indirectly (reduced births) to its pace of population aging. This article offers an overview of the main issues surrounding population aging in Puerto Rico. Policymakers and government leaders must plan for Puerto Rico's unconventional population aging, which will exacerbate traditional concerns about the sustainability of government services and long-term economic prospects. Additional concerns emerge related to reduced social support networks and their impact on caregiving dynamics and implications for health. Puerto Rico's unique history and political relationship with the United States presents challenges and benefits for its aging population. Research on aging in Puerto Rico and public health policies must adapt to the needs of the country's aging society.

INTRODUCTION Hypertension affects up to 5% of children worldwide and predicts later cardiovascular morbidity. Associations of short sleep and hypertension have been frequently reported in adults but less consistently in children. This study aims to examine the role of late bedtimes, a marker of short sleep duration, and potentially misaligned circadian rhythms, on incident elevated blood pressure (BP) in a large cohort of Mexican children. METHODS Participants included 2,033 adolescents recruited from public schools in Morelos, Mexico, free from elevated BP (<90th sex, age, and height-standardized percentile). Fourteen months later, all adolescents had a second BP assessment. We abstracted baseline habitual bedtimes from questionnaires to evaluate the association between bedtime and elevated BP incidence (≥90th percentile). Risk ratios and 95% confidence intervals were estimated with discrete-time mixed survival models, adjusting for potential confounders and accounting for clustering by school. RESULTS Participants were 12.5 (SD = 0.6) years old at baseline. At the follow-up visit 10% of adolescents had developed elevated BP. Compared to participants with a habitual weekday bedtime between 9 and 10 pm, those with a weekday bedtime 11 pm or later had a 1.87 times higher risk of developing elevated BP over the follow-up period (95% CI = 1.09, 2.21), after accounting for confounders. Participants with earlier weekday bedtimes also had a higher risk of elevated BP (RR = 1.96; 95% CI = 1.27, 3.01). The associations persisted after accounting for wake time. CONCLUSION These data showed a U-shaped association between weekday bedtime and elevated/high BP risk among Mexican adolescents.

The combined effects of declining fertility and increased longevity have accelerated population aging in different parts of the world. Unlike other countries, Puerto Rico is also experiencing unprecedented levels of working-age out-migration. The full impact of high out-migration on Puerto Rican demography is not fully understood. Placing Puerto Rico’s aging process in an international context is useful in identifying the role out-migration is having on the accelerated aging of the Puerto Rican society. Using the World Population Prospects 2019 estimates, we compared the pattern of rapid aging found for Puerto Rico with the trajectories of six other countries with the highest population of 65+ in the World, Europe, and the Caribbean from 1960 to 2020. Prior to 2010, the aging process in Puerto Rico was comparable to the other countries. After 2010, the percent of the population over 65 years in Puerto Rico nearly doubled from 11% to 21%. The nearly doubling of the percent of older adults is not observed in any of the comparison countries. We find that the rapid aging of Puerto Rico, changing from a linear trend to an exponential one, is a result of accelerating levels of out-migration, which is concentrated in the working-age population.

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