Population Weighting in Statistical Analysis

Si, Yajuan; Lee, Sunghee; Heeringa, Steven G.

doi:10.1001/jamainternmed.2023.6300

Cited by 5 publications

(2 citation statements)

References 7 publications

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“… 5 , 32 Finally, although we used weights in our analyses as recommended by the HRS, our findings may not be nationally representative due to the relatively small sample size and to potential for differences in weights for participants with linked vs unlinked Medicare data. 22 The similar estimates for risk factors in our unweighted models, however, increase confidence in our findings.…”

Section: Discussionsupporting

confidence: 76%

“…Fourth, given the variability in time between hospitalization and post-LTCH HRS interviews, we repeated our models accounting for time as a covariate. Fifth, because survey weights may not yield a nationally representative sample for our cohort, 22 we repeated our primary models using unweighted data. For all analyses, unless otherwise specified, we accounted for the complex survey design of the HRS and generated weighted means and percentages.…”

Section: Methodsmentioning

confidence: 99%

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Survival, Function, and Cognition After Hospitalization in Long-Term Acute Care Hospitals

Jain,

Gan,

Nguyen

et al. 2024

JAMA Netw Open

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ImportanceMore than 70 000 Medicare beneficiaries receive care in long-term acute care hospitals (LTCHs) annually for prolonged acute illness. However, little is known about long-term functional and cognitive outcomes of middle-aged and older adults after hospitalization in an LTCH.ObjectiveTo describe survival, functional, and cognitive status after LTCH hospitalization and to identify factors associated with an adverse outcome.Design, Setting, and ParticipantsThis retrospective cohort study included middle-aged and older adults enrolled in the Health and Retirement Study (HRS) with linked fee-for-service Medicare claims. Included participants were aged 50 years or older with an LTCH admission between January 1, 2003, and December 31, 2016, with HRS interviews available before admission. Data were analyzed between November 1, 2021, and June 30, 2023.Main Outcomes and MeasuresFunction and cognition were ascertained from HRS interviews conducted every 2 years. The primary outcome was death or severe impairment in the 2.5 years after LTCH hospitalization, defined as dependencies in 2 or more activities of daily living (ADLs) or dementia. Multivariable logistic regression was performed to evaluate associations with a priori selected risk factors including pre-LTCH survival prognosis (Lee index score), pre-LTCH impairment status, and illness severity characterized by receipt of mechanical ventilation and prolonged intensive care unit stay of 3 days or longer.ResultsThis study included 396 participants, with a median age of 75 (IQR, 68-82) years. Of the participants, 201 (51%) were women, 125 (28%) had severe impairment, and 318 (80%) died or survived with severe impairment (functional, cognitive, or both) within 2.5 years of LTCH hospitalization. After accounting for acute illness characteristics, prehospitalization survival prognosis as determined by the Lee index score and severe baseline impairment (functional, cognitive, or both) were associated with an increased likelihood of death or severe impairment in the 2.5 years after LTCH hospitalization (adjusted odds ratio [AOR], 3.2 [95% CI, 1.7 to 6.0] for a 5-point increase in Lee index score; and AOR, 4.5 [95% CI, 1.3 to 15.4] for severe vs no impairment).Conclusions and RelevanceIn this cohort study, 4 of 5 middle-aged and older adults died or survived with severe impairment within 2.5 years of LTCH hospitalization. Better preadmission survival prognosis and functional and cognitive status were associated with lower risk of an adverse outcome, and these findings should inform decision-making for older adults with prolonged acute illness.

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Section: Discussionsupporting

confidence: 76%

Section: Methodsmentioning

confidence: 99%

Survival, Function, and Cognition After Hospitalization in Long-Term Acute Care Hospitals

Jain,

Gan,

Nguyen

et al. 2024

JAMA Netw Open

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Mortality and Function After Widowhood Among Older Adults With Dementia, Cancer, or Organ Failure

Rodin,

Smith,

Espejo

et al. 2024

JAMA Netw Open

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ImportanceThe widowhood effect, in which mortality increases and function decreases in the period following spousal death, may be heightened in older adults with functional impairment and serious illnesses, such as cancer, dementia, or organ failure, who are highly reliant on others, particularly spouses, for support. Yet there are limited data on widowhood among people with these conditions.ObjectiveTo determine the association of widowhood with function and mortality among older adults with dementia, cancer, or organ failure.Design, Setting, and ParticipantsThis longitudinal cohort study used population-based, nationally representative data from the Health and Retirement Study database linked to Medicare claims from 2008 to 2018. Participants were married or partnered community-dwelling adults aged 65 years and older with and without cancer, organ failure, or dementia and functional impairment (function score &lt;9 of 11 points), matched on widowhood event and with follow-up until death or disenrollment. Analyses were conducted from September 2021 to May 2024.ExposureWidowhood.Main Outcomes and MeasuresFunction score (range 0-11 points; 1 point for independence with each activity of daily living [ADL] or instrumental activity of daily living [IADL]; higher score indicates better function) and 1-year mortality.ResultsAmong 13 824 participants (mean [SD] age, 70.1 [5.5] years; 6416 [46.4%] female; mean [SD] baseline function score, 10.2 [1.6] points; 1-year mortality: 0.4%) included, 5732 experienced widowhood. There were 319 matched pairs of people with dementia, 1738 matched pairs without dementia, 95 matched pairs with cancer, 2637 matched pairs without cancer, 85 matched pairs with organ failure, and 2705 matched pairs without organ failure. Compared with participants without these illnesses, widowhood was associated with a decline in function immediately following widowhood for people with cancer (change, −1.17 [95% CI, −2.10 to −0.23] points) or dementia (change, −1.00 [95% CI, −1.52 to −0.48] points) but not organ failure (change, −0.84 [95% CI, −1.69 to 0.00] points). Widowhood was also associated with increased 1-year mortality among people with cancer (hazard ratio [HR], 1.08 [95% CI, 1.04 to 1.13]) or dementia (HR, 1.14 [95% CI, 1.02 to 1.27]) but not organ failure (HR, 1.02 [95% CI, 0.98 to 1.06]).Conclusions and RelevanceThis cohort study found that widowhood was associated with increased functional decline and increased mortality in older adults with functional impairment and dementia or cancer. These findings suggest that persons with these conditions with high caregiver burden may experience a greater widowhood effect.

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Advancing high quality longitudinal data collection: Implications for the HEALthy Brain and Child Development (HBCD) Study design and recruitment

Si,

Bandoli,

Cole

et al. 2024

Developmental Cognitive Neuroscience

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Population Weighting in Statistical Analysis

Abstract: This Guide to Statistics and Methods provides an overview of weighted analyses of population-based survey, which can help achieve statistically valid, representative population-based findings.

Cited by 5 publications

References 7 publications

Survival, Function, and Cognition After Hospitalization in Long-Term Acute Care Hospitals

Survival, Function, and Cognition After Hospitalization in Long-Term Acute Care Hospitals

Mortality and Function After Widowhood Among Older Adults With Dementia, Cancer, or Organ Failure

Advancing high quality longitudinal data collection: Implications for the HEALthy Brain and Child Development (HBCD) Study design and recruitment

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