May Beydoun - Academia.edu (original) (raw)

Papers by May Beydoun

BMC Public Health, Oct 22, 2016

Background: Studies uncovering factors beyond socioeconomic status (SES) that would explain racia... more Background: Studies uncovering factors beyond socioeconomic status (SES) that would explain racial and ethnic disparities in mortality are scarce. Methods: Using prospective cohort data from the Third National Health and Nutrition Examination Survey (NHANES III), we examined all-cause and cause-specific mortality disparities by race, mediation through key factors and moderation by age (20-49 vs. 50+), sex and poverty status. Cox proportional hazards, discrete-time hazards and competing risk regression models were conducted (N = 16,573 participants, n = 4207 deaths, Median time = 170 months (1-217 months)). Results: Age, sex and poverty income ratio-adjusted hazard rates were higher among Non-Hispanic Blacks (NHBs) vs. Non-Hispanic Whites (NHW). Within the above-poverty young men stratum where this association was the strongest, the socio-demographic-adjusted HR = 2.59, p < 0.001 was only partially attenuated by SES and other factors (full model HR = 2.08, p = 0.003). Income, education, diet quality, allostatic load and self-rated health, were among key mediators explaining NHB vs. NHW disparity in mortality. The Hispanic paradox was observed consistently among women above poverty (young and old). NHBs had higher CVD-related mortality risk compared to NHW which was explained by factors beyond SES. Those factors did not explain excess risk among NHB for neoplasm-related death (fully adjusted HR = 1.41, 95 % CI: 1.02-2.75, p = 0.044). Moreover, those factors explained the lower risk of neoplasm-related death among MA compared to NHW, while CVD-related mortality risk became lower among MA compared to NHW upon multivariate adjustment. Conclusions: In sum, racial/ethnic disparities in all-cause and cause-specific mortality (particularly cardiovascular and neoplasms) were partly explained by socio-demographic, SES, health-related and dietary factors, and differentially by age, sex and poverty strata.

International Journal of Epidemiology, Feb 4, 2020

Background: Obesity (OB) is a serious epidemic in the United States. Methods: We examined OB patt... more Background: Obesity (OB) is a serious epidemic in the United States. Methods: We examined OB patterns and time trends across socioeconomic and geographic parameters and projected the future situation. Large national databases were used. Overweight (OW), OB and severe obesity (SOB) were defined using body mass index cut-points/percentiles; central obesity (CO), waist circumference cut-point in adults and waist:height ratio cutoff in youth. Various meta-regression analysis models were fit for projection analyses. Results: OB prevalence had consistently risen since 1999 and considerable differences existed across groups and regions. Among adults, men's OB (33.7%) and OW (71.6%)

Muscle & Nerve, Feb 22, 2020

INTRODUCTION We compared outcomes of therapeutic plasma exchange (TPE) versus intravenous immunog... more INTRODUCTION We compared outcomes of therapeutic plasma exchange (TPE) versus intravenous immunoglobulin (IVIG) among hospitalized patients diagnosed with Guillain-Barré Syndrome (GBS) METHODS: In a retrospective cohort study of 6,642 records (2,637 TPE and 4,005 IVIG) from the 2002-2014 Nationwide Inpatient Sample, treatment type was examined as predictor of length of stay, total charges and in-hospital death with regression modeling using risk adjustment and propensity scoring to control for confounders. RESULTS Compared to those receiving IVIG, patients who underwent TPE experienced prolonged hospitalization by about 7.5 days, greater hospitalization costs by approximately $46,000, and increased in-hospital death with an odds ratio of 2.78. Results did not change after controlling for confounders through risk adjustment, propensity score adjustment or matching. DISCUSSION TPE may be associated with poorer healthcare utilization outcomes versus IVIG, although confounding by indication could not be ascertained. This article is protected by copyright. All rights reserved.

American Journal of Cardiology, Aug 1, 2017

To investigate patient outcomes following hospitalization for out-of-hospital cardiac arrest (OHC... more To investigate patient outcomes following hospitalization for out-of-hospital cardiac arrest (OHCA) in the United States. We used the 2002 to 2013 Nationwide Inpatient Sample database to identify adults ≥ 18 years old with an ICD-9-CM principal diagnosis code of cardio-respiratory arrest (427.5) or ventricular fibrillation (VF) (427.41). In 4 pre-defined federal geographic regions: Northeast, Midwest, South and West, means and proportions of survival, survival stratified by initial rhythm, hospital charges and cost were estimated. Multiple linear and logistic regression models were conducted. Of 154,177 OHCA patients hospitalized in the U.S, 25,873 (16.8%) were in the Northeast, 38,296 (24.8%) in the Midwest, 57,305 (37.2%) in the South, and 32,703 (21.2%) in the West. Variability in survival was noted in VF arrests; compared to the Northeast, survival was higher in the Midwest and South [AOR 1.16, 95% CI (1.02-1.32) and AOR 1.24, 95% CI (1.09-1.40) respectively], with no difference detected in the West [AOR 0.93, 95% CI (0.82-1.06)]. No variability in survival was noted following non-VF arrests (p > 0.05). Hospital charges rose significantly across all regions of the United States (P-trend < 0.001), and were higher in the West as compared with the Northeast [(Hospital charges >$109,000/admission, AOR 1.76; 95% CI (1.50-2.06)]. In conclusion, Nationwide, we observed significant regional variability in survival of hospitalized patients following out of hospital VF cardiac arrest, no survival variability following non-VF arrests and a steady increase in hospital charges.

The FASEB Journal, Apr 1, 2011

We examined the relationship of elevated depressive symptoms with antioxidant status. Cross-secti... more We examined the relationship of elevated depressive symptoms with antioxidant status. Cross-sectional data from the National Health and Nutrition Examination Surveys 2005-6 on US adults aged 20-85 years were analysed. Depressive symptoms were measured using the Patient Health Questionnaire with a score cutoff point of 10 to define 'elevated depressive symptoms'. Serum antioxidant status was measured by serum levels of carotenoids, retinol (free and retinyl esters), vitamin C and vitamin E. The main analyses consisted of multiple logistic and zero-inflated Poisson regression models, taking into account sampling design complexity. The final sample consisted of 1798 US adults with complete data. A higher total serum carotenoid level was associated with a lower likelihood of elevated depressive symptoms with a reduction in the odds by 37 % overall with each SD increase in exposure, and by 34 % among women (P,0•05). A dose-response relationship was observed when total serum carotenoids were expressed as quartiles (Q 4 (1•62-10•1 mmol/l) v. Q 1 (0•06-0•86 mmol/l) : OR 0•41; 95 % CI 0•23, 0•76, P, 0•001; P for trend¼0•035), though no significant associations were found with the other antioxidant levels. Among carotenoids, b-carotene (men and women combined) and lutein þ zeaxanthins (women only, after control for dietary lutein þ zeaxanthin intake and supplement use) had an independent inverse association with elevated depressive symptoms among US adults. None of the other serum antioxidants had a significant association with depressive symptoms, independently of total carotenoids and other covariates. In conclusion, total carotenoids (mainly b-carotene and lutein þ zeaxanthins) in serum were associated with reduced levels of depressive symptoms among community-dwelling US adults.

Circulation, Nov 10, 2015

Background: Regional Differences in health outcomes following OHCA has been poorly studied, and w... more Background: Regional Differences in health outcomes following OHCA has been poorly studied, and was the focus of this investigation. Methods: We used the 2002 to 2012 Nationwide Inpatient Sample database to identify adults ≥ 18 years old, with an ICD-9 code principal diagnosis of cardio respiratory arrest (427.5) or ventricular fibrillation (427.1). Trauma patients were excluded. In 4 predefined federal geographic regions: North East, Midwest, South and West, means and proportions of total hospital charges (adjusted to the 2012 consumer price index,) and mortality rate were calculated. Multiple linear and logistic regression models, were adjusted for patient demographics, hospital characteristics and Charlson Comorbidity Index. Trends in binary outcome were examined with YearхRegion interaction terms. Results: From 2002 to 2012, of 155,592 OHCA patients who survived to hospital admission , 26,007 (16.7%) were in the Northeast, 39,921 (25.7% ) in the Midwest, 56,263 (36.2%) in the South, and 33,401 (21.5% ) in the West. Total hospital charges (THC) rose significantly over the years across all regions of the United States ( P trend &amp;amp;lt;0.0001), and were higher in the West Vs the North East (THC&amp;amp;gt;$109,000/admission, AOR 1.85; 95% CI 1.53-2.24, p&amp;amp;lt;0.0001), and not different in other regions. Compared to the Northeast, mortality was lower in the Midwest ( AOR 0.86, 95% CI 0.77-0.97 p=0.01), marginally lower in the South ( AOR 0.91, 95% CI 0.82-1.01 p=0.07), with no difference detected between the West and the Northeast ( AOR 1.02, 95% CI 0.90-1.16 P=0.78). Increased expenditure was not rewarded by an increase in survival, as trends in Mortality did not differ significantly between regions (YearхRegion effects P&amp;amp;gt;0.05, P trend =0.29). Conclusions: Nationwide, there is a considerable variability in survival and charges associated with caring for the post arrest patient. Higher charges did not yield better outcomes. Further investigation is needed to optimize health care delivery.

Journal of Womens Health, Apr 1, 2020

Background: To examine patterns and outcomes of bariatric surgeries, including Roux-en-Y gastric ... more Background: To examine patterns and outcomes of bariatric surgeries, including Roux-en-Y gastric bypass (RYGB), laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB), among women diagnosed with polycystic ovarian syndrome (PCOS). Materials and Methods: Retrospective cohort study using 1998-2011 Nationwide Inpatient Sample data. A total of 52,668 hospital discharge records met eligibility criteria among PCOS women, 18-49 years. Of those, 17,759 had an obesity/overweight diagnosis and 4310 underwent bariatric surgery. Furthermore, 3086 underwent RYGB (n = 2411), LSG (n = 126), or LAGB (n = 549), and were compared to 78,931 non-PCOS controls. Multiple regression models were constructed to examine patient-and hospital-level predictors of obesity/ overweight and bariatric surgery, as well as type of bariatric surgery (RYGB, LSG, or LAGB) as a predictor of in-hospital outcomes and PCOS status. Results: The prevalence of obesity/overweight (&34%) among women diagnosed with PCOS, and of bariatric surgery (&24%) among women diagnosed with PCOS and obese/overweight varied by patient-and hospitallevel characteristics. Women having PCOS and overweight/obesity, who underwent LSG or LAGB, had shorter hospital stay, reduced hospital charges, and better disposition at discharge compared to those who underwent RYGB. PCOS cases and non-PCOS controls experienced similar treatment selection and in-hospital outcomes after bariatric surgery. Also, PCOS cases and non-PCOS controls experienced similar in-hospital outcomes after undergoing RYGB, LSG, or LAGB. Conclusions: Compared to RYGB, LSG and LAGB resulted in improved in-hospital outcomes among obese/overweight PCOS and non-PCOS patients. Further research is needed to examine health care disparities in the context of PCOS, obesity/overweight, and bariatric surgery.

Journal of Health Services Research & Policy, Jul 1, 2019

Introduction Understanding the role of Medicaid for health centre patients with chronic diseases ... more Introduction Understanding the role of Medicaid for health centre patients with chronic diseases can aid policymakers in designing and improving programmes to effectively meet the needs of this vulnerable segment of the population. This study compares the number of chronic conditions, health services utilization and access to care between patients with Medicaid coverage and uninsured patients seen at US health centres. Methods We used data from the 2014 Health Center Patient Survey. Measures included number of chronic conditions, number of physician visits, number of prescription drugs used, access to a usual source of care, the receipt of a routine checkup, unmet need for care and unmet need for prescription drugs. We conducted bivariate analyses to determine differences of outcome measures between the Medicaid and uninsured patient groups. Multiple linear and logistic regression models were conducted to test associations of Medicaid and other health-related factors with outcome measures. Results Bivariate results indicated there were no differences between Medicaid and uninsured patients in number of chronic diseases, having a usual source of care and receipt of a routine checkup. Significant differences existed in health services utilization measures and unmet health needs measures. After controlling for confounding factors, the differences in these measures were still apparent. Uninsured status was linked to a reduced physician visit frequency by −3.03 (95% CI: −4.05, −2.00) as compared with Medicaid patients (p < 0.001) and was associated with a reduced frequency of prescription drugs used by −0.38 (95% CI: −0.67, −0.10, p < 0.01) after controlling for the other covariates. Conclusion Despite having comparable needs to Medicaid patients, uninsured patients with chronic conditions continue to have substantial unmet needs for health care services and limited access to the health care system. Health centres serve an important role in eliminating such disparity regardless of insurance status. In addition, Medicaid eligibility may also have a substantial and positive impact on improving health services utilization and access to care among these low-income patients.

Fertility and Sterility, Feb 1, 2011

Objective-To characterize pubertal development of the first generation of young adults born as a ... more Objective-To characterize pubertal development of the first generation of young adults born as a result of in-vitro fertilization (IVF). Demographic, clinical and body size characteristics were examined in relation to developmental milestones. Design-Cross-sectional. Setting-Academic center. Patients-Young adults (18-26 years) conceived by IVF (no gamete/embryo manipulation),

Sleep Medicine, Jul 1, 2023

Hormonal studies, 2015

Background: In men, hypovitaminosis D as well as high and low testosterone levels have been linke... more Background: In men, hypovitaminosis D as well as high and low testosterone levels have been linked to adverse events, including death. A biological interaction has been previously suggested between vitamin D and androgens. In a cohort study using Third National Health and Nutrition Examination Survey data, we simultaneously investigated circulating vitamin D and biomarkers of sex steroid hormones as predictors of all-cause mortality. Methods: Age-adjusted and fully-adjusted Cox regression models were constructed to estimate hazard ratios (HR) and their 95% confidence intervals (CI). Whereas the vitamin D sufficient group (25(OH)D 3 ≥30 ng/ml) was selected as a referent, biomarkers of sex steroid hormones (testosterone, estradiol, SHBG) were defined as Loge-transformed continuous variables. Results: Of 1,472 men with a mean age of 42.1 years at baseline, 382 died over a median of 192 months of follow-up. Estradiol levels were significantly higher among vitamin D deficient compared to vitamin D sufficient men and sex hormone binding globulin level was significantly higher in vitamin D sufficient compared to vitamin D insufficient or deficient groups. An inverse non-linear relationship was observed between all-cause mortality rate and levels of testosterone, estradiol and vitamin D, in fully-adjusted models. There were no significant interaction effects between vitamin D and sex steroid hormones in relation to all-cause mortality rate. Conclusions: Vitamin D and sex steroid hormones, but not sex hormone binding globulin, may be inversely and non-linearly related to all-cause mortality among adult men, after adjustment for baseline demographic, socioeconomic, lifestyle and clinical characteristics.

Scientific Reports, Sep 28, 2021

The purpose of this study was to comparehospitalization outcomes among US inpatients with brain m... more The purpose of this study was to comparehospitalization outcomes among US inpatients with brain metastases who received stereotactic radiosurgery (SRS) and/or non-SRS radiation therapies without neurosurgical intervention. A cross-sectional study was conducted whereby existing data on 35,199 hospitalization records (non-SRS alone: 32,981; SRS alone: 1035; SRS + non-SRS: 1183) from 2005 to 2014 Nationwide Inpatient Sample were analyzed. Targeted maximum likelihood estimation and Super Learner algorithms were applied to estimate average treatment effects (ATE), marginal odds ratios (MOR) and causal risk ratio (CRR) for three distinct types of radiation therapy in relation to hospitalization outcomes, including length of stay (' ≥ 7 days' vs. ' < 7 days') and discharge destination ('non-routine' vs. 'routine'), controlling for patient and hospital characteristics. Recipients of SRS alone (ATE = − 0.071, CRR = 0.88, MOR = 0.75) or SRS + non-SRS (ATE = − 0.17, CRR = 0.70, MOR = 0.50) had shorter hospitalizations as compared to recipients of non-SRS alone. Recipients of SRS alone (ATE = − 0.13, CRR = 0.78, MOR = 0.59) or SRS + non-SRS (ATE = − 0.17, CRR = 0.72, MOR = 0.51) had reduced risks of non-routine discharge as compared to recipients of non-SRS alone. Similar analyses suggested recipients of SRS alone had shorter hospitalizations and similar risk of nonroutine discharge when compared to recipients of SRS + non-SRS radiation therapies. SRS alone or in combination with non-SRS therapies may reduce the risks of prolonged hospitalization and nonroutine discharge among hospitalized US patients with brain metastases who underwent radiation therapy without neurosurgical intervention. Brain metastases are the most common intracranial tumors affecting 8-10% of cancer patients; the majority experience 1-3 brain lesions with poor prognosis in terms of overall survival, progression-free survival and neurological function 1-4. Uncontrolled brain metastases often result in headaches, neurocognitive dysfunction, seizures, and eventually death 3. Approximately 170,000 cases are diagnosed on an annual basis in the United States 5,6 , and the frequency is expected to increase with improved therapeutic options and continued routine surveillance using magnetic resonance imaging 3. Although brain metastases are the main cause of morbidity and mortality among cancer patients, younger age, higher Karnofsky Performance Score (KPS), fewer brain lesions, and uncontrolled extracranial disease were associated with improved prognosis 5. The life expectancy of patients having brain metastases is approximately 12 months if they receive recommended radiation and/or surgical therapies or less than 12 months if they only receive supportive care 1,7. Whereas neurologic manifestations affect 70% of patients with brain metastases

American Journal of Emergency Medicine, Jun 1, 2021

BACKGROUND Management of patients with syncope lacks standardization. We sought to assess regiona... more BACKGROUND Management of patients with syncope lacks standardization. We sought to assess regional variation in hospitalization rates and resource utilization of patients with syncope. METHODS We identified adults with syncope using the Nationwide Emergency Department Sample from years 2006 to 2014. Demographics and comorbidity characteristics were compared across geographic regions in the US. Multiple regression was conducted to compare outcomes. RESULTS 9,132,176 adults presented with syncope. Syncope in the Northeast (n = 1,831,889) accounted for 20.1% of visits; 22.6% in the Midwest (n = 2,060,940), 38.5% in the South (n = 3,527,814) and 18.7% in the West (n = 1,711,533). Mean age was 56 years with 57.7% being female. The Northeast had the highest risk-adjusted hospitalization rate (24.5%) followed by the South (18.6%, ORadj 0.58; 95% CI 0.52-0.65, p < 0.001), the Midwest (17.2%, ORadj 0.51; 95% CI 0.46-0.58, p < 0.001) and West (15.8%, ORadj 0.45; 95% CI 0.39-0.51, p < 0.001). Risk-adjusted rates of syncope hospitalizations significantly declined from 25.8% (95% CI 24.8%-26.7%) in 2006 to 11.7% (95% CI 11.0%-12.5%) in 2014 (Ptrend < 0.001). The Northeast had the lowest risk-adjusted ED (Emergency Department) service charges per visit ($3320) followed by the Midwest ($4675, IRRadj 1.41; 95% CI 1.30-1.52, p < 0.001), the West ($4814, IRRadj 1.45; 95% CI 1.31-1.60, p < 0.001) and South ($4969, IRRadj 1.50; 95% CI 1.38-1.62, p < 0.001). Service charges increased from 3047/visit(953047/visit (95% CI 3047/visit(952912-$3182) in 2006 to 6267/visit(956267/visit (95% CI 6267/visit(955947-$6586) in 2014 (Ptrend < 0.001). CONCLUSIONS Significant regional variability in hospitalization rates and ED service charges exist among patients with syncope. Standardizing practices may be needed to reduce variability.

Context: Recent evidence indicates that a higher plasma level of 25-hydroxyvitamin D [25(OH)D] is... more Context: Recent evidence indicates that a higher plasma level of 25-hydroxyvitamin D [25(OH)D] is associated with lower adiposity and a reduced number of metabolic disturbances (MetD). Objectives: We examined associations among dietary quality, 25(OH)D, percent body fat (%BF), and MetD, and a pathway linking them, across central obesity.

Journal of racial and ethnic health disparities, Sep 27, 2018

Objective The aim of this study is to examine how health outcomes varied by treatment selection a... more Objective The aim of this study is to examine how health outcomes varied by treatment selection and race/ethnicity among hospitalized US patients with ruptured or unruptured IAs. Methods A retrospective cohort study was conducted using a sample of 62,224 hospital discharges from the 2002-2012 Nationwide Inpatient Sample. Logistic regression models evaluated treatment selection as predictor of in-hospital survival (IHS: Byes,^Bno^) and length of stay (LOS ≤ 7 days, > 7 days), overall and across racial/ethnic groups, taking hospital-and patient-level confounders into account, while stratifying by IA rupture status. Results Compared to surgical clipping, endovascular coiling was associated with better IHS, after controlling for confounders. Compared to surgical clipping, LOS ≤ 7 days was less likely in patients with combination of treatments and more likely among patients with endovascular coiling as well as balloon-or stent-assisted coiling. Observed relationships varied significantly by race and ethnicity for IHS, but not for LOS ≤ 7 days. Whereas combination of treatments were associated with worse IHS than surgical clipping among Blacks alone, endovascular coiling was associated with better IHS than surgical clipping among White and Other racial/ethnic subgroups. These relationships were for the most part consistent among patients with and without IA rupture. Conclusions Racial and ethnic subgroups of IA patients experienced differential IHS by treatment selection, irrespective of IA rupture status. Prospective cohort studies are needed to further elucidate these racial and ethnic disparities, while collecting data on IA size, location, and morphology as well as Hunt and Hess grade for ruptured IA.

Journal of Cranio-maxillofacial Surgery, Aug 1, 2018

The purpose of this cross-sectional study is to examine the relationship between surgical treatme... more The purpose of this cross-sectional study is to examine the relationship between surgical treatments for sleep-disordered breathing (SDB) and composite measure of surgical complications in a nationally representative sample of hospital discharges among U.S. adults. We performed secondary analyses of 33,679 hospital discharges from the 2002-2012 Nationwide Inpatient Sample that corresponded to U.S. adults (≥18 years) who were free of head-and-neck neoplasms, were diagnosed with SDB and had undergone at least one of seven procedures. Multivariate logistic regression models were constructed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI), controlling for age, sex, race/ethnicity, obstructive sleep apnea (OSA) and obesity diagnoses. Positive associations were found between composite measure of surgical complications and specific procedures: palatal procedure (aOR = 12.69, 95% CI: 11.91,13.53), nasal surgery (aOR = 6.47, 95% CI: 5.99,6.99), transoral robotic assist (aOR = 5.06, 95% CI: 4.34-5.88), tongue base/hypopharynx (aOR = 4.24, 95% CI: 3.88,4.62), maxillomandibular advancement (MMA) (aOR = 3.24, 95% CI: 2.74,3.84), supraglottoplasty (aOR = 2.75, 95% CI: 1.81,4.19). By contrast, a negative association was found between composite measures of surgical complications and tracheostomy (aOR = 0.033, 95% CI: 0.031,0.035). In conclusion, most procedures for SDB, except tracheostomy, were positively associated with complications, whereby palatal procedures exhibited the strongest and supraglottoplasty exhibited the weakest association.

Journal of the Endocrine Society, Mar 19, 2019

Context: Serum anti-Müllerian hormone level (AMH) and body mass index may be jointly associated w... more Context: Serum anti-Müllerian hormone level (AMH) and body mass index may be jointly associated with cardiometabolic risk. Objectives: Examine the contribution of AMH to cardiometabolic disturbances by weight status among US adult men. Design: Cross-sectional analysis using data from the 1999 to 2004 waves of the National Health and Nutrition Examination Survey. Setting: Multistage probability sampling of the noninstitutionalized US population.

Nutrients

Limited investigation has been done on diet quality trajectories over adulthood. The main study o... more Limited investigation has been done on diet quality trajectories over adulthood. The main study objectives were to determine the diet quality group trajectories (GTs) over time and to detect changes in a socio-economically and racially diverse middle-aged cohort. Data from three waves of the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study were used to determine diet quality with group-based trajectory modeling (GBTM). Three quality indices—the Healthy Eating Index (HEI), the Dietary Inflammatory Index (DII), and the Mean Adequacy Ratio (MAR)—were explored. The rate of change in quality over time was determined by mixed-effects regression analysis. Three diet quality GTs, low, middle, and high quality, were identified for each index and confirmed with spaghetti plots. Within each GT, only small changes in diet quality scores were observed, with improvements for the HEI and DII indices and a slight decline in MAR scores. Weighted kappa values revealed t...

Journal of Affective Disorders

Journal of Alzheimer's Disease

Background: Cross-sectional studies have linked cognition to allostatic load (AL) which reflects ... more Background: Cross-sectional studies have linked cognition to allostatic load (AL) which reflects multisystem dysregulation from life course exposure to stressors. Objective: To examine baseline and changes in AL and their relationships with 11 cognitive function test scores, while exploring health disparities according to sex and race. Methods: Longitudinal [Visit 1 (2004–2009) and Visit 2 (2009–2013)] data were analyzed from 2,223 Healthy Aging in Neighborhoods of Diversity across the Life Span participants. We calculated AL total score using cardiovascular, metabolic, and inflammatory risk indicators, and applied group-based trajectory modeling to define AL change. Results: Overall and stratum-specific relationships were evaluated using mixed-effects linear regression models that controlled for socio-demographic, lifestyle, and health characteristics. Baseline AL was significantly associated with higher log-transformed Part A Trail Making Test score [Loge (TRAILS A)] (β= 0.020, p ...