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Research ArticleOriginal Research

Having a Usual Source of Care Is Associated with Longer Telomere Length in a National Sample of Older Adults

Peter T. Baltrus, Chaohua Li and Anne H. Gaglioti
The Journal of the American Board of Family Medicine November 2020, 33 (6) 832-841; DOI: https://doi.org/10.3122/jabfm.2020.06.200008
Peter T. Baltrus
From the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (PB, CL, AG); Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA (PB); Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA (AG).
PhD
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Chaohua Li
From the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (PB, CL, AG); Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA (PB); Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA (AG).
MPH
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Anne H. Gaglioti
From the National Center for Primary Care, Morehouse School of Medicine, Atlanta, GA (PB, CL, AG); Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA (PB); Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA (AG).
MD, MS, FAAFP
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Article Figures & Data

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  • Figure 1.
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    Figure 1.

    The difference in telomere length between those with and without a usual source of care (A); and the attenuation in the difference in telomere length in the stepwise models that account for demographics, health conditions, and health behaviors (B). Abbreviation: WBC, white blood cell.

  • Figure 2.
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    Figure 2.

    Forest plot of β coefficients and 95% CIs for the relationship between each variable in the fully adjusted model and leukocyte telomere length (base pairs).

Tables

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    Table 1.

    Demographic Characteristics of NHANES 1999-2002 Participants Aged 50-84 Years by Usual Source of Care (n = 3175), Percent for Categorical Variables and Standard Error for Continuous Variables in Parenthesis

    VariableFull Sample (n = 3175)Usual Source of Care
    Yes (n = 2953)No (n = 222)P-Value
    Mean telomere length (base pair)5564.9 (37.4)5569.2 (37.5)5500.1 (44.9).041
    Mean Age (years)62.9 (0.2)63.2 (0.2)59.0 (0.7)<.001
    Mean WBC count (millions/µL)7.0 (0.1)7.0 (0.1)7.4 (0.2).105
    Gender.018
     Male1606 (46.3)1475 (45.7)131 (55.5)
     Female1569 (53.7)1478 (54.3)91 (44.5)
    Race/ethnicity<.001
     Non-Hispanic White1851 (81.3)1769 (82.2)82 (67.9)
     Non-Hispanic Black467 (6.9)441 (6.9)26 (7.9)
     Mexican American and Hispanic782 (8.6)673 (7.8)109 (21.1)
     Other races75 (3.2)70 (3.1)5 (3.1)
    Education level.009
     Less than high school1195 (24.6)1063 (23.7)132 (38.9)
     High school721 (26.1)683 (26.2)38 (24.0)
     Some college656 (24.7)626 (25.0)30 (19.8)
     College and above603 (24.6)581 (25.1)22 (17.2)
    Covered by health insurance
     Yes2874 (92.6)2755 (94.7)119 (60.6)<.001
     No301 (7.4)198 (5.3)103 (39.4)
    CVD History<.001
     Yes599 (16.9)583 (17.5)16 (6.6)
     No2576 (83.1)2370 (82.5)206 (93.4)
    Emphysema history.163
     Yes97 (3.5)96 (3.7)1 (1.0)
     No3078 (96.5)2857 (96.3)221 (99.0)
    High blood pressure<.001
     Yes1493 (43.6)1443 (45.2)50 (18.1)
     No1682 (56.4)1510 (54.8)172 (81.9)
    Smoking status<.001
     Current smoker491 (16.7)419 (15.3)72 (38.1)
     Former smoker1240 (39.0)1178 (39.9)62 (25.8)
     Never smoked1444 (44.3)1356 (44.8)88 (36.1)
    Physical inactivity.003
     Yes1592 (43.3)1454 (42.3)138 (58.9)
     No1583 (56.7)1499 (57.7)84 (41.1)
    • CVD, cardiovascular disease; WBC, white blood cell; NHANES, National Health and Nutrition Examination Survey.

    • Values are number of subjects (weighted proportion) for categorical variables or weighted means (standard error) for continuous variables. P-values were calculated using weighted χ2 tests or t-test.

    • View popup
    Table 2.

    Unadjusted and Adjusted Relationships Between Telomere Length (Base Pairs) and Covariates Among NHANES 1999–2002 Participants Aged 50–84 Years

    VariablesUnadjustedAdjusted for Age, Age Squared, White Blood Cell Count
    β CoefficientSEP-Valueβ CoefficientSEP-Value
    Usual source of care
     Yes69.132.3.041122.930.5<.001
     Norefref
    Gender
     Male−56.616.2.002−75.215.5<.001
     Femalerefref
    Age (years)−13.81.4<.001NA
    WBC count (millions/µL)−18.77.1.014NA
    Race/ethnicity
     Non-Hispanic Whiterefref
     Non-Hispanic Black117.548.2.02181.346.4.091
     Mexican American and Hispanic25.985.6.764−5.980.5.942
     Other races62.588.3.4848.882.9.916
    Education level
     Less than high schoolrefref
     High school71.930.6.02661.929.2.042
     Some college54.934.1.11815.131.6.636
     College and above135.531.0<.00170.630.5.028
    Covered by health insurance
     Yes−58.564.5.37215.560.2.799
     Norefref
    CVD history
     Yes−147.935.0<.001−67.635.9.070
     Norefref
    Emphysema history
     Yes−189.551.2.001−116.955.8.045
     Norefref
    High blood pressure
     Yes18.520.4.37274.822.9.003
     Norefref
    Smoking status
     Current smoker−16.139.4.685−58.534.5.101
     Former smoker1.2029.6.968−3.528.7.903
     Never smokedrefRef
    Physically inactivity
     Yes−85.332.1.013−47.431.8.146
     Norefref
    • CVD, cardiovascular disease; WBC, white blood cell; NHANES, National Health and Nutrition Examination Survey; SE, standard error.

    • Linear regression was used to calculate β coefficients, standard errors, and P-values.

    • View popup
    Table 3.

    Adjusted Relationship Between Telomere Length (Base Pairs) and Usual Source of Care Among NHANES 1999–2002 Participants Aged 50-84 Years Using Multivariate Linear Regression

    VariablesModel 1Model 2Model 3
    βSEPβSEPβSEP
    Usual Source of care
     Yes115.528.7<.001108.528.8.00198.330.0.003
     Norefrefref
    Gender
     Male−76.516.6<.001−67.516.5<.001−77.317.4<.001
     Femalerefrefref
    Age (years)−3.118.6.867−6.618.4.722−8.318.4.653
    Age Squared−0.10.1.573−0.10.1.707−0.10.1.783
    WBC count (millions/µL)−12.96.6.061−13.96.9.054−11.96.3.067
    Race/ethnicity
     Non-Hispanic Whiterefrefref
     Non-Hispanic Black98.548.7.05380.049.3.11694.348.3.060
     Mexican American and Hispanic29.385.9.73621.585.4.80325.484.6.766
     Other races6.282.5.9409.683.2.90918.683.7.826
    Education level
     Less than high schoolrefrefref
     High school65.030.5.04164.730.9.04559.632.1.073
     Some college21.436.9.56617.335.7.6316.338.5.872
     College and above90.738.5.02686.136.2.02472.136.9.061
    Covered by health insurance
     Yes−16.163.3.801−24.764.2.703−32.762.6.605
     Norefrefref
    CVD History
     Yes−72.335.1.048−70.935.8.057
     Norefref
    Emphysema history
     Yes−105.258.3.082−99.259.8.108
     Norefref
    High blood pressure
     Yes73.423.6.00473.622.8.003
     Norefref
    Smoking status
     Current smoker−12.836.7.731
     Former smoker28.327.5.312
     Never smokedref
    Physically inactivity
     Yes−45.933.2.177
     Noref
    • CVD, cardiovascular disease; WBC, white blood cell; NHANES, National Health and Nutrition Examination Survey; SE, standard error.

    • Linear regression was used to calculate β coefficients, standard errors, and P-values.

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The Journal of the American Board of Family     Medicine: 33 (6)
The Journal of the American Board of Family Medicine
Vol. 33, Issue 6
November-December 2020
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Having a Usual Source of Care Is Associated with Longer Telomere Length in a National Sample of Older Adults
Peter T. Baltrus, Chaohua Li, Anne H. Gaglioti
The Journal of the American Board of Family Medicine Nov 2020, 33 (6) 832-841; DOI: 10.3122/jabfm.2020.06.200008

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Having a Usual Source of Care Is Associated with Longer Telomere Length in a National Sample of Older Adults
Peter T. Baltrus, Chaohua Li, Anne H. Gaglioti
The Journal of the American Board of Family Medicine Nov 2020, 33 (6) 832-841; DOI: 10.3122/jabfm.2020.06.200008
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Keywords

  • Aging
  • Cross-Sectional Studies
  • Healthy Aging
  • Leukocytes
  • Linear Models
  • Nutrition Surveys
  • Primary Health Care
  • Telomere

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