Guohua Li

Guohua Li
Columbia University | CU · Departments of Anesthesiology and Epidemiology

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440
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Publications

Publications (440)
Article
Background Racial and ethnic diversification of the physician and nurse workforce is recommended as a leverage point to address the impact of structural racism in maternal care but empirical evidence supporting this recommendation is currently lacking. Objective To assess the association between state-level registered nurse workforce racial and et...
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Objective: To assess occupational circumstances associated with adverse mental health among healthcare workers during the COVID-19 pandemic. Methods: A cross-sectional study examined responses to an online survey conducted among 2076 licensed healthcare workers during the first pandemic peak. Mental health (depression, anxiety, stress, and anger...
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Injury prevention encompasses all the processes, strategies, and approaches designed to mitigate any unintentional or intentional bodily damage from external causes, such as motor vehicle crashes, falls from height, or incidents resulting in deprivation of the two essential elements needed for the proper functioning of the body, oxygen and heat. Th...
Chapter
The use of cannabis, alcohol, and other drugs is a major risk factor for assaultive injuries and violent deaths. Cannabis is one of the most frequently detected drugs among homicide victims as well as perpetrators. It is evident that as more countries move toward legalizing cannabis, this drug is playing an increasingly important role in homicide v...
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Advances in injury prevention and control are among the most important public health achievements in the US in the past century. 1 However, progress in injury prevention and control is largely limited to reductions in fatalities from unintentional mechanisms, such as motor vehicle crashes, occupational mishaps, drowning, and fires and burns. There...
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OBJECTIVES/GOALS: Early clinical case reports have described incidental epileptiform changes during electrophysiological monitoring. The objective of this study was to perform a systematic review of all existing investigations of epileptiform activity during sevoflurane use in pediatric anesthesia. The heterogenous EEG data will be analyzed in a me...
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Importance: Characterizing and addressing racial and ethnic disparities in peripartum pain assessment and treatment is a national priority. Objective: To evaluate the association of race and ethnicity with the provision and timing of an epidural blood patch (EBP) for management of postdural puncture headache in obstetric patients. Design, setti...
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Purpose To assess the association of neighborhood demographic and socioeconomic characteristics with COVID-19 incidence and mortality in New York City (NYC) over the first two waves of outbreak. Methods This retrospective study used neighborhood-level data from 177 modified ZIP code tabulation areas in NYC between 03/01/2020 and 04/30/2021. Resul...
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Older adults are at risk of driving cessation as they age, which can result in negative health outcomes including loss of independence. This study aimed to investigate the associations of self-care health behaviors with the risk of driving cessation. Demographics, health and driving characteristics were captured from healthcare systems in Denver, C...
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Introduction Mobility is closely tied to the ability to safely drive. In older adulthood, many people begin to avoid difficult driving situations, such as driving at night, during rush hour, on freeways, or in unfamiliar areas. Reasons for such avoidance include driving self-regulation (SR; an intentional response to perceived difficulty), lifestyl...
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(Int J Obstet Anesth. 2021;45:90–98) Postdural puncture headache (PDPH) following neuraxial analgesia for labor is associated with several adverse postpartum outcomes including delayed discharge, persistent backache and neurological complications. Thankfully, over the past 2 decades, anesthesia care has improved and anesthesia-related complications...
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(Anesth Analg. 2021;133:340–348. doi: 10.1213/ANE.0000000000005371) Severe maternal morbidity (SMM) during delivery is increasing in the United States and disproportionately occurs in racial and ethnic minority groups. The 2014 Medicaid expansion was implemented to provide more women access to health insurance coverage. While more low-income women...
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Importance: Addressing severe maternal morbidity (SMM) is a public health priority in the US. Use of labor neuraxial analgesia for vaginal delivery is suggested to reduce the risk of postpartum hemorrhage (PPH), the leading cause of preventable severe maternal morbidity. Objective: To assess the association between the use of labor neuraxial ana...
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Objective: To synthesize the empirical research evidence about the association between Medicaid expansion under the Affordable Care Act (ACA) and increasing perinatal care access and utilization among low-income women. Data sources: We searched MEDLINE through PubMed (1966-present), EMBASE (Ovid), the Cumulative Index to Nursing and Allied Healt...
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Introduction: The COVID-19 Healthcare Personnel Study (CHPS) was designed to assess adverse short-term and long-term physical and mental health impacts of the coronavirus disease-2019 (COVID-19) pandemic on New York's physicians, nurse practitioners, and physician assistants. Methods: Online population-based survey. Survey-weighted descriptive r...
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Introduction: New York State implemented an 11-week elective surgery ban in response to the coronavirus disease-2019 (COVID-19) pandemic, during which pediatric patients from the 10 New York Presbyterian network hospitals requiring urgent or emergent surgical procedures were cared for at Morgan Stanley Children's Hospital (MSCH). Materials and me...
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Background: Risk prediction models for postoperative mortality after intra-abdominal surgery have typically been developed using preoperative variables. It is unclear if intraoperative data add significant value to these risk prediction models. Methods: With IRB approval, an institutional retrospective cohort of intra-abdominal surgery patients...
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Aging is associated with an increase in avoidance of challenging driving situations (e.g., driving at night, during rush hour, on freeways, and in unfamiliar areas). Such avoidance behavior may be due to driving self-regulation (SR), an intentional response to perceived declining abilities, or it may be due to other factors such as lifestyle change...
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Background: In the United States, New York State’s health care system experienced unprecedented stress as an early epicenter of the coronavirus disease 2019 (COVID-19) pandemic. This study aims to assess the level of hopelessness in New York State physicians working on the frontlines during the first wave of the COVID-19 outbreak. Methods: A confid...
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(Obstet Gynecol. 2021;137:791–800) Where women deliver has significant consequences due to racial and ethnic disparities in maternal morbidity within the United States. Rates of severe maternal morbidity and failure to rescue are strong indicators for hospital performance, which have been reportedly higher in Black and Hispanic women than in White...
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Introduction: Social isolation is a modifiable risk factor for negative health outcomes among older adults. This work assessed the relationship between geography (i.e., urban vs. non-urban residence) and social isolation in a cohort of older drivers. Methods: The AAA LongROAD cohort with 2,989 older adult drivers from across the country were includ...
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Background Children undergoing spinal fusion often receive blood products. The goal of this study was to develop a preoperative score to help physicians identify those who are at risk of allogeneic red blood cell (RBC) transfusion. Study design and methods This retrospective study of children undergoing spinal fusion in the ACS-NSQIP Pediatric dat...
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Importance: Multiple studies have reported that people with autism spectrum disorder (ASD) are at a higher risk for self-injurious behavior and suicide. However, the magnitude of this association varies between studies. Objective: To appraise the available epidemiologic studies on the risk of self-injurious behavior and suicidality among childre...
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Background: Utilization of extracorporeal membrane oxygenation (ECMO) for adult critically ill patients is increasing, but data in obstetric cohorts are scant. This study analyzed ECMO utilization and maternal outcomes in obstetric patients in the United States. Methods: Data were abstracted from the 1999-2014 National Inpatient Sample (NIS), a...
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(Anaesthesia. 2020;75:1424–1427) (Anesth Analg. 2021. doi: 10.1213/ANE.0000000000005389. Epub ahead of print) While the US Food and Drug Administration has issued a warning about the neurodevelopmental effects of anesthetic drugs in the third trimester of pregnancy and children under the age of 3, no clinical study has evaluated long-term neurodeve...
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Background: Medicaid expansions under the Affordable Care Act have increased insurance coverage and prenatal care utilization in low-income women. However, it is not clear whether they are associated with any measurable improvement in maternal health outcomes. In this study, we compared the changes in the incidence of severe maternal morbidity (SM...
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Objective To identify factors associated with distress experienced by physicians during their first COVID-19 triage decisions. Methods An online survey was administered to physicians licensed in New York State. Results Of the 164 physicians studied, 20.7% experienced severe distress during their first COVID-19 triage decisions. The mean distress...
Article
(Anesth Analg. 2020;131:1421–1429) Postpartum depression (PPD) affects up to 1 in 7 women in the United States. There is a need to identify actionable risk factors for PPD prior to the beginning of depressive symptoms. Cesarean delivery has been associated with increased risk of PPD compared to vaginal delivery. There have not been any studies inve...
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Recent research indicates that children with autism are at increased risk of maltreatment. We examined news media reports on homicide incidents involving children with autism as victims in the United States between 2000 and 2019. Of the 52 victims studied, 47 (90.4%) were male. Age of victims ranged from 2 to 20 years (mean = 10.4 ± 5.3 years). Par...
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Introduction Fall fatality rates among U.S. older adults increased 30% from 2007 to 2016. In response, the Centers for Disease Control and Prevention developed the Stopping Elderly Accidents, Deaths, and Injuries algorithm for fall risk screening, assessment, and intervention. The current Stopping Elderly Accidents, Deaths, and Injuries algorithm w...
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Emerging evidence suggests that atypical changes in driving behaviors may be early signals of mild cognitive impairment (MCI) and dementia. This study aims to assess the utility of naturalistic driving data and machine learning techniques in predicting incident MCI and dementia in older adults. Monthly driving data captured by in-vehicle recording...
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Objective: To analyze racial and ethnic disparities in failure to rescue (ie, death) associated with severe maternal morbidity and describe temporal trends. Methods: This was a retrospective cohort study using administrative data. Data for delivery hospitalizations with severe maternal morbidity, as defined by the Centers for Disease Control and...
Article
As people age, some of the commonly experienced psychomotor, visual, and cognitive declines can interfere with the ability to safely drive, often leading to situational avoidance of challenging driving situations. The effect of hearing impairment on these avoidance behaviors has not been comprehensively studied. Data from the American Automobile As...
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Potentially inappropriate medications (PIMs) identified by the American Geriatrics Society should generally be avoided by older adults because of ineffectiveness or excess risk of adverse effects. Few studies have examined the effects of PIMs on driving safety measured by prospectively and objectively collected driving data. Data for this study cam...
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Background: Exposure to surgery and anesthesia in early childhood has been found to be associated with an increased risk of behavioral deficits. While the US Food and Drug Administration (FDA) has warned against prenatal exposure to anesthetic drugs, little clinical evidence exists to support this recommendation. This study evaluates the associati...
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Background Anemia is associated with intensive care unit (ICU) outcomes, but data describing this association in sub-Saharan Africa are scarce. Patients in this region are at risk for anemia due to endemic conditions like malaria and because transfusion services are limited. Methods This was a prospective cohort study of ICU patients at Kamuzu Cen...
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Context: Given the wide-ranging health impacts of justice system involvement, we examined evidence for the association between adverse childhood experiences (ACEs) and justice system contact in the United States. Objective: To synthesize epidemiological evidence for the association between ACEs and justice system contact. Data sources: We sear...
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Better information is needed about how declines in sensory and cognitive function affect older drivers. This study assessed how hearing loss affects engagement in four challenging driving patterns. Data from the AAA Longitudinal Research on Aging Drivers study was used, including objectively-measured driving; three measures of hearing: reported hea...
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Background: Use of alcohol and other drugs is a major risk factor for assaultive injuries and violent deaths. The purpose of this study was to examine the time trends in the prevalence of alcohol and marijuana detected in homicide victims. Methods: We analyzed toxicological testing data for homicide victims (n = 12,638) from the 2004-2016 Nation...
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Background: The potential for impaired driving due to medication use can occur at any age, though older adults are more likely to take multiple prescribed medications and experience side effects that may affect driving ability. The purpose of this study was to characterize the relationship between medications and driving safety behaviors. Methods...
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Background Whether exposure to a single general anaesthetic (GA) in early childhood causes long-term neurodevelopmental problems remains unclear. Methods PubMed/MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Library were searched from inception to October 2019. Studies evaluating neurodevelopmental outcomes and prospectively enrolling c...
Preprint
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Introduction The COVID-19 Healthcare Personnel Study (CHPS) was designed to assess and mitigate adverse short and long-term physical and mental health impacts of the COVID-19 pandemic on New York’s health care workforce. Here we report selected baseline results. Methods Online survey of New York State physicians, nurse practitioners and physician...
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Background: Pharmaceutical companies and drug distributors are intensely scrutinized in numerous lawsuits for their role in instigating the opioid epidemic. Many individual physicians have also been held accountable for activities related to prescribing opioid medications. The purpose of this study was to examine the epidemiologic patterns of crim...
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Background Labor neuraxial analgesia utilization has increased in the United States (U.S.) but its impact on maternal safety is unknown. This study analyzed the temporal trends in the incidence of post-dural puncture headache (PDPH) in obstetrics. Methods Data for vaginal or intrapartum cesarean deliveries came from the National Inpatient Sample 2...
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Background: Despite updated playground equipment and improved industry standards, playgrounds remain a common source of childhood injury. Fractures account for 35% of all playground injuries presenting to emergency departments (EDs). We aimed to examine the time trends and epidemiologic patterns of playground equipment-related extremity fractures...
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Background: Marijuana and alcohol each play a significant role in fatal crash initiation. We decomposed the total effect of marijuana use in the presence or absence of alcohol on fatal crash initiation into direct and indirect effects. Methods: Pair-matched data on 5856 culpable drivers (initiators) and 5856 nonculpable drivers (noninitiators) i...
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Background: Aspects of intraoperative management (eg, hypotension) are associated with acute kidney injury (AKI) in noncardiac surgery patients. However, it is unclear if and how the addition of intraoperative data affects a baseline risk prediction model for postoperative AKI. Methods: With institutional review board (IRB) approval, an institut...
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Background: Postoperative opioid prescriptions may be associated with risks of unintentional poisoning and drug diversion in other household members. The objective of this study was to explore the association between mothers' postoperative opioid prescriptions and incidence of opioid-related events in their children (aged 1 to 24 years). Data and...
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This prospective cohort study evaluated the associations of day and time of admission to the Intensive Care Unit (ICU) with hospital mortality at a referral hospital in Malawi, a low-income country in sub-Saharan Africa. Patients admitted to the ICU during the day (08:00–16:00) were compared to those admitted at night (16:01–07:59); patients admitt...
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Background: Opioid medications are important therapeutic options to mitigate the harmful effects of pain but can also impair driving ability. We sought to explore opioid use, pain levels, and driving experiences among older drivers. Methods: Cognitively intact drivers ages 65 to 79 years were recruited for the multisite AAA Longitudinal Research...
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Problems related to unknown or imprecisely measured populations at risk are common in epidemiologic studies of disease frequency. The size of the population at risk is typically conceptualized as a denominator to be used in combination with a count of disease cases (a numerator) to calculate incidence or prevalence. However, the size of the populat...
Preprint
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Background The reported prevalence of autism spectrum disorder (ASD) has increased markedly in the past two decades and children with autism are at increased risk of unintentional injury and self-inflicted injury. The risk of assaultive injury in children with autism, however, has not been well described. Our objective was to examine the characteri...
Article
Objective To evaluate healthcare utilization in Medicaid enrolled children with neonatal abstinence syndrome (NAS) in the first 2 years of life. Study design A retrospective, longitudinal cohort study evaluating Medicaid enrolled children born in New York (1999-2011) and Texas (1999-2010) was performed. Healthcare utilization, including inpatient...
Preprint
Full-text available
Background: Pharmaceutical companies and drug distributors are intensely scrutinized in numerous lawsuits for their role in instigating the opioid epidemic. Many individual physicians have also been held accountable for activities related to prescribing opioid medications. The purpose of this study was to examine the epidemiologic patterns of lawsu...
Preprint
Full-text available
Background: Pharmaceutical companies and drug distributors are intensely scrutinized in numerous lawsuits for their role in instigating the opioid epidemic. Many individual physicians have also been held accountable for activities related to prescribing opioid medications. The purpose of this study was to examine the epidemiologic patterns of lawsu...
Preprint
Full-text available
Background: Pharmaceutical companies and drug distributors are intensely scrutinized in numerous lawsuits for their role in instigating the opioid epidemic. Many individual physicians have also been held accountable for activities related to prescribing opioid medications. The purpose of this study was to examine the epidemiologic patterns of crimi...
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Full-text available
The study sought to understand the relationship between in-vehicle technologies (IVTs) and self-regulatory behaviors among older drivers. In a large multi-site study of 2990 older drivers, self-reported data on the presence of IVTs and avoidance of various driving behaviors (talking on a mobile phone while driving, driving at night, driving in bad...
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Prescription drug monitoring programs (PDMPs) are a crucial component of federal and state governments' response to the opioid epidemic. Evidence about the effectiveness of PDMPs in reducing prescription opioid-related adverse outcomes is mixed. We conducted a systematic review to examine whether PDMP implementation within the U.S. is associated wi...
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The US older adult population is projected to considerably increase in the future, and continued driving mobility is important for health aspects in populations with fewer transportation alternatives. This study evaluated whether frailty is associated with low-mileage driving (<1865 miles per year) and driving cessation among older adults. Baseline...
Article
(Anesthesiology. 2019;130:912–922) Over the last decade, the use of general anesthesia for cesarean delivery has decreased, as neuraxial anesthesia has been associated with significantly lower risk of adverse maternal events. Consequently, anesthesia-related morbidity also decreased during that time. The estimated rate for general anesthesia use in...
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Background: State governments in the United States are increasingly viewing marijuana legalization as a policy option for controlling the opioid epidemic under the premise that marijuana is a less harmful substitute for opioids. The purpose of this study is to assess whether marijuana use is associated with decreased odds of prescription opioid us...
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Study design: Retrospective cohort. Objective: To evaluate the effectiveness and safety of antifibrinolytic (AF) agents in reducing perioperative blood transfusion in pediatric patients undergoing spinal fusion. Summary of background data: The potential for AF to decrease bleeding and reduce exposure to allogenic transfusions has led to widesp...
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Background: Previous research suggests that, compared with regional anesthesia, general anesthesia is associated with increased odds of postoperative depressive disorders. No study has specifically evaluated the possible protective effect of neuraxial anesthesia for cesarean delivery on maternal mental health compared with general anesthesia. This...
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Background: The cost-benefit of stocking dantrolene in maternity units for treating malignant hyperthermia (MH) has been recently questioned because of the low incidence of MH crisis in the general population and the low utilization of general anesthesia in obstetrics. However, no study has examined the prevalence of MH susceptibility in obstetric...
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Importance The use of intensive care at the end of life continues to be common. Although the provision of palliative care has been advocated as a way to mitigate the use of high-intensity care, it is unknown whether implementation of hospital-based palliative care services is associated with reduced use of intensive care at the end of life. Object...
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Background: Some recent clinical studies have found that early childhood exposure to anesthesia is associated with increased risks of behavioral deficits and clinical diagnoses of attention deficit/hyperactivity disorder (ADHD). While diagnoses in claims data may be subject to inaccuracies, pharmacy claims are highly accurate in reflecting medicat...
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Introduction The present study uses data from the American Automobile Association (AAA) Longitudinal Research on Aging Drivers (LongROAD) study to assess the association of the frailty phenotype with reduced driving space and involvement in motor vehicle crashes. Methods The LongROAD study is a multisite prospective cohort study of participants ag...
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The crash rate per mile driven among older adults is higher than that of most age groups and comparable to that of the youngest, most inexperienced drivers. The low-mileage bias posits that the elevated rate among older adults results from an increased rate among those who accrue the fewest annual miles. This study evaluated whether low physical ca...
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When older adults reduce their driving, there can be subsequent decreases in life satisfaction. In this cross-sectional study, we used baseline data from the multi-site Longitudinal Research on Aging Drivers (LongROAD) study to examine whether social support moderates the negative association between reduced driving and life satisfaction. The outco...