
Ruijia ChenBoston University | BU · Department of Epidemiology
Ruijia Chen
Doctor of Science
Social epidemiology; cognitive aging; health disparities; Alzheimer's Disease and Dementia
About
81
Publications
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Introduction
I am a social epidemiologist and am interested in lifecourse social determinants of cognitive aging.
Skills and Expertise
Education
September 2015 - May 2021
September 2010 - May 2012
Publications
Publications (81)
Background
Racial disparities in cognitive function are well documented, but factors driving these disparities remain underexplored. This study aims to quantify the extent to which cumulative stress exposures across the life course explain Black–White disparities in executive function and episodic memory in middle-aged and older adults.
Methods
Da...
This cross-sectional study examines racial and ethnic disparities in estimated excess deaths from homicide, suicide, transportation, and drug overdoses during the COVID-19 pandemic.
Background
Many studies have evaluated the stress-cognition association, but few have captured the cumulative nature of stress or distinguished the influences of stressors occurring in childhood versus adulthood. Using a lifecourse approach, we investigated whether cumulative stress exposures are associated with poorer cognitive function and faster...
Introduction:
The challenge of accounting for practice effects (PEs) when modeling cognitive change was amplified by the COVID-19 pandemic, which introduced period and mode effects that may bias the estimation of cognitive trajectory.
Methods:
In three Kaiser Permanente Northern California prospective cohorts, we compared predicted cognitive tra...
Importance:
Adults with Alzheimer disease and related dementias (ADRD) are particularly vulnerable to the direct and indirect effects of the COVID-19 pandemic. Deaths associated with ADRD increased substantially in pandemic year 1. It is unclear whether mortality associated with ADRD declined when better prevention strategies, testing, and vaccine...
Objective
To assess the utility and challenges of using natural language processing (NLP) in electronic health records (EHRs) to ascertain health‐related social needs (HRSNs) among older adults.
Study Setting and Design
We extracted HRSN information using the NLP system Clinical Text Analysis and Knowledge Extraction System (cTAKES), combined with...
Background
The All of Us (AoU) Research Program, an ongoing large‐scale research initiative enrolling diverse groups across the U.S offers a valuable opportunity for dementia research. It is vital to assess if AoU findings are applicable to the general population. We compared dementia incidence and risk factor associations in AoU to those in a popu...
Background
Neurocognitive health is influenced by multiple modifiable and non‐modifiable lifestyle factors. Machine learning tools offer a promising approach to better understand complex models of cognitive function. We used extreme gradient boosting (XG Boost), an algorithm of decision‐tree modeling, to analyze the association between 15 late‐life...
Causal inference in population health research on aging is critical for understanding determinants of healthy aging and informing potential avenues of intervention. Such research faces a number of methodological challenges including data availability, detection bias, selection bias, confounding, and reverse causation. Novel statistical methods and...
Stress exposures across the lifespan, such as childhood adversities and financial strain, may contribute to social disparities in cognitive outcomes. Individuals from socially disadvantaged backgrounds tend to be exposed to more stressors than their advantaged counterparts. Prior research has indicated that psychosocial stressors are key determinan...
Many epidemiologic studies of dementia use electronic health record (EHR) data, which are vulnerable to detection bias. Dementia is more likely to be detected when patients have more contact with the healthcare system. Using EHR data from the UK Biobank (UKB) and All of Us (AoU), we evaluated potential detection bias by estimating associations of t...
Background: The large and diverse All of Us Research Program offers tremendous opportunities for health research. However, results may not be generalizable to the US population due to the program's targeted recruitment efforts.
Methods: We compared All of Us participants to those from the nationally representative 1999-2018 National Health and Nutr...
Objectives
We investigated the associations of lifetime and everyday discrimination with cognitive function.
Methods
Data were from the Chicago Community Adult Health Study (n=2952, mean age=43 years [SD=17]). We fitted multivariable linear regression models to quantify the discrimination-cognition associations.
Results
Major lifetime (β1 vs 0 ep...
Objectives:
On average, adults racialized as non-Hispanic Black and Hispanic sleep more poorly than adults racialized as non-Hispanic White (hereafter, Black, Hispanic, White), but associations between factors that may moderate sleep-memory associations in these groups, such as neighborhood conditions, are unclear. Poorer neighborhood conditions (...
Objective
Experiencing potentially traumatic events across one’s lifecourse increases risk for poor physical health outcomes. Existing models emphasize the effects of any lifetime trauma exposure, risk accumulation (multiple traumas over time), and sensitive periods of exposure (specific exposure timepoints leading to lasting consequences). We exam...
Objective
Most prior research on physical activity (PA) and cognition is based on predominantly white cohorts and focused on associations of PA with mean (average) cognition versus the distribution of cognition. Quantile regression offers a novel way to quantify how PA affects cognition across the entire distribution.
Methods
The Kaiser Healthy Ag...
Introduction
Low educational attainment is associated with increased risk of COVID-19 mortality, but it remains unclear whether the link between education and COVID-19 mortality is causal or due to confounding factors, such as childhood socio-economic status or cognitive skills. To address this question, we evaluated whether older adults’ risk of C...
Most neuroimaging studies linking regional brain volumes with cognition correct for total intracranial volume (ICV), but methods used for this correction differ across studies. It is unknown whether different ICV correction methods yield consistent results. Using a brain‐wide association approach in the MRI substudy of UK Biobank ( N = 41,964; mean...
INTRODUCTION
The prevalence of poor sleep quality and sleep apnea differs by race and ethnicity and may contribute to racial disparities in cognitive aging. We investigated whether sleep quality and sleep apnea risk were associated with cognitive function and decline and whether the associations differed by race/ethnicity.
METHODS
Participants fro...
Objective
To test whether the impacts of Medicaid's Home and Community‐Based Services (HCBS) expenditures have been equitable.
Data Sources and Study Setting
This is a secondary data analysis. We linked annual data on state‐level Medicaid HCBS expenditures with individual data from U.S. Health and Retirement Study (HRS; 2006–2016).
Study Design
W...
Background
Understanding determinants of cognitive decline relies on several modeling assumptions. Alternative longitudinal modeling strategies–such as accounting for aging using time‐on‐study (estimated based on within‐person comparisons), baseline age (estimated based on between‐person comparisons), or current age (estimated based on both within‐...
Background
Social support shapes the health of older adults with Alzheimer’s disease and related dementias (ADRD), and marital status is linked to ADRD risk and all‐cause mortality. During the Covid‐19 pandemic, older adults with ADRD may have been particularly reliant on key social ties such as spouses. We estimated excess ADRD mortality by marita...
Background
Neurocognitive sequelae of SARS‐CoV‐2 infection have been suggested as potentially leading to a higher incidence of dementia, but the underlying mechanisms remain unclear. By comparing brain magnetic resonance imaging (MRI) between participants with and without a history of SARS‐CoV‐2 infection, prior work identified infection‐related st...
Background
Social networks may influence late‐life cognition directly via affecting brain structures or indirectly through enhancing cognitive resilience – i.e., the ability to maintain cognitive function in the presence of neurodegeneration. This study assesses the associations of social networks with markers of neurodegeneration, and determines w...
Delayed dementia diagnosis may exacerbate dementia symptoms and reduce opportunities for care arrangements, further harming older adults’ health and well-being. Social isolation may increase the risk of delayed dementia diagnosis via a lack of support that prevents seeking help and accessing primary and specialty care for diagnosis. We investigated...
Objective
Social support may protect against Alzheimer’s disease and related dementias (ADRD), potentially through emotional or instrumental support elements. Black and Hispanic/Latinx older adults bear a disproportionate burden of ADRD. However, independent effects of emotional and instrumental support on cognition, a primary indicator of ADRD ris...
Objective
Cardiovascular disease (CVD) is a well-known risk factor for cognitive impairment and dementia, particularly among minoritized groups that have experienced a history of low childhood socioeconomic status (SES). Although previous literature has linked all levels of SES to varying degrees of stress exposure, children raised in higher SES ho...
BACKGROUND
Little is known about the population of individuals who live with a spouse with cognitive impairment (CI) or dementia.
METHODS
Using the US Health and Retirement Study, 2000 to 2018, we estimated the population of adults ≥ 50 years old co‐residing with a spouse with probable CI/dementia. We described their socio‐demographic and health c...
Objectives:
Associations of stress-related coping strategies with lifespan among the general population are understudied. Coping strategies are characterized as being either adaptive or maladaptive, but it is unknown the degree to which variability in tailoring their implementation to different contexts may influence lifespan.
Method:
Women (N =...
INTRODUCTION
The results of the CLARITY‐AD, GRADUATE I and II, and TRAILBLAZER‐ALZ 2 trials have rekindled discussion on the impact of amyloid‐targeting drugs. We use a Bayesian approach to quantify how rational observers would have updated their prior beliefs based on new trial results.
METHODS
We used publicly available data from the CLARITY‐AD,...
BACKGROUND
Epidemiological studies demonstrate higher loneliness is associated with increased risk of developing cardiovascular disease (CVD). However, most studies are conducted with populations in Western developed countries, whose cultures generally emphasize independence. Less clear is whether these associations are also evident in more interde...
INTRODUCTION
Cancer survivors are less likely than comparably aged individuals without a cancer history to develop Alzheimer's disease and related dementias (ADRD).
METHODS
In the UK Biobank, we investigated associations between cancer history and five structural magnetic resonance imaging (MRI) markers for ADRD risk, using linear mixed‐effects mo...
INTRODUCTION
The timing of educational attainment may modify its effects on late‐life cognition, yet most studies evaluate education only at a single time point.
METHODS
Kaiser Healthy Aging and Diverse Life Experiences (KHANDLE) Study cohort participants (N = 554) reported educational attainment (dichotomized at any college education) at two time...
Background:
The mediating roles of neuropathologies and neurovascular damage in the relationship between early-life education and later-life cognitive function are unknown.
Objective:
To examine whether Alzheimer's and neurovascular biomarkers mediate the relationships between education and cognitive functions.
Methods:
Data were from 537 adul...
Background: Consistent methods for evaluating the link between brain structure and cognition are essential for understanding determinants of neurologic outcomes. Studies examining associations between brain volumetric measures and cognition use various statistical approaches to account for variation in intracranial volume (ICV). It is unclear if co...
Introduction: Results of the CLARITY-AD and GRADUATE I and II trials rekindled discussion on the impact of amyloid-targeting drugs. We use a Bayesian approach to quantify how a rational observer might update their prior beliefs based on new trial results.
Methods: We used publicly available data from the CLARITY-AD and GRADUATE I & II trials to est...
Importance:
Prior research has established that Hispanic and non-Hispanic Black residents in the US experienced substantially higher COVID-19 mortality rates in 2020 than non-Hispanic White residents owing to structural racism. In 2021, these disparities decreased.
Objective:
To assess to what extent national decreases in racial and ethnic dispa...
Objective:
To understand the association between psychosocial stressors and cardiovascular health by evaluating: (a) lifespan patterns of childhood and adulthood stressors in relation to hemodynamic acute stress reactivity and recovery and (b) the role of optimism in these associations.
Method:
Participants (n = 1,092, 56% women, 21% racial/ethn...
Background and Objectives: Cancer survivors are less likely than comparably-aged individuals without a cancer history to develop Alzheimer's disease and related dementias (ADRD). We investigated the association between cancer history and structural magnetic resonance imaging (MRI) markers for ADRD risk, using linear mixed-effects models to assess d...
Despite growing research linking stressors with poorer cognition, less research explicitly considers stress from several sources, which often co-occurs and accumulate to influence health. We used the Global Gateway Harmonized data (HRS: n=8,888; mean age: 74 years; ELSA: n=6,715; mean age: 65 years) to examine whether higher cumulative stress is as...
Poor sleep quality has been linked to worse cognitive function, but most research has been conducted in predominantly White samples. We investigated whether poorer sleep quality is associated with lower levels of and faster declines in cognition and whether these associations differ by race/ethnicity. We used data from KHANDLE (N = 1,438; mean age:...
Objective
This study aimed to examine the associations of perceived stress, stressors, and distress with sleep disturbance and duration among Asian immigrants.
Design/setting/participants
The sample included 400 Asian immigrants aged 50-75 years old recruited from primary care physicians’ clinics.
Methods
We fit multivariable regression models to...
As research documenting disparate impacts of COVID-19 by race and ethnicity grows, little attention has been given to dynamics in mortality disparities during the pandemic and whether changes in disparities persist. We estimate age-standardized monthly all-cause mortality in the United States from January 2018 through February 2022 for seven racial...
Background
During the first year of the COVID-19 pandemic, workers in essential sectors had higher rates of SARS-CoV-2 infection and COVID-19 mortality than those in non-essential sectors. It is unknown whether disparities in pandemic-related mortality across occupational sectors have continued to occur during the periods of SARS-CoV-2 variants and...
Objectives
Some stress-related coping strategies contribute to survival among medical populations, but it is unclear if they relate to longevity in the general population. While coping strategies are characterized as being adaptive or maladaptive, whether capacity to tailor their implementation to different contexts (i.e., flexibility of use) may i...
Introduction
Understanding educational patterns in excess mortality during the COVID-19 pandemic may help identify strategies to reduce disparities. It is unclear whether educational inequalities in COVID-19 mortality have persisted throughout the pandemic, spanned the full range of educational attainment, or varied by other demographic indicators...
Excess mortality has exceeded reported deaths from Covid-19 during the pandemic. This gap may be attributable to deaths that occurred among individuals with undiagnosed Covid-19 infections or indirect consequences of the pandemic response such as interruptions in medical care; distinguishing these possibilities has implications for public health re...
This study examined effects of experimentally-induced optimism on physical activity and stress reactivity with community volunteers. Using an intervention to induce short-term optimism, we conducted two harmonized randomized experiments, performed simultaneously at separate academic institutions. All participants were randomized to either the induc...
Introduction
A small body of epidemiological research suggests that working in an essential sector is a risk factor for SARS-CoV-2 infection or subsequent disease or mortality. However, there is limited evidence to date on the US, or on how the risks associated with essential work differ across demographic subgroups defined by age, sex, and race/et...
Background
During the first year of the pandemic, essential workers faced higher rates of SARS-CoV-2 infection and COVID-19 mortality than non-essential workers. It is unknown whether disparities in pandemic-related mortality across occupational sectors have continued to occur, amidst SARS-CoV-2 variants and vaccine availability.
Methods
We obtain...
Little is known about how integrating peers into frontline staff might improve the quality of inpatient psychiatric care. In the current study, we interviewed 18 former adult patients of inpatient psychiatric facilities using semi-structured interviews. We first asked about positive and negative past experiences with traditional staff. We then aske...
Significance
Experiencing early life adversity may negatively impact mental health; however, many of these individuals display psychological resilience or positive psychological health despite experiences of early adversity. This positive capacity for mental health may extend to physical health benefits, including lower cardiometabolic disease. Whi...
Introduction: Racial disparities in cognitive function have been well-documented in the literature, but factors driving the disparities remain under explored. This study aims to quantify the extent to which cumulative stress exposures across the life course explain Black–White disparities in executive function and episodic memory. Method: Data were...
Depression is associated with poor cardiovascular health (CVH) and increased risk of cardiovascular disease in high-income countries. However, it is unclear whether depression, particularly somatic depressive symptoms, may similarly contribute to poor CVH in a different socioeconomic context. Our aim was to investigate the association between depre...
Exposure to discrimination or unfair treatment has emerged as an important risk factor for illness and disease that disproportionately affects racial and ethnic minorities. Discriminatory experiences may operate like other stressors in that they activate physiological responses that adversely affect the maintenance of homeostasis. Research suggests...
Elder mistreatment, a pervasive public health issue, is of growing concern. Interpersonal relationships are culturally constructed, and attempts to understand elder mistreatment in different racial or ethnic groups should take into account cultural context. Culture affects how racial and ethnic groups perceive elder mistreatment and help-seeking be...
Objective:
This study aimed to examine the explanatory role of health behaviors, socioeconomic position (SEP), and psychosocial stressors on racial/ethnic obesity disparities in a multiethnic and multiracial sample of adults.
Methods:
Using data from the Chicago Community Adult Health Study (2001-2003), Oaxaca-Blinder decomposition analysis was...
The purpose of this study was to: (1) examine the associations of individual-level objective socioeconomic status (OSS), subjective socioeconomic status (SSS), and area-based indicators of socioeconomic status, with 12-month DSM-IV mood, anxiety, alcohol use, and drug use disorders; and, (2) determine the extent of racial/ethnic differences in thes...
Background
Psychosocial stress has been implicated as a risk factor for overweight and obesity. However, research on psychosocial stressors and overweight and obesity has typically focused on single stressors in isolation, which may overestimate the impact of a specific stressor and fail to describe the role of cumulative stress on overweight and o...
Background:
Despite equivalent or lower lifetime and past-year prevalence of mental disorder among racial/ethnic minorities compared to non-Latino Whites in the United States, evidence suggests that mental disorders are more persistent among minorities than non-Latino Whites. But, it is unclear how nativity and socioeconomic status contribute to o...
Elder abuse is a growing and emergent global public health concern. A better understanding of risk factors of elder abuse could help us develop effective screening methods to identify individuals who are at risk of elder abuse, allocate resources and services to those who are in need of help, and develop preventions and interventions to address the...
This study aimed to explore the gender differences in the experiences of loneliness in the U.S. Chinese older population. The data were drawn from the PINE study, a population-based study of U.S. Chinese adults aged 60 years and older. The Revised-University of California at Los Angeles Loneliness Scale (R-UCLA) was used to measure loneliness. Over...
This study explored the prevalence and correlates of elder mistreatment among community-dwelling Chinese women in the U.S. Data were from the Population Study of Chinese Elderly in Chicago (PINE), a population-based study of U.S. Chinese older adults aged 60 years and above. Of the 1,833 older women, 289 (15.8%) reported suffering from elder mistre...
Background:
Elder mistreatment and suicidal ideation are important public health concerns among aging populations. However, very few studies have been conducted to explore the association between elder mistreatment and suicidal ideation.
Objectives:
To examine the association between elder mistreatment and suicidal ideation among Chinese older a...
Objectives:
To examine the risk of overall elder mistreatment (EM) and its subtypes in each sociodemographic and socioeconomic group based on different definitional criteria.
Methods:
In person interviews were conducted with 3,159 Chinese older adults in the Greater Chicago Area from 2011 to 2013. Psychological mistreatment, physical mistreatmen...
This study aimed to examine the prevalence and correlates of gambling participation and problems among community-dwelling Chinese older adults in the U.S. Based on a community-based participatory research approach, the study enrolled 3,159 Chinese older adults aged 60 years and above in the greater Chicago area. Among the participants, 58.9% were w...
This study examined the socio-demographic and health related characteristics of elder mistreatment (EM) in a community-dwelling older Chinese population. Methods: Guided by a community-based participatory research approach, the PINE study conducted in-person interviews with 3,159 U.S. Chinese older adults aged 60 years and older in the Greater Chic...
Background:
This study aimed to explore the prevalence and correlates of anxiety disorders and any anxiety symptoms among community-dwelling U.S. Chinese older adults.
Methods:
Guided by a community-based participatory research approach, 3,159 community-dwelling Chinese older adults in the Greater Chicago area were interviewed in person between...
Background:
The burden of medical conditions is increasing among U.S. older adults, yet we have very limited knowledge about medical conditions among Chinese older adults in the United States. This study aimed to examine the prevalence of medical conditions and its sociodemographic and health-related correlates within the context of a population-b...
Background:
Suicidal ideation is a public health issue that has a significant impact at the individual, family, community, and societal levels. This study aimed to examine the association between filial piety and suicidal ideation among U.S. Chinese older adults.
Methods:
Guided by a community-based participatory research approach, 3,159 communi...
Background:
Experiences of discrimination are detrimental to health and well-being. This study aimed to examine experiences of discrimination and responses to unfair treatment among community-dwelling U.S. Chinese older adults.
Method:
Guided by a community-based participatory research approach, 3,159 community-dwelling Chinese older adults aged...
Objective: This study examined the prevalence and correlates of suicidal ideation among U.S. Chinese older adults. Method: Guided by the community-participatory research approach, the PINE (Population Study of Chinese Elderly in Chicago) study is a population-based epidemiological study conducted from 2011 to 2013 of 3,159 community-dwelling Chines...
Objective: This study examined perceptions and correlates of both positive and negative social support among U.S. Chinese older adults. Method: Data were drawn from the Population Study of Chinese Elderly in Chicago study, a population-based study of U.S. community-dwelling Chinese older adults aged 60 years and above in the Greater Chicago area. R...
Objective: This study aimed to examine the prevalence of depressive symptoms among U.S. Chinese older adults. Method: Data were from the Population Study of Chinese Elderly in Chicago (PINE) study, a population-based survey of U.S. Chinese older adults aged 60 years and above. The Patient Health Questionnaire (PHQ-9) was used to examine depressive...
Objective: This study aimed to examine the prevalence and correlates of elder mistreatment among U.S. Chinese older adults. Method: Data were drawn from the Population-Based Study of ChINese Elderly (PINE) study, a population-based epidemiological survey of 3,159 U.S. Chinese older adults in the Greater Chicago area. The study design was guided by...
Background: This study aims to explore gender differences in depressive symptoms in U.S. Chinese older adults. Methods: Data were from the PINE study, a population-based study of U.S. Chinese older adults aged 60 years and above. The PHQ-9 was used to measure depressive symptoms. Results: Depressive symptoms were more prevalent in U.S. Chinese olde...
Older adults with dementia may be at high risk for abuse, but the topic has not been well studied. We conducted a literature review to examine the relationships between elder abuse and dementia. We found that psychological abuse was the most common form of abuse among older adults, with estimates of its prevalence ranging from 27.9 percent to 62.3...
Purpose
– The purpose of this paper is to examine the prevalence of suicide attempts and explore the suicide methods among community-dwelling Chinese older adults.
Design/methodology/approach
– Data were drawn from the Population Study of Chinese Elderly in Chicago (PINE) study, a population-based epidemiological study of Chinese older adults aged...
Background: Health education is one of the proven ways to improve knowledge and change health attitudes and behaviors. This study is intended to assess the effectiveness of five health workshops in a Chinese community, focusing on depression, elder abuse, nutrition, breast cancer and stroke.
Methods: A community-based participatory research approac...
Elder abuse and psychological distress are both important geriatric syndromes and are independently associated with premature morbidity and mortality. Despite recent advances, there has been little systematic exploration of the association between elder abuse and psychological distress. This systematic review synthesizes the qualitative and quantit...