Zachary Zimmer

University of California, San Francisco | UCSF · Department of Social and Behavioral Sciences

War and traumatic events have negative health impacts across the life course, and most wars are situated in lower- and middle-income countries, where many survivors are now or will soon be entering old age. To date, however, most aging research has focused on health effects in high-income countries, neglecting the burdens of war exposure for the br...

Objectives This article investigates the role of pain in disability trends in the United States, within the context of recent unfavorable disability trends and the concurrent rise in pain. Method We conducted a two-part analysis using National Health Interview Survey data from 2002 to 2018 for US adults aged 45-84. First, we assessed how changes i...

This study examines religiosity patterns across childhood and later adulthood and their associations with later-life health using an experimental module from the 2016 Health and Retirement Study ( N = 1649; Mean Age = 64.0). Latent class analysis is used to categorize individuals by commonalities in religious attendance, religious identity, and spi...

Chronic pain is a serious and prevalent condition that can affect many facets of life. However, uncertainty remains regarding the strength of the association between chronic pain and death and whether the association is causal. We investigate the pain–mortality relationship using data from 19,971 participants aged 51+ years in the 1998 wave of the...

Background The recently launched DNA methylation profiling platform, Illumina MethylationEPIC BeadChip Infinium microarray v2.0 (EPICv2), is highly correlated with measurements obtained from its predecessor MethylationEPIC BeadChip Infinium microarray v1.0 (EPICv1). However, the concordance between the two versions in the context of DNA methylation...

Background and Objectives The role of early life stressors in subjective aging is weakly understood, especially in low- to middle-income countries. This paper investigated how early life stressors encountered in armed conflict influence subjective age among Vietnamese older adults who experienced war over decades of their early life. Research Desi...

In this paper, we investigate the long-term effects of the Vietnam War on physical and mental health outcomes of Vietnamese who were children (age 6 to 9 and 10 to 14), teenagers (age 15 to 19), and young adults (age 20 +) during the war, including differences by gender and military participation, and examine the ways in which these effects are mod...

We aimed to assess the nature and degree of association between exposure to potentially traumatic wartime experiences in early life and later-life frailty. The Vietnam Health and Aging Study included war survivors in Vietnam, age 60+. Latent class analysis (LCA) is used to construct classes exposed to similar numbers and types of wartime experience...

Background Vulnerable older adults living with Alzheimer’s disease or Alzheimer’s disease and related dementia (AD/ADRD) and chronic pain generally receive fewer pain medications than individuals without AD/ADRD, especially in nursing homes. Little is known about pain management in older adults with AD/ADRD in the community. The aim of the study wa...

Background and Objectives Pain treatments and their efficacy have been studied extensively. Yet surprisingly little is known about the types of treatments, and combinations of treatments, that community-dwelling adults use to manage pain, as well as how treatment types are associated with individual characteristics and national-level context. To fi...

Despite growing recognition of the importance of social, economic, and political contexts for population health and health inequalities, research on pain disparities relies heavily on individual-level data, while neglecting overarching macrolevel factors such as state-level policies and characteristics. Focusing on moderate or severe arthritis-attr...

Previous literature has rarely examined the role of pain in the process of disablement. We investigate how pain associates with disability transitions among older adults, using educational attainment as a moderator. Data are from the National Health and Aging Trends Study, N=6,357; 33,201 one-year transitions between 2010-2020. We estimate multinom...

War exposure is a critical yet often ignored determinant of health in Asia. Cursory calculations suggest up to 80 per cent of Asians were alive at a point when a cumulatively intense war was ongoing in their country of current residence. As an example, data from Vietnam indicate that large proportions alive during past wars in that country experien...

Objectives: This study computes years and proportion of life that older adults living in the U.S. can expect to live pain free and in different pain states, by age, sex, and level of education. The analysis addresses challenges related to dynamics and mortality selection when studying associations between education and pain in older populations....

Objective We explore how earlier-life military roles and war trauma associate with later-life respiratory health in Vietnam. Method: The population-based sample aged 60+ is from the 2018 Vietnam Health and Aging Study. Poisson and binary logistic regressions investigate correlates of overall lung health, measured as total number of four conditions...

Research on religiosity and health has generally focussed on the United States, and outcomes of health or mortality but not both. Using the European Values Survey 2008, we examined cross-sectional associations between four dimensions of religiosity/spirituality: attendance, private prayer, importance of religion, belief in God; and healthy life exp...

Cambodia is a country where labor migration has been consistently high, particularly out of rural areas. Migration increases the distance between parents and their children, which may lead to a reduction in sources of support. Based on these contemporary realities, it is important to understand the factors that impact provision of support from migr...

There is wide variation in population-level pain prevalence estimates in studies of survey data around the world. The role of country-level social, economic, and political contextual factors in explaining this variation has not been adequately examined. We estimated the prevalence of unspecified pain in adults aged 25+ years across 52 countries usi...

Objectives: To assess the nature and degree of association between exposure to potentially-traumatic wartime experiences in early life, such as living in a heavily bombed region or witnessing death first-hand, and later-life frailty. Methods: The Vietnam Health and Aging Study included war survivors in Vietnam, 60+, who completed a survey and he...

Multistate life tables are used to estimate life expected in three frailty states: frailty free, mild/moderate frailty, severe frailty. Estimates are provided for the combination of education and wealth by age, stratified by sex. Data consider 17,115 cases from the Health and Retirement Study, 2000–2014. Frailty is measured using a 59 item frailty...

Chronic pain is a common, costly, and consequential health problem. However, despite some important analytic contributions, sociological research on pain has not yet coalesced into a unified subfield. We present three interrelated bodies of evidence and illustrative new empirical findings using 2010 to 2018 National Health Interview Survey data to...

Chronic pain is a common, costly, and consequential health problem. However, despite some important analytic contributions, sociological research on pain has not yet coalesced into a unified subfield. We present three interrelated bodies of evidence, and illustrative new empirical findings using 2010-2018 NHIS data, to argue that pain should have a...

Background Though studies measuring war-related stressors and resultant trauma among U.S. military veterans are abundant, few studies address how wartime stressors affect military veterans native to warzones. Even fewer assess the stress exposure and resulting trauma experienced by Vietnamese civilians. This study aimed to construct a scale to quan...

Adopting a multistate life table approach, this study estimates number of years the very old in China expect to live in an independent living arrangement (alone or with spouse only)—an estimate we term “independent living life expectancy” (ILLE)—as opposed to in coresidence with adult children or others. We also estimate how ILLE and proportion of...

Determining long-term trends in chronic pain prevalence is critical for evaluating and shaping U.S. health policies, but little research has examined such trends. This study (1) provides estimates of pain trends among U.S. adults across major population groups; (2) tests whether sociodemographic disparities in pain have widened or narrowed over tim...

Background The majority of evidence indicates that exposure to war and other traumatic events continue to have negative impacts on health across the life course. However, existing research on health effects of war exposure primarily concentrates on short-term impacts among veterans in high-income countries sent elsewhere to battle. Yet, most wars s...

Determining long-term trends in chronic pain prevalence is critical for evaluating and shaping US health policies, but little research has examined such trends. This study (1) provides estimates of pain trends among US adults across major population groups; (2) tests whether sociodemographic disparities in pain have widened or narrowed over time; a...

Background: While sleep duration has been shown to be associated with health outcomes, few studies have been conducted among the oldest old. In addition, the impact of sleep duration on quality of dying is unknown. We aimed to evaluate how sleep duration affects all-cause mortality and quality of dying in people aged 80 + . Methods: This communi...

Populations in the global south are disproportionately exposed to the stressors of development, disaster and armed conflict, all of which heighten cardiovascular disease (CVD) risk. We consider how war-related stressors exert a lasting influence upon population health, in particular the cardiovascular health of war survivors now entering older adul...

Background: Though studies measuring war-related stressors and resultant trauma among U.S. military veterans are abundant, few studies address how wartime stressors affect military veterans native to warzones. Even fewer assess the stress exposure and resulting trauma experienced by civilians. This study aimed to develop and evaluate a measure of w...

Objective: To examine how lifestyles and leisure activities are associated with cognitive health expectancy among older adults. Results: For young-old (aged 65), an absolute increase in life years without cognitive impairment was found among those with a healthy diet, engaging in mental activities and in social activities. For old-old (aged 85),...

Recent unprecedented increases in mortality and morbidity during midlife are often ascribed to rising despair in the US population. An alternative and less often examined explanation is that these trends reflect, at least in part, the lagged effects of the obesity epidemic. Adults in midlife today are more likely to live with obesity and have a gre...

Objectives: We examine recent trends in pain prevalence among adults aged 50+ across Europe. Methods: Data for 15 countries from the Survey of Health, Ageing, and Retirement in Europe are examined for two periods: 2004–2011 and 2013–2015. Trends are shown descriptively, using a multilevel modeling strategy controlling for covariates, and modeled on...

Although the provision, receipt, and bidirectionality of support exchanges are important for generational well-being, our understanding of them is lacking in Eastern Europe, a region undergoing swift population aging and social change. This study links intergenerational support exchanges to determinants in Romania, with a focus on proximity of adul...

This paper extends investigation of religiosity and longevity to Taiwan using a 1989 survey: N = 3849, aged 60+, with 18 years of follow-up. Religious activity is measured as worship and performance of rituals. A Gompertz regression, adjusted and non-adjusted for covariates and mediating factors, shows the hazard of dying is lower for the religious...

Background: Survivors of war throughout the world experience illnesses and injuries that are crucial to understand, given the ongoing treatment and adaptation they demand. In developing countries like Vietnam, where population aging and chronic disease burdens are rapidly rising, aging populations have seen a disproportionate share of armed confli...

Objectives: Existing literature shows religion is associated with health and survival separately. We extend this literature by considering health and survival together using a multistate life table approach to estimate total, disability-free, and disabled life expectancy (LE), separately for women and men, for 2 disability measures, and by 2 indic...

This study examines the extent to which the Spanish language influences the way in which respondents report health using the ubiquitous self-assessed health (SAH) outcome. We account for citizenship status, ethnicity, and a series of other covariates. The study uses the 2003-2016 national health and nutrition examination survey (NHANES) (n=39,107)....

Objectives: Eight years of panel data are used to investigate the association between three dimensions of religiosity and total and disability-free life expectancy (TLE/DFLE) in Taiwan. Method: Data come from the 1999 “Taiwan Longitudinal Study on Aging” (TLSA; N = 4,440; Age 55+). Dimensions of religiosity are public, private, belief, and coping....

The objective of this paper is to understand global connections between indicators of religiosity and health and how these differ cross-nationally. Data are from World Values Surveys (93 countries, N=121,770). Health is based on a self-assessed question about overall health. First, country-specific regressions are examined to determine the associat...

This paper examines composition of households formed after the outmigration of a household member in rural Cambodian and correlates household types with indicators of economic condition. The paper focuses on households containing left-behind parents and the children of migrants. Excess mortality in the 1970s due to war suggests the association betw...

Considering a network approach to health determinants, we test the hypothesis that benefits of high socioeconomic status (SES) may be transmitted up the generational ladder from offspring to parents. Studies that examine own SES and own health outcomes, or SES of parents and outcomes of young or adolescent children, are common. Those that investiga...

Persistent population aging worldwide is focusing attention on modifiable factors that can improve later life health. There is evidence that religiosity and spirituality are among such factors. Older people tend to have high rates of involvement in religious and/or spiritual endeavors and it is possible that population aging will be associated with...

The purpose of this research is to determine whether disability-free life expectancy (DFLE) in China has been increasing more rapidly than total life expectancy (TLE). Such a scenario would be consistent with a compression of morbidity, a situation that is especially desirable in a country experiencing rapid population aging and gains in old-age lo...

The disablement process can be viewed conceptually as a progression from disease to impairment to functional limitation and finally disability (frequently operationalized as activity limitation). This article assesses the extent to which early phases of the process are associated with individual-level disability trajectories by age. We use data fro...

Objectives. Identify common trajectories of physical functional limitation and mortality among Taiwanese 50 and older as they age, link these to underlying transitions in onset, recovery, and mortality, and assess associations between trajectories and a set of risk factors. Method. Longitudinal data from 4 waves of the Survey of Health and Living S...

The aim of this study was to examine disability trends among men and women aged 70+ in Beijing, China; determine whether trends are impacted upon by changes in population composition; and investigate whether trends are experienced similarly across socio-demographic subgroups. Fifteen-year panel data were used to model probability of reporting activ...

Research has implicated religious activity as a health determinant, but questions remain, including whether associations persist in places where Judeo-Christian religions are not the majority; whether public versus private religious expressions have equivalent impacts, and the precise advantage expressed as years of life. This article addresses the...

This study examines links between migration status and location of adult children and measures associated with the well-being of older parents. Data come from older adults born between 1940 and 1950 living in a region in northwest Cambodia near the Thai border with good access to Phnom Penh. Analyses are conducted from the perspectives of the older...

This paper examines associations between three indicators of socioeconomic status, education, income and bank savings, as well as one composite of these three measures, and self-assessed health for adults aged 50+ across rural and urban Thailand, comparing 1994 and 2007. Between 1994 and 2007 Thailand experienced rapid social changes that could imp...

This article uses a group-based modeling approach to jointly estimate disability and mortality trajectories over time based on data from the population aged 80 and older in China, and explores relations of demographic, socioeconomic, and early-life characteristics to membership in gender-specific trajectory groups. A three-group model best fits the...

This analysis offers the first strong evidence of trends in late-life disability in an emerging economy. For the population of Taiwan aged 65 and older, consistent measures of limitations in seeing, hearing, physical functions, instrumental activities of daily living (IADLs), and activities of daily living (ADLs) were available for three to six sur...

This study has two aims: (a) to examine gender differentials in disability transitions and active life expectancies among older adults in Japan and (b) to determine whether these gender differentials vary by age, socioeconomic characteristics, and disease profile. Active and inactive states are defined as living with and without disabilities using...

Transitions from marriage to widowhood are consequential and fraught with risk in developing country contexts. We investigate whether transitions to widowhood, as well as transitions to worsened functional health, predict transition into coresidential living arrangements with children in a rapidly aging China. We also inquire whether coresidence tr...

Abstract This paper focuses on changes,in the prevalence of functional limitations among nationally representative samples of adults aged 65 and older in Taiwan as measured in 1993, 1996, and 1999. Using data from the Survey of Health and Living Status of the Elderly in Taiwan, we investigate changes in difficulties walking and climbing stairs, two...

This study’s aims are to: 1) determine the prevalence of functional limitations among older adults in Cambodia using activities of daily living (ADLs); 2) compare limitation prevalence with other countries in the region; 3) estimate active life expectancy; 4) examine standard correlates of functional status and assess whether they are associated wi...

The detrimental consequences of the AIDS epidemic for older adults in sub-Saharan Africa suggest the need to investigate their characteristics, living situations, and well-being. In this study, we examine the living arrangements of persons aged 60 and older in 16 countries. Data come from the household roster component of recent Demographic and Hea...

Using data from Demographic and Health Surveys, this study examines living arrangements of older adults in 43 developing countries and compares patterns by gender, world regions, and macro-level measures of socioeconomic development. Indicators include household size, headship, relationship to head, and coresidence with spouse, children, and others...

The main purpose of the study is to assess urban versus rural differences in functional status transitions among older Chinese, aged 55+, and to examine how individual and community level socioeconomic indicators alter the rural/urban effects and themselves influence transitions. The study uses a hierarchical linear modeling approach that considers...

What we know about transitions in coresidence of elders in China is based on panel data involving survivors. This article examines the tendency to and determinants of shifts in coresidence with adult children among the very old, comparing survivors of an intersurvey period with those who died (decedents). Data come from the Chinese Longitudinal Hea...

Social characteristics that differ by place of residence are consequential for health. To study implications of this among older adults in rural vs. urban China, this study employs data from the Beijing municipality, a region that has witnessed growth and gaps in development. Life and active life expectancy is assessed using a multistate life table...

To examine the extent to which an association exists between health of older parents and return migration of children in rural Thailand. Data come from the 2006 Migration Impact Survey specifically designed to obtain information on the impact of migration on older adults in rural areas. Associations are examined from both the perspectives of parent...

The main purpose of the study is to assess urban versus rural differences in functional status transitions among older Chinese, aged 55+, and to examine how individual and community level socioeconomic indicators alter the rural/urban effects and themselves influence transitions. The study uses a hierarchical linear modeling approach that considers...

Cross-sectional and repeated surveys from household components of Demographic and Health Surveys in sub-Saharan Africa were examined to determine whether household composition indicators for older adults (N = 52,573), involving offspring and grandchildren, correlated with national levels of AIDS mortality. One in 4 was living with a grandchild whos...

The beach chair position is commonly used in both arthroscopic and open shoulder procedures. There has been recent concern that beach chair positioning may be an independent risk factor for intraoperative cerebrovascular insult, especially in concert with hypotensive anesthesia. We attempted to quantify the prevalence of intraoperative cerebrovascu...

In this study, the authors focused on older adults in Beijing with three objectives: to examine gender differences in functional health and mortality at the end of a five-year study period, controlling for initial functional health; to determine the extent to which these differences were a function of exposure versus vulnerability to risk factors;...

To explore the experience of stroke influencing the life expectancy (LE), active life expectancy (ALE), inactive life expectancy (IALE), and the trend of life expectancy among older adults, from 1990s to 2000s in Beijing, China. A representative sample of 3257 elderly people living in urban or rural communities in Beijing were followed up from 1990...

Increasing stroke prevalence, population ageing and economic change in China necessitate a better understanding of the impact of stroke. This study examines the impact of stroke on disability and trends over time. Data are from longitudinal surveys conducted in the Beijing municipality from 1992 to 1997 and 2000 to 2004. Multi-state life tables con...

This paper examines interactions between older adults living in rural areas of Thailand and Cambodia and their adult children. Thai data come from the Survey of the Welfare of the Elderly (N= 3,202 older adults and 17,517 adult children). Cambodia data are from the Survey of the Elderly in Cambodia (N= 777 older adults and 3,751 adult children). Re...

This study examines the probability that an older adult—from one of six Asian societies sampled—lives in the same household or proximate to an adult child and how this probability fluctuates by the number of children, rural/urban residence, and several other covariates. Proximate residence is defined as living either with or near a child. Results s...

Little research exists on health determinants among adults living in economically deprived regions despite the fact that these areas comprise a good part of the world. This paper examines the distribution of wealth then tests associations between wealth inequality and a variety of health outcomes, among older adults, in one of the world's poorest r...

This chapter begins with the notion that families in China act altruistically toward the old in that they operate as a single corporate unit, aiming toward the comfortable survival of all members. Coresidence with elders, based on this perspective, more likely occurs when needs are greatest, for instance, when health deteriorates or spouse dies. Th...

Urban/rural residence is a critical health determinant and one researchers have historically found to distinguish health experiences. In this study, we investigated variations in older adult mortality across urban and rural areas of China and assessed mechanisms driving an urban advantage through a series of socioeconomic and health service covaria...

Consistent and robust associations between education and health have been found for older adults in developed countries, with effects generally being stronger for men than for women. Tests of the association in developing countries are still limited, existing results are inconsistent, and variations by gender have not been examined. Using two waves...

Rapid population aging is occurring in many parts of the developing world. Age structures are shifting from a relative concentration of younger to older individuals. Formal and informal health care needs across the developing world are changing concurrently. Therefore, population aging has enormous implications for health and social policy. This es...

The objective of this paper is to examine short-term trends in the prevalence of limitation in Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and Nagi physical functioning tasks among persons age 60 years or older in five Asian settings: Indonesia, the Philippines, Singapore, Taiwan and the Beijing Municipality. Th...

Little systematic quantitative research is available on the parents of adults who become ill and die of AIDS despite their large number and the wide range of adverse consequences. This study, based on survey data from Cambodia, explores economic and social effects on parents in a country characterized by extreme poverty and a substantial AIDS epide...

In societies in which families are highly integrated, the education of family members may be linked to survival. Such may be the case in Taiwan, where there are large gaps in levels of education across generations and high levels of resource transfers between family members. This study employs 14 years of longitudinal data from Taiwan to examine th...