Racial Disparities in Olfactory Loss Among Older Adults in the United States

Pinto, Jayant M.; Schumm, L. Philip; Wroblewski, Kristen; Kern, David W.; McClintock, Martha K.

doi:10.1093/gerona/glt063

Cited by 79 publications

(133 citation statements)

References 36 publications

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“…We found differences in the distribution of OI scores between blacks and whites of both sexes, in line with previous findings that showed differences in OI decline between older whites and blacks. 9 We also found that poorer OI was associated with increased risk of dementia over 12 years among both blacks and whites. While the magnitude of the effect was stronger in whites than blacks, our results suggest that olfactory function may help identify those at risk for dementia across racial groups.…”

Section: Resultssupporting

confidence: 54%

“…Our study is the first to compare the association between olfaction and dementia in black vs white cognitively normal older adults, despite known differences in OI, 9 dementia risk, [10][11][12][13] and related factors, including the prevalence of and cognitive risk associated with both diabetes mellitus 34,35 and APOE e4.…”

Section: Resultsmentioning

confidence: 99%

“…[6][7][8] Thus, olfactory testing may be a useful screen to identify risk of neurodegenerative disease. Because most previous studies have been limited to white older adults, potential race differences in the olfaction-dementia relationship remain unexplored, despite previously reported race differences in olfaction 9 and dementia risk.…”

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confidence: 99%

“…15 The B-SIT was computed as the sum of the correct responses for a maximum possible score of 12. On the basis of prior evidence of race disparities in OI performance, 9 we tested the distribution of OI scores and found significant differences between the 2 race groups. In the absence of standardized race-adjusted B-SIT norms, we divided the participants into race-and sex-stratified tertiles labeled good, moderate, and poor, roughly corresponding to the clinical impairment classifications used by the B-SIT: normosmic, mildly microsmic, and anosmic.…”

mentioning

confidence: 99%

“…All analyses were stratified by race because of previously reported racial differences in olfaction, 9 observed differences in the distribution of OI score, and our observed interaction of race on dementia risk (p 5 0.04). We reported frequencies/percentages and means/SDs for participant characteristics, which were tested for differences across the sequence of OI categories with trend tests.…”

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confidence: 99%

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Olfaction and risk of dementia in a biracial cohort of older adults

et al. 2017

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Objective: Prior studies indicate that olfactory function may be an early marker for cognitive impairment, but the body of evidence has been largely restricted to white populations. Methods:We studied 2,428 community-dwelling black and white older adults (baseline age 70-79 years) without dementia enrolled in the Health, Aging, and Body Composition (Health ABC) study. Olfaction was measured as odor identification (OI) with the 12-item Cross Cultural Smell Identification Test in year 3. We defined incident dementia over 12 years on the basis of hospitalization records, prescription for dementia medication, or 1.5-SD decline in race-stratified global cognition score. We assessed dementia risk associated with OI score (by tertile) using Cox proportional hazards models. All analyses were stratified by race.Results: Poorer OI in older adults without dementia was associated with increased risk of dementia. After adjustment for demographics, medical comorbidities, and lifestyle characteristics, white participants in the poor or moderate OI tertile had greater risk of dementia (adjusted hazard ratio [HR] 3.34, 95% confidence interval [CI] 2.45-4.54; and HR 1.84, 95% CI 1.33-2.54, respectively) compared to those in the good tertile of function. Among blacks, worse OI was associated with an increased risk of dementia, but the magnitude of the effect was weaker (p for interaction 5 0.04) for the poor OI tertile (adjusted HR 2.03, 95% CI 1.44-2.84) and for the moderate tertile (adjusted HR 1.42, 95% CI 0.97-2.10). There was no interaction between OI and APOE e4 and risk of dementia.Conclusions: While the magnitude of the association was stronger in whites, we found that poor OI was associated with increased risk of dementia among both black and white older adults. Olfactory testing may be a simple, inexpensive, and highly sensitive method of identifying older adults at risk for developing dementia, particularly when combined with other early markers.

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Section: Resultssupporting

confidence: 54%

Section: Resultsmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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Olfaction and risk of dementia in a biracial cohort of older adults

et al. 2017

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Association Between Olfactory Dysfunction and Mortality in US Adults

Choi

Jang

Kim

et al. 2021

JAMA Otolaryngol Head Neck Surg

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oor olfactory function has been directly implicated in malnutrition, 1 decreased safety, 2 and overall worse quality of life. 3 It is responsible for more than 200 000 physician visits per year, representing a significant public health burden. 4,5 Emerging evidence suggests that olfactory dysfunction is significantly associated with increased all-cause mortality among older adults. 4,[6][7][8][9][10][11] Most notably, a recent study by Liu et al 12 examining community-dwelling older adults aged 71 to 82 years showed clear evidence that poor olfaction alone explains higher long-term mortality, particularly in individuals with excellent to good health at baseline. Liu et al 12 found the elevated risk of mortality of patients with poor olfaction was only partially explained by neurodegenerative dis-ease, cardiovascular disease, and weight loss. Olfaction is emerging as an early indicator of brain aging that can be objectively measured with a relatively simple smell test in the clinical setting.Choi et al 13 previously used the National Health and Nutrition Examination Survey (NHANES) to demonstrate that objectively measured olfactory dysfunction is associated with cognitive impairment independently of demographics and cardiovascular factors. Herein we further investigate the associations of olfactory dysfunction (measured by both objective smell test and self-report) with all-cause 5-year mortality in US adults 40 years or older, independently of cardiovascular factors, cognition, and depression. IMPORTANCE A study of olfactory dysfunction and mortality in a large national cohort will aid in better understanding their association when accounting for multiple relevant factors and possible underlying mechanisms. OBJECTIVE To investigate the association of olfactory dysfunction with all-cause 5-year mortality in US adults.

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Assessment of Self-reported Sense of Smell, Objective Testing, and Associated Factors in Middle-aged and Older Women

Cao

Yang

D’Aloisio

et al. 2022

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEPoor olfaction is common in older adults and signifies multiple adverse health outcomes, but it often goes unrecognized.OBJECTIVE To characterize the self-awareness of poor olfaction in women, including its prevalence, associated factors, reporting reliability, validity against an objective test, and factors associated with validity. DESIGN, SETTING, AND PARTICIPANTS These cross-sectional survey data and a case-control subsample were taken from the National Institute of Environmental Health Sciences' Sister Study. Of 41 118 participants (aged 41-85 years) who reported olfaction in 2014 through 2016, 3406 (aged 50-79 years) reported olfaction again in 2018 through 2019 and completed the 12-item Brief Smell Identification Test, version A, including 2353 women who self-reported poor olfaction in 2014 through 2016 and 1053 women who reported normal olfaction. Data analyses were performed between May 28, 2021, and December 23, 2021.MAIN OUTCOMES AND MEASURES Self-reported (yes/no) and objectively tested poor olfaction defined as a Brief Smell Identification Test score of 9 or lower. Multivariable logistic regressions were used to assess factors that might be associated with the prevalence and reporting accuracy of self-reported olfaction. In subsample analyses, the sampling strategy was accounted for to extrapolate data to eligible cohort samples. RESULTSOf the 41 118 women (mean [SD] age, 64.3 [8.7] years) included in the analysis, 3322 (8.1%) self-reported poor olfaction. Higher prevalence was associated with older age, not being married, current smoking status, frequent coffee drinking, overweight or obesity, less than optimal health, Parkinson disease, cognitive impairment, depression, anxiety, and seasonal allergy, whereas a lower prevalence was associated with non-Hispanic Black race and physical activity. In the subsample analyses, olfaction status reported 3 years apart showed a modest agreement (κ, 0.56; 95% CI, 0.51-0.61). The prevalence of objectively tested poor olfaction was 13.3% (95% CI, 11.5%-15.0%), and in contrast with self-reports, it was twice as high in non-Hispanic Black women as in non-Hispanic White women (24.5% vs 12.5%). Compared with objective tests, self-reports showed a low sensitivity (22.6%; 95% CI, 19.6%-25.6%), especially in non-Hispanic Black women (12.4%; 95% CI, 7.0%-17.8%). The specificity was uniformly high (>90%). Among participants who reported poor olfaction, higher odds of true vs false positives were associated with age older than 60 years (60-64

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Racial Disparities in Olfactory Loss Among Older Adults in the United States

Cited by 79 publications

References 36 publications

Olfaction and risk of dementia in a biracial cohort of older adults

Olfaction and risk of dementia in a biracial cohort of older adults

Association Between Olfactory Dysfunction and Mortality in US Adults

Assessment of Self-reported Sense of Smell, Objective Testing, and Associated Factors in Middle-aged and Older Women

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