Research Spotlights: February 2022

Increased anxiety and worrying may lead to increase heart disease and diabetes risk factors in men at younger ages

The mechanisms that explain the link between anxiety and cardiometabolic risk are not well understood in men. Limitations in study designs that are best to develop more understanding of associations have restricted understanding of the relationships. This study funded by the NIA, NCATS, and U.S. Department of Veterans Affairs sought to understand associations between anxiety characteristics, neuroticism and worry, and trends in cardiometabolic risk over four decades in a prospective study of men.

In 1975, active participants in the Normative Aging Study (NAS) were mailed surveys, which included the short form of the Eysenck Personality Inventory Questionnaire (EPI-Q), to assess neuroticism. Worry was assessed via a 20-item scale asking participants to rate how much worry they experienced about a variety of issues. Seven cardiometabolic biomarkers were assessed every three to five years creating a cardiometabolic risk score (CMR) that categorized risk level. The final analytic sample included 1561 healthy men (average age = 53 years; 97% white). Mixed effects regression models were used to evaluate associations for neuroticism and worry and their effect on CMR trajectories over time and age. Cox regression was used to examine the association of neuroticism and worry with having high-risk CMR biomarkers.

The researchers found that the risk for cardiometabolic disease increased as men aged, from their 30s into their 80s, regardless of anxiety levels. Men who had higher levels of anxiety and worry consistently had increased odds of developing cardiometabolic disease over time compared to those with lower levels of anxiety or worry. These findings indicate higher anxiety levels are associated with consistent differences in the risk of cardiometabolic disease by middle-age in men. Anxious men may show a decline in cardiometabolic health earlier in adulthood and the effect remains stable, leading to higher CMR in older adulthood. Additional research is needed to confirm these results in a more diverse population. However, this study does provide evidence of the negative impact of anxiety in early adulthood in men and suggests assessing cardiometabolic and psychological risk factors at earlier ages may help to impact and lower cardiometabolic disease risk.

Lee LO, Grimm KJ, Spiro A 3rd, Kubzansky LD. Neuroticism, Worry, and Cardiometabolic Risk Trajectories: Findings From a 40-Year Study of Men. J Am Heart Assoc. 2022 Feb;11(3):e022006. doi: 10.1161/JAHA.121.022006. Epub 2022 Jan 24. PMID: 35072514.

Cash payments to low-income families impact infant brain activity

Recently published research supported by the NICHD, HHS Administration for Children and Families, and others, examined the impacts of providing unconditional monthly cash transfers to low-income mothers on the brain activity of their babies in the first year of life. Previous research has demonstrated an association between early childhood poverty and lower school achievement, educational attainment, and adult earnings. However, causality between poverty and early childhood development had not been established. In the current study (Baby’s First Years), the research team conducted the first randomized control trial of poverty reduction in early childhood. Researchers examined the impact of unconditional cash support on mid-to-high frequency brain power (i.e., alpha, beta, and gamma) and low-frequency power (i.e., theta). Greater mid-to-high frequency brain power is associated with higher language, cognitive, and socio-emotional scores, where low-frequency brain power is associated with the development of behavioral, attention, or learning problems.

Researchers randomized low-income mother-infant dyads from four geographically diverse areas (New York City, New Orleans, Omaha, and Minneapolis–St. Paul, Minnesota) to either a high-cash gift group ($333 per month, or an approximately 20% boost in annual income) or a low-cash gift group ($20 per month). Mothers and infants were from racially and ethnically diverse backgrounds and all infants were healthy at birth. Intent-to-treat analyses were conducted on absolute and relative EEG power to assess the differential impacts of the cash transfer condition on infant brain activity when the infants were one year old.

The researchers found that with respect to absolute power, the high-cash gift group showed higher power in the alpha, beta, and gamma bands compared to the low-cash gift group, but no differences in the low-frequency theta band. Difference in relative power were similar but smaller than for absolute power and did not reach statistical significance.

The study findings have some limitations. The sample size for the overall study included 1,000 mother-infant dyads but only 435 infants were able to undergo an EEG due to the pandemic. Additionally, estimates for the effect of the cash gift in the two highest frequency bands were statistically significant before, but not after, adjustments for multiple comparisons. The authors note that there is a plausible causal link between cash gifts and infant brain activity, because not all effects remained significant after correcting for multiple comparisons, further replication is needed.

In summary, the results of this study suggest that providing unconditional monthly cash supports to families living in poverty may impact childhood brain activity and development. Childhood poverty has been linked to negative outcomes across a range of domains. This research highlights the potential for unconditional cash benefits to promote healthy childhood development and wellbeing.

Troller-Renfree SV, Costanzo MA, Duncan GJ, et al. The impact of a poverty reduction intervention on infant brain activity. Proc Natl Acad Sci U S A. 2022;119(5):e2115649119. doi:10.1073/pnas.2115649119. URL:

Access to ambulatory healthcare services decreased during the COVID-19 pandemic, especially for poorer Americans

The COVID-19 pandemic has impacted the lives of Americans in many ways, including in their use of healthcare services. In a recent study funded by NIA and others, researchers looked at the use of different ambulatory care services by populations with different insurance types over the course of the pandemic. Based on a prior study, the use outpatient health services decreased sharply early in the COVID-19 pandemic, then rebounded to near-normal levels by the end of 2020. In this study, researchers sought to determine if this recovery in care was the same across all populations.

In order to answer this question, researchers looked at the use of six ambulatory care services: emergency department visits, doctor office visits, behavioral health services, colonoscopy screenings, mammogram screenings, and HIV screenings or contraception counseling. They compared the utilization of those services across the U.S. among patients with commercial insurance, Medicare Advantage, Medicare fee-for-service insurance, and those with Medicaid or Medicare-Medicaid dual eligibility insurance between Jan. 1, 2019, and Feb. 28, 2021.

The results showed that during the initial COVID-19 surge in March-April 2020, overall use of ambulatory care services decreased to 67% of expected non-pandemic levels. This was likely due to the Centers for Medicare and Medicaid Services instructions to healthcare providers to reduce certain outpatient services to preserve resources for critical care and to reduce the transmission of COVID-19. Additionally, many patients canceled scheduled outpatient appointments out of fear of contracting the virus. During the period of November-December 2020, utilization of these services rebounded to 97% of expected rates. During January-February 2021, there was a second COVID-19 surge, which resulted in an 86% decrease in the expected rates of use of these services. The return to the expected healthcare service utilization rates varied by insurance type, with Medicaid and Medicare-Medicaid dual eligible patients having lower rates of recovery.

The findings of this study show that 2020 recovery in utilizing ambulatory healthcare services, many of which focus on preventive and behavioral health, was not equal across all populations. This decrease was most prominent in patients that were socioeconomically disadvantaged patients, such as those with Medicaid or Medicare-Medicaid dual eligibility insurance. The implications of these findings suggest that this decrease in healthcare usage may lead to further exacerbating the inequities in access to vital health services for the most vulnerable populations. More research is needed to understand the reasons for these decreases in healthcare use, particularly among socioeconomically disadvantaged patients. These results also indicate the need for various interventional approaches to addressing this challenge.

Mafi JN, Craff M, Vangala S, Pu T, Skinner D, Tabatabai-Yazdi C, Nelson A, Reid R, Agniel D, Tseng CH, Sarkisian C, Damberg CL, Kahn KL. Trends in US Ambulatory Care Patterns During the COVID-19 Pandemic, 2019-2021. JAMA. 2022 Jan 18;327(3):237-247. doi: 10.1001/jama.2021.24294. PMID: 35040886; PMCID: PMC8767442.