ingest cdrApp 2018-08-23T17:24:58.091Z d39a25df-af15-48e9-aec2-c9af81a997a2 modifyDatastreamByValue RELS-EXT fedoraAdmin 2018-08-23T17:25:48.112Z Setting exclusive relation addDatastream MD_TECHNICAL fedoraAdmin 2018-08-23T17:25:59.450Z Adding technical metadata derived by FITS addDatastream MD_FULL_TEXT fedoraAdmin 2018-08-23T17:26:21.824Z Adding full text metadata extracted by Apache Tika modifyDatastreamByValue RELS-EXT fedoraAdmin 2018-08-23T17:26:43.887Z Setting exclusive relation modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-09-27T17:42:24.961Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2019-03-21T18:54:53.856Z Terra Fatukasi Author Department of Epidemiology Gillings School of Global Public Health FRAILTY PREVALENCE, ONE-YEAR RISK, AND THE EFFECT OF SMOKING AMONG WOMEN WITH AND WITHOUT HIV INFECTION The gap in life expectancy between people with HIV and the general population is diminishing. However, evidence suggests that people with HIV may be experiencing aging-related conditions at earlier ages. The objective of this dissertation was to estimate the prevalence of frailty, a syndrome of physical vulnerability, estimate the one-year risk of frailty, and examine the effect of smoking on the one-year risk of frailty among women with and at risk for HIV. This project used data from the Women’s Interagency HIV Study between October 2015 and September 2017. The Fried Frailty Index was used to define frail status as exceeding the threshold for at least three of five frailty components: slowness, weakness, unintentional weight loss, exhaustion, and low physical activity. Among 1,404 women with a median age of 52 years (interquartile range: 47-57), we found that frailty prevalence was 11.5% (15.3% HIV-, 10.1% HIV+). The most common frailty components were low physical activity and exhaustion. The one-year risk of frailty was 6.6% (95% confidence interval: 4.1, 9.1) and similar for women with and without HIV. After adjustment for confounding, current smokers were 1.68 times as likely to become frail compared to non-smokers (95% CI: 0.69, 4.06). Women with high cumulative smoking exposure were 2.72 times as likely to become frail compared to women with low cumulative smoking exposure (95% CI: 0.96, 7.67), and this latter effect appeared to be more pronounced among women with HIV (adjusted RR = 4.10; 95% CI: 1.22, 13.78). In a low income, predominately black population of women in their mid-fifties with and without HIV infection, the prevalence and risk of frailty is comparable to women in the general population at least 65 years old. Reported smoking exposure is independently associated with increased frailty risk in this population, even over a one-year period of follow-up. These findings demonstrate that modifiable risk factors, such as smoking, could play a crucial role in preventing frailty, especially among people with HIV. Future studies are needed to investigate trends in frailty risk over time and to examine the long-term impacts of smoking on frailty among people with HIV. Summer 2018 2018 Epidemiology frailty, HIV, human immunodeficiency virus, incidence, prevalence, smoking, women eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Adaora Adimora Thesis advisor Stephen Cole Thesis advisor Andrew Edmonds Thesis advisor Jessie Edwards Thesis advisor Deborah Gustafson Thesis advisor text Terra Fatukasi Creator Department of Epidemiology Gillings School of Global Public Health FRAILTY PREVALENCE, ONE-YEAR RISK, AND THE EFFECT OF SMOKING AMONG WOMEN WITH AND WITHOUT HIV INFECTION The gap in life expectancy between people with HIV and the general population is diminishing. However, evidence suggests that people with HIV may be experiencing aging-related conditions at earlier ages. The objective of this dissertation was to estimate the prevalence of frailty, a syndrome of physical vulnerability, estimate the one-year risk of frailty, and examine the effect of smoking on the one-year risk of frailty among women with and at risk for HIV. This project used data from the Women’s Interagency HIV Study between October 2015 and September 2017. The Fried Frailty Index was used to define frail status as exceeding the threshold for at least three of five frailty components: slowness, weakness, unintentional weight loss, exhaustion, and low physical activity. Among 1,404 women with a median age of 52 years (interquartile range: 47-57), we found that frailty prevalence was 11.5% (15.3% HIV-, 10.1% HIV+). The most common frailty components were low physical activity and exhaustion. The one-year risk of frailty was 6.6% (95% confidence interval: 4.1, 9.1) and similar for women with and without HIV. After adjustment for confounding, current smokers were 1.68 times as likely to become frail compared to non-smokers (95% CI: 0.69, 4.06). Women with high cumulative smoking exposure were 2.72 times as likely to become frail compared to women with low cumulative smoking exposure (95% CI: 0.96, 7.67), and this latter effect appeared to be more pronounced among women with HIV (adjusted RR = 4.10; 95% CI: 1.22, 13.78). In a low income, predominately black population of women in their mid-fifties with and without HIV infection, the prevalence and risk of frailty is comparable to women in the general population at least 65 years old. Reported smoking exposure is independently associated with increased frailty risk in this population, even over a one-year period of follow-up. These findings demonstrate that modifiable risk factors, such as smoking, could play a crucial role in preventing frailty, especially among people with HIV. Future studies are needed to investigate trends in frailty risk over time and to examine the long-term impacts of smoking on frailty among people with HIV. Epidemiology frailty; HIV; human immunodeficiency virus; incidence; prevalence; smoking; women Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Epidemiology Adaora Adimora Thesis advisor Stephen Cole Thesis advisor Andrew Edmonds Thesis advisor Jessie Edwards Thesis advisor Deborah Gustafson Thesis advisor 2018 2018-08 eng text Terra Fatukasi Creator Department of Epidemiology Gillings School of Global Public Health FRAILTY PREVALENCE, ONE-YEAR RISK, AND THE EFFECT OF SMOKING AMONG WOMEN WITH AND WITHOUT HIV INFECTION The gap in life expectancy between people with HIV and the general population is diminishing. However, evidence suggests that people with HIV may be experiencing aging-related conditions at earlier ages. The objective of this dissertation was to estimate the prevalence of frailty, a syndrome of physical vulnerability, estimate the one-year risk of frailty, and examine the effect of smoking on the one-year risk of frailty among women with and at risk for HIV. This project used data from the Women’s Interagency HIV Study between October 2015 and September 2017. The Fried Frailty Index was used to define frail status as exceeding the threshold for at least three of five frailty components: slowness, weakness, unintentional weight loss, exhaustion, and low physical activity. Among 1,404 women with a median age of 52 years (interquartile range: 47-57), we found that frailty prevalence was 11.5% (15.3% HIV-, 10.1% HIV+). The most common frailty components were low physical activity and exhaustion. The one-year risk of frailty was 6.6% (95% confidence interval: 4.1, 9.1) and similar for women with and without HIV. After adjustment for confounding, current smokers were 1.68 times as likely to become frail compared to non-smokers (95% CI: 0.69, 4.06). Women with high cumulative smoking exposure were 2.72 times as likely to become frail compared to women with low cumulative smoking exposure (95% CI: 0.96, 7.67), and this latter effect appeared to be more pronounced among women with HIV (adjusted RR = 4.10; 95% CI: 1.22, 13.78). In a low income, predominately black population of women in their mid-fifties with and without HIV infection, the prevalence and risk of frailty is comparable to women in the general population at least 65 years old. Reported smoking exposure is independently associated with increased frailty risk in this population, even over a one-year period of follow-up. These findings demonstrate that modifiable risk factors, such as smoking, could play a crucial role in preventing frailty, especially among people with HIV. Future studies are needed to investigate trends in frailty risk over time and to examine the long-term impacts of smoking on frailty among people with HIV. Epidemiology frailty; HIV; human immunodeficiency virus; incidence; prevalence; smoking; women Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Adaora Adimora Thesis advisor Stephen Cole Thesis advisor Andrew Edmonds Thesis advisor Jessie Edwards Thesis advisor Deborah Gustafson Thesis advisor 2018 2018-08 eng text Fatukasi_unc_0153D_17900.pdf uuid:ad83f1f0-d188-4217-867f-32b2a6678332 2020-08-23T00:00:00 2018-07-17T15:11:08Z proquest application/pdf 1063171