Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults
Multimorbidity-having two or more coexisting chronic conditions-is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies...
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| Veröffentlicht in: | PloS one 2019-06, Vol.14 (6), p.e0218462-e0218462 |
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| creator | Quiñones, Ana R Botoseneanu, Anda Markwardt, Sheila Nagel, Corey L Newsom, Jason T Dorr, David A Allore, Heather G |
| description | Multimorbidity-having two or more coexisting chronic conditions-is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies differences in rates of chronic disease accumulation and multimorbidity development among non-Hispanic white, non-Hispanic black, and Hispanic study participants starting in middle-age and followed up to 16 years.
We analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly-available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic disease burden among 8,872 non-Hispanic black, non-Hispanic white, and Hispanic participants who were 51-55 years of age at their first interview any time during the study period (1998-2014) and all subsequent follow-up observations until 2014. Multimorbidity was defined as having two or more of seven somatic chronic diseases: arthritis, cancer, heart disease (myocardial infarction, coronary heart disease, angina, congestive heart failure, or other heart problems), diabetes, hypertension, lung disease, and stroke. We used negative binomial generalized estimating equation models to assess the trajectories of multimorbidity burden over time for non-Hispanic black, non-Hispanic white, and Hispanic participants. In covariate-adjusted models non-Hispanic black respondents had initial chronic disease counts that were 28% higher than non-Hispanic white respondents (IRR 1.279, 95% CI 1.201, 1.361), while Hispanic respondents had initial chronic disease counts that were 15% lower than non-Hispanic white respondents (IRR 0.852, 95% CI 0.775, 0.938). Non-Hispanic black respondents had rates of chronic disease accumulation that were 1.1% slower than non-Hispanic whites (IRR 0.989, 95% CI 0.981, 0.998) and Hispanic respondents had rates of chronic disease accumulation that were 1.5% faster than non-Hispanic white respondents (IRR 1.015, 95% CI 1.002, 1.028). Using marginal effects commands, this translates to predicted values of chronic disease for white respondents who begin the study period with 0.98 chronic diseases and end with 2.8 chronic diseases; black respondents who begin the study period with 1.3 chronic diseases and end with 3.3 chronic diseases; and Hispanic respondents who begin the study period with 0.84 chronic disease |
| doi_str_mv | 10.1371/journal.pone.0218462 |
| format | Article |
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We analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly-available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic disease burden among 8,872 non-Hispanic black, non-Hispanic white, and Hispanic participants who were 51-55 years of age at their first interview any time during the study period (1998-2014) and all subsequent follow-up observations until 2014. Multimorbidity was defined as having two or more of seven somatic chronic diseases: arthritis, cancer, heart disease (myocardial infarction, coronary heart disease, angina, congestive heart failure, or other heart problems), diabetes, hypertension, lung disease, and stroke. We used negative binomial generalized estimating equation models to assess the trajectories of multimorbidity burden over time for non-Hispanic black, non-Hispanic white, and Hispanic participants. In covariate-adjusted models non-Hispanic black respondents had initial chronic disease counts that were 28% higher than non-Hispanic white respondents (IRR 1.279, 95% CI 1.201, 1.361), while Hispanic respondents had initial chronic disease counts that were 15% lower than non-Hispanic white respondents (IRR 0.852, 95% CI 0.775, 0.938). Non-Hispanic black respondents had rates of chronic disease accumulation that were 1.1% slower than non-Hispanic whites (IRR 0.989, 95% CI 0.981, 0.998) and Hispanic respondents had rates of chronic disease accumulation that were 1.5% faster than non-Hispanic white respondents (IRR 1.015, 95% CI 1.002, 1.028). Using marginal effects commands, this translates to predicted values of chronic disease for white respondents who begin the study period with 0.98 chronic diseases and end with 2.8 chronic diseases; black respondents who begin the study period with 1.3 chronic diseases and end with 3.3 chronic diseases; and Hispanic respondents who begin the study period with 0.84 chronic diseases and end with 2.7 chronic diseases.
Middle-aged non-Hispanic black adults start at a higher level of chronic disease burden and develop multimorbidity at an earlier age, on average, than their non-Hispanic white counterparts. Hispanics, on the other hand, accumulate chronic disease at a faster rate relative to non-Hispanic white adults. Our findings have important implications for improving primary and secondary chronic disease prevention efforts among non-Hispanic black and Hispanic Americans to stave off greater multimorbidity-related health impacts.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0218462</identifier><identifier>PMID: 31206556</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Accumulation ; Adults ; African Americans ; Age ; Angina ; Angina pectoris ; Arthritis ; Cardiovascular diseases ; Care and treatment ; Cerebral infarction ; Chronic conditions ; Chronic Disease - epidemiology ; Chronic Disease - ethnology ; Chronic diseases ; Chronic illnesses ; Comorbidity ; Congestive heart failure ; Continental Population Groups ; Coronary artery disease ; Coronary heart disease ; Diabetes ; Diabetes mellitus ; Disease control ; Elderly ; Ethnic Groups ; Ethnicity ; European Continental Ancestry Group ; Female ; Health aspects ; Heart attack ; Heart attacks ; Heart diseases ; Heart failure ; Hispanic Americans ; Humans ; Hypertension ; Lung diseases ; Male ; Medical records ; Medical research ; Medicine and Health Sciences ; Middle age ; Middle Aged ; Minority & ethnic groups ; Multimorbidity ; Multimorbidity - trends ; Myocardial infarction ; Older people ; People and Places ; Physical Sciences ; Population ; Public health ; Race ; Respiratory tract diseases ; Retirement ; Socioeconomic factors ; Stroke ; Trajectory analysis ; United States</subject><ispartof>PloS one, 2019-06, Vol.14 (6), p.e0218462-e0218462</ispartof><rights>COPYRIGHT 2019 Public Library of Science</rights><rights>2019 Quiñones et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2019 Quiñones et al 2019 Quiñones et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-e91e280bd62c9850b314873b099ab1d223d2a3c8fc5a939255e4da06e25207ed3</citedby><cites>FETCH-LOGICAL-c692t-e91e280bd62c9850b314873b099ab1d223d2a3c8fc5a939255e4da06e25207ed3</cites><orcidid>0000-0001-6554-7734</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6576751/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6576751/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79569,79570</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31206556$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Quiñones, Ana R</creatorcontrib><creatorcontrib>Botoseneanu, Anda</creatorcontrib><creatorcontrib>Markwardt, Sheila</creatorcontrib><creatorcontrib>Nagel, Corey L</creatorcontrib><creatorcontrib>Newsom, Jason T</creatorcontrib><creatorcontrib>Dorr, David A</creatorcontrib><creatorcontrib>Allore, Heather G</creatorcontrib><title>Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Multimorbidity-having two or more coexisting chronic conditions-is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies differences in rates of chronic disease accumulation and multimorbidity development among non-Hispanic white, non-Hispanic black, and Hispanic study participants starting in middle-age and followed up to 16 years.
We analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly-available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic disease burden among 8,872 non-Hispanic black, non-Hispanic white, and Hispanic participants who were 51-55 years of age at their first interview any time during the study period (1998-2014) and all subsequent follow-up observations until 2014. Multimorbidity was defined as having two or more of seven somatic chronic diseases: arthritis, cancer, heart disease (myocardial infarction, coronary heart disease, angina, congestive heart failure, or other heart problems), diabetes, hypertension, lung disease, and stroke. We used negative binomial generalized estimating equation models to assess the trajectories of multimorbidity burden over time for non-Hispanic black, non-Hispanic white, and Hispanic participants. In covariate-adjusted models non-Hispanic black respondents had initial chronic disease counts that were 28% higher than non-Hispanic white respondents (IRR 1.279, 95% CI 1.201, 1.361), while Hispanic respondents had initial chronic disease counts that were 15% lower than non-Hispanic white respondents (IRR 0.852, 95% CI 0.775, 0.938). Non-Hispanic black respondents had rates of chronic disease accumulation that were 1.1% slower than non-Hispanic whites (IRR 0.989, 95% CI 0.981, 0.998) and Hispanic respondents had rates of chronic disease accumulation that were 1.5% faster than non-Hispanic white respondents (IRR 1.015, 95% CI 1.002, 1.028). Using marginal effects commands, this translates to predicted values of chronic disease for white respondents who begin the study period with 0.98 chronic diseases and end with 2.8 chronic diseases; black respondents who begin the study period with 1.3 chronic diseases and end with 3.3 chronic diseases; and Hispanic respondents who begin the study period with 0.84 chronic diseases and end with 2.7 chronic diseases.
Middle-aged non-Hispanic black adults start at a higher level of chronic disease burden and develop multimorbidity at an earlier age, on average, than their non-Hispanic white counterparts. Hispanics, on the other hand, accumulate chronic disease at a faster rate relative to non-Hispanic white adults. Our findings have important implications for improving primary and secondary chronic disease prevention efforts among non-Hispanic black and Hispanic Americans to stave off greater multimorbidity-related health impacts.</description><subject>Accumulation</subject><subject>Adults</subject><subject>African Americans</subject><subject>Age</subject><subject>Angina</subject><subject>Angina pectoris</subject><subject>Arthritis</subject><subject>Cardiovascular diseases</subject><subject>Care and treatment</subject><subject>Cerebral infarction</subject><subject>Chronic conditions</subject><subject>Chronic Disease - epidemiology</subject><subject>Chronic Disease - ethnology</subject><subject>Chronic diseases</subject><subject>Chronic illnesses</subject><subject>Comorbidity</subject><subject>Congestive heart failure</subject><subject>Continental Population Groups</subject><subject>Coronary artery disease</subject><subject>Coronary heart disease</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Disease control</subject><subject>Elderly</subject><subject>Ethnic Groups</subject><subject>Ethnicity</subject><subject>European Continental Ancestry Group</subject><subject>Female</subject><subject>Health aspects</subject><subject>Heart attack</subject><subject>Heart attacks</subject><subject>Heart diseases</subject><subject>Heart failure</subject><subject>Hispanic Americans</subject><subject>Humans</subject><subject>Hypertension</subject><subject>Lung diseases</subject><subject>Male</subject><subject>Medical records</subject><subject>Medical research</subject><subject>Medicine and Health Sciences</subject><subject>Middle age</subject><subject>Middle Aged</subject><subject>Minority & ethnic groups</subject><subject>Multimorbidity</subject><subject>Multimorbidity - trends</subject><subject>Myocardial infarction</subject><subject>Older people</subject><subject>People and Places</subject><subject>Physical Sciences</subject><subject>Population</subject><subject>Public health</subject><subject>Race</subject><subject>Respiratory tract diseases</subject><subject>Retirement</subject><subject>Socioeconomic factors</subject><subject>Stroke</subject><subject>Trajectory analysis</subject><subject>United States</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk11r2zAUhs3YWLts_2BshsHYLpLqw1Lsm0Ep-wgUCt3HrTiWjhMF2Uolu6z_fsrilnj0YuhCQnre9xwd6WTZa0oWlC_p2dYPoQO32PkOF4TRspDsSXZKK87mkhH-9Gh9kr2IcUuI4KWUz7MTThmRQsjTzF-DtuDOsN90VufGNg0G7DTG3HZ5O7jetj7U1tj-Ljd4i87vWuz6HDqT603wB1VEiJiD1kOSQG99lzc-5K01xuEc1mhyMMksvsyeNeAivhrnWfbzy-cfF9_ml1dfVxfnl3MtK9bPsaLISlIbyXRVClJzWpRLXpOqgpoaxrhhwHXZaAEVr5gQWBggEplgZImGz7K3B9-d81GNtYqKsYJRUkhJErE6EMbDVu2CbSHcKQ9W_d3wYa0g9FY7VILXtCCUoBZNAZCSkKYpUx4la3iZkplln8ZoQ92i0alAAdzEdHrS2Y1a-1slxVIuBU0GH0aD4G8GjL1qbdToHHToh0PeJWe82qPv_kEfv91IrSFdwHaNT3H13lSdi7IqZCE4T9TiESoNg63V6WM1Nu1PBB8ngsT0-LtfwxCjWn2__n_26teUfX_EbhBcv4neDfufFKdgcQB18DEGbB6KTIna98V9NdS-L9TYF0n25viBHkT3jcD_AKKXCL8</recordid><startdate>20190617</startdate><enddate>20190617</enddate><creator>Quiñones, Ana R</creator><creator>Botoseneanu, Anda</creator><creator>Markwardt, Sheila</creator><creator>Nagel, Corey L</creator><creator>Newsom, Jason T</creator><creator>Dorr, David A</creator><creator>Allore, Heather G</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0001-6554-7734</orcidid></search><sort><creationdate>20190617</creationdate><title>Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults</title><author>Quiñones, Ana R ; Botoseneanu, Anda ; Markwardt, Sheila ; Nagel, Corey L ; Newsom, Jason T ; Dorr, David A ; Allore, Heather G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-e91e280bd62c9850b314873b099ab1d223d2a3c8fc5a939255e4da06e25207ed3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Accumulation</topic><topic>Adults</topic><topic>African Americans</topic><topic>Age</topic><topic>Angina</topic><topic>Angina pectoris</topic><topic>Arthritis</topic><topic>Cardiovascular diseases</topic><topic>Care and treatment</topic><topic>Cerebral infarction</topic><topic>Chronic conditions</topic><topic>Chronic Disease - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Quiñones, Ana R</au><au>Botoseneanu, Anda</au><au>Markwardt, Sheila</au><au>Nagel, Corey L</au><au>Newsom, Jason T</au><au>Dorr, David A</au><au>Allore, Heather G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2019-06-17</date><risdate>2019</risdate><volume>14</volume><issue>6</issue><spage>e0218462</spage><epage>e0218462</epage><pages>e0218462-e0218462</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Multimorbidity-having two or more coexisting chronic conditions-is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies differences in rates of chronic disease accumulation and multimorbidity development among non-Hispanic white, non-Hispanic black, and Hispanic study participants starting in middle-age and followed up to 16 years.
We analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly-available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic disease burden among 8,872 non-Hispanic black, non-Hispanic white, and Hispanic participants who were 51-55 years of age at their first interview any time during the study period (1998-2014) and all subsequent follow-up observations until 2014. Multimorbidity was defined as having two or more of seven somatic chronic diseases: arthritis, cancer, heart disease (myocardial infarction, coronary heart disease, angina, congestive heart failure, or other heart problems), diabetes, hypertension, lung disease, and stroke. We used negative binomial generalized estimating equation models to assess the trajectories of multimorbidity burden over time for non-Hispanic black, non-Hispanic white, and Hispanic participants. In covariate-adjusted models non-Hispanic black respondents had initial chronic disease counts that were 28% higher than non-Hispanic white respondents (IRR 1.279, 95% CI 1.201, 1.361), while Hispanic respondents had initial chronic disease counts that were 15% lower than non-Hispanic white respondents (IRR 0.852, 95% CI 0.775, 0.938). Non-Hispanic black respondents had rates of chronic disease accumulation that were 1.1% slower than non-Hispanic whites (IRR 0.989, 95% CI 0.981, 0.998) and Hispanic respondents had rates of chronic disease accumulation that were 1.5% faster than non-Hispanic white respondents (IRR 1.015, 95% CI 1.002, 1.028). Using marginal effects commands, this translates to predicted values of chronic disease for white respondents who begin the study period with 0.98 chronic diseases and end with 2.8 chronic diseases; black respondents who begin the study period with 1.3 chronic diseases and end with 3.3 chronic diseases; and Hispanic respondents who begin the study period with 0.84 chronic diseases and end with 2.7 chronic diseases.
Middle-aged non-Hispanic black adults start at a higher level of chronic disease burden and develop multimorbidity at an earlier age, on average, than their non-Hispanic white counterparts. Hispanics, on the other hand, accumulate chronic disease at a faster rate relative to non-Hispanic white adults. Our findings have important implications for improving primary and secondary chronic disease prevention efforts among non-Hispanic black and Hispanic Americans to stave off greater multimorbidity-related health impacts.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>31206556</pmid><doi>10.1371/journal.pone.0218462</doi><tpages>e0218462</tpages><orcidid>https://orcid.org/0000-0001-6554-7734</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2019-06, Vol.14 (6), p.e0218462-e0218462 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2242104660 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Free Full-Text Journals in Chemistry; Public Library of Science (PLoS) |
| subjects | Accumulation Adults African Americans Age Angina Angina pectoris Arthritis Cardiovascular diseases Care and treatment Cerebral infarction Chronic conditions Chronic Disease - epidemiology Chronic Disease - ethnology Chronic diseases Chronic illnesses Comorbidity Congestive heart failure Continental Population Groups Coronary artery disease Coronary heart disease Diabetes Diabetes mellitus Disease control Elderly Ethnic Groups Ethnicity European Continental Ancestry Group Female Health aspects Heart attack Heart attacks Heart diseases Heart failure Hispanic Americans Humans Hypertension Lung diseases Male Medical records Medical research Medicine and Health Sciences Middle age Middle Aged Minority & ethnic groups Multimorbidity Multimorbidity - trends Myocardial infarction Older people People and Places Physical Sciences Population Public health Race Respiratory tract diseases Retirement Socioeconomic factors Stroke Trajectory analysis United States |
| title | Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults |
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