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Rieman-Klingler MC, Jung J, Tesfai K, Loomba R, Non AL. Integrating genetic and socioeconomic data to predict the progression of nonalcoholic fatty liver disease. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2024; 184:e24979. [PMID: 38778456 DOI: 10.1002/ajpa.24979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/25/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease globally, with an estimated prevalence exceeding 25%. Variants in the PNPLA3 and HSD17B13 genes have been a focus of investigations surrounding the etiology and progression of NAFLD and are believed to contribute to a greater burden of disease experienced by Hispanic Americans. However, little is known about socioeconomic factors influencing NAFLD progression or its increased prevalence among Hispanics. MATERIALS AND METHODS We cross-sectionally analyzed 264 patients to assess the role of genetic and socioeconomic variables in the development of advanced liver fibrosis in individuals at risk for NAFLD. RESULTS Adjusting for age, sex, body mass index, and PNPLA3 genotype, lacking a college degree was associated with 3.3 times higher odds of advanced fibrosis (95% confidence interval [CI]: 1.21-8.76, p = 0.019), an effect comparable to that of possessing the major PNPLA3 risk variant. Notably, the effect of PNPLA3 genotype on advanced fibrosis was attenuated to nonsignificance following adjustment for education and other socioeconomic markers. The effect of the protective HSD17B13 variant, moreover, diminished after adjustment for education (odds ratio [OR]: 0.39 [95% CI: 0.13-1.16, p = 0.092]), while lower education continued to predict advanced fibrosis following multivariable adjustment with an OR of 8.0 (95% CI: 1.91-33.86, p = 0.005). DISCUSSION Adjusting for education attenuated the effects of genotype and Hispanic ethnicity on liver fibrosis, suggesting that social factors-rather than genes or ethnicity-may be driving disease severity within some populations. Findings reveal the importance of including socioenvironmental controls when considering the role of genetics or ethnicity in complex disease.
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Affiliation(s)
- Maria C Rieman-Klingler
- Department of Anthropology, University of California, San Diego, La Jolla, California, USA
- School of Medicine, University of California, San Diego, La Jolla, California, USA
- Medical Scientist Training (MD/PhD) Program, University of California, San Diego, La Jolla, California, USA
| | - Jinho Jung
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Kaleb Tesfai
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology and Hepatology, Department of Medicine, University of California, San Diego, La Jolla, California, USA
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA
| | - Amy L Non
- Department of Anthropology, University of California, San Diego, La Jolla, California, USA
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Noghanibehambari H, Fletcher J. Unequal before death: The effect of paternal education on children's old-age mortality in the United States. POPULATION STUDIES 2024; 78:203-229. [PMID: 38445522 DOI: 10.1080/00324728.2023.2284766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/12/2023] [Indexed: 03/07/2024]
Abstract
A growing body of research documents the relevance of parental education as a marker of family socio-economic status for children's later-life health outcomes. A strand of this literature evaluates how the early-life environment shapes mortality outcomes during infancy and childhood. However, the evidence on mortality during the life course and old age is limited. This paper contributes to the literature by analysing the association between paternal education and children's old-age mortality. We use data from Social Security Administration death records over the years 1988-2005 linked to the United States 1940 Census. Applying a family(cousin)- fixed-effects model to account for shared environment, childhood exposures, and common endowments that may confound the long-term links, we find that having a father with a college or high-school education, compared with elementary/no education, is associated with a 4.6- or 2.6-month-higher age at death, respectively, for the child, conditional on them surviving to age 47.
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3
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Borho L, Bao R, Elishaev E, Dinkins KD, O'Brien EE, Berger J, Boisen M, Comerci J, Courtney-Brooks M, Edwards RP, Garrett AA, Kelley JL, Lesnock J, Mahdi HS, Olawaiye A, Rush S, Sukumvanich P, Taylor S, Arend RC, Norian L, Modugno F. Association of allostatic load with overall survival in epithelial ovarian cancer. Gynecol Oncol 2024; 186:204-210. [PMID: 38843663 PMCID: PMC11216875 DOI: 10.1016/j.ygyno.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE Elevated allostatic load (AL), an integrated, cumulative marker of physiologic damage due to socioenvironmental stress, is associated with increased mortality in patients with breast, lung, and other cancers. The relationship between allostatic load and mortality in ovarian cancer patients remains unknown. We examined the relationship between allostatic load and overall survival in ovarian cancer patients. METHODS This cross-sectional study used data from 201 patients enrolled in a prospective observational ovarian cancer cohort study at a National Cancer Institute-designated Comprehensive Cancer Center from October 2012 through June 2022. All patients underwent debulking surgery and completed a full course of standard-of-care platinum-based chemotherapy. Follow-up was completed through January 2024. Allostatic load was calculated as a summary score by assigning one point to the worst sample quartile for each of ten biomarkers measured within 45 days before the ovarian cancer diagnosis. High allostatic load was defined as having an allostatic load in the top quartile of the summary score. A Cox proportional hazard model with robust variance tested the association between allostatic load and overall survival. RESULTS There were no associations between allostatic load and ovarian cancer clinical characteristics. After accounting for demographic, clinical, and treatment factors, high allostatic load was associated with a significant increase in mortality (hazard ratio 2.17 [95%CI, 1.13-4.15]; P = 0.02). CONCLUSION Higher allostatic load is associated with worse survival among ovarian cancer patients. Allostatic load could help identify patients at risk for poorer outcomes who may benefit from greater socioenvironmental support during treatment.
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Affiliation(s)
- Lauren Borho
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - Riyue Bao
- Department of Hematology/Oncology, University of Pittsburgh School of Medicine and Hillman Cancer Center, Pittsburgh, PA, United States of America
| | - Esther Elishaev
- Department of Pathology, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - Kaitlyn D Dinkins
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine and O'Neal Comprehensive Cancer Center, Birmingham, AL, United States of America
| | - Emily E O'Brien
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - Jessica Berger
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - Michelle Boisen
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - John Comerci
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - Madeleine Courtney-Brooks
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - Robert P Edwards
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - Alison Aunkst Garrett
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - Joseph L Kelley
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - Jamie Lesnock
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - Haider S Mahdi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - Alexander Olawaiye
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - Shannon Rush
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - Paniti Sukumvanich
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - Sarah Taylor
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America
| | - Rebecca C Arend
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine and O'Neal Comprehensive Cancer Center, Birmingham, AL, United States of America
| | - Lyse Norian
- Department of Nutrition Sciences, University of Alabama at Birmingham School of Health Professions, Nutrition Obesity Research Center, O'Neal Comprehensive Cancer Center, Birmingham, AL, United States of America
| | - Francesmary Modugno
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine and Magee-Womens Research Institute and Foundation, Pittsburgh, PA, United States of America; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States of America; Women's Cancer Research Center, Magee-Womens Research Institute and Foundation and Hillman Cancer Center, Pittsburgh, PA, United States of America
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Duignan L, Dutton DJ. The association between allostatic load and guaranteed annual income using the Canadian Longitudinal Study on Aging: A cross-sectional analysis of the benefits of guaranteed public pensions. Health Policy 2024; 143:105054. [PMID: 38522246 DOI: 10.1016/j.healthpol.2024.105054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Old Age Security (OAS) represents an public policy through which income-related inequalities in health may be improved. The goal of this cross-sectional study was to investigate the health benefits of receiving OAS in financially insecure older Canadians. METHODS Using data from the Canadian Longitudinal Study on Aging (CLSA) (n=15,691), ordered logistic regression was used to measure associations between financial insecurity and allostatic load. RESULTS Receiving OAS as highest personal income source appeared to remove the health penalty of being financially insecure. While financial insecurity was associated with worse allostatic load in both males and females not receiving OAS, those receiving OAS as highest personal income source had better allostatic load compared to other financially insecure older adults (ORM: 0.398, 95 % CI: 0.227, 0.696; ORF: 0.677, 95 % CI: 0.483, 0.949). DISCUSSION While longitudinal data would be needed to draw causal inferences, these results suggest OAS may play a role improving health outcomes and narrowing income-related health inequalities. Such findings may have important implications on older adults, other vulnerable populations, and future directions of Canadian health and public policy.
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Affiliation(s)
- Luke Duignan
- Faculty of Medicine, Dalhousie University, 5790 University Ave, Halifax, NS B3H 1V7, Canada.
| | - Daniel J Dutton
- Department of Community Health and Epidemiology, Dalhousie University, Canada
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Sánchez-Moreno E, Gallardo-Peralta L, Barrón López de Roda A, Rivera Álvarez JM. Socioeconomic status, loneliness, and depression among older adults: a cross-sectional study in Spain. BMC Geriatr 2024; 24:361. [PMID: 38654160 DOI: 10.1186/s12877-024-04978-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The association between socioeconomic status and depression is weaker in older adults than in younger populations. Loneliness may play a significant role in this relationship, explaining (at least partially) the attenuation of the social gradient in depression. The current study examined the relationship between socioeconomic status and depression and whether the association was affected by loneliness. METHODS A cross-sectional design involving dwelling and nursing homes residents was used. A total of 887 Spanish residents aged over 64 years took part in the study. Measures of Depression (GDS-5 Scale), Loneliness (De Jong-Gierveld Loneliness Scale), Socioeconomic Status (Education and Economic Hardship), and sociodemographic parameters were used. The study employed bivariate association tests (chi-square and Pearson's r) and logistic regression analyses. RESULTS The percentage of participants at risk of suffering depression was significantly higher among those who had not completed primary education (45.5%) and significantly lower among those with university qualifications (16.4%) (X2 = 40.25;p <.001), and respondents who could not make ends meet in financial terms faced a higher risk of depression (X2 = 23.62;p <.001). In terms of the respondents who experienced loneliness, 57.5% were at risk of depression, compared to 19% of those who did not report loneliness (X2 = 120.04;p <.001). The logistic regression analyses showed that having university qualifications meant a 47% reduction in the risk of depression. This risk was 86% higher among respondents experiencing financial difficulties. However, when scores for the loneliness measure were incorporated, the coefficients relating to education and economic hardships ceased to be significant or were significantly reduced. CONCLUSION Loneliness can contribute to explaining the role played by socioeconomic inequalities in depression among older adults.
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Affiliation(s)
- Esteban Sánchez-Moreno
- Department of Sociology: Methods and Theory, Universidad Complutense de Madrid, Madrid, Spain
| | - Lorena Gallardo-Peralta
- Department of Social Work and Social Services, Faculty of Social Work, Universidad Complutense de Madrid, Campus de Somosaguas, 28223, Pozuelo, Madrid, Spain.
| | - Ana Barrón López de Roda
- Department of Social, Organizational and Differential Psychology, Universidad Complutense de Madrid, Madrid, Spain
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Franco-O'Byrne D, Santamaría-García H, Migeot J, Ibáñez A. Emerging Theories of Allostatic-Interoceptive Overload in Neurodegeneration. Curr Top Behav Neurosci 2024. [PMID: 38637414 DOI: 10.1007/7854_2024_471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Recent integrative multilevel models offer novel insights into the etiology and course of neurodegenerative conditions. The predictive coding of allostatic-interoception theory posits that the brain adapts to environmental demands by modulating internal bodily signals through the allostatic-interoceptive system. Specifically, a domain-general allostatic-interoceptive network exerts adaptive physiological control by fine-tuning initial top-down predictions and bottom-up peripheral signaling. In this context, adequate adaptation implies the minimization of prediction errors thereby optimizing energy expenditure. Abnormalities in top-down interoceptive predictions or peripheral signaling can trigger allostatic overload states, ultimately leading to dysregulated interoceptive and bodily systems (endocrine, immunological, circulatory, etc.). In this context, environmental stress, social determinants of health, and harmful exposomes (i.e., the cumulative life-course exposition to different environmental stressors) may interact with physiological and genetic factors, dysregulating allostatic interoception and precipitating neurodegenerative processes. We review the allostatic-interoceptive overload framework across different neurodegenerative diseases, particularly in the behavioral variant frontotemporal dementia (bvFTD). We describe how concepts of allostasis and interoception could be integrated with principles of predictive coding to explain how the brain optimizes adaptive responses, while maintaining physiological stability through feedback loops with multiple organismic systems. Then, we introduce the model of allostatic-interoceptive overload of bvFTD and discuss its implications for the understanding of pathophysiological and neurocognitive abnormalities in multiple neurodegenerative conditions.
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Affiliation(s)
- Daniel Franco-O'Byrne
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Hernando Santamaría-García
- Global Brain Health Institute, University of California-San Francisco, San Francisco, CA, USA
- Trinity College Dublin, Dublin, Ireland
- Department of Psychiatry, Pontificia Universidad Javeriana, Bogotá, Colombia
- Center of Memory and Cognition Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Joaquín Migeot
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Agustín Ibáñez
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile.
- Global Brain Health Institute, University of California-San Francisco, San Francisco, CA, USA.
- Trinity College Dublin, Dublin, Ireland.
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina.
- Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin, Ireland.
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Ibanez A, Kringelbach ML, Deco G. A synergetic turn in cognitive neuroscience of brain diseases. Trends Cogn Sci 2024; 28:319-338. [PMID: 38246816 DOI: 10.1016/j.tics.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/15/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024]
Abstract
Despite significant improvements in our understanding of brain diseases, many barriers remain. Cognitive neuroscience faces four major challenges: complex structure-function associations; disease phenotype heterogeneity; the lack of transdiagnostic models; and oversimplified cognitive approaches restricted to the laboratory. Here, we propose a synergetics framework that can help to perform the necessary dimensionality reduction of complex interactions between the brain, body, and environment. The key solutions include low-dimensional spatiotemporal hierarchies for brain-structure associations, whole-brain modeling to handle phenotype diversity, model integration of shared transdiagnostic pathophysiological pathways, and naturalistic frameworks balancing experimental control and ecological validity. Creating whole-brain models with reduced manifolds combined with ecological measures can improve our understanding of brain disease and help identify novel interventions. Synergetics provides an integrated framework for future progress in clinical and cognitive neuroscience, pushing the boundaries of brain health and disease toward more mature, naturalistic approaches.
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Affiliation(s)
- Agustin Ibanez
- Latin American Institute for Brain Health (BrainLat), Universidad Adolfo Ibanez, Santiago, Chile; Global Brain Health Institute (GBHI), University California San Francisco (UCSF), San Francisco, CA, USA; Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland; Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina; Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Morten L Kringelbach
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Centre for Eudaimonia and Human Flourishing, University of Oxford, Oxford, UK
| | - Gustavo Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Roc Boronat 138, Barcelona 08018, Spain; Institució Catalana de la Recerca i Estudis Avançats (ICREA), Passeig Lluís Companys 23, Barcelona 08010, Spain.
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8
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Neufcourt L, Castagné R, Wilsgaard T, Grimsgaard S, Chadeau-Hyam M, Vuckovic D, Ugarteche-Perez A, Farbu EH, Sandanger TM, Delpierre C, Kelly-Irving M. Educational patterning in biological health seven years apart: Findings from the Tromsø Study. Psychoneuroendocrinology 2024; 160:106670. [PMID: 37992555 DOI: 10.1016/j.psyneuen.2023.106670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Social-to-biological processes is one set of mechanisms underlying the relationship between social position and health. However, very few studies have focused on the relationship between social factors and biology at multiple time points. This work investigates the relationship between education and the dynamic changes in a composite Biological Health Score (BHS) using two time points seven years apart in a Norwegian adult population. METHODS We used data from individuals aged 30 years and above who participated in Tromsø6 (2007-2008) and Tromsø7 (2015-2016) (n = 8117). BHS was defined using ten biomarkers measured from blood samples and representing three physiological systems (cardiovascular, metabolic, inflammatory). The higher the BHS, the poorer the health status. FINDINGS Linear regression models carried out on BHS revealed a strong educational gradient at two distinct time points but also over time. People with lower educational attainment were at higher risk of poor biological health at a given time point (βlow education Tromsø6=0.30 [95 %-CI=0.18-0.43] and βlow education Tromsø7=0.30 [95 %-CI=0.17-0.42]). They also presented higher longitudinal BHS compared to people with higher education (βlow education = 0.89 [95 %-CI=0.56-1.23]). Certain biomarkers related to the cardiovascular system and the metabolic system were strongly socially distributed, even after adjustment for sex, age, health behaviours and body mass index. CONCLUSION This longitudinal analysis highlights that participants with lower education had their biological health deteriorated to a greater extent over time compared to people with higher education. Our findings provide added evidence of the biological embodiment of social position, particularly with respect to dynamic aspects for which little evidence exists.
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Affiliation(s)
- Lola Neufcourt
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France.
| | - Raphaële Castagné
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Sameline Grimsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Dragana Vuckovic
- Department of Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, Imperial College London, London, UK; MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Ainhoa Ugarteche-Perez
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Erlend Hoftun Farbu
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Torkjel M Sandanger
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Cyrille Delpierre
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Michelle Kelly-Irving
- CERPOP-UMR1295, EQUITY research team, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
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9
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Ibanez A, Northoff G. Intrinsic timescales and predictive allostatic interoception in brain health and disease. Neurosci Biobehav Rev 2024; 157:105510. [PMID: 38104789 PMCID: PMC11184903 DOI: 10.1016/j.neubiorev.2023.105510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/29/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
The cognitive neuroscience of brain diseases faces challenges in understanding the complex relationship between brain structure and function, the heterogeneity of brain phenotypes, and the lack of dimensional and transnosological explanations. This perspective offers a framework combining the predictive coding theory of allostatic interoceptive overload (PAIO) and the intrinsic neural timescales (INT) theory to provide a more dynamic understanding of brain health in psychiatry and neurology. PAIO integrates allostasis and interoception to assess the interaction between internal patterns and environmental stressors, while INT shows that different brain regions operate on different intrinsic timescales. The allostatic overload can be understood as a failure of INT, which involves a breakdown of proper temporal integration and segregation. This can lead to dimensional disbalances between exteroceptive/interoceptive inputs across brain and whole-body levels (cardiometabolic, cardiovascular, inflammatory, immune). This approach offers new insights, presenting novel perspectives on brain spatiotemporal hierarchies and interactions. By integrating these theories, the paper opens innovative paths for studying brain health dynamics, which can inform future research in brain health and disease.
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Affiliation(s)
- Agustin Ibanez
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), CA, USA; Latin American Brain Health (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile; Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina; Trinity College Dublin, Dublin, Ireland.
| | - Georg Northoff
- Mental Health Center, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People's Republic of China; Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, People's Republic of China; Mind, Brain Imaging and Neuroethics, Institute of Mental Health Research, University of Ottawa, Ottawa, Canada.
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10
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Arias de la Torre J, Vilagut G, Ronaldson A, Bakolis I, Dregan A, Navarro-Mateu F, Pérez K, Szücs A, Bartoll-Roca X, Molina AJ, Elices M, Pérez-Solá V, Martín V, Serrano-Blanco A, Valderas JM, Alonso J. Reconsidering the Use of Population Health Surveys for Monitoring of Mental Health. JMIR Public Health Surveill 2023; 9:e48138. [PMID: 37995112 PMCID: PMC10704303 DOI: 10.2196/48138] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/18/2023] [Accepted: 09/26/2023] [Indexed: 11/24/2023] Open
Abstract
Monitoring of the mental health status of the population and assessment of its determinants are 2 of the most relevant pillars of public mental health, and data from population health surveys could be instrumental to support them. Although these surveys could be an important and suitable resource for these purposes, due to different limitations and challenges, they are often relegated to the background behind other data sources, such as electronic health records. These limitations and challenges include those related to measurement properties and cross-cultural validity of the tools used for the assessment of mental disorders, their degree of representativeness, and possible difficulties in the linkage with other data sources. Successfully addressing these limitations could significantly increase the potential of health surveys in the monitoring of mental disorders and ultimately maximize the impact of the relevant policies to reduce their burden at the population level. The widespread use of data from population health surveys, ideally linked to electronic health records data, would enhance the quality of the information available for research, public mental health decision-making, and ultimately addressing the growing burden of mental disorders.
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Affiliation(s)
- Jorge Arias de la Torre
- Care in Long Term Conditions Research Division, King's College London, London, United Kingdom
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Biomedical Sciences, Universidad de León, León, Spain
| | - Gemma Vilagut
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Amy Ronaldson
- Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Ioannis Bakolis
- Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Alex Dregan
- Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Fernando Navarro-Mateu
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Katherine Pérez
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Anna Szücs
- Department of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Xavier Bartoll-Roca
- Agència de Salut Pública de Barcelona (ASPB), Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Antonio J Molina
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Biomedical Sciences, Universidad de León, León, Spain
| | - Matilde Elices
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Víctor Pérez-Solá
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Vicente Martín
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Biomedical Sciences, Universidad de León, León, Spain
| | - Antoni Serrano-Blanco
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Institut de Recerca Sant Joan de Déu, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | | | - Jordi Alonso
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Health Services Research Group, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medical and Life Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
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11
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Curci SG, Luecken LJ, Hernández JC, Winstone LK, Perez M. Multilevel prenatal socioeconomic predictors of Mexican American children's cardiometabolic health in preschool and school age. Health Psychol 2023; 42:788-799. [PMID: 37883036 PMCID: PMC10683869 DOI: 10.1037/hea0001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Using a life course perspective, this longitudinal study examines the extent to which prenatal family- and neighborhood-level socioeconomic factors influence the cardiometabolic health of low-income Mexican American children. It was hypothesized that prenatal maternal residence in a more economically disadvantaged neighborhood and more family-level economic hardship would each be associated with higher adiposity and blood pressure (BP) at child age 4.5 years, and higher adiposity, BP, inflammation and a less healthy lipid profile at child age 7.5 years. METHOD The sample consisted of 322 low-income, Mexican American mother-child dyads, 181 of whom completed the 7.5-year laboratory visit. Using maternal prenatal residence and U.S. census data, neighborhood concentrated disadvantage index was computed. RESULTS Higher prenatal neighborhood concentrated disadvantage predicted higher 4.5-year adiposity in children, which, in turn, predicted higher adiposity, BP, and inflammation, and less healthy lipid profile (higher triglycerides, lower high-density lipoprotein cholesterol) at 7.5 years. Higher child 4.5-year BP was concurrently associated with higher adiposity and predicted higher 7.5-year BP. CONCLUSIONS Extending previous work with this sample, the current study found associations between cardiometabolic risk indicators as early as preschool among Mexican American children. Furthermore, this study builds on existing literature by expanding our understanding of the effect of prenatal neighborhood concentrated disadvantage on cardiometabolic phenotypes during early childhood. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Weiss J, Beydoun MA, Beydoun HA, Fanelli-Kuczmarski MT, Banerjee S, Hamrah A, Evans MK, Zonderman AB. Pathways explaining racial/ethnic disparities in incident all-cause dementia among middle-aged US adults. Alzheimers Dement 2023; 19:4299-4310. [PMID: 36868873 PMCID: PMC10475144 DOI: 10.1002/alz.12976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/16/2022] [Accepted: 01/13/2023] [Indexed: 03/05/2023]
Abstract
INTRODUCTION Racial disparities in dementia incidence exist, but less is known about their presence and drivers among middle-aged adults. METHODS We used time-to-event analysis among a sample of 4378 respondents (age 40-59 years at baseline) drawn from the third National Health and Nutrition Examination Surveys (NHANES III) with administrative linkage-spanning the years 1988-2014-to evaluate potential mediating pathways through socioeconomic status (SES), lifestyle, and health-related characteristics. RESULTS Compared with Non-Hispanic White (NHW) adults, Non-White adults had a higher incidence of AD-specific (hazard ratio [HR] = 2.05, 95% confidence interval [CI]: 1.21, 3.49) and all-cause dementia (HR = 2.01, 95% CI: 1.36, 2.98). Diet, smoking, and physical activity were among characteristics on the pathway between race/ethnicity, SES, and dementia, with health-mediating effects of smoking and physical activity on dementia risk. DISCUSSION We identified several pathways that may generate racial disparities in incident all-cause dementia among middle-aged adults. No direct effect of race was observed. More studies are needed to corroborate our findings in comparable populations.
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Affiliation(s)
- Jordan Weiss
- Stanford Center on Longevity, Stanford University, Stanford, CA, USA
| | - May A. Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institutes on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Hind A. Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Marie T. Fanelli-Kuczmarski
- Laboratory of Epidemiology and Population Sciences, National Institutes on Aging, NIA/NIH/IRP, Baltimore, MD, USA
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - Sri Banerjee
- Public Health Doctoral Programs, Walden University, Minneapolis, MN, USA
| | | | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institutes on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institutes on Aging, NIA/NIH/IRP, Baltimore, MD, USA
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Wu A, Setiawan VW, Stram D, Crimmins E, Tseng CC, Lim U, Park SY, White K, Cheng I, Haiman C, Wilkens L, Le Marchand L. Racial, Ethnic, and Socioeconomic Differences in a Deficit Accumulation Frailty Index in the Multiethnic Cohort Study. J Gerontol A Biol Sci Med Sci 2023; 78:1246-1257. [PMID: 36255109 PMCID: PMC11255091 DOI: 10.1093/gerona/glac216] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Frailty status has been sparsely studied in some groups including Native Hawaiians and Asian Americans. METHODS We developed a questionnaire-based deficit accumulation frailty index (FI) in the Multiethnic Cohort (MEC) and examined frailty status (robust, FI 0 to <0.2, prefrail, FI 0.2 to <0.35, and frail FI ≥ 0.35) among 29 026 men and 40 756 women. RESULTS After adjustment for age, demographic, lifestyle factors, and chronic conditions, relative to White men, odds of being frail was significantly higher (34%-54%) among African American, Native Hawaiian, and other Asian American men, whereas odds was significantly lower (36%) in Japanese American men and did not differ in Latino men. However, among men who had high school or less, none of the groups displayed significantly higher odds of prefrail or frail compared with White men. Relative to White women, odds of being frail were significantly higher (14%-33%) in African American and Latino women, did not differ for other Asian American women and lower (14%-36%) in Native Hawaiian and Japanese American women. These racial and ethnic differences in women were observed irrespective of education. Risk of all-cause mortality was higher in prefrail and frail men than robust men (adjusted hazard ratio [HR] = 1.69, 1.59-1.81; HR = 3.27, 3.03-3.53); results were similar in women. All-cause mortality was significantly positively associated with frailty status and frailty score across all sex, race, and ethnic groups. CONCLUSIONS Frailty status differed significantly by race and ethnicity and was consistently associated with all-cause mortality. The FI may be a useful tool for aging studies in this multiethnic population.
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Affiliation(s)
- Anna H Wu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - V Wendy Setiawan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Daniel O Stram
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Eileen M Crimmins
- Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Chiu-Chen Tseng
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Unhee Lim
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Song-Yi Park
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Kami K White
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Iona Cheng
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Christopher A Haiman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Center for Genetic Epidemiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Lynne R Wilkens
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Loïc Le Marchand
- Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
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Hao B, Chen J, Cai Y, Li H, Zhu Z, Xu W, Liu H. Association between allostatic load and adverse outcomes among older patients with heart failure with preserved ejection fraction. BMC Geriatr 2023; 23:360. [PMID: 37296410 PMCID: PMC10257257 DOI: 10.1186/s12877-023-04091-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 06/05/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND The allostatic load (AL) refers to the cumulative weakening of multiple physiological systems caused by repeated adaptation of the body to stressors There are still no studies have focused on the association between AL and the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). The present study aimed to investigate the association between AL and adverse outcomes, including mortality and HF admission, among elderly male patients with HFpEF. METHODS We conducted a prospective cohort study of 1111 elderly male patients with HFpEF, diagnosed between 2015 and 2019 and followed up through 2021. We constructed an AL measure using a combination of 12 biomarkers. The diagnosis of HFpEF was made according to the 2021 European Society of Cardiology guidelines. A Cox proportional hazards model was used to determine the associations between AL and adverse outcomes. RESULTS In multivariate analysis, AL was significantly associated with increased risk of all-cause mortality (medium AL: adjusted hazard ratio [HR] = 2.53; 95% confidence interval [CI] 1.37-4.68; high AL: HR = 4.21; 95% CI 2.27-7.83; per-score increase: HR = 1.31; 95% CI 1.18-1.46), cardiovascular mortality (medium AL: HR = 2.67; 95% CI 1.07-6.68; high AL: HR = 3.13; 95% CI 1.23-7.97; per-score increase: HR = 1.20; 95% CI 1.03-1.40), non-cardiovascular mortality (medium AL: HR = 2.45; 95% CI 1.06-5.63; high AL: HR = 5.81; 95% CI 2.55-10.28; per-score increase: HR = 1.46; 95% CI 1.26-1.69), and HF admission (medium AL: HR = 2.68; 95% CI 1.43-5.01; high AL: HR = 3.24; 95% CI 1.69-6.23; per-score increase: HR = 1.24; 95% CI 1.11-1.39). Consistent results were found in multiple subgroup analyses. CONCLUSIONS A higher AL was associated with poor prognosis in elderly men with HFpEF. AL relies on information that is easily obtained in physical examinations and laboratory parameters and can be assessed in various care and clinical settings to help risk stratification of HFpEF patients.
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Affiliation(s)
- Benchuan Hao
- Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China
| | - Jianqiao Chen
- Department of Geriatrics, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yulun Cai
- Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China
| | - Huiying Li
- Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China
| | - Zifan Zhu
- Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China
| | - Weihao Xu
- Department of Cardiology, Guangdong Provincial People's Hospital, Guangdong Provincial Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China.
- Department of Geriatrics, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
| | - Hongbin Liu
- Department of Cardiology, The Second Medical Centre, Chinese PLA General Hospital, Beijing, China.
- Beijing Key Laboratory of Chronic Heart Failure Precision Medicine, Beijing, China.
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Jaffee SR, Widom CS. Resilience to Maltreatment in Early Adulthood Does Not Predict Low Allostatic Load at Midlife. Ann Behav Med 2023; 57:489-498. [PMID: 37040622 PMCID: PMC10413319 DOI: 10.1093/abm/kaac057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Although childhood maltreatment is associated with a host of poor health and social outcomes in adulthood, many individuals manifest resilience. PURPOSE We tested competing predictions about whether achieving positive psychosocial outcomes in young adulthood would be differentially predictive of allostatic load at midlife for those with and without a childhood history of maltreatment. METHODS The sample included 808 individuals, 57% of whom had court-documented records of childhood abuse or neglect between 1967 and 1971, and demographically matched controls without those histories. Participants provided information on socioeconomic, mental health, and behavioral outcomes in interviews conducted between 1989 and 1995 (mean age = 29.2 years). Indicators of allostatic load were measured between 2003 and 2005 (mean age = 41.2 years). RESULTS The relationship between positive life outcomes in young adulthood and allostatic load in middle adulthood varied depending on childhood maltreatment status (b = .16, 95% CI: .03; .28); for adults who did not experience childhood maltreatment, more positive life outcomes predicted lower allostatic load (b = -.12, 95% CI: -.23; -.01), whereas the relationship was not significant for adults with a childhood history of maltreatment (b = .04, 95% CI: -.06; .13). There were no differences in the results predicting allostatic load for African-American and White respondents. CONCLUSIONS Childhood maltreatment may have enduring effects on physiological functioning that are manifest in elevated allostatic load scores in middle age. Alternatively, resilience to maltreatment-as manifest in positive functioning in socioeconomic and behavioral domains-may not be sufficiently stable over adulthood to buffer individuals from the physiological consequences of stressful environments.
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Affiliation(s)
- Sara R Jaffee
- Department of Psychology, University of Pennsylvania, 425 South University Ave., Philadelphia, PA 19104, USA
| | - Cathy Spatz Widom
- Department of Psychology, John Jay College of Criminal Justice, New York, New York, USA
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16
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Beydoun HA, Beydoun MA, Gamaldo A, Kwon E, Weiss J, Hossain S, Evans MK, Zonderman AB. Trajectories in allostatic load as predictors of sleep quality among urban adults: Healthy aging in neighborhoods of diversity across the life span study. Sleep Med 2023; 107:300-307. [PMID: 37269706 DOI: 10.1016/j.sleep.2023.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 04/18/2023] [Accepted: 04/30/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVE /Background: The allostatic framework is a theoretical perspective that identifies allostatic load (AL) as a meaningful measure of dysregulation and desynchrony across biological processes due to cumulative stress exposure, thereby increasing disease risk. Research exploring the relationships of AL with sleep quality have yielded inconsistent findings. We examined AL at three visits (2004-2009 [Visit 1], 2009-2013 [Visit 2] and 2013-2017 [Visit 3]) in relation to sleep quality [Visit 3] among urban adults by sex, race and age group. PATIENTS/METHODS We analyzed data on 1489 Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) participants [59.6% female, baseline age: 48.2 years, 58.5% African Americans] with available data on cardiovascular, metabolic and inflammatory AL markers and Pittsburgh Sleep Quality Index (PSQI) scores. Least squares regression models were constructed to evaluate AL score at Visit 1 (ALv1) and z-transformed probability of higher trajectory in AL score between Visit 1 and Visit 3 (ALtraj) as predictors of PSQI score at Visit 3, controlling for demographic, lifestyle and health characteristics at Visit 1. ALtraj was generated using group-based trajectory modeling. RESULTS In fully adjusted models, ALv1 and PSQI score were positively related among men only (β = 0.43, P = 0.001), whereas higher ALtraj was associated with PSQI score among women (β = 0.51, P = 0.001), White (β = 0.45, P = 0.011) and African American (β = 0.33, P = 0.014) populations. There were no statistically significant interactions according to age group (<50 vs. ≥ 50). CONCLUSIONS Disparities exist whereby AL trajectory predicted sleep quality among women irrespective of race and baseline AL predicted sleep quality among men. Future studies should examine bi-directional AL-sleep relationships.
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Affiliation(s)
- Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA.
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA.
| | - Alyssa Gamaldo
- Human Development and Family Studies, Pennsylvania State University, College Station, PA, USA.
| | - Edward Kwon
- Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA.
| | - Jordan Weiss
- Stanford Center on Longevity, Stanford University, Stanford, CA, USA.
| | - Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA.
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA.
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA.
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HAYWARD MARKD, FARINA MATEOP. Dynamic Changes in the Association Between Education and Health in the United States. Milbank Q 2023; 101:396-418. [PMID: 37096600 PMCID: PMC10126982 DOI: 10.1111/1468-0009.12611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/27/2022] [Accepted: 01/06/2023] [Indexed: 04/26/2023] Open
Abstract
Policy Points We reviewed some of the recent advances in education and health, arguing that attention to social contextual factors and the dynamics of social and institutional change provide critical insights into the ways in which the association is embedded in institutional contexts. Based on our findings, we believe incorporating this perspective is fundamentally important to ameliorate current negative trends and inequality in Americans' health and longevity.
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Affiliation(s)
- MARK D. HAYWARD
- Population Research Center and Department of SociologyUniversity of Texas at Austin
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18
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Farina MP, Kim JK, Crimmins EM. Racial/Ethnic Differences in Biological Aging and Their Life Course Socioeconomic Determinants: The 2016 Health and Retirement Study. J Aging Health 2023; 35:209-220. [PMID: 35984401 PMCID: PMC9898094 DOI: 10.1177/08982643221120743] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objectives: This study examined differences in accelerated biological aging among non-Hispanic Blacks, Hispanics, and non-Hispanic Whites in the United States and assessed whether including life course socioeconomic conditions attenuated observed racial/ethnic differences. Methods: Data came from the Venous Blood Collection Subsample of the Health and Retirement Study. We used a comprehensive summary measure of biological age (BA-22). We determined whether key lifetime socioeconomic conditions contributed to racial/ethnic differences in biological aging. Results: Findings indicated that non-Hispanic Blacks and Hispanics have accelerated aging, and non-Hispanic Whites have decelerated aging. Racial/ethnic differences were strongly tied to educational attainment. We also observed a significant difference by birthplace for Hispanics. US-born Hispanics had accelerated biological aging, whereas foreign-born Hispanics did not. In age-stratified analyses, these racial/ethnic differences were found for adults aged 56-74, but not for adults aged 75+. Conclusions: These findings provide insight into biological differences underlying racial/ethnic disparities in health.
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Affiliation(s)
- Mateo P Farina
- Andrus Gerontology Center, University of Southern California, Los Angeles, CA, USA
| | - Jung Ki Kim
- Andrus Gerontology Center, University of Southern California, Los Angeles, CA, USA
| | - Eileen M. Crimmins
- Andrus Gerontology Center, University of Southern California, Los Angeles, CA, USA
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Comparing Predictors and Outcomes of Higher Allostatic Load across Zoo-Housed African Great Apes. JOURNAL OF ZOOLOGICAL AND BOTANICAL GARDENS 2023. [DOI: 10.3390/jzbg4010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Stressors over the lifespan can contribute to physiological dysregulation, or allostatic load. Allostatic load has been studied in humans using allostatic load indices (ALIs) for over 25 years, but the same methods are rarely applied to other species. We constructed an ALI for zoo-housed western lowland gorillas, chimpanzees, and bonobos and tested potential predictors of and health outcomes associated with allostatic load. Allostatic load scores ranged from 0–6 for gorillas and chimpanzees and 0–7 for bonobos. Age was significantly associated with allostatic load in gorillas and chimpanzees but not bonobos. Cumulative stressful events were positively associated with allostatic load in chimpanzees. Wild-caught gorillas had higher allostatic load than zoo-born conspecifics, but rearing differences between zoo-born animals were not significant for any species. Age may affect associations of allostatic load with stressful events and birthplace as results change when it is included as a covariate. Allostatic load was not retained in best-fit models for risk of all-cause morbidity, cardiac disease, or mortality risk. Some analyses herein were limited by the use of retrospective data, such as reason for sample collection and length of records provided for individual animals. Nevertheless, these data indicate additional research is needed to optimize ALIs for non-human primates.
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Beydoun HA, Beydoun MA, Kwon E, Hossain S, Fanelli-Kuczmarski MT, Maldonado A, Evans MK, Zonderman AB. Longitudinal association of allostatic load with depressive symptoms among urban adults: Healthy Aging in Neighborhoods of Diversity across the Life Span study. Psychoneuroendocrinology 2023; 149:106022. [PMID: 36640448 PMCID: PMC9931667 DOI: 10.1016/j.psyneuen.2022.106022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Evidence suggests that lifetime exposure to stressful life events and chronic stressors may be linked to geriatric depression. Allostatic load (AL) is considered a mediator of the stress-health relationship and has been linked to psychosocial factors reflecting health disparities. The purpose of this study was to examine the longitudinal associations of AL with depressive symptoms scores among urban adults, before and after stratifying by sex and race. METHODS Secondary analyses were performed using Visit 1 (2004-2009), Visit 2 (2009-2013) and Visit 3 (2013-2017) data collected on 2298 Healthy Aging in Neighborhoods of Diversity across the Life Span study participants (baseline age: 30-64 y). AL at Visit 1 (ALv1) and z-transformed probability of higher AL trajectory (ALtraj) between Visits 1 and 3 were calculated using cardiovascular, metabolic and inflammatory risk indicators. The 20-item Center for Epidemiologic Studies Depression (CES-D) scale was used to calculate total and domain-specific depressive symptoms scores. Mixed-effects linear models controlled for socio-demographic, lifestyle and health characteristics. RESULTS In fully adjusted models, a positive cross-sectional relationship was observed between ALv1 and "somatic complaints" depressive symptoms (β = 0.21, P = 0.006) score at Visit 1, whereas ALtraj was associated with increasing depressive symptoms score (β = 0.086, P = 0.003) between Visits 1 and 3. An inverse relationship was observed between ALtraj and "positive affect" depressive symptoms score at Visit 1 among women (β = -0.31, P < 0.0001) and White adults (β = -0.32, P = 0.004). Among women, ALtraj was also positively related to change in "somatic complaints" depressive symptoms score between Visits 1 and 3 (β = 0.043, P = 0.020). CONCLUSIONS Among urban adults, AL may be associated with "somatic complaints" depressive symptoms at baseline. Higher AL trajectories may predict increasing depressive symptoms (overall) and increasing "somatic complaints" depressive symptoms (among women). A higher AL trajectory may be associated with lower "positive affect" depressive symptoms at baseline among women and White adults only.
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Affiliation(s)
- Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA.
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - Edward Kwon
- Department of Family Medicine, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - Marie T Fanelli-Kuczmarski
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - Ana Maldonado
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
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Beydoun HA, Beydoun MA, Maldonado AI, Fanelli-Kuczmarski MT, Weiss J, Evans MK, Zonderman AB. Allostatic Load and Cognitive Function Among Urban Adults in the Healthy Aging in Neighborhoods of Diversity across the Life Span Study. J Alzheimers Dis 2023; 92:425-443. [PMID: 36776055 PMCID: PMC10896260 DOI: 10.3233/jad-220888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Cross-sectional studies have linked cognition to allostatic load (AL) which reflects multisystem dysregulation from life course exposure to stressors. OBJECTIVE To examine baseline and changes in AL and their relationships with 11 cognitive function test scores, while exploring health disparities according to sex and race. METHODS Longitudinal [Visit 1 (2004-2009) and Visit 2 (2009-2013)] data were analyzed from 2,223 Healthy Aging in Neighborhoods of Diversity across the Life Span participants. We calculated AL total score using cardiovascular, metabolic, and inflammatory risk indicators, and applied group-based trajectory modeling to define AL change. RESULTS Overall and stratum-specific relationships were evaluated using mixed-effects linear regression models that controlled for socio-demographic, lifestyle, and health characteristics. Baseline AL was significantly associated with higher log-transformed Part A Trail Making Test score [Loge (TRAILS A)] (β= 0.020, p = 0.004) and increasing AL was associated with higher Benton Visual Retention Test score [BVRT] (β= 0.35, p = 0.002) at baseline, in models that controlled for age, sex, race, poverty status, education, literacy, smoking, drug use, the 2010 healthy eating index and body mass index. Baseline AL and AL change were not related to change in cognitive function between visits. There were no statistically significant interaction effects by sex or race in fully-adjusted models. CONCLUSION At baseline, AL was associated with worse attention or executive functioning. Increasing AL was associated with worse non-verbal memory or visuo-constructional abilities at baseline. AL was not related to change in cognitive function over time, and relationships did not vary by sex or race.
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Affiliation(s)
- Hind A. Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - May A. Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - Ana I. Maldonado
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Marie T. Fanelli-Kuczmarski
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - Jordan Weiss
- Stanford Center on Longevity, Stanford University, Stanford, CA, USA
| | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, MD, USA
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Beese S, Postma J, Graves JM. Allostatic Load Measurement: A Systematic Review of Reviews, Database Inventory, and Considerations for Neighborhood Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192417006. [PMID: 36554888 PMCID: PMC9779615 DOI: 10.3390/ijerph192417006] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 05/27/2023]
Abstract
BACKGROUND Neighborhoods are critical to understanding how environments influence health outcomes. Prolonged environmental stressors, such as a lack of green spaces and neighborhood socioeconomic disadvantage, have been associated with higher allostatic load levels. Since allostatic load levels experienced earlier in life have stronger associations with mortality risk, neighborhoods may be uniquely suited to monitor and mitigate the impacts of environmental stressors. Researchers often study allostatic load in neighborhoods by utilizing administrative boundaries within publicly accessible databases as proxies for neighborhoods. METHODS This systematic review of reviews aims to identify commonly used biomarkers in the measurement of allostatic load, compare measurement approaches, inventory databases to study allostatic load, and spotlight considerations referenced in the literature where allostatic load is studied in neighborhoods. The review was conducted using the search term "allostatic load" in the MEDLINE, CINAHL, and PsychINFO databases. The search results were filtered to include reviews. RESULTS The search returned 499 articles after deduplication. Overall, 18 synthesis reviews met the inclusion criteria and were retained for extraction. The synthesis reviews analyzed represented 238 studies published from 1995 to 2020. The original ten biomarkers were most often used to measure allostatic load. More recently, body mass index and C-reactive protein have additionally been frequently used to measure allostatic load burden. CONCLUSIONS The scientific contributions of this study are that we have identified a clear gap in geographic considerations when studying allostatic load. The implication of this study is that we have highlighted geographic concepts when conducting neighborhood-level research using administrative databases as a neighborhood proxy and outlined emerging future trends that can enable future study of allostatic load in the neighborhood context.
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Affiliation(s)
- Shawna Beese
- College of Agricultural, Human, and Natural Resources Sciences, Washington State University, Pullman, WA 99164, USA
- College of Nursing, Washington State University, Spokane, WA 99202, USA
| | - Julie Postma
- College of Nursing, Washington State University, Spokane, WA 99202, USA
| | - Janessa M. Graves
- College of Nursing, Washington State University, Spokane, WA 99202, USA
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Pathways explaining racial/ethnic and socio-economic disparities in incident all-cause dementia among older US adults across income groups. Transl Psychiatry 2022; 12:478. [PMID: 36379922 PMCID: PMC9666623 DOI: 10.1038/s41398-022-02243-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/21/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
Differential racial and socioeconomic disparities in dementia incidence across income groups and their underlying mechanisms remain largely unknown. A retrospective cohort study examining all-cause dementia incidence across income groups was conducted linking third National Health and Nutrition Examination Surveys (NHANES III) to Centers for Medicare and Medicaid Services-Medicare data over ≤26 y of follow-up (1988-2014). Cox regression and generalized structural equations models (GSEM) were constructed among adults aged≥60 y at baseline (N = 4,592). Non-Hispanic Black versus White (NHW) adults had higher risk of dementia in age and sex-adjusted Cox regression models (HR = 1.34, 95%CI: 1.15-1.55, P < 0.001), an association that was attenuated in the SES-adjusted model (HR = 1.15, 95%CI: 1.01-1.34, P = 0.092). SES was inversely related to dementia risk overall (per Standard Deviation, HR = 0.80, 95% CI:0.69-0.92, P = 0.002, Model 2), mainly within the middle-income group. Within the lowest and middle-income groups and in socio-economic status (SES)-adjusted models, Mexican American participants were at lower all-cause dementia risk compared with their NHW counterparts. GSEM models further detected 3 pathways explaining >55% of the total effect of SES on dementia risk (Total effect = -0.160 ± 0.067, p = 0.022), namely SES→LIFESTYLE→DEMENTIA (Indirect effect (IE) = -0.041 ± 0.014, p = 0.004), SES→LIFESTYLE→COGN→DEMENTIA (IE = -0.006 ± 0.001, p < 0.001), SES→COGN→DEMENTIA(IE = -0.040 ± 0.008, p < 0.001), with the last two remaining significant or marginally significant in the uppermost income groups. Diet and social support were among key lifestyle factors involved in socio-economic disparities in dementia incidence. We provide evidence for modifiable risk factors that may delay dementia onset differentially across poverty-income ratio groups, underscoring their importance for future observational and intervention studies.
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Migeot JA, Duran-Aniotz CA, Signorelli CM, Piguet O, Ibáñez A. A predictive coding framework of allostatic-interoceptive overload in frontotemporal dementia. Trends Neurosci 2022; 45:838-853. [PMID: 36057473 PMCID: PMC11286203 DOI: 10.1016/j.tins.2022.08.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/27/2022] [Accepted: 08/09/2022] [Indexed: 10/31/2022]
Abstract
Recent allostatic-interoceptive explanations using predictive coding models propose that efficient regulation of the body's internal milieu is necessary to correctly anticipate environmental needs. We review this framework applied to understanding behavioral variant frontotemporal dementia (bvFTD) considering both allostatic overload and interoceptive deficits. First, we show how this framework could explain divergent deficits in bvFTD (cognitive impairments, behavioral maladjustment, brain atrophy, fronto-insular-temporal network atypicality, aberrant interoceptive electrophysiological activity, and autonomic disbalance). We develop a set of theory-driven predictions based on levels of allostatic interoception associated with bvFTD phenomenology and related physiopathological mechanisms. This approach may help further understand the disparate behavioral and physiopathological dysregulations of bvFTD, suggesting targeted interventions and strengthening clinical models of neurological and psychiatric disorders.
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Affiliation(s)
- Joaquin A Migeot
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile; Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibanez, Santiago, Chile
| | - Claudia A Duran-Aniotz
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile; Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibanez, Santiago, Chile
| | - Camilo M Signorelli
- Department of Computer Science, University of Oxford, Oxford, UK; Physiology of Cognition, GIGA-CRC In Vivo Imaging, University of Liège, Liège, Belgium; Cognitive Neuroimaging Unit, INSERM, Saclay, France
| | - Olivier Piguet
- The University of Sydney, School of Psychology and Brain & Mind Centre, Sydney, Australia
| | - Agustín Ibáñez
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago, Chile; Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Global Brain Health Institute, University of California-San Francisco, San Francisco, CA, USA, and Trinity College Dublin, Dublin, Ireland.
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McLoughlin S, Präg P, Bartley M, Kenny RA, McCrory C. Intergenerational Social Mobility and Allostatic Load in Midlife and Older Ages: A Diagonal Reference Modeling Approach. J Gerontol B Psychol Sci Soc Sci 2022; 78:154-166. [PMID: 36008104 PMCID: PMC9890911 DOI: 10.1093/geronb/gbac122] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES This study aims to understand the association of life-course intergenerational social mobility with allostatic load (AL) burden in midlife and older ages in Ireland. METHODS The study involved biological data for 3,987 older adults participating in The Irish Longitudinal Study on Ageing (TILDA). Intergenerational social mobility was characterized using the cross-classification of origin socioeconomic position (SEP; i.e., father's occupation) and destination SEP (i.e., own occupation). AL was operationalized using 12 biomarkers tapping cardiovascular, metabolic, renal, and immune system dysregulation. Diagonal reference modeling (DRM) and ordinary least square regression techniques were applied to explore the effect of social mobility on AL burden. RESULTS A total of 55.5% experienced intergenerational mobility: 37.5% were upwardly mobile, 18.0% were downwardly mobile. A social gradient in AL was observed among the socially non-mobile. Destination SEP (b = 0.74, 95% CI = 0.57, 0.92) predominated in influence over origin, although both life stages exerted significant influence on later-life AL. Social mobility in either direction was not associated with AL burden. Mobility coefficients were substantially small across a large variety of model specifications. DISCUSSION Findings provide evidence for an accumulation model of social inequalities in which disparities in health are diluted rather than increased by social mobility (i.e., gradient constraint), with the socially mobile having an AL score that is intermediate between their origin class and destination class. This implies that the effects of origin SEP on health are not immutable, but are instead responsive to changing socioeconomic circumstances across the life course.
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Affiliation(s)
- Sinéad McLoughlin
- Address correspondence to: Sinéad McLoughlin, The Irish Longitudinal Study on Ageing (TILDA), Trinity Central, Trinity College Dublin, 152-160 Pearse Street, Dublin 2, Ireland. E-mail:
| | - Patrick Präg
- Center for Research in Economics and Statistics (CREST), ENSAE, Institut Polytechnique de Paris, Palaiseau, France
| | - Mel Bartley
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland,Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Cathal McCrory
- The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
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Choi YJ, Ailshire JA, Kim JK, Crimmins EM. Diet Quality and Biological Risk in a National Sample of Older Americans. J Aging Health 2022; 34:539-549. [PMID: 34779298 PMCID: PMC9098695 DOI: 10.1177/08982643211046818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Using comprehensive measures of biological risk, this study aims to investigate the relationship between intake of individual dietary components, overall diet quality, and biological dysregulation. Methods: We analyzed nationally representative data from 3734 older adults who participated in the Health and Retirement Study Venous Blood Study in 2016 and Health Care and Nutrition Survey in 2013. Results: Eleven out of 13 individual dietary components were associated with lower biological risk. Respondents with poor/suboptimal quality diet had higher biological risk than those with good quality diet. Discussion: Findings from this study emphasize the importance of healthy eating in improving health of older adults. Encouraging intake of fruits, greens and beans, whole grains, and fatty acids, while limiting consumption of sodium, added sugar, and saturated fat would improve overall diet quality and contribute to the prevention of chronic diseases and morbidity.
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Affiliation(s)
- Yeon Jin Choi
- University of Southern California, Los Angeles, CA, USA
| | | | - Jung Ki Kim
- University of Southern California, Los Angeles, CA, USA
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Bacong AM, Hing AK, Morey B, Crespi CM, Kabamalan MM, Lee NR, Wang MC, de Castro AB, Gee GC. Health selection on self-rated health and the healthy migrant effect: Baseline and 1-year results from the health of Philippine Emigrants Study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000324. [PMID: 36082314 PMCID: PMC9450558 DOI: 10.1371/journal.pgph.0000324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 06/04/2022] [Indexed: 02/03/2023]
Abstract
Studies of migration and health focus on a "healthy migrant effect" whereby migrants are healthier than individuals not migrating. Health selection remains the popular explanation of this phenomenon. However, studies are mixed on whether selection occurs and typically examine migrants post-departure. This study used a novel pre-migration dataset to identify which health and social domains differ between migrants and their non-migrant counterparts and their contribution to explaining variance in self-rated health by migrant status at pre-migration and 1-year later. Data were used from the baseline and 1-year follow-up of the Health of Philippine Emigrants Study (HoPES). We used multivariable ordinary least squares regression to examine differences in self-rated health between migrants to the U.S. and a comparable group of non-migrants at baseline (premigration) and one year later, accounting for seven domains: physical health, mental health, health behavior, demographics, socioeconomic factors and healthcare utilization, psychosocial factors, and social desirability. A migrant advantage was present for self-rated health at baseline and 1-year. Accounting for all domains, migrants reported better self-rated health compared to non-migrants both at baseline (β = 0.32; 95% CI = 0.22, 0.43) and at 1-year (β = 0.28; 95% CI = 0.10, 0.46). Migrant status, health behavior, and mental health accounted for most of the variance in self-rated health both at baseline and 1-year follow-up. This analysis provides evidence of migrant health selection and nuanced understanding to what is being captured by self-rated health in studies of migrant health that should be considered in future research.
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Affiliation(s)
- Adrian Matias Bacong
- University of California-Los Angeles Fielding School of Public Health, Los Angeles, California, United States of America
| | - Anna K. Hing
- University of Minnesota – Twin Cities, Minneapolis, Minnesota, United States of America
| | - Brittany Morey
- University of California-Irvine, Irvine, California, United States of America
| | - Catherine M. Crespi
- University of California-Los Angeles Fielding School of Public Health, Los Angeles, California, United States of America
| | | | - Nanette R. Lee
- USC-Office of Population Studies Foundation, Inc., University of San Carlos, Cebu City, Philippines
| | - May C. Wang
- University of California-Los Angeles Fielding School of Public Health, Los Angeles, California, United States of America
| | - A. B. de Castro
- University of Washington, Seattle, Washington, United States of America
| | - Gilbert C. Gee
- University of California-Los Angeles Fielding School of Public Health, Los Angeles, California, United States of America
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28
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Obeng-Gyasi S, Li Y, Carson WE, Reisenger S, Presley CJ, Shields PG, Carbone DP, Ceppa DP, Carlos RC, Andersen BL. Association of Allostatic Load With Overall Mortality Among Patients With Metastatic Non-Small Cell Lung Cancer. JAMA Netw Open 2022; 5:e2221626. [PMID: 35797043 PMCID: PMC9264034 DOI: 10.1001/jamanetworkopen.2022.21626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/11/2022] [Indexed: 01/13/2023] Open
Abstract
Importance Adverse social determinants of health (SDHs) (eg, poverty) are associated with poor oncologic outcomes among patients with lung cancer. However, no studies have evaluated biological correlates of adverse SDHs, operationalized as allostatic load (AL), with mortality due to lung cancer. Objective To examine the association among AL, SDHs, and mortality among patients with metastatic non-small cell lung cancer (NSCLC). Design, Setting, and Participants This cross-sectional study of an observational cohort was performed at a National Cancer Institute-designated comprehensive cancer center with data accrued from June 1, 2017, to August 31, 2019. Patients with metastatic (stage IV) NSCLC enrolled at diagnosis into a prospective observational cohort study were included in the present analysis if they had all the biomarkers to calculate an AL score (N = 143). Follow-up was completed on August 31, 2021, and data were analyzed from July 1 to September 30, 2021. Exposures Social determinants of health. Main Outcomes and Measures Overall mortality and AL. Results A total of 143 patients met the study criteria with a median age of 63 (IQR, 55-71) years (89 men [62.2%] and 54 women [37.8%]). In terms of race and ethnicity, 1 patient (0.7%) was Asian, 7 (4.9%) were Black, 117 (81.8%) were White, 17 (11.9%) were of multiple races, and 1 (0.7%) was of other race or ethnicity. The mean (SD) AL was 2.90 (1.37). Elevated AL covaried with lower educational level (r = -0.26; P = .002), male sex (r = 0.19; P = .02), limited mobility (r = 0.19; P = .04), worsening self-care (r = 0.30; P < .001), problems engaging in usual activities (r = 0.21; P = .01), depressive symptoms (r = 0.23; P = .005), and a high number of stressful life events (r = 0.30; P < .001). Multivariable analysis found only increasing difficulty with mobility (r = 0.37 [95% CI, 0.13-0.60]; P = .002) and male sex (r = 0.63 [95% CI, 0.19-1.08]; P = .005) associated with higher AL. On adjusted analysis, elevated AL (hazard ratio, 1.43 [95% CI, 1.16-1.79]; P = .001) and low educational level (hazard ratio, 2.11 [95% CI, 1.03-4.34]; P = .04) were associated with worse overall mortality. Conclusions and Relevance The findings of this cross-sectional study suggest that higher AL was associated with adverse SDHs and worse overall mortality among patients with advanced NSCLC. These results provide a framework for replication and further studies of AL as a biological correlate for SDH and future prognostic marker.
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Affiliation(s)
- Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus
| | - Yaming Li
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William E. Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus
| | - Sarah Reisenger
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Carolyn J. Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus
| | - Peter G. Shields
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus
| | - David P. Carbone
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus
| | - DuyKhanh P. Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis
| | - Ruth C. Carlos
- University of Michigan Comprehensive Cancer Center, Ann Arbor
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The Mediating Role of Cardiometabolic Dysregulation on the Relation Between Adverse Childhood Experiences and Adult Cognition. Psychosom Med 2022; 84:695-701. [PMID: 35472197 DOI: 10.1097/psy.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Adverse childhood experiences (ACEs) are uncontrollable stressful events during early life that predispose adults to adverse health outcomes, such as impaired cognitive functioning. However, little is known about the factors indirectly impacting this relation. Biological dysregulation may be one pathway that can help explain the relations between ACEs and later cognition. The current study examined the mediating role of cardiometabolic dysregulation on the relation between ACEs and cognition. METHODS Our study gathered data from 1053 participants using three waves of the Midlife in the United States longitudinal study. Linear regression analyses and bootstrapped mediation analyses were performed to analyze the direct and indirect associations of cardiometabolic dysregulation on ACEs and cognition. RESULTS Our results showed a significant linear relationship between ACEs and cardiometabolic dysregulation ( b = 0.152, standard error [SE] = 0.056, p = .007), and a significant indirect association, such that cardiometabolic dysregulation mediated the relation between ACEs and cognitive status at wave II ( b = -0.007, SE = 0.004, p = .044) and cognitive status at wave III ( b = -0.006, SE = 0.003, p .042). There was no significant direct or indirect relation when cognitive change was the outcome variable. CONCLUSIONS The present study identifies a combined biological pathway that connects ACEs to cognition in late life. These findings supports the need to empirically determine biological mechanism that can be used to develop targeted clinical interventions to prevent the progression of chronic cognitive impairment.
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Beydoun MA, Noren Hooten N, Weiss J, Beydoun HA, Hossain S, Evans MK, Zonderman AB. Plasma neurofilament light and its association with all-cause mortality risk among urban middle-aged men and women. BMC Med 2022; 20:218. [PMID: 35692046 PMCID: PMC9190073 DOI: 10.1186/s12916-022-02425-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/31/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Neurofilament light chain (NfL) is released into the blood during neuronal damage. NfL is linked to mortality in neurological disorders, remaining unexplored in population studies. We investigated whether initial (v1) and annualized change (δ) in plasma NfL can predict all-cause mortality in middle-aged dementia-free urban adults. METHODS Longitudinal data were from 694 participants in the Healthy Aging in Neighborhoods of Diversity Across the Life Span study (HANDLS, mean agev1: 47.8 years, 42% male, 55.8% African American). Plasma NfL was measured prospectively at three visits. Analyses included Cox proportional hazards models for all-cause mortality risk and 4-way decomposition testing for interaction and mediation. RESULTS Unlike men, women exhibited a direct association between δNfL (above vs. below median) and all-cause mortality risk in both the minimally (HR = 3.91, 95% CI 1.10-13.9, p = 0.036) and fully adjusted models (HR = 4.92, 95% CI 1.26-19.2, p = 0.022), and for δNfL (per unit increase) in the full model (HR = 1.65, 95% CI 1.04-2.61, p = 0.034). In both models, and among women, 1 standard deviation of NfLv1 was associated with an increased all-cause mortality risk (reduced model: HR = 2.01, 95% CI 1.24-3.25, p = 0.005; full model: HR = 1.75, 95% CI 1.02-2.98, p = 0.041). Only few interactions were detected for cardio-metabolic risk factors. Notably, NfLv1 was shown to be a better prognostic indicator at normal hsCRP values among women, while HbA1c and δNfL interacted synergistically to determine mortality risk, overall. CONCLUSIONS These findings indicate that plasma NfL levels at baseline and over time can predict all-cause mortality in women and interacts with hsCRP and HbA1c to predict that risk.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, 251 Bayview Blvd., Suite 100, Room #: 04B118, Baltimore, MD, 21224, USA.
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, 251 Bayview Blvd., Suite 100, Room #: 04B118, Baltimore, MD, 21224, USA
| | - Jordan Weiss
- Department of Demography, University of California, Berkeley, Berkeley, CA, USA
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, 251 Bayview Blvd., Suite 100, Room #: 04B118, Baltimore, MD, 21224, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, 251 Bayview Blvd., Suite 100, Room #: 04B118, Baltimore, MD, 21224, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, NIA/NIH/IRP, 251 Bayview Blvd., Suite 100, Room #: 04B118, Baltimore, MD, 21224, USA
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Sandifer PA, Juster RP, Seeman TE, Lichtveld MY, Singer BH. Allostatic load in the context of disasters. Psychoneuroendocrinology 2022; 140:105725. [PMID: 35306472 PMCID: PMC8919761 DOI: 10.1016/j.psyneuen.2022.105725] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/28/2022] [Accepted: 03/10/2022] [Indexed: 11/18/2022]
Abstract
Environmental disasters, pandemics, and other major traumatic events such as the Covid-19 pandemic or war contribute to psychosocial stress which manifests in a wide range of mental and physical consequences. The increasing frequency and severity of such events suggest that the adverse effects of toxic stress are likely to become more widespread and pervasive in the future. The allostatic load (AL) model has important elements that lend themselves well for identifying adverse health effects of disasters. Here we examine several articulations of AL from the standpoint of using AL to gauge short- and long-term health effects of disasters and to provide predictive capacity that would enable mitigation or prevention of some disaster-related health consequences. We developed a transdisciplinary framework combining indices of psychosocial AL and physiological AL to produce a robust estimate of overall AL in people affected by disasters and other traumatic events. In conclusion, we urge researchers to consider the potential of using AL as a component in a proposed disaster-oriented human health observing system.
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Affiliation(s)
- Paul A Sandifer
- Center for Coastal Environmental and Human Health, School of Sciences and Mathematics, College of Charleston, 66 George Street, Charleston, SC 29424, USA.
| | - Robert-Paul Juster
- Department of Psychiatry and Addiction, University of Montreal, Montreal, Canada
| | - Teresa E Seeman
- David Geffen School of Medicine at UCLA, University of California Los Angeles, CA, USA
| | - Maureen Y Lichtveld
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Burton H Singer
- Emerging Pathogens Institute, University of Florida, Gainesville, FL, USA
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Beydoun MA, Beydoun HA, Fanelli-Kuczmarski MT, Weiss J, Hossain S, Canas JA, Evans MK, Zonderman AB. Association of Serum Antioxidant Vitamins and Carotenoids With Incident Alzheimer Disease and All-Cause Dementia Among US Adults. Neurology 2022; 98:e2150-e2162. [PMID: 35508396 DOI: 10.1212/wnl.0000000000200289] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/10/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Serum antioxidant vitamins and carotenoids may protect against neurodegeneration with age. We examined associations of these nutritional biomarkers with incident all-cause and AD dementia among U.S. middle-aged and older adults. METHODS Using data from the third National health and Nutrition Examination Surveys (1988-1994), linked with Centers for Medicare and Medicaid-Medicare follow-up data, we tested associations and interactions of serum vitamins A, C and E, and total and individual serum carotenoids and interactions with incident Alzheimer's Disease (AD) and all-cause dementia. Cox proportional hazards regression models were conducted. RESULTS After ≤26y follow-up (mean:16-17y, n=7,283 participants aged 45-90y at baseline), serum lutein+zeaxanthin was associated with reduced risk of all-cause dementia (65+ age group), even in the lifestyle-adjusted model (per SD, HR=0.93, 95%CI: 0.87-0.99, p=0.037), though attenuated in comparison to a socio-economic status (SES)-adjusted model (HR=0.92, 95% CI: 0.86-0.93, p=0.013). An inverse relationship was detected between serum β-cryptoxanthin (per SD increase) and all-cause dementia (45+ and 65+), for age and sex-adjusted models (HR=0.86, 95% CI:0.80-0.93, p<0.001 for 45+; HR=0.86, 95% CI:0.80-0.93, p=0.001 for 65+ ), a relationship remaining strong in SES-adjusted models (HR=0.89, 95%CI: 0.82-0.96, p=0.006 for 45+; HR=0.88, 95%CI:0.81-0.96, p=0.007 for 65+), but attenuated in subsequent models. Antagonistic interactions indicate putative protective effects of one carotenoid may be observed at lower levels other carotenoids or antioxidant vitamin. DISCUSSION Incident all-cause dementia was inversely associated with serum lutein+zeaxanthin and β-cryptoxanthin levels. Further studies with time-dependent exposures and randomized trials are needed to test neuroprotective effects of supplementing the diet with select carotenoids. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that incident all-cause dementia was inversely associated with serum lutein+zeaxanthin and β-cryptoxanthin levels.
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Affiliation(s)
- May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD, 21224 USA
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, 22060
| | | | - Jordan Weiss
- Department of Demography, University of California, Berkeley, Berkeley, CA 94720, USA
| | - Sharmin Hossain
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD, 21224 USA
| | - Jose Atilio Canas
- Department of Pediatrics, Johns Hopkins Medical Institutions, St. Petersburgh, FL, 33701, USA
| | - Michele Kim Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD, 21224 USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD, 21224 USA
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Zhou MS, Hasson RE, Baylin A, Leung CW. Associations between diet quality and allostatic load in US adults: findings from the National Health and Nutrition Examination Survey 2015-2018. J Acad Nutr Diet 2022; 122:2207-2217. [DOI: 10.1016/j.jand.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/03/2022] [Accepted: 05/02/2022] [Indexed: 11/24/2022]
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Beydoun MA, Weiss J, Beydoun HA, Fanelli‐Kuczmarski MT, Hossain S, El‐Hajj ZW, Evans MK, Zonderman AB. Pathways explaining racial/ethnic disparities in incident all-cause and Alzheimer's disease dementia among older US men and women. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2022; 8:e12275. [PMID: 35317081 PMCID: PMC8924949 DOI: 10.1002/trc2.12275] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 12/23/2021] [Accepted: 01/23/2022] [Indexed: 11/14/2022]
Abstract
Introduction Racial disparities in Alzheimer's disease (AD) and all-cause dementia (DEMENTIA) incidence may exist differentially among men and women, with unknown mechanisms. Methods A retrospective cohort study examining all-cause and AD dementia incidence was conducted linking Third National Health and Nutrition Examination Survey (NHANES III) to Centers for Medicare & Medicaid Services Medicare data over ≤26 years of follow-up (1988 to 2014). Cox regression and generalized structural equation models (GSEMs) were constructed among men and women ≥60 years of age at baseline (N = 4592). Outcomes included onset ages of all-cause and AD dementia, whereas the main exposures were race/ethnicity contrasts (RACE_ETHN). Potential mediators) included socio-economic status (SES), lifestyle factors (dietary quality [DIET] nutritional biomarkers [NUTR], physical activity [PA], social support [SS], alcohol [ALCOHOL], poor health [or HEALTH], poor cognitive performance [or COGN]. In addition to RACE_ETHN, the following were exogenous covariates in the GSEM and potential confounders in Cox models: age, sex, urban-rural, household size, and marital status. Results Non-Hispanic Black (NHB) women had a higher risk of DEMENTIA versus non-Hispanic White (NHW) women in GSEM, consistent with Cox models (age-adjusted model: hazard ratio [HR] = 1.34, 95% confidence interval [CI]: 1.10 to 1.61). The total effect of this RACE_ETHN contrast in women was explained by four main pathways: (1) RACE_ETHN→ poor cognitive performance (COGN, +) → DEMENTIA (+); (2) RACE_ETHN → SES (-) → COGN (-) → DEMENTIA (+); (3) RACE_ETHN → SES (-) → physical activity (PA, +) → COGN (-) → DEMENTIA (+); and (4) RACE_ETHN → SES (-) → DIET (+) → COGN (-) → DEMENTIA (+). A reduced AD risk in Mexican American (MA) women versus NHW women upon adjustment for SES and downstream factors (HR = 0.53, 95% CI: 0.35 to 0.80). For the non-White versus NHW contrast in incident DEMENTIA, pathways involved lower SES, directly increasing cognitive deficits (or indirectly through lifestyle factors), which then directly increases DEMENTIA . Discussion Socioeconomic and lifestyle factors explaining disparities between NHB and NHW in dementia onset among women are important to consider for future observational and intervention studies.
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Affiliation(s)
- May A. Beydoun
- Laboratory of Epidemiology and Population SciencesNational Institute on Aging, NIA/NIH/IRPBaltimoreMarylandUSA
| | - Jordan Weiss
- Department of DemographyUniversity of California‐BerkeleyBerkeleyCaliforniaUSA
| | - Hind A. Beydoun
- Department of Research ProgramsFort Belvoir Community HospitalFort BelvoirVirginiaUSA
| | - Marie T. Fanelli‐Kuczmarski
- Laboratory of Epidemiology and Population SciencesNational Institute on Aging, NIA/NIH/IRPBaltimoreMarylandUSA
| | - Sharmin Hossain
- Laboratory of Epidemiology and Population SciencesNational Institute on Aging, NIA/NIH/IRPBaltimoreMarylandUSA
| | | | - Michele K. Evans
- Laboratory of Epidemiology and Population SciencesNational Institute on Aging, NIA/NIH/IRPBaltimoreMarylandUSA
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population SciencesNational Institute on Aging, NIA/NIH/IRPBaltimoreMarylandUSA
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Doan SN, Yu SH, Wright B, Fung J, Saleem F, Lau AS. Resilience and Family Socialization Processes in Ethnic Minority Youth: Illuminating the Achievement-Health Paradox. Clin Child Fam Psychol Rev 2022; 25:75-92. [PMID: 35201542 PMCID: PMC8867687 DOI: 10.1007/s10567-022-00389-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 12/05/2022]
Abstract
Youth in marginalized communities who "strive" to rise above adversity, including systemic racism and poverty, are considered "resilient." African-American, Latinx, and Asian-American youth often achieve admirable academic success despite limited social capital and high early life stress by adopting a "striving persistent behavioral style" (SPBS). SPBS may be supported by family socialization processes that facilitate reliance on self-regulation processes. Unfortunately, a young person's resilience in one domain (i.e., academic) can come at a cost in other domains, including physical and mental health morbidities that are under-identified and under-treated. Indeed, research suggests a link between SPBS in the face of adversity and later health morbidities among ethnic minority youth. Herein, we describe SPBS as an adaptation to minority stress that not only promotes social mobility but may also stoke physical and mental health disparities. We review how family processes related to academic, emotional, and ethnic-racial socialization can facilitate the striving persistent behavioral style. We emphasize the double bind that ethnic minority families are caught in and discuss directions for future research and clinical implications for individual and family-level interventions. While needed, we argue that individual and family-level interventions represent a near-term work around. Solutions and factors that shape the need for SPBS and its cost must be addressed structurally.
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Affiliation(s)
- Stacey N Doan
- Claremont Mckenna College and City of Hope National Medical Center, 880 N. Columbia Ave, Claremont, CA, 91711, USA.
| | | | | | - Joey Fung
- Fuller School of Psychology, Fullerton, USA
| | | | - Anna S Lau
- University of California, Los Angeles, USA
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Ye X, Zhu D, Ding R, He P. The Effect of China's Compulsory Education Reforms on Physiological Health in Adulthood: A Natural Experiment. Health Policy Plan 2021; 37:376-384. [PMID: 34888661 DOI: 10.1093/heapol/czab147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/20/2021] [Accepted: 12/09/2021] [Indexed: 11/14/2022] Open
Abstract
Lower education is related to higher biological risks for physiological health, but it remains unclear whether the risks can be reduced through policies aimed at increasing years of education. We utilized China's compulsory education reforms as a unique natural experiment, which stipulates that primary and lower secondary education is mandatory and free for all school-age children. Using a regression discontinuity design (RDD), we assessed the effect of the reform eligibility on biomarkers. The reforms resulted in an increase in years of education for those from communities with the middle 1/3 per capita income (PCI) (β = 2.44, 95% CI = 0.23 - 4.64). Reform eligibility had no impact on allostatic risks for the total sample (β = 0.065, 95% CI = -0.70 - 0.83) and for those from communities with the lowest (β = 0.35, 95% CI = -0.77 - 1.47) or highest third of PCI (β = 0.68, 95% CI = -0.64 - 2.00), while it reduced the metabolic risk (β = -0.14, 95% CI = -0.26 - -0.015) and total allostatic load (β = -1.58, 95% CI = -3.00 - -0.16) among those from communities with the middle third PCI. The results were confirmed by sensitivity analyses of different placebo cutoff points and bandwidths. The reforms led to better physiological health to some extent, but the effect only manifested in people from communities with a moderate community PCI, and had little impact on affluent or disadvantaged groups. Our findings stressed that the institutional context and respondents' socioeconomic environment must be taken into account when assessing the health impact of China's compulsory education reforms.
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Affiliation(s)
- Xin Ye
- School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China.,China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Dawei Zhu
- China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Ruoxi Ding
- China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Ping He
- China Center for Health Development Studies, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
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Wu Q, Ailshire JA, Kim JK, Crimmins EM. Cardiometabolic Risk Trajectory Among Older Americans: Findings From the Health and Retirement Study. J Gerontol A Biol Sci Med Sci 2021; 76:2265-2274. [PMID: 34252185 PMCID: PMC8599082 DOI: 10.1093/gerona/glab205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cardiometabolic risk (CMR) is a key indicator of physiological decline with age, but age-related declines in a nationally representative older US population have not been previously examined. METHODS We examined the trajectory of CMR over 8 years of aging, from 2006/2008 to 2014/2016, among 3528 people older than age 50 in the Health and Retirement Study. We used growth curve models to examine change in total CMR as well as in individual cardiometabolic biomarkers to understand how baseline differences and rates of change vary across sociodemographic characteristics, by smoking status, and medication use. RESULTS Total CMR did not change among respondents who survived over 8 years. Despite significant differences in CMR across demographic and education groups at baseline, the pace of change with age did not differ by these characteristics. Among individual biomarkers, risk levels of diastolic blood pressure, resting heart rate, and total cholesterol decreased over 8 years while glycosylated hemoglobin, waist circumference, and pulse pressure increased over that time. Both the statistical significance levels and the magnitudes of the reduction over time with age in diastolic blood pressure, resting heart rate, and total cholesterol in models adjusted for age, race/ethnicity, gender, smoking, and education were reduced after controlling for blood pressure and cholesterol medication. CONCLUSIONS The relatively constant total CMR level over 8 years occurred because some indicators improved with age while some deteriorated in this period. Medication use contributed to the improvement in blood pressure, resting heart rate, and total cholesterol.
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Affiliation(s)
- Qiao Wu
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Jennifer A Ailshire
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Jung Ki Kim
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Eileen M Crimmins
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
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Beydoun MA, Noren Hooten N, Maldonado AI, Beydoun HA, Weiss J, Evans MK, Zonderman AB. BMI and Allostatic Load Are Directly Associated with Longitudinal Increase in Plasma Neurofilament Light among Urban Middle-Aged Adults. J Nutr 2021; 152:535-549. [PMID: 34718678 PMCID: PMC8826916 DOI: 10.1093/jn/nxab381] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/13/2021] [Accepted: 10/26/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Plasma neurofilament light chain (NfL) is a novel biomarker for age-related neurodegenerative disease. We tested whether NfL may be linked to cardiometabolic risk factors, including BMI, the allostatic load (AL) total score (ALtotal), and related AL continuous components (ALcomp). We also tested whether these relations may differ by sex or by race. METHODS We used data from the HANDLS (Healthy Aging in Neighborhoods of Diversity across the Life Span) study [n = 608, age at visit 1 (v1: 2004-2009): 30-66 y, 42% male, 58% African American] to investigate associations of initial cardiometabolic risk factors and time-dependent plasma NfL concentrations over 3 visits (2004-2017; mean ± SD follow-up time: 7.72 ± 1.28 y), with outcomes being NfLv1 and annualized change in NfL (δNfL). We used mixed-effects linear regression and structural equations modeling (SM). RESULTS BMI was associated with lower initial (γ01 = -0.014 ± 0.002, P < 0.001) but faster increase in plasma NfL over time (γ11 = +0.0012 ± 0.0003, P < 0.001), a pattern replicated for ALtotal. High-sensitivity C-reactive protein (hsCRP), serum total cholesterol, and resting heart rate at v1 were linked with faster plasma NfL increase over time, overall, while being uncorrelated with NfLv1 (e.g., hsCRP × Time, full model: γ11 = +0.004 ± 0.002, P = 0.015). In SM analyses, BMI's association with δNfL was significantly mediated through ALtotal among women [total effect (TE) = +0.0014 ± 0.00038, P < 0.001; indirect effect = +0.00042 ± 0.00019, P = 0.025; mediation proportion = 30%], with only a direct effect (DE) detected among African American adults (TE = +0.0011 ± 0.0004, P = 0.015; DE = +0.0010 ± 0.00048, P = 0.034). The positive associations between ALtotal/BMI and δNfL were mediated through increased glycated hemoglobin (HbA1c) concentrations, overall. CONCLUSIONS Cardiometabolic risk factors, particularly elevated HbA1c, should be screened and targeted for neurodegenerative disease, pending comparable longitudinal studies. Other studies examining the clinical utility of plasma NfL as a neurodegeneration marker should account for confounding effects of BMI and AL.
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Affiliation(s)
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging/NIH/Intramural Research Program, Baltimore, MD, USA
| | - Ana I Maldonado
- Department of Psychology, University of Maryland, Baltimore County, Catonsville, MD, USA
| | - Hind A Beydoun
- Department of Research Programs, Fort Belvoir Community Hospital, Fort Belvoir, VA, USA
| | - Jordan Weiss
- Department of Demography, University of California, Berkeley, Berkeley, CA, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging/NIH/Intramural Research Program, Baltimore, MD, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging/NIH/Intramural Research Program, Baltimore, MD, USA
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Guidi J, Lucente M, Sonino N, Fava GA. Allostatic Load and Its Impact on Health: A Systematic Review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2021; 90:11-27. [PMID: 32799204 DOI: 10.1159/000510696] [Citation(s) in RCA: 406] [Impact Index Per Article: 135.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Allostatic load refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity. When environmental challenges exceed the individual ability to cope, then allostatic overload ensues. Allostatic load is identified by the use of biomarkers and clinical criteria. OBJECTIVE To summarize the current knowledge on allostatic load and overload and its clinical implications based on a systematic review of the literature. METHODS PubMed, PsycINFO, Web of Science, and the Cochrane Library were searched from inception to December 2019. A manual search of the literature was also performed, and reference lists of the retrieved articles were examined.We considered only studies in which allostatic load or overload were adequately described and assessed in either clinical or non-clinical adult populations. RESULTS A total of 267 original investigations were included. They encompassed general population studies, as well as clinical studies on consequences of allostatic load/overload on both physical and mental health across a variety of settings. CONCLUSIONS The findings indicate that allostatic load and overload are associated with poorer health outcomes. Assessment of allostatic load provides support to the understanding of psychosocial determinants of health and lifestyle medicine. An integrated approach that includes both biological markers and clinimetric criteria is recommended.
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Affiliation(s)
- Jenny Guidi
- Department of Psychology, University of Bologna, Bologna, Italy,
| | | | - Nicoletta Sonino
- Department of Statistical Sciences, University of Padova, Padova, Italy.,Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA
| | - Giovanni A Fava
- Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA
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Richardson LJ, Goodwin AN, Hummer RA. Social status differences in allostatic load among young adults in the United States. SSM Popul Health 2021; 15:100771. [PMID: 34584929 PMCID: PMC8455854 DOI: 10.1016/j.ssmph.2021.100771] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 11/22/2022] Open
Abstract
Allostatic load refers to wear and tear on the body due to repeated activation of the stress response and, thus, may be an early subclinical indicator of future disease and mortality risk. To date, few studies of allostatic load have focused on young adults, racial/ethnic comparisons that include Mexican Americans, or the interplay between race/ethnicity, gender, and educational attainment. To fill these gaps, we used data on non-Hispanic Black, non-Hispanic White, and Mexican-origin respondents from Waves I (1994-1995) and IV (2007-2008) of the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 11,807). We calculated allostatic load scores based on respondents' values for 10 metabolic, cardiovascular, and inflammatory biomarkers measured at Wave IV, when respondents were 24-34 years old. We then used negative binomial regression models to assess the combined effects of race/ethnicity, gender, and educational attainment on allostatic load, while controlling for key covariates. We found that Black women had significantly higher allostatic load scores than White women and Black men, net of educational attainment and other covariates. Yet, education modified the relationship between race/ethnicity, gender, and allostatic load. Obtaining a college education was protective for White males and females but no more or less protective for other women and deleterious for Black males. In other words, by the time they reach young adulthood, the cumulative physiological burden of stress on Black women and college-educated Black men is already greater than it is among their similarly or less educated White counterparts. These findings provide important information about the intermediate physiological dysregulation that underlies social inequalities in stress-related health outcomes, especially those that occur at the intersections of race/ethnicity, gender, and educational attainment. They also suggest that research on its antecedents should focus on earlier life periods.
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Affiliation(s)
- Liana J. Richardson
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Hamilton Hall, CB #3210, Chapel Hill, NC, 27599-3210, USA
- Carolina Population Center, 123 W. Franklin Street, CB #8120, Chapel Hill, NC, 27516-2524, USA
| | - Andrea N. Goodwin
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Hamilton Hall, CB #3210, Chapel Hill, NC, 27599-3210, USA
- Carolina Population Center, 123 W. Franklin Street, CB #8120, Chapel Hill, NC, 27516-2524, USA
| | - Robert A. Hummer
- Department of Sociology, University of North Carolina at Chapel Hill, 155 Hamilton Hall, CB #3210, Chapel Hill, NC, 27599-3210, USA
- Carolina Population Center, 123 W. Franklin Street, CB #8120, Chapel Hill, NC, 27516-2524, USA
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Walubita T, Forrester SN, Jesdale BM. Allostatic Load Among Black Sexual Minority Women. J Womens Health (Larchmt) 2021; 30:1165-1170. [PMID: 34030488 PMCID: PMC8403173 DOI: 10.1089/jwh.2020.8912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Allostatic load is the physiological deterioration that accumulates as the body responds to stress, resulting in disparities in chronic disease. Although perceptions of stress vary, marginalization and social disadvantage are associated with elevated allostatic load. Allostatic load is understudied in the multiply marginalized populations of sexual minority Black women. Methods: We used data from six waves of the National Health and Nutrition Examination Survey (2001-2010, 2015-2016) to identify heterosexual (n = 78), lesbian (n = 21), and bisexual (n = 57) Black women. We quantified allostatic load using nine biomarkers, and compared mean allostatic load across the three groups, adjusting for age, educational attainment, income, and country of birth to account for possible confounding. Results: We found no significant differences in allostatic load among heterosexual, lesbian, and bisexual Black women. Conclusions: These findings suggest that sexual orientation may not contribute to within-group differences in allostatic load among Black women, a group previously noted to have elevated allostatic load.
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Affiliation(s)
- Tubanji Walubita
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sarah N. Forrester
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bill M. Jesdale
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Miller HN, LaFave S, Marineau L, Stephens J, Thorpe RJ. The impact of discrimination on allostatic load in adults: An integrative review of literature. J Psychosom Res 2021; 146:110434. [PMID: 33810863 PMCID: PMC8172431 DOI: 10.1016/j.jpsychores.2021.110434] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 03/15/2021] [Accepted: 03/21/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of the paper is to critically review the current state of the literature on the association between discrimination and allostatic load (AL) in adults and determine whether this association differs by sociodemographic characteristics. METHODS An extensive literature search was conducted in PubMed, CINAHL, PsycINFO, and Embase to identify studies that investigated the association between discrimination and AL. The search was limited to the English language, articles that were peer-reviewed and articles that were published within the last 10 years. RESULTS A total of 11 studies met the eligibility criteria for this review, 8 of which were cross-sectional and 3 of which were longitudinal. There was heterogeneity in the type of discrimination measured, the composition of AL summary score, and the analytic approach utilized to examine the relationship of interest. Nine studies found a significant, positive association between discrimination and AL. The types of discrimination found to be positively associated with AL included lifetime discrimination, childhood racial discrimination, everyday discrimination, and everyday weight discrimination. One study found that this association differed by educational attainment. CONCLUSION There is evidence that discrimination is associated with AL. Longitudinal studies with diverse samples are needed to further explore this association and how it differs based on sociodemographic characteristics.
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Affiliation(s)
- Hailey N Miller
- Duke University School of Nursing, United States of America.
| | - Sarah LaFave
- Johns Hopkins University School of Nursing, United States of America.
| | - Lea Marineau
- Johns Hopkins University School of Nursing, United States of America.
| | - Janna Stephens
- The Ohio State University College of Nursing, United States of America.
| | - Roland J Thorpe
- Johns Hopkins University Bloomberg School of Public Health, United States of America.
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Samuel LJ, Gaskin DJ, Trujillo AJ, Szanton SL, Samuel A, Slade E. Race, ethnicity, poverty and the social determinants of the coronavirus divide: U.S. county-level disparities and risk factors. BMC Public Health 2021; 21:1250. [PMID: 34187414 PMCID: PMC8240081 DOI: 10.1186/s12889-021-11205-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/03/2021] [Indexed: 12/12/2022] Open
Abstract
Background Communities with more Black or Hispanic residents have higher coronavirus rates than communities with more White residents, but relevant community characteristics are underexplored. The purpose of this study was to investigate poverty-, race- and ethnic-based disparities and associated economic, housing, transit, population health and health care characteristics. Methods Six-month cumulative coronavirus incidence and mortality were examined using adjusted negative binomial models among all U.S. counties (n = 3142). County-level independent variables included percentages in poverty and within racial/ethnic groups (Black, Hispanic, Native American, Asian), and rates of unemployment, lacking a high school diploma, housing cost burden, single parent households, limited English proficiency, diabetes, obesity, smoking, uninsured, preventable hospitalizations, primary care physicians, hospitals, ICU beds and households that were crowded, in multi-unit buildings or without a vehicle. Results Counties with higher percentages of Black (IRR = 1.03, 95% CI: 1.02–1.03) or Hispanic (IRR = 1.02, 95% CI: 1.01–1.03) residents had more coronavirus cases. Counties with higher percentages of Black (IRR = 1.02, 95% CI: 1.02–1.03) or Native American (IRR = 1.02, 95% CI: 1.01–1.04) residents had more deaths. Higher rates of lacking a high school diploma was associated with higher counts of cases (IRR = 1.03, 95% CI: 1.01–1.05) and deaths (IRR = 1.04, 95% CI: 1.01–1.07). Higher percentages of multi-unit households were associated with higher (IRR = 1.02, 95% CI: 1.01–1.04) and unemployment with lower (IRR = 0.96, 95% CI: 0.94–0.98) incidence. Higher percentages of individuals with limited English proficiency (IRR = 1.09, 95% CI: 1.04–1.14) and households without a vehicle (IRR = 1.04, 95% CI: 1.01–1.07) were associated with more deaths. Conclusions These results document differential pandemic impact in counties with more residents who are Black, Hispanic or Native American, highlighting the roles of residential racial segregation and other forms of discrimination. Factors including economic opportunities, occupational risk, public transit and housing conditions should be addressed in pandemic-related public health strategies to mitigate disparities across counties for the current pandemic and future population health events. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11205-w.
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Affiliation(s)
- Laura J Samuel
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Rm 426, Baltimore, MD, 21205, USA.
| | - Darrell J Gaskin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Antonio J Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Rm 426, Baltimore, MD, 21205, USA.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Andrew Samuel
- Department of Economics, Loyola University Maryland Sellinger School of Business, Baltimore, USA
| | - Eric Slade
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Rm 426, Baltimore, MD, 21205, USA
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Samuel LJ, Gaskin DJ, Trujillo AJ, Szanton SL, Samuel A, Slade E. Race, ethnicity, poverty and the social determinants of the coronavirus divide: U.S. county-level disparities and risk factors. BMC Public Health 2021. [PMID: 34187414 DOI: 10.1186/s12889-021-11205-w/tables/3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Communities with more Black or Hispanic residents have higher coronavirus rates than communities with more White residents, but relevant community characteristics are underexplored. The purpose of this study was to investigate poverty-, race- and ethnic-based disparities and associated economic, housing, transit, population health and health care characteristics. METHODS Six-month cumulative coronavirus incidence and mortality were examined using adjusted negative binomial models among all U.S. counties (n = 3142). County-level independent variables included percentages in poverty and within racial/ethnic groups (Black, Hispanic, Native American, Asian), and rates of unemployment, lacking a high school diploma, housing cost burden, single parent households, limited English proficiency, diabetes, obesity, smoking, uninsured, preventable hospitalizations, primary care physicians, hospitals, ICU beds and households that were crowded, in multi-unit buildings or without a vehicle. RESULTS Counties with higher percentages of Black (IRR = 1.03, 95% CI: 1.02-1.03) or Hispanic (IRR = 1.02, 95% CI: 1.01-1.03) residents had more coronavirus cases. Counties with higher percentages of Black (IRR = 1.02, 95% CI: 1.02-1.03) or Native American (IRR = 1.02, 95% CI: 1.01-1.04) residents had more deaths. Higher rates of lacking a high school diploma was associated with higher counts of cases (IRR = 1.03, 95% CI: 1.01-1.05) and deaths (IRR = 1.04, 95% CI: 1.01-1.07). Higher percentages of multi-unit households were associated with higher (IRR = 1.02, 95% CI: 1.01-1.04) and unemployment with lower (IRR = 0.96, 95% CI: 0.94-0.98) incidence. Higher percentages of individuals with limited English proficiency (IRR = 1.09, 95% CI: 1.04-1.14) and households without a vehicle (IRR = 1.04, 95% CI: 1.01-1.07) were associated with more deaths. CONCLUSIONS These results document differential pandemic impact in counties with more residents who are Black, Hispanic or Native American, highlighting the roles of residential racial segregation and other forms of discrimination. Factors including economic opportunities, occupational risk, public transit and housing conditions should be addressed in pandemic-related public health strategies to mitigate disparities across counties for the current pandemic and future population health events.
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Affiliation(s)
- Laura J Samuel
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Rm 426, Baltimore, MD, 21205, USA.
| | - Darrell J Gaskin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Antonio J Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Sarah L Szanton
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Rm 426, Baltimore, MD, 21205, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Andrew Samuel
- Department of Economics, Loyola University Maryland Sellinger School of Business, Baltimore, USA
| | - Eric Slade
- Johns Hopkins University School of Nursing, 525 North Wolfe St., Rm 426, Baltimore, MD, 21205, USA
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Moore JX, Bevel MS, Aslibekyan S, Akinyemiju T. Temporal changes in allostatic load patterns by age, race/ethnicity, and gender among the US adult population; 1988-2018. Prev Med 2021; 147:106483. [PMID: 33640399 PMCID: PMC8826516 DOI: 10.1016/j.ypmed.2021.106483] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/08/2021] [Accepted: 02/22/2021] [Indexed: 12/21/2022]
Abstract
The objective of this study is to provide an assessment of allostatic load (AL) burden among US adults across race/ethnicity, gender, and age groups over a 30-year time period. We analyzed data from 50,671 participants of the National Health and Nutrition Examination Survey (NHANES) years 1988 through 2018. AL score was defined as the sum total for abnormal measures of the following components: serum albumin, body mass index, serum C - reactive protein, serum creatinine, diastolic blood pressure, glycated hemoglobin, systolic blood pressure, total cholesterol, and serum triglycerides. We performed modified Poisson regression to estimate the adjusted Relative Risks (aRRs) of allostatic load, and generalized linear models to determine adjusted mean differences accounting for NHANES sampling weights. Among US adults aged 18 or older, the prevalence of high AL increased by more than 45% from 1988 to 1991 to 2015-2018, from 33.5% to 48.6%. By the latest period, 2015-2018, Non-Hispanic Black women (aRR: 1.292; 95% CI: 1.290-1.293) and Latina women (aRR: 1.266; 95% CI: 1.265-1.267) had higher risks of AL than non-Hispanic White women. Similar trends were observed among men. Age-adjusted mean AL score among NH-Black and Latinx adults was higher than for NH-Whites of up to a decade older regardless of gender. From 1988 through 2018, Adults aged 40 years old and older had over 2-fold increased risks of high AL when compared to adults 18-29 years old. After 30-years of collective data, racial disparities in allostatic load persist for NH-Black and Latinx adults.
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Affiliation(s)
- Justin Xavier Moore
- Division of Epidemiology, Department of Population Health Sciences, Augusta University, Augusta, GA, USA; Institute of Preventive and Public Health, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Malcolm S Bevel
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Stella Aslibekyan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tomi Akinyemiju
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
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Huibregtse BM, Newell-Stamper BL, Domingue BW, Boardman JD. Genes Related to Education Predict Frailty Among Older Adults in the United States. J Gerontol B Psychol Sci Soc Sci 2021; 76:173-183. [PMID: 31362310 DOI: 10.1093/geronb/gbz092] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This article expands on research that links education and frailty among older adults by considering the role of genes associated with education. METHOD Data come from a sample of 7,064 non-Hispanic, white adults participating in the 2004-2012 waves of the Health and Retirement Study. Frailty was measured with two indices: (a) The Frailty Index which corresponds to a deficit accumulation model; and (b) The Paulson-Lichtenberg Frailty Index which corresponds to the biological syndrome/phenotype model. Genes associated with education were quantified using an additive polygenic score. Associations between the polygenic score and frailty indices were tested using a series of multilevel models, controlling for multiple observations for participants across waves. RESULTS Results showed a strong and negative association between genes for education and frailty symptoms in later life. This association exists above and beyond years of completed education and we demonstrate that this association becomes weaker as older adults approach their 80s. DISCUSSION The results contribute to the education-health literature by highlighting new and important pathways through which education might be linked to successful aging.
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Affiliation(s)
- Brooke M Huibregtse
- Institute of Behavioral Science, University of Colorado Boulder.,Institute for Behavioral Genetics, University of Colorado Boulder
| | - Breanne L Newell-Stamper
- Institute of Behavioral Science, University of Colorado Boulder.,Institute for Behavioral Genetics, University of Colorado Boulder.,Department of Integrative Physiology, University of Colorado Boulder
| | - Benjamin W Domingue
- Institute of Behavioral Science, University of Colorado Boulder.,Graduate School of Education, Stanford University, California
| | - Jason D Boardman
- Institute of Behavioral Science, University of Colorado Boulder.,Institute for Behavioral Genetics, University of Colorado Boulder.,Department of Sociology, University of Colorado Boulder
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Javalkar K, Robson VK, Gaffney L, Bohling AM, Arya P, Servattalab S, Roberts JE, Campbell JI, Sekhavat S, Newburger JW, de Ferranti SD, Baker AL, Lee PY, Day-Lewis M, Bucholz E, Kobayashi R, Son MB, Henderson LA, Kheir JN, Friedman KG, Dionne A. Socioeconomic and Racial and/or Ethnic Disparities in Multisystem Inflammatory Syndrome. Pediatrics 2021; 147:peds.2020-039933. [PMID: 33602802 PMCID: PMC8086000 DOI: 10.1542/peds.2020-039933] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To characterize the socioeconomic and racial and/or ethnic disparities impacting the diagnosis and outcomes of multisystem inflammatory syndrome in children (MIS-C). METHODS This multicenter retrospective case-control study was conducted at 3 academic centers from January 1 to September 1, 2020. Children with MIS-C were compared with 5 control groups: children with coronavirus disease 2019, children evaluated for MIS-C who did not meet case patient criteria, children hospitalized with febrile illness, children with Kawasaki disease, and children in Massachusetts based on US census data. Neighborhood socioeconomic status (SES) and social vulnerability index (SVI) were measured via a census-based scoring system. Multivariable logistic regression was used to examine associations between SES, SVI, race and ethnicity, and MIS-C diagnosis and clinical severity as outcomes. RESULTS Among 43 patients with MIS-C, 19 (44%) were Hispanic, 11 (26%) were Black, and 12 (28%) were white; 22 (51%) were in the lowest quartile SES, and 23 (53%) were in the highest quartile SVI. SES and SVI were similar between patients with MIS-C and coronavirus disease 2019. In multivariable analysis, lowest SES quartile (odds ratio 2.2 [95% confidence interval 1.1-4.4]), highest SVI quartile (odds ratio 2.8 [95% confidence interval 1.5-5.1]), and racial and/or ethnic minority background were associated with MIS-C diagnosis. Neither SES, SVI, race, nor ethnicity were associated with disease severity. CONCLUSIONS Lower SES or higher SVI, Hispanic ethnicity, and Black race independently increased risk for MIS-C. Additional studies are required to target interventions to improve health equity for children.
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Affiliation(s)
- Karina Javalkar
- Departments of Medicine and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts;,Department of Pediatrics, Boston University, Boston, Massachusetts;,Contributed equally as co-first authors
| | - Victoria K. Robson
- Departments of Medicine and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts;,Department of Pediatrics, Boston University, Boston, Massachusetts;,Contributed equally as co-first authors
| | - Lukas Gaffney
- Departments of Medicine and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts;,Department of Pediatrics, Boston University, Boston, Massachusetts
| | - Amy M. Bohling
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Puneeta Arya
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts;,Division of Cardiology and
| | - Sarah Servattalab
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts;,Massachusetts General Hospital for Children, Massachusetts General Hospital, Boston, Massachusetts; and
| | - Jordan E. Roberts
- Divisions of Immunology and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Jeffrey I. Campbell
- Infectious Diseases and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Sepehr Sekhavat
- Department of Pediatrics, Boston University, Boston, Massachusetts;,Department of Cardiology, Boston Medical Center, Boston, Massachusetts
| | - Jane W. Newburger
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Sarah D. de Ferranti
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Annette L. Baker
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Pui Y. Lee
- Divisions of Immunology and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Megan Day-Lewis
- Divisions of Immunology and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Emily Bucholz
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Ryan Kobayashi
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Mary Beth Son
- Divisions of Immunology and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Lauren A. Henderson
- Divisions of Immunology and,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - John N. Kheir
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Kevin G. Friedman
- Cardiology, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Audrey Dionne
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston, Massachusetts; .,Cardiology, Boston Children's Hospital, Boston, Massachusetts
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Rogers JM, Epstein DH, Phillips K, Strickland JC, Preston KL. Exploring the Relationship Between Substance Use and Allostatic Load in a Treatment/Research Cohort and in a US Probability Sample (NHANES 2009-2016). Front Psychiatry 2021; 12:630195. [PMID: 34408672 PMCID: PMC8367194 DOI: 10.3389/fpsyt.2021.630195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 07/05/2021] [Indexed: 11/30/2022] Open
Abstract
Allostatic load, an operationalization for cumulative strain on physiology from adaptation (allostasis) to stress over a lifetime, can manifest as damage to cardiovascular, neuroendocrine, and metabolic systems. The concept of allostatic load may be particularly useful in research on substance-use disorders (SUDs) because SUD researchers have sought to better understand the relationship between chronic stressors and drug use. Theoretical models hold that SUDs can be conceptualized as a spiral toward a state of persistent allostasis (i.e., allostasis so persistent as to represent homeostasis at a new, unhealthy set point). Regardless of the extent to which those models are accurate, increased allostatic load could be a mechanism by which frequent drug administration increases risk for adverse outcomes. We conducted two secondary analyses to evaluate allostatic load in the context of drug use, including alcohol use, in a locally recruited sample with a high proportion of illicit substance use (N = 752) and in a nationally representative sample from the NHANES 2009-2016. We hypothesized that after controlling for age and other potential confounds, people with longer histories of drug use would have higher allostatic-load scores. Multiple regression was used to predict allostatic load from participants' drug-use histories while controlling for known confounds. In the locally recruited sample, we found that longer lifetime use of cocaine or opioids was related to increased allostatic load. In NHANES 2009-2016, we found few or no such associations. Lengthy histories of problematic non-medical substance use may facilitate more rapid increases in allostatic load than aging alone, and, together with findings from previous investigations, this finding suggests increased risk for chronic disease.
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Affiliation(s)
- Jeffrey M Rogers
- Behavioral Pharmacology and Therapeutics Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
| | - David H Epstein
- Behavioral Pharmacology and Therapeutics Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
| | - Karran Phillips
- Behavioral Pharmacology and Therapeutics Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kenzie L Preston
- Behavioral Pharmacology and Therapeutics Research Branch, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, United States
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GERONIMUS ARLINET, PEARSON JAYA, LINNENBRINGER ERIN, EISENBERG ALEXAK, STOKES CARMEN, HUGHES LANDOND, SCHULZ AMYJ. Weathering in Detroit: Place, Race, Ethnicity, and Poverty as Conceptually Fluctuating Social Constructs Shaping Variation in Allostatic Load. Milbank Q 2020; 98:1171-1218. [PMID: 33135829 PMCID: PMC7772642 DOI: 10.1111/1468-0009.12484] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Policy Points Despite 30 years of attention to eliminating population health inequity, it remains entrenched, calling for new approaches. Targeted universalism, wellness-based local development, and Jedi Public Health approaches that are community informed, evidence based, and focused on improving everyday settings and diverse lived experiences are important policy directions. State and federal revenue transfers are necessary to mitigate the harms of austerity and assure greater equity in fiscal and population health in places like Detroit, Michigan. CONTEXT US population health inequity remains entrenched, despite mandates to eliminate it. To promote a public health approach of consequence in this domain, stakeholders call for moving from risk-factor epidemiology toward consideration of dynamic local variations in the physiological impacts of structured lived experience. METHODS Using a community-based, participatory research approach, we collected and analyzed a unique data set of 239 black, white, and Mexican adults from a stratified, multistage probability sample of three Detroit, Michigan, neighborhoods. We drew venous blood, collected saliva, took anthropometric measurements, and assayed specimens to measure allostatic load (AL), an indicator of stress-mediated biological dysregulation, linking participants' AL scores and survey responses. In a series of nested Poisson models, we regressed AL on socioeconomic, psychosocial, neighborhood, and behavioral stressors to test the hypothesis that race/ethnicity and poverty-to-income ratio (PIR) are conceptually fluctuating variables whose impacts on AL are sensitive to structured lived experience. FINDINGS White and Mexican Detroit participants with PIR < 1 have higher AL than counterparts nationally; black participants in Detroit and nationwide had comparable AL. Within Detroit, disparities by PIR were higher in whites than blacks, with no significant difference by PIR in Mexicans. The size of estimated effects of having PIR < 1 for whites is 58 percentage points greater than that of Mexicans and twice that of blacks. CONCLUSIONS Structurally rooted unobserved heterogeneity bias threatens the validity of independent main effects interpretations of associations between race/ethnicity, socioeconomic characteristics, or place and health. One-size-fits-all analytic or policy models developed from the perspective of the dominant social group insufficiently address the experiences of diverse populations in specific settings and historical moments; nor do they recognize culturally mediated protective resources residents may have developed against material and psychosocial hardship.
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Affiliation(s)
- ARLINE T. GERONIMUS
- School of Public HealthUniversity of Michigan
- Institute for Social Research, University of Michigan
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Alkandari A, Alarouj M, Elkum N, Sharma P, Devarajan S, Abu-Farha M, Al-Mulla F, Tuomilehto J, Bennakhi A. Adult Diabetes and Prediabetes Prevalence in Kuwait: Data from the Cross-Sectional Kuwait Diabetes Epidemiology Program. J Clin Med 2020; 9:E3420. [PMID: 33113867 PMCID: PMC7694112 DOI: 10.3390/jcm9113420] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/13/2020] [Accepted: 10/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study aimed to estimate the prevalence of diabetes and prediabetes in adults in Kuwait. METHODS The Kuwait Diabetes Epidemiology Program was a nationally representative, cross-sectional study of diabetes and obesity in Kuwait conducted between 2011 and 2014. The survey sampled 4937 adults in Kuwait aged 20 years or more and recorded participants' demographics, behaviours, medical history, physical measurements and blood biochemical measurements. Prediabetes was defined as fasting plasma glucose between 6.1 and 6.9 mmol/L or HbA1c between 6 and 6.4% (42-47 mmol/mol). Diabetes was defined as self-reported history with prescribed glucose-lowering medication or FPG ≥7mmol/L or HbA1c level ≥6.5% (≥48 mmol/mol). RESULTS The overall adjusted prevalence of diabetes was 19.1%. The overall adjusted prevalence of prediabetes was 13.5%. Diabetes prevalence was 5.4%, 14.2%, 38.7% and 64.8% in adults aged 20-29, 30-44, 45-59 and 60 years or more, respectively. Diabetes prevalence was 22.4% in men and 14.4% in women. Prediabetes prevalence was 14.8% in men and 11.5% in women. In Kuwaitis, diabetes and prediabetes prevalence was 21.8% and 11.1%, respectively, while prevalence in non-Kuwaitis was 18.2% for diabetes and 14.3% for prediabetes. CONCLUSION These findings illustrate the severe public health challenge posed by diabetes in Kuwait.
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Affiliation(s)
- Abdullah Alkandari
- Dasman Diabetes Institute, Kuwait City 15462, Kuwait; (M.A.); (P.S.); (S.D.); (M.A.-F.); (F.A.-M.); (A.B.)
| | - Monira Alarouj
- Dasman Diabetes Institute, Kuwait City 15462, Kuwait; (M.A.); (P.S.); (S.D.); (M.A.-F.); (F.A.-M.); (A.B.)
| | - Naser Elkum
- Sidra Medical and Research Center, Doha 26999, Qatar;
| | - Prem Sharma
- Dasman Diabetes Institute, Kuwait City 15462, Kuwait; (M.A.); (P.S.); (S.D.); (M.A.-F.); (F.A.-M.); (A.B.)
| | - Sriraman Devarajan
- Dasman Diabetes Institute, Kuwait City 15462, Kuwait; (M.A.); (P.S.); (S.D.); (M.A.-F.); (F.A.-M.); (A.B.)
| | - Mohamed Abu-Farha
- Dasman Diabetes Institute, Kuwait City 15462, Kuwait; (M.A.); (P.S.); (S.D.); (M.A.-F.); (F.A.-M.); (A.B.)
| | - Fahd Al-Mulla
- Dasman Diabetes Institute, Kuwait City 15462, Kuwait; (M.A.); (P.S.); (S.D.); (M.A.-F.); (F.A.-M.); (A.B.)
| | - Jaakko Tuomilehto
- Public Health Prevention Unit, Finnish Institute for Health and Welfare, FI-00271 Helsinki, Finland;
| | - Abdullah Bennakhi
- Dasman Diabetes Institute, Kuwait City 15462, Kuwait; (M.A.); (P.S.); (S.D.); (M.A.-F.); (F.A.-M.); (A.B.)
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