Association of Self-Rated Health With Functional Limitations in Patients With CKD

Association between functional dependence and cardiovascular disease among middle-aged and older adults: Findings from the China health and retirement longitudinal study

Background

The effect of different functional dependency types on cardiovascular disease (CVD) is largely unknown. Here, we aimed to investigate the association between functional dependence and CVD among middle-aged and older adults by conducting a cross-sectional and longitudinal study.

Methods

The study sample comprised 16,459 individuals of ≥40 years (including 10,438 without CVD) who had participated in the 2011 China Health and Retirement Longitudinal Study (CHARLS). Functional dependence was categorized based on the "interval-of-need" method, while CVD was defined as physician-diagnosed heart disease or stroke. Cox proportional hazard regression was employed to assess the effects of functional dependence on CVD. Moreover, patients were grouped according to the functional status changes, and the impact of these changes on CVD was observed. Heterogeneity, subgroup, and interaction analyses were used to evaluate the consistency of the study findings. Finally, a mediation analysis was performed to estimate the potential mediation effects on the relationship between functional dependence and CVD risk.

Results

CVD prevalence in the overall study population was 13.73 % (2260/16,459), while its prevalence among individuals with functional independence, low dependency, medium dependency, and high dependency was 9.60 % (1085/11,302), 14.25 % (119/835), 17.72 % (115/649), and 25.01 % (941/3763), respectively. Additionally, medium (odds ratio: 1.33, 95 % confidence interval: 1.06-1.68) and high functional dependency (1.55, 95 % CI: 1.38-1.75) were associated with CVD. A total of 2987 (28.62 %) participants with CVD were identified during the 9-year follow-up, with 4.85 % (145/2987) of the CVD cases being attributed to functional dependence. The individuals with medium (HR: 1.20, 95 % CI: 1.01-1.44) and high functional dependency (1.25, 95 % CI: 1.14-1.37) were more likely to develop CVD than their peers with functional independence. Furthermore, persistent functional dependence (HR: 1.72, 95 % CI: 1.52-1.94) and transition from functional independence to dependence (1.79, 95 % CI: 1.61-1.98) were associated with a higher CVD risk than continuous functional independence. Hypertension and diabetes may partially mediate CVD caused by functional dependence.

Conclusion

Functional dependence is associated with high CVD risk. Therefore, appropriate healthcare attention must be directed towards functionally dependent populations to protect their cardiovascular health.

Self-rated health and HIV outcomes among adults with diagnosed HIV - Medical Monitoring Project, United States

OBJECTIVES

To evaluate associations between self-rated health (SRH) and care outcomes among United States adults with diagnosed HIV infection.

DESIGN

We analyzed interview and medical record data collected during June 2020-May 2021 from the Medical Monitoring Project, a complex, nationally representative sample of 3692 people with HIV (PWH). Respondents reported SRH on a 5-point Likert type scale (poor to excellent), which we dichotomized into "good or better" and "poor or fair". We computed weighted percentages with 95% confidence intervals (CIs) and age-adjusted prevalence ratios (aPRs) to investigate associations between SRH and HIV outcomes and demographic, psychosocial, and behavioral characteristics.

RESULTS

Nationally, 72% of PWH reported "good or better" SRH. PWH with the following characteristics had a lower prevalence of "good or better" SRH, compared with those without: any missed HIV care appointment in the last 12 months (aPR 0.86, 95% CI: 0.81-0.91), symptoms of moderate or severe depression (aPR 0.51, 95% CI: 0.43-0.59) and anxiety (aPR 0.60, 95% CI: 0.54-0.68), unstable housing or homelessness (aPR 0.77, 95% CI: 0.71-0.82), and hunger or food insecurity (aPR 0.74, 95% CI: 0.69-0.80), as well as having a mean CD4 count <200 cells/mm 3 vs. CD4 + >500 cells/mm 3 (aPR 0.70, 95% CI: 0.57-0.86).

CONCLUSIONS

Though SRH is a holistic measure reflective of HIV outcomes, integrated approaches addressing needs beyond physical health are necessary to improve SRH among PWH in the United States. Modifiable factors like mental health, unstable housing or homelessness, and food insecurity warrant further study as potential high-yield targets for clinical and policy interventions to improve SRH among PWH.

Correlates of Rates and Treatment Readiness for Depressive Symptoms, Pain, and Fatigue in Hemodialysis Patients: Results from the TĀCcare Study

Key Points

Lower neighborhood walkability was associated with higher depressive symptoms and fatigue and younger age with depressive symptoms. Depressive symptoms, pain, and fatigue were frequently reported, often occurred together, and were often not all already treated. Patients with a higher symptom burden and men may be more likely to be ready to seek treatment for depressive symptoms, pain, or fatigue.

Background

Patients on hemodialysis (HD) often experience clinically significant levels of pain, fatigue, and depressive symptoms. We explored potential sociodemographic differences in symptom burden, current treatment, and readiness to seek treatment for these symptoms in patients screened for the TĀCcare trial.

Methods

In-center HD patients from Pennsylvania and New Mexico were screened for fatigue (≥5 on 0–10-point Likert scale), pain (Likert scale ≥4), depressive symptoms (≥10 Patient Health Questionnaire-9), and readiness to seek treatment (5–item Stages of Behavior Change questionnaire). Symptom burden and treatment status by sociodemographic factors were evaluated using chi square, Fisher exact tests, and logistic regression models.

Results

From March 2018 to December 2021, 506 of 896 (57%) patients screened met eligibility criteria and completed the symptom screening (mean age 60±13.9 years, 44% female, 17% Black, 25% American Indian, and 25% Hispanics). Of them, 77% screened positive for ≥1 symptom and 35% of those were receiving treatment for ≥1 of these symptoms. Pain, fatigue, and depressive symptom rates were 52%, 64%, and 24%, respectively. Age younger than 65 years was associated with a higher burden of depressive symptoms, pain, and reporting ≥1 symptom (P <0.05). The percentage of patients ready to seek treatment increased with symptom burden. More men reported readiness to seek treatment (85% versus 68% of women, P <0.001). Among those with symptoms and treatment readiness, income was inversely associated with pain (>$60,000/yr: odds ratio [OR]=0.16, confidence interval [CI]=0.03 to 0.76) and living in less walkable neighborhoods with more depressive symptoms (OR= 5.34, CI=1.19 to 24.05) and fatigue (OR= 5.29, CI=1.38 to 20.33).

Conclusions

Pain, fatigue, and depressive symptoms often occurred together, and younger age, less neighborhood walkability, and lower income were associated with a higher burden of symptoms in HD patients. Male patients were less likely to be receiving treatment for symptoms. These findings could inform priority HD patient symptom identification and treatment targets.

Trends of healthy and unhealthy working life expectancy in Germany between 2001 and 2020 at ages 50 and 60: a question of educational level?

BACKGROUND

Extending the number of active working years is an important goal both for maintaining individual quality of life and safeguarding social security systems. Against this background, we examined the development of healthy and unhealthy working life expectancy (HWLE/UHWLE) in the general population and for different educational groups.

METHODS

The study is based on data from the German Socio-Economic Panel study, including 88 966 women and 85 585 men aged 50-64 years and covering four time periods (2001-05, 2006-2010, 2011-2015 and 2016-2020). Estimates of HWLE and UHWLE in terms of self-rated health (SRH) were calculated using the Sullivan's method. We adjusted for hours worked and stratified by gender and educational level.

RESULTS

Working-hours adjusted HWLE at age 50 increased in women and men from 4.52 years (95% CI 4.42 to 4.62) in 2001-2005 to 6.88 years (95% CI 6.78 to 6.98) in 2016-2020 and from 7.54 years (95% CI 7.43 to 7.65) to 9.36 years (95% CI 9.25 to 9.46), respectively. Moreover, UHWLE also rose with the proportion of working life spent in good SRH (health ratio) remaining largely stable. At age 50, educational differences in HWLE between the lowest and highest educational groups increased over time in women and in men from 3.72 to 4.99 years and from 4.06 to 4.40 years, respectively.

CONCLUSIONS

We found evidence for an overall increase but also for substantial educational differences in working-hours adjusted HWLE, which widened between the lowest and highest educational group over time. Our findings suggest that policies and health prevention measures at workplace should be more focused on workers with low levels of education in order to extend their HWLE.

Factors associated with poor self-rated health among chronic kidney disease patients and their health care utilization: Insights from LASI wave-1, 2017-18

Background

Chronic kidney disease (CKD), associated with other chronic conditions affects the physical, behavioral, and psychological aspects of an individual, leading to poor self-rated health. Hence, we aimed to assess the factors associated with poor self-rated health (SRH) in CKD patients. Additionally, we assessed their health care utilization.

Methods

This is an observational study consisting of 527 CKD patients from Longitudinal Aging Study in India (LASI), 2017-2018. A descriptive statistic computed prevalence. Regression analysis assessed the association between poor SRH and socio-demographic variables presented as adjusted odds ratio with a confidence interval of 95%. Health care utilization among CKD patients was graphically presented.

Results

Around 64% of CKD patients had poor SRH. Aged 75 years and above (AOR=1.8, 95% CI= 0.5-6.8), rural residents (AOR= AOR 1.8, 95% CI =1.0 -3.1) and those with other chronic conditions (AOR=5.1, 95% CI= 2.3-11.0) were associated with poor SRH. Overall 79% of the CKD patients availed health care facility, most (44.8%) of those visit private facility.

Conclusion

We observed older adults, females, rural residents, and having other chronic conditions were associated with poor SRH among CKD patients which highlights the need for equitable and strengthened health care system. There is an urgent need to provide accessible, affordable and quality healthcare services for these individuals so as to maintain continuity of care.

Self-rated health and the risk of incident chronic kidney disease: a community‐based Korean study

BACKGROUND

The relationship between self-rated health (SRH) and the development of incident chronic kidney disease (CKD) has not been explored in the general population.

METHODS

We reviewed the data of 7027 participants in the Ansung-Ansan cohort study. SRH was categorized as poor, fair, or good, and the outcome was the development of CKD, defined as the first event of an estimated glomerular filtration rate < 60 mL/min/1.73 m², at least twice during the follow-up period. Hazard ratios (HRs) and confidence intervals (CIs) were calculated using Cox proportional hazards regression analysis.

RESULTS

Over a mean follow-up duration of 11.9 years, 951 participants (13.5%) developed CKD. Compared with poor self-rated health, the HR (95% CI) of fair self-rated health for incident CKD development was 0.771 (0.657-0.905; P = 0.001), whereas that of good self-rated health was 0.795 (0.676-0.935; P = 0.006). However, the renal hazard of good self-rated health did not differ from that of fair self-rated health. In the fully adjusted model, the HR (95% CI) of poor self-rated health compared to non-poor self-rated health for incident CKD was 1.278 (1.114-1.465, P < 0.001). Old age, smoking, cardiovascular disease, diabetes, hypertension, impaired sleep, and high levels of C-reactive protein and white blood cell counts were associated with increased odds of poor self-rated health, whereas male sex, college graduate level of education, and alcohol consumption were associated with decreased odds of poor self-rated health.

CONCLUSION

Poor self-rated health is independently associated with CKD development. Therefore, the early detection of potential CKD patients through a brief questionnaire assessment may help control the incidence of CKD.

Baseline characteristics of participants in the NAVKIDS2 trial: a patient navigator program in children with chronic kidney disease

BACKGROUND

Children with chronic kidney disease (CKD) require multidisciplinary care to meet their complex healthcare needs. Patient navigators are trained non-medical personnel who assist patients and caregivers to overcome barriers to accessing health services through care coordination. This trial aims to determine the effectiveness of a patient navigator program in children with CKD.

METHODS

The NAVKIDS² trial is a multi-center, waitlisted, randomized controlled trial of patient navigators in children with CKD conducted at five sites across Australia. Children (0-16 years) with CKD from low socioeconomic status rural or remote areas were randomized to an intervention group or a waitlisted control group (to receive intervention after 6 months). The study primary and secondary endpoints include the self-rated health (SRH) (primary), and utility-based quality of life, progression of kidney dysfunction of the child, SRH, and satisfaction with healthcare of the caregiver at 6 months post-randomization.

RESULTS

The trial completed recruitment in October 2021 with expected completion of follow-up by October 2022. There were 162 patients enrolled with 80 and 82 patients randomized to the immediate intervention and waitlisted groups, respectively. Fifty-eight (36%) participants were from regional/remote areas, with a median (IQR) age of 9.5 (5.0, 13.0) years, 46% were of European Australian ethnicity, and 65% were male. A total of 109 children (67%) had CKD stages 1-5, 42 (26%) were transplant recipients, and 11 (7%) were receiving dialysis.

CONCLUSION

The NAVKIDS² trial is designed to evaluate the effectiveness of patient navigation in children with CKD from families experiencing socioeconomic disadvantage. A higher resolution version of the Graphical abstract is available as Supplementary information.

The association between self-rated health and all-cause mortality and explanatory factors in China's oldest-old population

Background

Self-rated health (SRH) is considered a condensed summary of information about bodily conditions that involves people’s biological, cognitive, and cultural status, but has been under-studied in the oldest old population. This study aimed to investigate the association between SRH and all-cause mortality among the oldest-old population in China and to explore potential explanatory factors in this association.

Methods

The study was based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018 and included 30 222 participants aged 80 years or older (ie, the oldest old) in the analysis. We used Cox models to assess the association between SRH and mortality in this population and its subgroups, and used the Percentage Excess Risk Mediated approach to identify potential contributing factors.

Results

After adjustment of confounders, people with “good” “neutral”, and “bad/very bad” SRH were significantly associated with 8% (95% confidence interval (CI) = 3%-13%), 23% (95% CI = 18%-29%), and 52% (95% CI = 44%-61%) higher hazard of mortality respectively, compared with those with “very good” SRH. The significant SRH-mortality associations were exclusive to men and those with at least primary education. The adjustment of “regular physical activity”, “leisure activity”, “activities of daily living (ADL)”, and “cognitive function” all led to noticeable attenuation to the SRH-mortality association, with “leisure activity” causing the most attenuation (64.9%) in the “Good SRH” group.

Conclusions

Self-rated health is significantly associated with all-cause mortality among the oldest old population in China, particularly among men and the educated, and is considerably explained by regular physical activity, leisure activity, ADL, and cognitive function. We advocate the use of SRH as a simple and efficient tool in research and (potentially) health care practices.

Loneliness and physical function impairment: Perceived health status as an effect modifier in community-dwelling older adults in Ghana

Background

Methods

Results

Conclusions