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Tao C, Liu Z, Fan Y, Yuan Y, Wang X, Qiao Z, Li Z, Xu Q, Lou Z, Wang H, Li X, Li R, Lu C. Estimating neighborhood-based mortality risk associated with air pollution: A prospective study. JOURNAL OF HAZARDOUS MATERIALS 2024; 475:134861. [PMID: 38870855 DOI: 10.1016/j.jhazmat.2024.134861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Abstract
Effect modification of integrated neighborhood environment on associations of air pollution with mortality remained unclear. We analyzed data from UK biobank prospective study (n = 421,650, median 12.5 years follow-up) to examine disparities of mortality risk associated with air pollution among varied neighborhood settings. Fine particulate matter (PM2.5), PM10 and nitrogen dioxide (NO2) were measured and assigned to each participants' address. Diverse ecological and societal settings of neighborhoods were integrated with principal component analysis and categorized into disadvantaged, intermediate and advantaged levels. We estimated mortality risk associated with air pollution across diverse neighborhoods using Cox regression. We calculated community-level proportions of mortality attributable to air pollutants. There was evidence of higher all-cause and respiratory disease mortality risk associated with PM2.5 and NO2 among those in disadvantaged neighborhoods. In disadvantaged communities, air pollutants explained larger proportions of deaths and such disparities persisted over past decades. Across 2010-2021, reducing PM2.5 and NO2 to 10 μg/m3 (World Health Organization limits) would save 87,000 (52,000-120,000) and 91,000 (37,000-145,000) deaths of populations aged ≥ 40 years, with 150 000 deaths occurred in disadvantaged neighborhood settings. These findings suggested that disadvantaged neighborhoods can exacerbate mortality risk associated with air pollution.
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Affiliation(s)
- Chengzhe Tao
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Zhaoyin Liu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yun Fan
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Yiting Yuan
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Xinru Wang
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Ziyan Qiao
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Zhi Li
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Qiaoqiao Xu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Zhe Lou
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China
| | - Haowei Wang
- School of Public Health, Imperial College London, UK; MRC Centre for Global Infectious Disease Analysis and Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, UK
| | - Xiang Li
- School of Public Health, Imperial College London, UK; MRC Centre for Global Infectious Disease Analysis and Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, UK
| | - Ruiyun Li
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China.
| | - Chuncheng Lu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing 211166, China.
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Qu Y, Zhang G, Wu Z, Luo H, Chen R, Jia H, Sun X. Associations of Socioeconomic Status Inequity with Incident Age-related Macular Degeneration in Middle-Aged and Elderly Population. HEALTH DATA SCIENCE 2024; 4:0148. [PMID: 38952896 PMCID: PMC11214909 DOI: 10.34133/hds.0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/14/2024] [Indexed: 07/03/2024]
Abstract
Background: The relationship between socioeconomic status (SES) inequity and incident age-related macular degeneration (AMD) remains unclear. We aim to investigate whether low SES increases the risk of AMD and to explore the effect of a healthy lifestyle on this association. Methods: This prospective cohort study included 316,663 UK Biobank individuals. SES inequity was identified via latent class analysis using education, household income, and occupational status. Healthy lifestyle score was calculated based on smoking, alcohol drinking, and physical activity (PA). Incident AMD was defined according to diagnosis records. Cox proportional hazards models were used to evaluate the relationship of low SES and AMD. Interrelationships of healthy lifestyle score on SES-AMD association were explored, including modification, mediation, and joint effects. Results: During the average 12.2 years of follow-up, 6,355 AMD cases were diagnosed. Participants with medium SES (hazard ratio: 1.10 [95% confidence interval (CI) 1.01 to 1.21]) and low SES (hazard ratio: 1.22 [95% CI 1.11 to 1.34]) had an increased risk of incident AMD compared to participants with high SES. PA significantly affected this association. Moreover, the association between low SES and AMD was significantly mediated (11.3%, 95% CI: 6.56 to 23.0) by smoking. Similarly, alcohol drinking suppressed (9.59%, 95% CI: 4.00 to 23.2) the association between high SES and AMD. Besides, a significant joint effect of SES and healthy lifestyle score was found. Conclusions: We provide further evidence for the relationship of socioeconomic inequity, healthy lifestyle, and incident AMD. Future public health strategies should aim to reduce socioeconomic inequity to prevent AMD.
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Affiliation(s)
- Yanlin Qu
- Department of Ophthalmology, Shanghai General Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Guanran Zhang
- Department of Ophthalmology, Shanghai General Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
| | - Zhenyu Wu
- School of Public Health,
Fudan University, Shanghai, China
| | - Huihuan Luo
- School of Public Health,
Fudan University, Shanghai, China
| | - Renjie Chen
- School of Public Health,
Fudan University, Shanghai, China
| | - Huixun Jia
- Department of Ophthalmology, Shanghai General Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
- School of Public Health,
Fudan University, Shanghai, China
| | - Xiaodong Sun
- Department of Ophthalmology, Shanghai General Hospital,
Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai, China
- National Clinical Research Center for Eye Diseases, Shanghai, China
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Irankhah K, Asadimehr S, Kiani B, Jamali J, Rezvani R, Sobhani SR. Investigating the role of the built environment, socio-economic status, and lifestyle factors in the prevalence of chronic diseases in Mashhad: PLS-SEM model. Front Public Health 2024; 12:1358423. [PMID: 38813428 PMCID: PMC11133713 DOI: 10.3389/fpubh.2024.1358423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
Background Chronic diseases remain a significant contributor to both mortality and disability in our modern world. Physical inactivity and an unhealthy diet are recognized as significant behavioral risk factors for chronic diseases, which can be influenced by the built environment and socio-economic status (SES). This study aims to investigate the relationship between the built environment, SES, and lifestyle factors with chronic diseases. Methods The current study was conducted in Mashhad's Persian cohort, which included employees from Mashhad University of Medical Sciences (MUMS). In the study, 5,357 participants from the cohort were included. To assess the state of the built environment in Mashhad, a Geographic Information System (GIS) map was created for the city and participants in the Persian Mashhad study. Food intake and physical exercise were used to assess lifestyle. A food frequency questionnaire (FFQ) was used to assess food intake. To assess food intake, the diet quality index was computed. To assess the link between variables, the structural model was created in accordance with the study's objectives, and partial least square structural equation modeling (PLS-SEM) was utilized. Results The chronic diseases were positively associated with male sex (p < 0.001), married (p < 0.001), and higher age (p < 0.001). The chronic diseases were negatively associated with larger family size (p < 0.05), higher SES (p < 0.001), and higher diet quality index (DQI) (p < 0.001). No significant relationship was found between chronic disease and physical activity. Conclusion Food intake and socioeconomic status have a direct impact on the prevalence of chronic diseases. It seems that in order to reduce the prevalence of chronic diseases, increasing economic access, reducing the class gap and increasing literacy and awareness should be emphasized, and in the next step, emphasis should be placed on the built environment.
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Affiliation(s)
- Kiyavash Irankhah
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheil Asadimehr
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Kiani
- UQ Center for Clinical Research, The University of Queensland, Brisbane, QLD, Australia
| | - Jamshid Jamali
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Biostatistics, School of Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Rezvani
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyyed Reza Sobhani
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Albitres-Flores L, Perez-Leon S, Bernabe-Ortiz A, Tenorio-Mucha J, Cardenas MK, Vetter B, Safary E, Gamboa R, Cordova V, Gupta R, Moran A, Beran D, Lazo-Porras M. Co-creation process of an intervention to implement a multiparameter point-of-care testing device in a primary healthcare setting for non-communicable diseases in Peru. BMC Health Serv Res 2024; 24:401. [PMID: 38553724 PMCID: PMC10981306 DOI: 10.1186/s12913-024-10809-3] [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: 06/01/2023] [Accepted: 02/29/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Point-of-care testing (POCT) devices are diagnostic tools that can provide quick and accurate results within minutes, making them suitable for diagnosing non-communicable diseases (NCDs). However, these devices are not widely implemented in healthcare systems and for this reason is relevant to understand the implementation process. AIM To describe the process and define a strategy to implement a multiparameter POCT device for diagnosing and managing NCDs in one region of Peru. METHODS A descriptive and non-experimental study, using the participatory methodologies of co-creation process. It was conducted in one region of Peru (Tumbes) to design an intervention for implementing a multiparameter POCT device. Two co-creation sessions were conducted involving five groups: community members, primary healthcare workers, these groups in both rural and urban settings, and regional decision-makers. These sessions included activities to understand patient journeys in receiving care for NCDs, identify facilitators and barriers to POCT devices usage, and define an implementation strategy for POCT devices in both rural and urban settings of Tumbes. The research team analysed the data and summarized key topics for discussion after each session. RESULTS A total of 78 participants were enrolled across the five groups. Among community members: 22.2% had only diabetes, 24.1% had only hypertension, and 18.5% had both diagnoses. In the patient journey, community members mentioned that it took at least three days to receive a diagnosis and treatment for an NCD. Most of the participants agreed that the POCT devices would be beneficial for their communities, but they also identified some concerns. The strategy for POCT devices implementation included healthcare workers training, POCT devices must be placed in the laboratory area and must be able to perform tests for glucose, glycated haemoglobin, cholesterol, and creatinine. Advertising about POCT devices should be displayed at the healthcare centres and the municipality using billboards and flyers. CONCLUSIONS The co-creation process was useful to develop strategies for the implementation of multiparameter POCT devices for NCDs, involving the participation of different groups of stakeholders guided by moderators in both, rural and urban, settings in Peru.
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Affiliation(s)
- Leonardo Albitres-Flores
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silvana Perez-Leon
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Janeth Tenorio-Mucha
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Kathia Cardenas
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Ricardo Gamboa
- Global Health Center, Universidad Peruana Cayetano Heredia, Tumbes, Peru
| | | | - Reena Gupta
- Resolve to Save Lives, New York, NY, USA
- Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, USA
| | | | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals & University of Geneva, Geneva, Switzerland
| | - María Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals & University of Geneva, Geneva, Switzerland.
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Gao Y, Wu IXY. Lifestyle change in patients with cardiovascular disease: never too late to adopt a healthy lifestyle. Eur J Prev Cardiol 2024; 31:203-204. [PMID: 37793093 DOI: 10.1093/eurjpc/zwad320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Yinyan Gao
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, No. 172, Tongzipo Road, Yuelu District, Changsha 410015, China
| | - Irene X Y Wu
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, No. 172, Tongzipo Road, Yuelu District, Changsha 410015, China
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Wu Q, Zhao Y, Liu L, Liu Y, Liu J. Trend, regional variation and socioeconomic inequality in cardiovascular disease among the elderly population in China: evidence from a nationwide longitudinal study during 2011-2018. BMJ Glob Health 2023; 8:e013311. [PMID: 38101937 PMCID: PMC10729065 DOI: 10.1136/bmjgh-2023-013311] [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: 07/05/2023] [Accepted: 10/21/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) continues to pose a significant burden among the elderly population in China. There is a knowledge gap in the temporal trends, regional variations and socioeconomic inequalities among this vulnerable population. METHODS This study conducted cross-sectional and cohort analyses based on four survey waves of the China Health and Retirement Longitudinal Study among adults aged ≥60 years spanning 2011-2018 across 28 provinces. Cross-sectional analyses examined temporal trends, regional variations and socioeconomic inequalities in CVD prevalence. Cohort analyses identified individuals without CVD in 2011 and followed them up until 2018 to calculate CVD incidence. Generalised estimating equations (GEE) were employed to identify associated factors. RESULTS A total of 5451, 7258, 8820 and 11 393 participants were eligible for cross-sectional analyses, and 4392 and 5396 participants were included in cohort analyses of CVD and comorbid CVD. In 2018, the age-adjusted and sex-adjusted prevalence of CVD and comorbid CVD was 31.21% (95% CI 27.25% to 35.17%) and 3.83% (95% CI 2.85% to 4.81%), respectively. Trend analyses revealed a significant increase in the adjusted prevalence from 2011 to 2018 (p for trend <0.001). There were substantial provincial variations in the adjusted prevalence of CVD and comorbid CVD. Higher socioeconomic status (SES) participants exhibited higher prevalence, and the concentration curves and concentration indices suggested persistent but narrowing inequalities in CVD and comorbid CVD across survey waves. Cohort analyses from 2011 to 2018 yielded overall CVD and comorbid CVD incidence densities of 17.96 and 2.65 per 1000 person-years, respectively. GEE results indicated increased CVD risks among older individuals, women, higher SES participants and northern residents. CONCLUSION More efforts should be taken to optimise strategies for high-quality CVD prevention and management in China's elderly population. Future interventions and policies should address age-specific and gender-specific, geographical, and socioeconomic disparities to ensure equitable access and outcomes for all.
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Affiliation(s)
- Qiong Wu
- Graduate School of the PLA General Hospital, Chinese PLA General Hospital, Beijing, China
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Zhao
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lihua Liu
- Hospital Management Institute, Department of Innovative Medical Research, Chinese PLA General Hospital, Beijing, China
| | - Yuehui Liu
- Hospital Management Institute, Department of Innovative Medical Research, Chinese PLA General Hospital, Beijing, China
| | - Jianchao Liu
- Hospital Management Institute, Department of Innovative Medical Research, Chinese PLA General Hospital, Beijing, China
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Oliveira EPD, Garcia Lira Neto JC, Barreto ICDHC, Costa ACPDJ, Freire de Freitas Júnior RW, Sousa DFD, Araújo MFMD. [Cross-cultural adaptation and evidence of psychometric validity of the Family Health Scale for Brazilian Portuguese]. CAD SAUDE PUBLICA 2023; 39:e00048823. [PMID: 38088720 PMCID: PMC10712955 DOI: 10.1590/0102-311xpt048823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/05/2023] [Accepted: 08/09/2023] [Indexed: 12/18/2023] Open
Abstract
This study aimed to translate and cross-culturally adapt the Family Health Scale into Brazilian Portuguese and analyze evidence of its psychometric validity. The 32 items on family health were cross-culturally adapted, using the content validity index to calculate semantic, idiomatic, cultural, and conceptual characteristics of the scale and its items. A pre-test to identify evidence of validity was applied to 40 families. At another time, the instrument was applied to 354 families in a Brazilian northeastern city. The index of agreement between the raters ranged from 0.84 for the scale items to 0.98 for the total scale, according to Kendall's coefficient. According to Cronbach's alpha, evidence of psychometric validity is adequate. Most families had a moderate degree of health, according to the scale. Therefore, the Brazilian version of the Family Health Scale showed conceptual, semantic, cultural, and operational equivalence with the original items, along with satisfactory psychometric properties for use among the Brazilian population with effectiveness and safety.
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Patriota P, Ko Maung K, Marques-Vidal P. Reported recommendations to address cardiovascular risk factors differ by socio-economic status in Brazil. Results from the Brazilian National Health Survey 2019. Prev Med Rep 2023; 36:102527. [PMID: 38116250 PMCID: PMC10728434 DOI: 10.1016/j.pmedr.2023.102527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/17/2023] [Accepted: 11/25/2023] [Indexed: 12/21/2023] Open
Abstract
Background Management of cardiovascular risk factors (high cholesterol, diabetes, and hypertension) should start by implementing a healthy lifestyle. Whereas lifestyle recommendations are provided irrespective of the patient's socio-economic status has not been recently assessed in the Brazilian population. Aims To assess the preventive measures against cardiovascular risk factors according to educational level and income in the Brazilian population. Methods Survey data of the 2019 Brazilian National Health Survey (PNS). The PNS is a nationwide household-based survey carried out by the Brazilian Ministry of Health. The PNS included face-to-face interviews and collected information on lifestyle management of high cholesterol, diabetes, and hypertension by a healthy diet, an adequate weight, exercise, and quitting smoking. The participant's educational level and income (in multiples of the basic salary per capita) was collected. Results Of the 88,052 participants included, 13,151 (14.9%), 6,986 (7.9%) and 22,516 (25.6%) reported being diagnosed with high cholesterol, diabetes, or hypertension, respectively. Dietary recommendations were the most frequently provided (94.5%, 94.6% and 88.1% for high cholesterol diabetes, and hypertension, respectively), while recommendations to quit smoking to current smokers were the least frequently provided (74.9%, 85.8% and 81.1% for high cholesterol, diabetes, and hypertension, respectively). After multivariable adjustment, participants with a higher educational level or a higher income had a higher likelihood of reporting receipt lifestyle recommendations for high cholesterol or hypertension, while no associations were found for most recommendations for diabetes. Conclusion Better-educated, wealthier Brazilians report receiving more lifestyle recommendations regarding high cholesterol and hypertension management more frequently than lower-educated or with low-income.
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Affiliation(s)
- Pollyanna Patriota
- Pôle Santé Vallée de Joux – Joux Valley Health Center, Le Sentier, Switzerland
| | - Ko Ko Maung
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Ni Y, Zhou Y, Kivimäki M, Cai Y, Carrillo-Larco RM, Xu X, Dai X, Xu X. Socioeconomic inequalities in physical, psychological, and cognitive multimorbidity in middle-aged and older adults in 33 countries: a cross-sectional study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e618-e628. [PMID: 37924843 DOI: 10.1016/s2666-7568(23)00195-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Many physical, psychological, and cognitive disorders are highly clustered among populations with low socioeconomic status. However, the extent to which socioeconomic status is associated with different combinations of these disorders is unclear, particularly outside high-income countries. We aimed to evaluate these associations in 33 countries including high-income countries, upper-middle-income countries, and one lower-middle-income country. METHODS This cross-sectional multi-region study pooled individual-level data from seven studies on ageing between 2017 and 2020. Education and total household wealth were used to measure socioeconomic status. Physical disorder was defined as having one or more of the self-reported chronic conditions. Psychological and cognitive disorders were measured by study-specific instruments. The outcome included eight categories: no disorders, physical disorder, psychological disorder, cognitive disorder, and their four combinations. Multivariable-adjusted logistic regression models were used to estimate odds ratios (ORs) and 95% CIs for the associations of socioeconomic status with these outcomes separately for high-income countries, upper-middle-income countries, and the lower-middle-income country. FINDINGS Among 167 376 individuals aged 45 years and older, the prevalence of multimorbidity was 24·5% in high-income countries, 33·9% in upper-middle-income countries, and 8·1% in the lower-middle-income country (India). Lower levels of education, household wealth, and a combined socioeconomic status score were strongly associated with physical, psychological, and cognitive multimorbidity in high-income countries and upper-middle-income countries, with ORs (low vs high socioeconomic status) for physical-psychological-cognitive multimorbidity of 12·36 (95% CI 10·29-14·85; p<0·0001) in high-income countries and of 23·84 (18·85-30·14; p<0·0001) in upper-middle-income countries. The associations in the lower-middle-income country were mixed. Participants with both a low level of education and low household wealth had the highest odds of multimorbidity (eg, OR for physical-psychological-cognitive multimorbidity 21·21 [15·95-28·19; p<0·0001] in high-income countries, 37·07 [25·66-53·56; p<0·0001] in upper-middle-income countries, and 54·96 [7·66-394·38; p<0·0001] in the lower-middle-income country). INTERPRETATION In study populations from high-income countries, upper-middle-income countries, and the lower-middle-income country, the odds of multimorbidity, which included physical, psychological, and cognitive disorders, were more than ten times greater in individuals with low socioeconomic status. Equity-oriented policies and programmes that reduce social inequalities in multimorbidity are urgently needed to achieve Sustainable Development Goals. FUNDING Zhejiang University, Fundamental Research Funds for the Central Universities, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Wellcome Trust, Medical Research Council, National Institute on Aging, and Academy of Finland. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Yujie Ni
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, China
| | - Yaguan Zhou
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, China
| | - Mika Kivimäki
- UCL Brain Sciences, University College London, London, UK
| | - Ying Cai
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Rodrigo M Carrillo-Larco
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Xin Xu
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, China
| | - Xiaochen Dai
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Xiaolin Xu
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, China; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
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Mohammadzadeh P, Moradpour F, Nouri B, Mostafavi F, Najafi F, Moradi G. Socioeconomic inequalities in metabolic syndrome and its components in a sample of Iranian Kurdish adults. Epidemiol Health 2023; 45:e2023083. [PMID: 37723842 PMCID: PMC10867515 DOI: 10.4178/epih.e2023083] [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: 02/24/2023] [Accepted: 08/15/2023] [Indexed: 09/20/2023] Open
Abstract
OBJECTIVES The worldwide incidence of metabolic syndrome (MetS) has increased in recent decades. In this study, we investigated the socioeconomic inequalities associated with MetS and its components in a sample of the Iranian Kurdish population. METHODS We used data from 3,996 participants, aged 35 years to 70 years, from the baseline phase of the Dehgolan Prospective Cohort Study (February 2018 to March 2019). The concentration index and concentration curve were used to measure inequality and the Blinder-Oaxaca decomposition method was used to examine the contribution of various determinants to the observed socioeconomic inequality in MetS and its components. RESULTS The prevalence of MetS was 34.44% (95% confidence interval [CI], 32.97 to 35.93). The prevalence of MetS was 26.18% for those in the highest socioeconomic status (SES), compared with 40.51% for participants in the lowest SES. There was a significant negative concentration index for MetS (C=-0.13; 95% CI, -0.16 to -0.09), indicating a concentration of MetS among participants with a lower SES. The most prevalent component was abdominal obesity (59.14%) with a significant negative concentration index (C=-0.21; 95% CI, -0.25 to -0.18). According to decomposition analysis, age, gender, and education were the highest contributing factors to inequality in MetS and its components. CONCLUSIONS This study showed socioeconomic inequality in MetS. People with a low SES were more likely to have MetS. Therefore, policymakers and health managers need to develop appropriate strategies to reduce these inequalities in MetS across age groups, genders, and education levels, especially among women and the elderly.
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Affiliation(s)
- Pardis Mohammadzadeh
- Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Farhad Moradpour
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Bijan Nouri
- Health Metrics and Evaluation Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Farideh Mostafavi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farid Najafi
- Department of Epidemiology, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ghobad Moradi
- Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
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11
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Ibarra-Sanchez AS, Chen G, Wisløff T. Are relative educational inequalities in multiple health behaviors widening? A longitudinal study of middle-aged adults in Northern Norway. Front Public Health 2023; 11:1190087. [PMID: 37674677 PMCID: PMC10477439 DOI: 10.3389/fpubh.2023.1190087] [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: 03/20/2023] [Accepted: 07/31/2023] [Indexed: 09/08/2023] Open
Abstract
Introduction Educational inequality in multiple health behaviors is rarely monitored using data from the same individuals as they age. The aim of this study is to research changes in relative educational inequality in multiple variables related to health behavior (smoking, physical activity, alcohol intake, and body mass index), separately and collectively (healthy lifestyle), among middle-aged adults living in Northern Norway. Methods Data from adult respondents aged 32-87 in 2008 with repeated measurements in 2016 (N = 8,906) were drawn from the sixth and seventh waves of the Tromsø Study. Logistic regression was used to assess the relative educational inequality in the variables related to health behavior. The analyses were performed for the total sample and separately for women and men at both baseline and follow-up. Results Educational inequality was observed in all the variables related to health behavior at baseline and follow-up, in both men and women. Higher levels of educational attainment were associated with healthier categories (non-daily smoking, physical activity, normal body mass index, and a healthy lifestyle), but also with high alcohol intake. The prevalence of daily smoking and physical inactivity decreased during the surveyed period, while high alcohol intake, having a body mass index outside of the normal range and adhering to multiple health recommendations simultaneously increased. The magnitude of relative educational inequality measured at baseline increased at the follow-up in all the variables related to health behavior. Differences were larger among women when compared to men, except in physical inactivity. Conclusion Persistent and increasing relative disparities in health behavior between the highest education level and lower education levels are found in countries with well-established and comprehensive welfare systems like Norway. Addressing these inequalities is essential for reducing both the chronic disease burden and educational disparities in health.
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Affiliation(s)
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, VIC, Australia
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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12
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Wang L, Zhang H, Yao H, Gong C, Zhong J, Liu D, Liang Z. Social determinants of health and hypertension in women compared with men in the United States: An analysis of the NHANES study. Clin Cardiol 2023; 46:958-966. [PMID: 37430468 PMCID: PMC10436798 DOI: 10.1002/clc.24079] [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: 04/20/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Social determinants of health (SDH) reflecting social deprivation have been developed for population health management. There is a paucity of data on the prevalence of SDH and its associations with prevalent hypertension in women compared with men. METHODS A total of 49 791 participants aged over 20 years from the 1999-2018 National Health and Nutrition Examination Surveys, were included. Information on the SDH, including race/ethnicity, education level, family income, housing, marriage status, employment, were collected. We calculated the prevalence ratio (PR) for each adverse SDH with prevalent hypertension and uncontrolled hypertension by using Cox regression with equal times of follow-up assigned to all individuals with adjustment for age, diabetes, taking lipid-lowering medication, and health behaviors. The population-attributable fractions (PAF) of the SDH were also assessed. RESULTS A lower proportion of low education attainment was observed in women than men (women: 16.8% vs. men: 17.9%, p = .003), but women had higher proportions of low family income (15.3% vs. 12.5%, p < .001), unmarried state (47.3% vs. 40.9%, p < .001), and unemployment (22.7% vs. 10.7%, p < .001). All the SDH was significantly associated with hypertension in women. There were significant dose-response associations between the numbers of adverse SDH with hypertension. The total PAF of SDH for prevalent hypertension was greater in women (22.2%) than in men (13.9%). CONCLUSIONS The widely influential SDH is associated with prevalent hypertension and uncontrolled hypertension. To improve hypertension management, health resources should prioritize socioeconomically disadvantaged groups considering gender differences.
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Affiliation(s)
- Li Wang
- Department of CardiologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Hao Zhang
- Department of Clinical MedicineNorth China University of Science and TechnologyTangshanChina
| | - Hong Yao
- Department of CardiologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Chunlin Gong
- Department of CardiologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Jiaoyue Zhong
- Department of CardiologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Dongxue Liu
- Department of CardiologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Zhaoguang Liang
- Department of CardiologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
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Friberg-Felsted K, Caserta M. Essentials to Improve the Effectiveness of Healthy Aging Programming: Consideration of Social Determinants and Utilization of a Theoretical Model. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6491. [PMID: 37569031 PMCID: PMC10418411 DOI: 10.3390/ijerph20156491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023]
Abstract
Older adult health, while partially determined by genetics, is mostly determined by behavioral and lifestyle choices. Researchers and interventionists develop and administer behavioral health interventions with older adults, and interventions are advertised in any number of settings, for example, by providers in healthcare settings and by activity directors in senior centers or assisted living facilities. However, previous studies and metanalyses indicate that many interventions targeting older adults are unsuccessful in recruitment or in retention. While providers and activity directors may assume older adults are unwilling to participate in behavioral change, in reality, low participation may be caused by erroneous design and administration. The objective of this manuscript is to recommend to creators and implementers of behavioral interventions for older adults that they focus on two critical considerations: the contextual perspective pertaining to healthy aging as well as an appropriately employed theoretical model that most effectively informs program design and implementation. In this commentary, we discuss how Prochaska and DiClemente's Transtheoretical Model of Health Behavior Change may lead to more desirable outcomes as it considers that a person may be at any one of six stages of change, from pre-contemplation to maintenance. Currently, many behavioral interventions are targeted at individuals who are poised for action or in maintenance phases, ignoring those in earlier phases, resulting in limited overall success. Regarding viewing healthy aging in a contextual manner, determinants external to the individual may remain unnoted and unconsidered when designing or recruiting for a behavioral intervention. In conclusion, the integration of an intrapersonal health behavior model such as the Transtheoretical Model of Health Behavior Change, coupled with clearer considerations of the interplay of contextual factors operating in the lives of older adults, may allow for more effective design and implementation, as well as resulting in higher participation in behavioral interventions targeted toward older adults.
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Affiliation(s)
- Katarina Friberg-Felsted
- Gerontology Interdisciplinary Program, College of Nursing, University of Utah, Salt Lake City, UT 84112, USA
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Ye CJ, Kong LJ, Wang YY, Dou C, Zheng J, Xu M, Xu Y, Li M, Zhao ZY, Lu JL, Chen YH, Ning G, Wang WQ, Bi YF, Wang TG. Mendelian randomization evidence for the causal effects of socio-economic inequality on human longevity among Europeans. Nat Hum Behav 2023; 7:1357-1370. [PMID: 37386110 DOI: 10.1038/s41562-023-01646-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/02/2023] [Indexed: 07/01/2023]
Abstract
Human longevity correlates with socio-economic status, and there is evidence that educational attainment increases human lifespan. However, to inform meaningful health policies, we need fine-grained causal evidence on which dimensions of socio-economic status affect longevity and the mediating roles of modifiable factors such as lifestyle and disease. Here we performed two-sample Mendelian randomization analyses applying genetic instruments of education, income and occupation (n = 248,847 to 1,131,881) to estimate their causal effects and consequences on parental lifespan and self-longevity (n = 28,967 to 1,012,240) from the largest available genome-wide association studies in populations of European ancestry. Each 4.20 years of additional educational attainment were causally associated with a 3.23-year-longer parental lifespan independently of income and occupation and were causally associated with 30-59% higher odds of self-longevity, suggesting that education was the primary determinant. By contrast, each one-standard-deviation-higher income and one-point-higher occupation was causally associated with 3.06-year-longer and 1.29-year-longer parental lifespans, respectively, but not independently of the other socio-economic indicators. We found no evidence for causal effects of income or occupation on self-longevity. Mediation analyses conducted in predominantly European-descent individuals through two-step Mendelian randomization suggested that among 59 candidates, cigarettes per day, body mass index, waist-to-hip ratio, hypertension, coronary heart disease, myocardial infarction, stroke, Alzheimer's disease, type 2 diabetes, heart failure and lung cancer individually played substantial mediating roles (proportion mediated, >10%) in the effect of education on specific longevity outcomes. These findings inform interventions for remediating longevity disparities attributable to socio-economic inequality.
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Affiliation(s)
- Chao-Jie Ye
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li-Jie Kong
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Ying Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun Dou
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Zheng
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhi-Yun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie-Li Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Hong Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei-Qing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yu-Fang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Tian-Ge Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumor, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Jin Y, Liang J, Hong C, Liang R, Luo Y. Cardiometabolic multimorbidity, lifestyle behaviours, and cognitive function: a multicohort study. THE LANCET. HEALTHY LONGEVITY 2023:S2666-7568(23)00054-5. [PMID: 37150183 DOI: 10.1016/s2666-7568(23)00054-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Little is known about the effect of lifestyle factors on cognitive decline related to cardiometabolic multimorbidity. We aimed to examine the association between cardiometabolic multimorbidity and cognitive decline, and the role of lifestyle factors in this association. METHODS We did a pooled multi-cohort study using pooled data from four cohort studies (the Health and Retirement Study; the English Longitudinal Study of Ageing; the Survey of Health, Ageing and Retirement in Europe; and the China Health and Retirement Longitudinal Study) across 14 countries. Eligible participants were age 50 years and older, and those who were missing information on exposure and outcomes, or who had been diagnosed with dementia or Parkinson's disease, were excluded. Cardiometabolic multimorbidity was defined as the co-occurrence of two or three cardiometabolic diseases, including diabetes, heart disease, and stroke. The primary outcome of cognitive function was measured in three domains, on the basis of the mean and SD of the corresponding tests: memory, numeracy, and orientation, in all participants with available data. A global cognitive score was created by summing the individual scores. FINDINGS The final sample consisted of 160 147 individuals across all four studies (73 846 [46·1%] men and 86 301 [53·9%] women) and participants had a mean age of 67·49 years (SD 10·43). An increasing number of cardiometabolic diseases was dose-dependently associated with the decline in cognitive function score (one disease, β=-0·15 [95% CI -0·17 to -0·13]; two diseases, β=-0·37 [-0·40 to -0·34]; three diseases, β=-0·57 [-0·64 to -0·50]), with comorbid diabetes and stroke (β=-0·23 [-0·29 to -0·17]) contributing most strongly to cardiometabolic disease-associated cognitive decline. Cognitive decline associated with cardiometabolic disease was accelerated with physical inactivity (one cardiometablic disease, p=0·020; two cardiometablic diseases, p=0·42; and three cardiometablic diseases, p=0·24), excessive alcohol use (one cardiometablic disease, p=0·016; two cardiometablic diseases, p=0·65; and three cardiometablic diseases, p=0·50), and the higher number of unhealthy lifestyle factors (one cardiometablic disease, p=0·79; two cardiometablic diseases, p=0·0050; and three cardiometablic diseases, p=0·888). INTERPRETATION These findings indicated a targeted approach for simultaneously developing preventative interventions on lifestyles and integrated treatment for cardiometabolic comorbidities to delay cognitive decline in older people. FUNDING Major Project of the National Social Science Fund of China, National Natural Science Foundation of China, China Medical Board, and Young Elite Scientists Sponsorship Program by CAST.
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Affiliation(s)
- Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Jersey Liang
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Chenlu Hong
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Richard Liang
- Department of Epidemiology & Population Health, School of Medicine, Stanford University, Stanford, CA, USA
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China.
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Jin Y, Hong C, Luo Y. Sex differences in cognitive aging and the role of socioeconomic status: Evidence from multi-cohort studies. Psychiatry Res 2023; 321:115049. [PMID: 36706558 DOI: 10.1016/j.psychres.2023.115049] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Sex differences exist in cognitive function, and socioeconomic status (SES) may play a role in changing these discrepancies. This study investigated the role of SES in contributing to sex differences in cognitive function. METHODS We conducted a pooled multi-cohort study on the basis of four comparative cohort studies from the UK, the US, Europe and China to assess sex differences and the role of SES in cognitive decline by birth cohort (1930-1938, 1939-1945, 1946-1968). Cognitive function was measured in three domains based on the mean and SD of the corresponding tests: episodic memory, working memory, and time orientation. SES was the summed scores of education and household wealth. FINDINGS 61,019 individuals were involved. Cognitive function of women declined faster than those of men as growing old (particularly after 80 years old). As SES increased, cognitive function increased more for women than for men in most cases among later-born cohorts (1930-1938, 1939-1945, 1946-1968) (e.g., episodic memory scores at 60 years old: women exhibited an increase from -0.09 [95%CI -0.12, -0.07] in low SES to 0.89 [0.86, 0.92] in high SES; men from -0.16 [-0.19, -0.14] to 0.59 [0.56, 0.62]). However, sex-specific cognitive benefits were absent in the oldest birth cohort (1895-1929). INTERPRETATION These findings highlight the importance of considering the role of SES in the discrepancy of sex difference in cognitive aging.
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Affiliation(s)
- Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China
| | - Chenlu Hong
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China.
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17
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Wang Z, Chan K, Poon AN, Guo Y. An equitable route forward from China's 'zero COVID' policy. Nat Med 2023; 29:514-515. [PMID: 36627341 DOI: 10.1038/d41591-023-00002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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18
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Li S, Wei J, Hu Y, Liu Y, Hu M, Shi Y, Xue Y, Liu M, Xie W, Guo X, Liu X. Long-term effect of intermediate particulate matter (PM 1-2.5) on incident asthma among middle-aged and elderly adults: A national population-based longitudinal study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 859:160204. [PMID: 36403826 DOI: 10.1016/j.scitotenv.2022.160204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/25/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There is insufficient evidence about the long-term effects of intermediate particulate matter (PM1-2.5) on asthma development in adults aged 45 years and above. This study aimed to investigate the relationship between long-term exposure to PM1-2.5 and the incidence of asthma in adults aged 45 years and above. METHODS A cohort study based on the China Health and Retirement Longitudinal Study (CHARLS) database was conducted to investigate the long-term effects of PM1-2.5 on self-reported asthma incidence in adults aged 45 years and above in China from 2011 to 2018. The PM concentrations were estimated using a high-resolution (1 km2) satellite-based spatiotemporal model. A covariate-adjusted generalized linear mixed model was used to analyze the relationship between long-term exposure to PM1-2.5 and the incidence of asthma. Effect modifications and sensitivity analysis were conducted. RESULTS After a 7-year follow-up, 103 (1.61 %) of the 6400 participants developed asthma. Each 10 μg/m3 increment in the 1-, 2-, 3-, and 4-year moving average concentrations of PM1-2.5 corresponded to a 1.82 [95 % confidence interval (CI):1.11-2.98], 1.95 (95 % CI: 1.24-3.07), 1.95 (95 % CI: 1.26-3.03) and 1.88 (95 % CI: 1.26-2.81) fold risk for incident asthma, respectively. A significant multiplicative interaction was observed between socioeconomic level and long-term exposure to PM1-2.5. Stratified analysis showed that smokers and those with lower socioeconomic levels were at higher risk of incident asthma related to PM1-2.5. Restricted cubic splines showed an increasing trend in asthma incidence with increasing PM1-2.5. Sensitivity analyses showed that our model was robust. CONCLUSION Long-term exposure to PM1-2.5 was positively associated with incident asthma in middle-aged and elderly individuals. Participants with a history of smoking and lower socioeconomic levels had a higher risk. More studies are warranted warrant to establish an accurate reference value of PM1-2.5 to mitigate the growing asthma burden.
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Affiliation(s)
- Shuting Li
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Jing Wei
- Department of Chemical and Biochemical Engineering, Iowa Technology Institute, Center for Global and Regional Environmental Research, University of Iowa, USA
| | - Yaoyu Hu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Yuhong Liu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Meiling Hu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Yadi Shi
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Yongxi Xue
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Mengmeng Liu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
| | - Wenhan Xie
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China
| | - Xiuhua Guo
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China; National Institute for Data Science in Health and Medicine, Capital Medical University, China; Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Australia.
| | - Xiangtong Liu
- School of Public Health, Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing 100069, China.
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Li WHC, Ho LLK, Cheung AT, Xia W, Song P, Chung JOK. Health-Risk Behaviors among Chinese Adults during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2157. [PMID: 36767525 PMCID: PMC9914950 DOI: 10.3390/ijerph20032157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 01/21/2023] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
This study analyzed archived data from a previous large-scale survey study on multiple health-risk behaviors among Chinese adults in Hong Kong between 21 June and 31 August 2021. In addition, this study examined participants' perceptions of the risks associated with their behaviors, their attitudes toward adopting healthy behaviors, and the impact of COVID-19 on their health-risk behaviors. A total of 4605 participants who had at least one health-risk behavior were included in the analysis. The results showed that about half of the participants were unaware that non-communicable diseases (NCDs) can be caused by health-risk behaviors such as tobacco use, harmful use of alcohol, physical inactivity, and an unhealthy diet. More than half of the participants did not have regular body checkups or monitor their physical health at home. Many participants paid more attention to their health due to the COVID-19 pandemic, but few made changes to their unhealthy habits or adopted a healthier lifestyle. Of the 704 smokers, 60.9% did not realize that smoking increases the risk of transmitting COVID-19 to others. Only 32.2% and 11.9% smokers had the intention to quit smoking and reduced their cigarette consumption, respectively. Additionally, 13.6% reported that their daily cigarette consumption had increased, and 78.8% changed their smoking behavior during the pandemic. Healthcare professionals must educate the public about the association between health-risk behaviors and NCDs and between COVID-19 and NCDs. The government should formulate a long-term plan to strengthen the primary healthcare system and address the challenges posed by the rising prevalence of NCDs.
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Affiliation(s)
- William Ho Cheung Li
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Laurie Long Kwan Ho
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Ankie Tan Cheung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Wei Xia
- School of Nursing, Sun Yat-Sen University, Guangzhou 510275, China
| | - Peige Song
- School of Public Health, Zhejiang University School of Medicine, Hangzhou 310027, China
- Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh EH8 9YL, UK
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20
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Kivimäki M, Marmot MG. Socioeconomic patterns in health behaviours after disease onset. Lancet Public Health 2022; 7:e648-e649. [PMID: 35907413 DOI: 10.1016/s2468-2667(22)00162-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/22/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - Michael G Marmot
- Institute of Health Equity, University College London, London, UK
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