Association between social participation and hypertension among older people in Japan: the JAGES Study

Social participation and functional disability trajectories in the last three years of life: The Japan Gerontological Evaluation Study

BACKGROUND

Functional disability has various patterns from onset until death. Although social participation is a known protective factor against functional disability among older individuals, it is unclear whether social participation is associated with the trajectory patterns of functional disability prior to death. This study assessed the association between social participation, specifically in horizontal and vertical groups, and the trajectories of functional disability prior to death.

METHODS

We used survey data from the 2010 Japan Gerontological Evaluation Study for functionally independent older adults combined with public long-term care insurance system data from 2010 to 2016 (n = 4,502). The outcome variables included five previously identified trajectory patterns using group-based trajectory modeling. As the explanatory variable, we used three definitions of social participation: any group, horizontal group (e.g., sports, hobbies), or vertical group (e.g., political, religious), at least once a month. We used a multinomial logistic regression analysis to calculate odds ratios with 95 % confidence intervals for the identified trajectory patterns.

RESULTS

Participation in any groups was significantly less likely to belong to "Accelerated disability" (OR=0.74 [95 % CIs 0.60-0.92]), "Persistently mild disability" (0.68 [0.55-0.84]), and "Persistently severe disability" (0.67 [0.50-0.83]) compared to "Minimum disability." Although participation in horizontal groups was similarly associated with trajectories regardless of gender, vertical groups was not associated with trajectories among males.

CONCLUSIONS

Social participation among older adults may be associated with an extended period of living without disabilities before death. This association may differ by gender and social participation group and requires further research.

Comparison of the Incidence of Functional Disability Correlated With Social Participation Among Older Adults in Japan

BACKGROUND

Japan, which has the world's longest life expectancy, has been reporting rejuvenation of physical function among its older adult population. However, evidence for the incidence of functional disability is limited. This study aimed to investigate the comparison in the incidence of functional disability.

DESIGN

We used data from the Japan Gerontological Evaluation Study.

SETTING AND PARTICIPANTS

The participants were 2 nonoverlapping cohorts of 22,522 (2010-2013 cohort) and 26,284 (2016-2019 cohort) individuals aged 65 years and older from 5 municipalities who were followed for 3 years each.

METHODS

The incidence rates of functional disability during the 3-year follow-up period were compared between cohorts. To examine the incident differences between the cohorts, we adjusted for social participation and 9 additional factors that would be expected to improve with social participation using the Weibull survival models adjusting for municipalities as random effects. The analysis was stratified by age groups (65-74 years old and ≥75).

RESULTS

The incidence rate of functional disability per 10,000 person-years decreased from 68.6 (2010-2013 cohort) to 51.4 (2016-2019 cohort) in the 65 to 74 years old group and 380.0 (2010-2013 cohort) to 282.6 (2016-2019 cohort) in the ≥75 group; the hazard ratios (95% CIs) were 0.75 (0.64-0.89) and 0.73 (0.67-0.80), respectively. However, these significant decreases disappeared with adjustments for social participation and additional factors.

CONCLUSIONS AND IMPLICATIONS

The incidence of functional disability decreased in a recent cohort, which may be explained by social participation and possibly related factors. Promoting social participation could contribute to a decreasing incidence of functional disability among older adults.

Association between workplace social capital and systolic blood pressure among 23 173 workers at 367 small-sized and medium-sized enterprises in Japan: a cross-sectional study

OBJECTIVES

Social capital (SC) has been shown to be inversely associated with elevated blood pressure. While SC in the workplace may also be associated with blood pressure, it has not been extensively studied. We aimed to investigate the association between workplace SC and systolic blood pressure (SBP).

DESIGN

A cross-sectional study.

SETTING

367 small-sized and medium-sized companies in Japan.

PARTICIPANTS

A total of 23 173 participants (15 991 males and 7182 females) aged ≥18 years.

EXPOSURE OF INTEREST

SC was assessed using individual responses to eight 4-point Likert questions used in the Brief Job Stress Questionnaire. Workplace SC was assessed as the mean of individual-level responses to the SC questions from those working in the same company.

OUTCOME MEASURE

Systolic blood pressure (SBP) RESULTS: A multilevel linear regression model revealed that higher workplace-level SC was linked with lower SBP (coef.=-0.53 per 1SD increment in workplace SC, 95% CI=-1.02 to -0.05) among females in the age-adjusted model, which remained statistically significant after adjusting for other covariates. After adjusting for individual-level SC, this association was attenuated and became non-significant (coef.=-0.41, 95% CI=-0.87 to 0.05), while individual-level SC was inversely associated with SBP (coef.=-0.43, 95% CI=-0.73 to -0.13). Among males, we did not find any evidence of significant inverse associations either in relation to workplace SC (coef.=-0.12, 95% CI=-0.46 to 0.21) or individual-level SC (coef.=0.19, 95% CI=-0.01 to 0.39).

CONCLUSIONS

Our study findings suggested that workplace-level SC can affect SBP differently by sex.

A Biopsychosocial Model Predicting Myocardial Infarction

Myocardial infarction is one of the main causes of death, and cardiovascular risk factors (CVRFs) are always considered when studying it. However, although it is known that other social and psychological variables, and especially frailty, can increase the risk of infarction, their simultaneous effect has not been extensively studied. This study is based on data from the SHARE project (latest wave, Wave 8), with a representative sample of 46,498 participants aged 50 or older (M = 70.40, SD = 9.33), of whom 57.4% were females. Statistical analyses included a full structural equation model that predicts 27% of infarction occurrence and evidences the significant effect of well-being, depression, and social connectedness on frailty. Frailty, in turn, explains 15.5% of the variability of CVRFs. This work supports the need to study these physical, social, and mental health factors together to intervene on frailty and, in turn, improve cardiovascular outcomes.

Association between multimorbidity patterns and incident depression among older adults in Taiwan: the role of social participation

Background

Previous research has found different multimorbidity patterns that negatively affects health outcomes of older adults. However, there is scarce evidence, especially on the role of social participation in the association between multimorbidity patterns and depression. Our study aimed to explore the relationship between multimorbidity patterns and depression among older adults in Taiwan, including the social participation effect on the different multimorbidity patterns.

Methods

Data were retracted from the Taiwan longitudinal study on ageing (TLSA) for this population-based cohort study. 1,975 older adults (age > 50) were included and were followed up from 1996 to 2011. We used latent class analysis to determine participants’ multimorbidity patterns in 1996, whereas their incident depression was determined in 2011 by CES-D. Multivariable logistic regression was used to analyse the relationship between multimorbidity patterns and depression.

Results

The participants’ average age was 62.1 years in 1996. Four multimorbidity patterns were discovered through latent class analysis, as follows: (1) Cardiometabolic group (n = 93), (2) Arthritis-cataract group (n = 105), (3) Multimorbidity group (n = 128) and (4) Relatively healthy group (n = 1649). Greater risk of incident depression was found among participants in the Multimorbidity group (OR: 1.62; 95% CI: 1.02–2.58) than the Relatively healthy group after the multivariable analysis. Compare to participants in the relatively healthy group with social participation, participants in the arthritis-cataract group without social participation (OR: 2.22, 95% CI: 1.03–4.78) and the multimorbidity group without social participation (OR: 2.21, 95% CI: 1.14–4.30) had significantly increased risk of having depression.

Conclusion

Distinct multimorbidity patterns among older adults in Taiwan are linked with the incident depression during later life, and social participation functioned as a protective factor.

Individual-level social capital is associated with depressive symptoms among middle-aged community dwellers in rural Vietnam: a cross-sectional study

OBJECTIVES

There has been comparatively little research on the association between social capital and depressive symptoms in low- and middle-income countries. To address this deficit this study examined the association among middle-aged adults in rural Vietnam.

DESIGN

A cross-sectional study.

SETTING

Data came from the baseline survey of the Khánh Hòa Cardiovascular Study, which is an ongoing prospective cohort study aiming to elucidate the determinants of cardiovascular diseases.

PARTICIPANTS

A total of 3000 people aged 40-60 years old residing in rural communes in Khánh Hòa province, Vietnam.

EXPOSURE OF INTEREST

Cognitive social capital (ie, low, middle and high) and structural social capital (in terms of social participation; yes or no) were assessed via a questionnaire.

PRIMARY OUTCOME MEASURE

Depressive symptoms were assessed with the 11-item Center for Epidemiologic Studies Depression Scale.

RESULTS

A robust Poisson regression model revealed that adults in the highest versus lowest cognitive social capital tertile had a 61% lower prevalence of depressive symptoms (prevalence ratio (PR)=0.39, 95% CI=0.31 to 0.49). Individuals with higher structural social capital were also significantly less likely to experience depressive symptoms (PR=0.74, 95% CI=0.61 to 0.90).

CONCLUSION

In a cohort of 3000 middle-aged rural residents in Vietnam, both cognitive and structural social capital assessed at the individual level were inversely associated with the prevalence of depressive symptoms.

Internet use and physical activity of older adults during the COVID-19 pandemic: a cross-sectional study in a northern Japanese City

Background

Little is known of whether Internet use is associated with physical activity among socially isolated older adults during the coronavirus disease 2019 (COVID-19) pandemic. This study investigated the association between Internet use and physical activity, and whether this association differs depending on social isolation among community-dwelling Japanese older adults.

Methods

A cross-sectional study was conducted with 1048 community-dwelling residents aged 65–90 years. Data were obtained using a self-reported questionnaire in August 2020. Physical activity was assessed using the International Physical Activity Questionnaire-Short Form. Multivariable logistic regression analyses were used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between Internet use and moderate-to-vigorous physical activity (MVPA).

Results

Internet use showed a significant association with MVPA (OR = 1.42, 95% CI: 1.06–1.90) after adjusting for age, sex, self-reported socioeconomic status, and other health-related characteristics. When the results were stratified by social participation and living status, Internet use was associated with a significantly higher likelihood of MVPA among participants with no social participation (OR = 1.81, 95% CI: 1.03–3.17) and living with family (OR = 1.40, 95% CI: 1.02–1.93).

Conclusion

Internet use was associated with sufficient physical activity, and this association may differ depending on the social isolation among community-dwelling older adults in Japan.

An Interpretable Machine Learning Approach to Predict Fall Risk Among Community-Dwelling Older Adults: a Three-Year Longitudinal Study

BACKGROUND

Adverse health effects resulting from falls are a major public health concern. Although studies have identified risk factors for falls, none have examined long-term prediction of fall risk. Furthermore, recent evidence suggests that there are additional risk factors, such as psychosocial factors.

OBJECTIVE

In this 3-year longitudinal study, we evaluated a predictive model for risk of fall among community-dwelling older adults using machine learning methods.

DESIGN

A 3-year follow-up prospective longitudinal study (from 2010 to 2013).

SETTING

Twenty-four municipalities in nine of the 47 prefectures (provinces) of Japan.

PARTICIPANTS

Community-dwelling individuals aged ≥65 years who were functionally independent at baseline (n = 61,883).

METHODS

The baseline survey was conducted from August 2010 to January 2012, and the follow-up survey was conducted from October to December 2013. Both surveys were conducted involving self-reported questionnaires. The measured outcome at the follow-up survey was self-reported multiple falls during the previous year. The 142 variables included in the baseline survey were regarded as candidate predictors. The random-forest-based Boruta algorithm was used to select predictors, and the eXtreme Gradient Boosting algorithm with 10 repetitions of nested k-fold cross-validation was used for modeling and model evaluation. Furthermore, we used shapley additive explanations to gain insight into the behavior of the prediction model.

KEY RESULTS

Fourteen out of 142 candidate features were selected as predictors. Among these predictors, experience of falling as of the baseline survey was the most important feature, followed by self-rated health and age. Moreover, sense of coherence was newly identified as a risk factor for falls.

CONCLUSIONS

This study suggests that machine learning tools can be adapted to explore new associative factors, make accurate predictions, and provide actionable insights for fall prevention strategies.

Social determinants of hypertension in high-income countries: A narrative literature review and future directions

Hypertension is a leading cause of cardiovascular disease and despite established strategies to lower blood pressure, the control of hypertension remains poor. This is true even in high-income countries with well-established welfare and medical systems. Among the social factors associated with hypertension (i.e., social determinants of hypertension, SDHT), individual socioeconomic status (SES), including education, income, and occupation, can be crucial for hypertension management (prevalence, awareness, treatment, and control). This article reviews the findings of recently published studies that examined the association between SES and hypertension management in high-income countries. It also discusses social prescribing, which targets social isolation and loneliness as modifiable SDHT to improve hypertension management.

Conceptual framework of social determinants of hypertension

Association between social participation and hypertension control among older people with self-reported hypertension in Japanese communities

Hypertension control remains poor worldwide despite well-established strategies for lowering blood pressure. Social participation has been associated with a lower prevalence of hypertension, but evidence is scarce regarding hypertension control. The aim of this study was to examine the relationship between social participation and hypertension control among older people. We used cross-sectional data from participants of the 2019 wave of the Japan Gerontological Evaluation Study (JAGES; n = 13,629). Social participation was defined as no participation, participation in one group, or participation in two or more groups. After adjusting for covariates, modified Poisson regression analysis showed that participation in two or more groups (prevalence ratio [95% confidence interval]: 1.08 [1.03-1.13]) was associated with better control of hypertension than no participation, but participation in one group (1.02 [0.96-1.08]) was not. Social participation in multiple groups was associated with better control of hypertension among older people in Japan.

Art and cultural activity engagement and depressive symptom onset among older adults: A longitudinal study from the Japanese Gerontological Evaluation Study

OBJECTIVES

Art and cultural activities can benefit mental health. However, there is insufficient evidence on active engagement in art and cultural activities for preventing depressive symptoms among older adults. Therefore, we examined the association of active engagement in art and cultural activities with depressive symptom onset among older adults using 3-year longitudinal data.

METHODS

This longitudinal study recruited non-institutionalised older adults independent in daily living from the Japan Gerontological Evaluation Study (JAGES) established in 2010, and those without depressive symptoms were followed for three years. Depressive symptoms were assessed using the 15-item Geriatric Depression Scale. Active engagement in nine art and cultural activities, including Japanese traditional cultural activities, were evaluated (musical performance, singing, dancing, handicrafts, painting, photography, poetry composition, calligraphy, and tea ceremony/flower arrangement).

RESULTS

Ultimately, 37,627 older adults without depressive symptoms at baseline were analysed. The participants' mean age (standard deviation) was 72.6 (5.5) years, and 51.5% were female. During the follow-up period, depressive symptoms occurred in 3844 participants (10.2%). Multivariable logistic regression analysis revealed that active engagement in art and cultural activities was inversely associated with depressive symptom onset (odds ratio = 0.80, 95% confidence interval = 0.73-0.87, p < 0.001). This association was confirmed regardless of age, gender, and socioeconomic status. Among the activities, especially dancing and photography were protective against depressive symptoms.

CONCLUSION

Active engagement in art and cultural activities may contribute to preventing depressive symptoms among older adults. Promoting art and cultural engagement could be important to protect their mental health.

Impact of the Changes in the Frequency of Social Participation on All-Cause Mortality in Japanese Older Adults: A Nationwide Longitudinal Study

Previous studies have shown that more frequent social participation was associated with a reduced risk of mortality. However, limited studies have explored the changes in the frequency of social participation in older adults. We investigated the impact of the changes in the frequency of social participation on all-cause mortality in Japanese older adults aged 60 years and older. The current study, conducted as a secondary analysis, was a retrospective cohort study using open available data. The participants were 2240 older adults (45.4% male and 54.6% female) sampled nationwide from Japan who responded to the interview survey. Changes in the frequency of social participation were categorized into four groups (none, initiated, decreased, and continued pattern) based on the responses in the baseline and last surveys. The Cox proportional-hazards model showed a decreased risk of all-cause mortality in decreased and continued patterns of social participation. Stratified analysis by sex showed a decreased risk of mortality in the continued pattern only among males. The results of the current study suggest that the initiation of social participation at an earlier phase of life transition, such as retirement, may be beneficial for individuals.

Is social participation associated with good self-rated health among visually impaired older adults?: the JAGES cross-sectional study

Background

While it has been recognized that visual impairment is associated with poor self-rated health (SRH), in addition to various negative health outcomes of visual impairment, the number of older adults with visual impairment is increasing due to population aging. As increasing evidence has been found for the effectiveness of social participation on good SRH, we examined whether there was an association between social participation and SRH and investigated whether the effect differed by visual status.

Methods

Questionnaire data on self-reported visual status, social participation, socioeconomic status, and SRH were obtained in 2016. A total of 24,313 community-dwelling individuals aged 65 and over participated. We examined the association of social participation and SRH status among older adults with visual impairment. Stratified analysis and analysis with an interaction term between social participation and visual status were also conducted. Social participation was assessed by the number of participating groups (no participation, one, two, and three or more).

Results

Overall visual impairment prevalence was 9.3% (95% CI: 8.9–9.7). Among those with and without visual impairment, prevalence of poor SRH was 38.4 and 13.1%, respectively. However, the association between social participation with SRH was similar, especially for those who participated in one or two groups. For people with (PR = 0.54) and without visual impairment (PR = 0.50), those who participated in two groups showed lower prevalence ratios for poor SRH compared to people without social participation.

Conclusion

Social participation showed a beneficial association with SRH among older adults with visual impairment. Future interventions could focus on the potentially positive role of social participation on SRH among older adults with visual impairment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02554-7.

Associations between Socioeconomic Status, Social Participation, and Physical Activity in Older People during the COVID-19 Pandemic: A Cross-Sectional Study in a Northern Japanese City

Physical activity (PA) is a key determinant of health in older adults. However, little is known about the effect of social factors on PA among older adults during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, we aimed to clarify the association between socioeconomic status, social participation, and PA during the pandemic. A cross-sectional study was conducted on 999 community-dwelling residents aged 65-90 years. A self-administered questionnaire was used to collect socioeconomic status, social participation, and PA data in August 2020. Multivariable logistic regression analyses were used to calculate the odds ratios (ORs) for the associations between socioeconomic status, social participation, and maintaining PA. For both sexes, PA was reduced by approximately 5%-10% after the onset of COVID-19-related distancing restrictions. Men with a low socioeconomic status were less physically active (OR = 0.49, 95% CI: 0.30-0.82). Women who reported social participation had higher odds of maintaining PA (OR = 1.67, 95% CI: 1.13-2.45) during the restrictions. Higher socioeconomic status and social participation levels before the COVID-19 pandemic may have helped older adults to maintain PA during the COVID-19 pandemic. Further research is needed to clarify the potential effects of these factors on the health of older adults.

Impact of Social Isolation Due to COVID-19 on Health in Older People: Mental and Physical Effects and Recommendations

OBJECTIVES

To review the impact of social isolation during COVID-19 pandemic on mental and physical health of older people and the recommendations for patients, caregivers and health professionals.

DESIGN

Narrative review.

SETTING

Non-institutionalized community-living people.

PARTICIPANTS

20.069 individuals from ten descriptive cross-sectional papers.

MEASUREMENTS

Articles since 2019 to 2020 published on Pubmed, Scielo and Google Scholar databases with the following MeSh terms ('COVID-19', 'coronavirus', 'aging', 'older people', 'elderly', 'social isolation' and 'quarantine') in English, Spanish or Portuguese were included. The studies not including people over 60 were excluded. Guidelines, recommendations, and update documents from different international organizations related to mental and physical activity were also analysed.

RESULTS

41 documents have been included in this narrative review, involving a total of 20.069 individuals (58% women), from Asia, Europe and America. 31 articles included recommendations and 10 addressed the impact of social distancing on mental or physical health. The main outcomes reported were anxiety, depression, poor sleep quality and physical inactivity during the isolation period. Cognitive strategies and increasing physical activity levels using apps, online videos, telehealth, are the main international recommendations.

CONCLUSION

Mental and physical health in older people are negatively affected during the social distancing for COVID-19. Therefore, a multicomponent program with exercise and psychological strategies are highly recommended for this population during the confinement. Future investigations are necessary in this field.

Impact of Social Isolation Due to COVID-19 on Health in Older People: Mental and Physical Effects and Recommendations

OBJECTIVES

To review the impact of social isolation during COVID-19 pandemic on mental and physical health of older people and the recommendations for patients, caregivers and health professionals.

DESIGN

Narrative review.

SETTING

Non-institutionalized community-living people.

PARTICIPANTS

20.069 individuals from ten descriptive cross-sectional papers.

MEASUREMENTS

Articles since 2019 to 2020 published on Pubmed, Scielo and Google Scholar databases with the following MeSh terms ('COVID-19', 'coronavirus', 'aging', 'older people', 'elderly', 'social isolation' and 'quarantine') in English, Spanish or Portuguese were included. The studies not including people over 60 were excluded. Guidelines, recommendations, and update documents from different international organizations related to mental and physical activity were also analysed.

RESULTS

41 documents have been included in this narrative review, involving a total of 20.069 individuals (58% women), from Asia, Europe and America. 31 articles included recommendations and 10 addressed the impact of social distancing on mental or physical health. The main outcomes reported were anxiety, depression, poor sleep quality and physical inactivity during the isolation period. Cognitive strategies and increasing physical activity levels using apps, online videos, telehealth, are the main international recommendations.

CONCLUSION

Mental and physical health in older people are negatively affected during the social distancing for COVID-19. Therefore, a multicomponent program with exercise and psychological strategies are highly recommended for this population during the confinement. Future investigations are necessary in this field.

Association Between Community-Level Social Participation and Self-reported Hypertension in Older Japanese: A JAGES Multilevel Cross-sectional Study

BACKGROUND

Many factors are associated with hypertension development. We focused on social participation as an aspect of social capital and investigated the contextual relationship between community-level social participation and hypertension using multilevel regression analyses.

METHODS

We used cross-sectional data from the 2016 Japan Gerontological Evaluation Study-a population-based study of functionally independent adults aged 65 years or older. The sample comprised 116,013 participants nested in 818 communities. Hypertension and social capital were defined by questionnaires. Social capital was assessed at both the individual and the community levels in 3 dimensions: civic participation (as an index of social participation), social cohesion, and reciprocity.

RESULTS

The prevalence rate of hypertension was 43.7%, and 44.1% of the respondents were involved in civic participation. Community-level civic participation, but not social cohesion or reciprocity, was negatively associated with hypertension in the total population (prevalence ratio (95% confidence interval): 0.98 (0.96-0.99), P = 0.004) and female group (0.97 (0.95-0.99), P = 0.015), and the association neared significance in the male group (0.98 (0.96-1.005), P = 0.13) after adjustment for individual-level social capital dimensions including civic participation, individual-level covariates, and population density as a community-level covariate. The interaction between community-level civic participation and sex in relation to hypertension was significant (P = 0.012).

CONCLUSIONS

We found a contextual preventive relationship between community-level civic participation and hypertension. The design of the contextual characteristics of communities by the promotion of social participation may help reduce the prevalence of hypertension in older people.

Reduced long-term care cost by social participation among older Japanese adults: a prospective follow-up study in JAGES

OBJECTIVES

Reducing costs related to functional disabilities and long-term care (LTC) is necessary in ageing societies. We evaluated the differences in the cumulative cost of public LTC insurance (LTCI) services by social participation.

DESIGN

Prospective observational study.

SETTING

Our baseline survey was conducted in March 2006 among people aged 65 or older who were not eligible for public LTCI benefits and were selected using a complete enumeration in Tokoname City, Japan. We followed up with their LTC services costs over a period of 11 years. Social participation was assessed by the frequency of participation in clubs for hobbies, sports or volunteering. We adopted a classical linear regression analysis and an inverse probability weighting (IPW), with multiple imputation of missing values.

PARTICIPANTS

Functionally independent 5377 older adults.

PRIMARY OUTCOME MEASURES

The cumulative cost of public LTCI services for 11 years.

RESULTS

Even when adjusting for the confounding variables, social participation at the baseline was negatively associated with the cumulative cost of LTCI services. The IPW model showed that in respondents who participated in hobby activities once a week or more, the cumulative cost of LTCI services for 11 years was lower, approximately US$3500 per person, in comparison to non-participants. Similarly, that in respondents who participated in sports group or clubs was lower, approximately US$6000 than non-participants.

CONCLUSIONS

Older adults' participation in community organisations may help reduce future LTC costs. Promoting participation opportunities in the community could ensure the financial stability of LTCI services.

Correlation between religion and hypertension

The objectives of the study were to investigate the relationship between religion and hypertension, as well as the theoretical mechanism through which religion exerts effect on hypertension. A MEDLINE literature search was performed on articles describing religion and hypertension (N = 543) excluding unqualified ones such as those without expected information, those neither correcting confounding factors nor matching the comparison groups and those reporting repeated trials. Eight extra articles from references of reviews were added to the included studies. Finally, 79 articles were formerly evaluated. Briefly, there are limited trials on correlation between religion and hypertension and their results are inconsistent. First of all, longitudinal investigations, especially the high-quality ones, are deficient. Secondly, studies evaluating religion as an integral are scarce, although they can assess religions most comprehensively. Third, few studies use several religious measurements that represent distinct dimensions of religion. Moreover, divergence exists among diverse populations, even if they are assessed by the same indicator. In addition, 59% studies are concerned with an unspecified species of religion, and Christianity is studied the most among those with a specific category of religion. Finally, the possible mechanism underlying religion and hypertension is complex, which can partially explain the different results among various populations. Comprehensive evaluation of a specific religion should be encouraged. In addition, for a specific population, the correlation between religion and hypertension should be examined particularly, even if similar investigations in other populations have been conducted. Finally, more evidence focused on the effects of distinct religions/sects is also required.

Preventive impact of social participation on the onset of non-communicable diseases among middle-aged adults: A 10-wave hazards-model analysis in Japan

Social participation (SP) is known to have a favorable impact on the health of older adults by reducing the risk of functional disability, psychological distress, cognitive impairment, and mortality. However, the preventive impact of SP on non-communicable diseases (NCDs) among middle-aged adults is largely understudied. Using the dataset from a population-based, 10-wave longitudinal survey that started with Japanese adults aged 50-59 years in 2005 (16,290 men and 17,248 women), we estimated Cox proportional hazards models to estimate the preventive impact of SP adjusted for baseline covariates. After controlling for baseline covariates, baseline participation in at least one of six types of SP prevented diabetes both for men (hazard rate [HR] = 0.86; 95% confidence interval [CI] = 0.77, 0.95) and women (HR = 0.75; 95% CI = 0.66, 0.85) and stroke both for men (HR = 0.83; 95% CI = 0.70, 0.99) and women (HR = 0.78; 95% CI = 0.64, 0.97). SP also had a preventive impact on hypertension only for women (HR = 0.91; 95% CI = 0.84, 0.99). SP did not prevent heart disease, hyperlipidemia, or cancer for either gender. We also found that SP tended to have a stronger preventive effect when it was conducted with other persons than done alone, highlighting personal interactions as a key aspect of SP for later health outcomes. Overall, the results showed that SP can prevent the onset of selected NCDs, suggesting that policy measures to encourage SP may be favorable for the health of middle-aged adults.

Association and Interaction Analysis of Body Mass Index and Triglycerides Level with Blood Pressure in Elderly Individuals in China

Objectives

To assess the extent of interaction between body mass index (BMI) and triglyceride (TG) level and its effects on blood pressure (BP) in elderly individuals in China.

Design

Cross-sectional study.

Setting

Data were taken from a cross-sectional study called the China Health and Retirement Longitudinal Study.

Participants

The analytic sample included 3629 subjects aged 45 to 96 years.

Main Outcome Measurements

Data were obtained from the China Health and Retirement Longitudinal Study, which is a cross-sectional study. Age-adjusted partial Pearson's correlation test was used to compare various characteristics and BP. Adjusted associations were first used as linear regression models, as appropriate. Then, general linear models adjusted for related potential confounders were used to examine the synergistic effects of BMI and TG level on BP. Finally, a binary logistic regression model adjusted for confounding factors was used to examine the association between BMI or TG level and hypertension.

Results

Age-adjusted partial Pearson's correlation coefficient showed that the TG level was positively correlated with both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in both men and women with BMI < 24.0 kg/m²; however, TG level was positively correlated with DBP in women with BMI ≥ 24.0 kg/m² but not with DBP in men with BMI ≥ 24.0 kg/m². Multiple linear regression analysis showed that BMI level was significantly and positively associated with both SBP and DBP in men and women with BMI < 24.0 kg/m², and TG level was significantly and positively associated with SBP in women with BMI < 24.0 kg/m², independent of other confounding factors. A general linear model analysis with adjustment for confounding factors (age, educational level, marital status, current residence, smoking, eating habits, taking activities, antidiabetic medication, antihypertensive therapy, fasting plasma glucose [FPG], low-density lipoprotein cholesterol [LDL-C], estimated glomerular filtration rate [eGFR], and serum uric acid [SUA]) showed no interaction between BMI and TG level and SBP (men, β = 0.572, P = 0.845; women, β = 0.122, P = 0.923) and DBP (men, β = -0.373, P = 0.810; women, β = 0.272, P = 0.828). A binary logistic regression model analysis with adjustment for confounding factors (age, educational level, marital status, current residence, smoking, drinking, eating habits, taking activities, major accidental injury, physical activity, history of cardiovascular disease, history of liver disease, antilipidemic medication, antidiabetic medication, antihypertensive therapy, FPG, LDL-C, high-density lipoprotein cholesterol [HDL-C], eGFR, and SUA) showed that overweight and obese men and women were more likely to have hypertension (men: odds ratio [OR] = 1.781, 95% confidence interval [CI] = 1.393–2.277; women: OR = 1.653, 95% CI = 1.330–2.055) and women with high TG were more likely to have hypertension (OR = 1.558, 95% CI = 1.219–1.992).

Conclusion

An interactive effect of BMI and TG level on BP was not observed in either men or women; however, independent effects of BMI on BP were observed in both men and women, and an association between TG level and hypertension was observed in women.

Contribution of social relationships to self-rated health among Japanese community-dwelling elderly

Objective: Participation in social activities is associated with physical and psychological health in the community-dwelling elderly population. We examined the two factors of social relations and community health resources, associated with higher self-rated health levels in the community-dwelling elderly.

Methods: A total of 145 community-dwelling elderly people ≥ 65 years old from two neighborhood associations in Nagasaki City were recruited for this study, representing 85% of the officially registered ≥ 65-year-old population in the target area. Face-to-face interviews using a structured questionnaire were conducted by trained interviewers in August 2009, with questions related to sociodemographic characteristics, social relationships, and self-rated health (SRH). Community health resources (type and walking distance from home) were evaluated by one of the authors as a community assessment.

Results: Seventy-eight community-dwelling elderly people (25 men and 53 women) participated in the study. Elderly people who reported going out every day were more likely to show higher SRH scores (excellent/good) than those going out less often (OR: 3.7; 95% confidence interval [CI]: 1.0, 14.2; P = 0.056). The numbers of interactions with friends in higher and lower SRH groups were 6.5 ± 8.4 (mean ± standard deviation) and 2.4 ± 1.1 (P = 0.01, Mann-Whitney U test), respectively. The numbers of relatives talking on the phone in higher and lower SRH groups were 2.9 ± 1.3 and 2.2 ± 1.2 (P = 0.031, Mann-Whitney U test), respectively. Meeting scores with friends in higher and lower SRH groups were 7.8 ± 5.8 and 4.5 ± 3.6 (P = 0.068), respectively. The scores of community health resources among higher and lower SRH groups were 21.2 ± 1.5 and 20.9 ± 1.4 (P = 0.547), respectively. The scores of community association/activities in higher and lower SRH groups were 3.9 ± 1.0 and 3.6 ± 0.9 (P = 0.227), respectively.

Conclusion: This study indicated the importance of interaction with friends and relatives for maintaining higher SRH among community-dwelling elderly people.

Epstein-Barr virus antibody titer as a stress biomarker and its association with social capital in rural Fujian communities, China

OBJECTIVES

There has been little research on the association between social capital and psychological stress measured by a biomarker, particularly in developing countries. Our objective was to investigate the association between Epstein-Barr virus (EBV) antibody titer, an indicator of cellular immune function previously shown to be associated with psychological stress, and social capital among rural community dwellers in Fujian Province, China.

METHODS

We conducted a cross-sectional survey in seven rural communities in Fujian in 2015. We used questionnaire data and dried blood spot samples for the measurement of biomarkers collected from 734 local residents for the analysis. We conducted a mixed effects regression analysis to investigate the association between EBV antibody titer and four social capital variables, which included cognitive and structural social capital assessed both at individual and community levels.

RESULTS

Community-level structural social capital was inversely associated with psychological stress (coefficient = -0.96, 95% confidence interval [CI] = -1.91, -0.01) while individual-level structural social capital was positively associated with it (coefficient = 0.21, 95% CI = 0.07, 0.36). Neither individual- nor community-level cognitive social capital was associated with psychological stress status.

CONCLUSIONS

In rural Fujian, China, social capital seemed to be an important determinant of psychological health. While living in a community with active social interaction may benefit the residents psychologically, social interaction in the form of strongly bonded relationships may be a source of psychological stress at the individual level due to the potential demands and obligations that may be associated with such connections.

Social participation and the onset of hypertension among the middle-aged and older population: Evidence from the China Health and Retirement Longitudinal Study

AIM

While previous studies have examined the association between health-related behaviors and hypertension, comparatively little attention has been paid to the role of social participation (i.e. participating in community organizations). The aim of the present study was to investigate the longitudinal association between social participation and hypertension among the middle-aged and older population (aged ≥45 years) in China where the prevalence of hypertension has been increasing rapidly in the past few decades.

METHODS

Data came from the China Health and Retirement Longitudinal Study waves 2011 and 2013. Information was obtained from 5483 participants on blood pressure, social participation and covariates. A sex-stratified Poisson regression model with a robust variance estimator was used to examine the associations.

RESULTS

During the period between 2011 and 2013, 20.6% of men and 17.2% of women developed hypertension. A Poisson regression model showed that participating in community organizations once a week or more frequently was inversely associated with the onset of hypertension in women (incidence rate ratio 0.80, 95% confidence interval 0.67-0.95, P = 0.012). Among men, no such association was found.

CONCLUSION

The present study suggests that promoting social participation might help mitigate the disease burden associated with hypertension in China, particularly among women. Geriatr Gerontol Int 2018; 18: 1093-1099.

Does Type of Residential Housing Matter for Depressive Symptoms in the Aftermath of a Disaster? Insights From the Great East Japan Earthquake and Tsunami

The 2011 Great East Japan Earthquake and Tsunami resulted in widespread property destruction and over 250,000 displaced residents. We sought to examine whether the type of housing arrangement available to the affected victims was associated with a differential incidence of depressive symptoms. In this prospective cohort study, which comprised participants aged ≥65 years from Iwanuma as a part of the Japan Gerontological Evaluation Study, we had information about the residents' mental health both before the disaster in 2010 and 2.5 years afterward. The Geriatric Depression Scale was used. Type of accommodation after the disaster was divided into 5 categories: no move, prefabricated housing (temporary housing), existing private accommodations (temporary apartment), newly established housing, and other. Poisson regression analysis was adopted, with and without multiple imputation. Among the 2,242 participants, 16.2% reported depressive symptoms at follow-up. The adjusted rate ratio for depressive symptoms among persons moving into prefabricated housing, compared with those who did not, was 2.07 (95% confidence interval: 1.45, 2.94). Moving into existing private accommodations or other types of accommodations was not associated with depression. The relationship between living environment and long-term mental health should be considered for disaster recovery planning.

Changes in social isolation and loneliness following total hip and knee arthroplasty: longitudinal analysis of the English Longitudinal Study of Ageing (ELSA) cohort

OBJECTIVE

To determine the prevalence and change in social isolation and loneliness in people before and after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in England.

DESIGN

The English Longitudinal Study of Ageing (ELSA) dataset, a prospective study of community-dwelling older adults, was used to identify people who had undergone primary THA or TKA because of osteoarthritis. Social isolation was assessed using the ELSA Social Isolation Index. Loneliness was evaluated using the Revised University of California, Los Angeles (UCLA) Loneliness Scale. The prevalence of social isolation and loneliness were calculated and multilevel modelling was performed to assess the potential change of these measures before arthroplasty, within a two-year operative-recovery phase and a following two-year follow-up.

RESULTS

The sample consisted of 393 people following THA and TKA. The prevalence of social isolation and loneliness changed from 16.9% to 18.8% pre-operative to 21.8% and 18.9% at the final post-operative follow-up respectively. This was not a statistically significant change for either measure (P = 0.15; P = 0.74). There was a significant difference in social isolation at the recovery phase compared to the pre-operative phase (P = 0.01), where people following arthroplasty reported an increase in social isolation (16.9-21.4%). There was no significant difference between the assessment phases in respect to UCLA Loneliness Scale score (P ≥ 0.74).

CONCLUSIONS

Given the negative physical and psychological consequences which social isolation and loneliness can have on individuals following THA or TKA, clinicians should be mindful of this health challenge for this population. The reported prevalence of social isolation and loneliness suggests this is an important issue.

Association between Social Relationship and Glycemic Control among Older Japanese: JAGES Cross-Sectional Study

Aim

The present study examined whether social support, informal socializing and social participation are associated with glycemic control in older people.

Methods

Data for this population-based cross-sectional study was obtained from the Japan Gerontological Evaluation Study (JAGES) 2010 linked to the annual health check-up data in Japan. We analyzed 9,554 individuals aged ≥65 years without the certification of needed long-term care. Multivariate logistic regression models were used to assess the effect of social support, informal socializing and social participations on glycemic control. The outcome measure was HbA1c ≥8.4%.

Results

1.3% of the participants had a level of HbA1c over 8.4%. Better glycemic control was significantly associated with meeting with friends one to four times per month (odds ratio [OR] 0.51, 95% confidence interval [CI]0.30–0.89, compared to meeting with friends a few times per year or less) and participation in sports groups (OR 0.50, 95% CI 0.26–0.97) even after adjusting for other variables. Meeting with friends more than twice per week, receiving social support, and being married were not associated with better control of diabetes.

Conclusions

Meeting with friends occasionally is associated with better glycemic control among older people.

Neighborhood Characteristics and Cardiovascular Risk among Older People in Japan: Findings from the JAGES Project

Previous studies have found an association between neighborhood characteristics (i.e., aspects of the physical and social environment) and the incidence of cardiovascular disease (CVD) and elevated CVD risk. This study investigated the relationship between neighborhood characteristics and CVD risk among older people in Japan where research on this association is scarce. Data came from the Japan Gerontological Evaluation Study project; questionnaire data collected from 3,810 people aged 65 years or older living in 20 primary school districts in Aichi prefecture, Japan, was linked to a computed composite CVD risk score based on biomarker data (i.e., hemoglobin A1c, systolic blood pressure, diastolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and estimated glomerular filtration rate). A sex-stratified multilevel linear regression analysis revealed that for male participants, living in neighborhoods with a higher perceived occurrence of traffic accidents and reduced personal safety was associated with an elevated CVD risk (coefficient = 1.08 per interquartile range increase, 95% confidence interval [CI] = 0.30 to 1.86) whereas males living in neighborhoods with a higher perceived proximity of exercise facilities had a lower risk (coefficient = −1.00, 95% CI = −1.78 to −0.21). For females, there was no statistically significant association between neighborhood characteristics and CVD risk. This study suggests that aspects of the neighborhood environment might be important for CVD morbidity and mortality in Japan, particularly among men.