A life-course approach to tackling noncommunicable diseases in women

OncoSexome: the landscape of sex-based differences in oncologic diseases

The NIH policy on sex as biological variable (SABV) emphasized the importance of sex-based differences in precision oncology. Over 50% of clinically actionable oncology genes are sex-biased, indicating differences in drug efficacy. Research has identified sex differences in non-reproductive cancers, highlighting the need for comprehensive sex-based cancer data. We therefore developed OncoSexome, a multidimensional knowledge base describing sex-based differences in cancer (https://idrblab.org/OncoSexome/) across four key topics: antineoplastic drugs and responses (SDR), oncology-related biomarkers (SBM), risk factors (SRF) and microbial landscape (SML). SDR covers sex-based differences in 2051 anticancer drugs; SBM describes 12 551 sex-differential biomarkers; SRF illustrates 350 sex-dependent risk factors; SML demonstrates 1386 microbes with sex-differential abundances associated with cancer development. OncoSexome is unique in illuminating multifaceted influences of biological sex on cancer, providing both external and endogenous contributors to cancer development and describing sex-based differences for the broadest oncological classes. Given the increasing global research interest in sex-based differences, OncoSexome is expected to impact future precision oncology practices significantly.

Life course socioeconomic position and care dependency in later life: a longitudinal multicohort study from 17 countries

Background

Care dependency, inability to perform basic daily tasks without assistance due to functional impairment, increases substantially with accelerated population ageing and becomes a pressing public health concern worldwide. Socioeconomic disadvantage has been shown to be associated with elevated risks of care dependency, but how risks are modified by changes in socioeconomic position remains unclear. From a life course perspective, we investigated the association between socioeconomic mobility across the lifespan and care dependency in later life.

Methods

In this longitudinal multicohort study, we pooled data collected between 2000 and 2019 from six prospective cohort studies across 17 countries from the Program on Global Ageing, Health, and Policy. Socioeconomic status (SES) at three different life stages was assessed based on parental education in childhood, participants' education in early adulthood, and non-housing wealth in middle-late adulthood. Care dependency was measured using activities of daily living (ADLs) and instrumental activities of daily living (IADLs) following WHO recommendations. Ordinal logistic mixed-effect models were applied to investigate associations between socioeconomic inequalities and their mobility across the life course with later-life care dependency. Furthermore, to investigate contributors to inequalities in care dependency, we applied the difference method to estimate the proportion of these inequalities explained by potential risk factors, and quantified the health and economic benefits of targeted interventions using population attributable fractions.

Findings

A total of 103,282 individuals were involved in this study, with an average baseline age of 63.29 (SD 10.70) years and a mean follow-up of 8.75 (SD 0.02) years. Low SES at any stage of life was associated with elevated probability, increased severity, and accelerated deterioration of care dependency in later life, with women being particularly vulnerable. For the probability of IADL dependency, socioeconomic differences by parental education persisted and were greatest at ages 75-80 years (18.10%, 95% CI 14.25%-21.95% for women; 10.23%, 5.82%-14.64% for men). Considering the severity of dependency, differences in low ADL dependency reversed in advanced old age, while differences in high ADL dependency widened consistently with age. Differences in high ADL dependency between high and low childhood SES groups increased from 0.66% (0.64%-0.67%) at age 50 to 15.79% (12.19%-19.39%) at age 100. Compared with a stable high SES throughout life, all other SES mobility trajectories were associated with elevated risks of both IADL and ADL dependency. Individuals who experienced a severe SES decline-high in childhood but low in adulthood-showed a more than ten times higher risk (IADL: OR 18.26, 95% CI 12.45-26.79; ADL: 11.95, 8.47-16.88). A lower risk was observed for those who moved from low SES in childhood to high SES in adulthood (IADL: 2.51, 1.00-6.33; ADL: 1.52, 0.62-3.72). Furthermore, out of risk factors ranging from lifestyles, diseases to social connections, lack of social activities was found to be the primary contributor to socioeconomic inequalities in care dependency (explaining up to 66.63%), with corresponding interventions achieving universal health and economic benefits across countries.

Interpretation

Changing socioeconomic status over the lifespan was associated with care dependency risk in later life. Promoting equal educational opportunities from an early age to equitably benefit the most socioeconomically disadvantaged could help mitigate care burdens. Encouraging participation in social activities has the potential to reduce socioeconomic differences in care dependency.

Funding

National Natural Science Foundation of China.

"We have to look deeper into why": perspectives on problem identification and prioritization of women's and girls' health across United Nations agencies

Eliminating gender inequality and promoting population health are stand-alone goals in the Sustainable Development Goals (SDGs). It is crucial to understand goal setting and policy making processes aimed at promoting gender and health equality given the entrenched and structural natures of these inequalities. Our research examines the process of problem and solution representation, priority setting, and factors that shape the policymaking process concerning women and girls within the UN system in relation to the SDGs. Data for this study were collected from semi-structured one-on-one interviews with participants who have work experience within the United Nations (UN) (n = 9). The analysis was informed by a qualitative descriptive methodology. Our findings identify the role of political forces in influencing policy, the challenges of limited and tied financial resources, the role of scientific evidence and data, and the purpose of different mandates across agencies. Political forces were found to shape the work of UN agencies, often hindering advancement of the SDG agenda. At the same time participants noted how they navigated opposition or what they considered regressive approaches to women and girls' health in order to pursue a more progressive agenda. Finite financial resources were also noted to play an important role in shaping SDG implementation pertaining to women and girls' health. Identification of the types of knowledge, evidence, and data that drive and are given preference in policy creation and development can highlight shortcomings and strengths of current modes of policy development and implementation. Key stakeholders and future research in health and development policy spheres can draw from our findings to gain insight into problem representation and prioritization. This will help identify underlying assumptions that inform work on women's and girls' health and how they shape policy agendas.

Sex differences in clinically diagnosed psychiatric disorders over the lifespan: a nationwide register-based study in Sweden

Background

Limited studies exist on sex differences in incidence rates of psychiatric disorders across the lifespan. This study aims to analyze sex differences in the incidence rates of clinically diagnosed psychiatric disorders over the lifespan.

Methods

We conducted a nationwide register-based cohort study, including all individuals who were born in Sweden and lived in Sweden between 2003 and 2019, including 4,818,071 females and 4,837,829 males. We calculated sex- and age-specific standardized incidence rates for any and 10 major types of psychiatric disorders. Multivariable-adjusted incidence rate differences (IRDs) for diagnosed psychiatric disorders between females and males were estimated.

Findings

During a follow-up of 119,420,908 person-years, males showed a higher incidence rate of any diagnosed psychiatric disorder than females at age 5-9 (IRD = -8.93; 95% CI: -9.08 to -8.79; per 1000 person-years), whereas females showed a higher rate than males at age 15-19 (IRD = 9.33; 95% CI: 9.12-9.54) and onwards (except age 60-69). Specifically, among females, excess rates were apparent for depressive, anxiety, eating, stress-related and bipolar disorders at age 10-54, whereas among males, excess rates were pronounced for autism and attention deficit hyperactivity disorders before age 14, drug use disorders at age 15-54, and alcohol use disorders in adulthood. For schizophrenia, the male excess at age 15-49 shifted to female excess at age 60-79. The magnitude of IRDs were greater in recent years and individuals with lower socioeconomic status.

Interpretation

Knowledge about the lifespan and socioeconomic variations in the sex differences in rates of diagnosed psychiatric disorders may inform targeted screening/intervention strategies.

Funding

Vetenskapsrådet, FORTE, Karolinska Institutet Strategic Research Area in Epidemiology and Biostatistics, and Icelandic Research Fund.

Prevalence, Awareness, Treatment, and Control of Type 2 Diabetes in South Korea (1998 to 2022): Nationwide Cross-Sectional Study

BACKGROUND

Type 2 diabetes poses an increasing disease burden in South Korea. The development and management of type 2 diabetes are closely related to lifestyle and socioeconomic factors, which have undergone substantial changes over the past few decades, including during the COVID-19 pandemic.

OBJECTIVE

This study aimed to investigate long-term trends in type 2 diabetes prevalence, awareness, treatment, and control. It also aimed to determine whether there were substantial alterations in the trends during the pandemic and whether these changes were more pronounced within specific demographic groups.

METHODS

This study examined the prevalence, awareness, treatment, and control of type 2 diabetes in a representative sample of 139,786 South Koreans aged >30 years, using data from the National Health and Nutrition Examination Survey and covering the period from 1998 to 2022. Weighted linear regression and binary logistic regression were performed to calculate weighted β coefficients or odds ratios. Stratified analyses were performed based on sex, age, region of residence, obesity status, educational background, household income, and smoking status. β (difference) was calculated to analyze the trend difference between the prepandemic period and the COVID-19 pandemic. To identify groups more susceptible to type 2 diabetes, we estimated interaction terms for each factor and calculated weighted odds ratios.

RESULTS

From 1998 to 2022, a consistent increase in the prevalence of type 2 diabetes was observed among South Koreans, with a notable rise to 15.61% (95% CI 14.83-16.38) during the pandemic. Awareness followed a U-shaped curve, bottoming out at 64.37% (95% CI 61.79-66.96) from 2013 to 2015 before increasing to 72.56% (95% CI 70.39-74.72) during the pandemic. Treatment also increased over time, peaking at 68.33% (95% CI 65.95-70.71) during the pandemic. Control among participants with diabetes showed no substantial change, maintaining a rate of 29.14% (95% CI 26.82-31.47) from 2020 to 2022, while control among treated participants improved to 30.68% (95% CI 27.88-33.48). During the pandemic, there was a steepening of the curves for awareness and treatment. However, while the slope of control among participants being treated increased, the slope of control among participants with diabetes showed no substantial change during the pandemic. Older populations and individuals with lower educational level exhibited less improvement in awareness and control trends than younger populations and more educated individuals. People with lower income experienced a deceleration in prevalence during the pandemic.

CONCLUSIONS

Over the recent decade, there has been an increase in type 2 diabetes prevalence, awareness, treatment, and control. During the pandemic, a steeper increase in awareness, treatment, and control among participants being treated was observed. However, there were heterogeneous changes across different population groups, underscoring the need for targeted interventions to address disparities and improve diabetes management for susceptible populations.

Gendered pleasures, risks and policies: Using a logic of candidacy to explore paradoxical roles of alcohol as a good/poor health behaviour for Australian women early during the pandemic

Drinking alcohol facilitates pleasure for women while also elevating disease risk. Symbolic expectations of what alcohol 'does in' life per lay insight (relax, identity-work, connect) sit in tension with scientific realities about what alcohol 'does to' women's bodies (elevate chronic disease risks such as breast cancer). Policy must work amidst - and despite - these paradoxes to reduce harm(s) to women by attending to the gendered and emergent configurations of both realities. This paper applies a logic of candidacy to explore women's alcohol consumption and pleasure through candidacies of wellness in addition to risk through candidacies of disease (e.g. breast cancer). Using qualitative data collected via 56 interviews with Australian women (n = 48) during early pandemic countermeasures, we explore how risk perceptions attached to alcohol (like breast cancer) co-exist with use-values of alcohol in daily life and elucidate alcohol's paradoxical role in women's heuristics of good/poor health behaviours. Women were aged 25-64 years, experienced varying life circumstances (per a multidimensional measure of social class including economic, social and cultural capital) and living conditions (i.e. partnered/single, un/employed, children/no children). We collated coding structures from data within both projects; used deductive inferences to understand alcohol's paradoxical role in candidacies of wellness and disease; abductively explored women's prioritisation of co-existing candidacies during the pandemic; and retroductively theorised prioritisations per evolving pandemic-inflected constructions of alcohol-related gendered risk/s and pleasure/s. Our analysis illuminates the ways alcohol was configured as a pleasure and form of wellness in relation to stress, productivity and respectability. It also demonstrates how gender was relationally enacted amidst the priorities, discourses and materialities enfolding women's lives during the pandemic. We consider the impact of policy regulation of aggressive alcohol marketing and banal availability of alcohol in pandemic environments and outline gender-responsive, multi-level policy options to reduce alcohol harms to women.

Call to action for a life course approach

Gestational diabetes remains the most common medical disorder in pregnancy, with short-term and long-term consequences for mothers and offspring. New insights into pathophysiology and management suggest that the current gestational diabetes treatment approach should expand from a focus on late gestational diabetes to a personalised, integrated life course approach from preconception to postpartum and beyond. Early pregnancy lifestyle intervention could prevent late gestational diabetes. Early gestational diabetes diagnosis and treatment has been shown to be beneficial, especially when identified before 14 weeks of gestation. Early gestational diabetes screening now requires strategies for integration into routine antenatal care, alongside efforts to reduce variation in gestational diabetes care, across settings that differ between, and within, countries. Following gestational diabetes, an oral glucose tolerance test should be performed 6-12 weeks postpartum to assess the glycaemic state. Subsequent regular screening for both dysglycaemia and cardiometabolic disease is recommended, which can be incorporated alongside other family health activities. Diabetes prevention programmes for women with previous gestational diabetes might be enhanced using shared decision making and precision medicine. At all stages in this life course approach, across both high-resource and low-resource settings, a more systematic process for identifying and overcoming barriers to preventative care and treatment is needed to reduce the current global burden of gestational diabetes.