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Beller J, Safieddine B, Sperlich S, Tetzlaff J, Geyer S. Time trends in limited lung function among German middle-aged and older adults. Sci Rep 2024; 14:5036. [PMID: 38424128 PMCID: PMC10904379 DOI: 10.1038/s41598-024-55624-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/26/2024] [Indexed: 03/02/2024] Open
Abstract
Limited lung function represents a serious health impairment. However, studies investigating changes in limited lung function over time are rare. Thus, the current study investigates time-related changes in limited lung function and potential social inequalities. Data from the 2008 and 2017 waves of the population-based German Aging Survey were used in a repeated cross-sectional study design (N = 8778), including participants aged 40 years and older. Lung function was assessed by the peak flow test. Socio-economic indicators included educational attainment, income and occupational group. Additionally, smoking history, occupational exposure to fumes and gases, and physical exercise were used as potentially explanatory variables for the observed changes. We found that the prevalence of limited lung function decreased strongly over time on a descriptive level from 9.0 to 5.4%. In line with these results, a decreasing trend emerged (OR = 0.48) when controlling for age and gender differences. When additionally controlling for changes in socio-economic indicators and explanatory variables there were still significant decreases over time, but the decline was slightly reduced (OR = 0.57). Moreover, similar significant relative decreases over time occurred for middle-aged and older participants, female and male participants, and those belonging to the different socio-economic groups. Thus, limited lung function generally decreased over time. This decrease could partially be explained by beneficial developments in socio-economic indicators, smoking, occupational exposures, and physical exercise. Future studies might investigate how changes in medicinal treatment and prevention efforts have contributed to the observed beneficial trends in lung health.
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Affiliation(s)
- Johannes Beller
- Hannover Medical School, Center for Public Health and Health Care, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Batoul Safieddine
- Hannover Medical School, Center for Public Health and Health Care, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stefanie Sperlich
- Hannover Medical School, Center for Public Health and Health Care, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Juliane Tetzlaff
- Hannover Medical School, Center for Public Health and Health Care, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Siegfried Geyer
- Hannover Medical School, Center for Public Health and Health Care, Medical Sociology Unit, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Albrektsen G, Wilsgaard T, Heuch I, Løchen ML, Thelle DS, Njølstad I, Grimsgaard S, Bønaa KH. Lipid Levels During Adult Lifetime in Men and Women With and Without a Subsequent Incident Myocardial Infarction: A Longitudinal Analysis of Data From the Tromsø Study 1974 to 2016. J Am Heart Assoc 2023:e030010. [PMID: 37449584 PMCID: PMC10382082 DOI: 10.1161/jaha.122.030010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023]
Abstract
Background The atherosclerotic effect of an adverse lipid profile is assumed to accumulate throughout life, leading to increased risk of myocardial infarction (MI). Still, little is known about age at onset and duration of unfavorable lipid levels before MI. Methods and Results Longitudinal data on serum lipid levels for 26 130 individuals (50.5% women, aged 20-89 years) were obtained from 7 population-based health surveys in Tromsø, Norway. Diagnoses of MI were obtained from national registers. A linear mixed model was applied to compare age- and sex-specific mean values of total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglyceride concentration by MI status (MI versus non-MI). Already from young adulthood, 20 to 35 years before the incident MI, individuals with a subsequent incident MI had on average more adverse lipid levels than individuals of the same age and sex without MI. Analogous to a dose-response relationship, there was a clear trend toward more severe adverse lipid levels the lower the age at incident MI (P<0.001, test for trend through ordered categories <55, 55-74, ≥75 years). This trend was particularly pronounced for high-density lipoprotein cholesterol in percentage of total cholesterol (both sexes) and for the relative relationship between triglyceride, high-density lipoprotein cholesterol, and total cholesterol level (women). The difference in mean lipid level by MI status was just as large in women as in men, but the age pattern differed (P≤0.05, tests of 3-way interaction). Conclusions Compared with general population mean levels, adverse lipid levels were seen 20 to 35 years before the incident MI in both men and women.
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Affiliation(s)
- Grethe Albrektsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Science NTNU-Norwegian University of Science and Technology Trondheim Norway
| | - Tom Wilsgaard
- Department of Community Medicine, Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway
| | - Ivar Heuch
- Department of Mathematics University of Bergen Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway
| | - Dag Steinar Thelle
- Department of Biostatistics Institute of Basic Medical Sciences, University of Oslo Oslo Norway
| | - Inger Njølstad
- Department of Community Medicine, Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway
| | - Sameline Grimsgaard
- Department of Community Medicine, Faculty of Health Sciences UiT The Arctic University of Norway Tromsø Norway
| | - Kaare Harald Bønaa
- Department of Circulation and Medical Images, Faculty of Medicine and Health Science NTNU-Norwegian University of Science and Technology Trondheim Norway
- Clinic for Heart Disease St. Olav University Hospital Trondheim Norway
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Krefting J, Sen P, David-Rus D, Güldener U, Hawe JS, Cassese S, von Scheidt M, Schunkert H. Use of big data from health insurance for assessment of cardiovascular outcomes. Front Artif Intell 2023; 6:1155404. [PMID: 37207237 PMCID: PMC10188985 DOI: 10.3389/frai.2023.1155404] [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: 02/24/2023] [Accepted: 04/13/2023] [Indexed: 05/21/2023] Open
Abstract
Outcome research that supports guideline recommendations for primary and secondary preventions largely depends on the data obtained from clinical trials or selected hospital populations. The exponentially growing amount of real-world medical data could enable fundamental improvements in cardiovascular disease (CVD) prediction, prevention, and care. In this review we summarize how data from health insurance claims (HIC) may improve our understanding of current health provision and identify challenges of patient care by implementing the perspective of patients (providing data and contributing to society), physicians (identifying at-risk patients, optimizing diagnosis and therapy), health insurers (preventive education and economic aspects), and policy makers (data-driven legislation). HIC data has the potential to inform relevant aspects of the healthcare systems. Although HIC data inherit limitations, large sample sizes and long-term follow-up provides enormous predictive power. Herein, we highlight the benefits and limitations of HIC data and provide examples from the cardiovascular field, i.e. how HIC data is supporting healthcare, focusing on the demographical and epidemiological differences, pharmacotherapy, healthcare utilization, cost-effectiveness and outcomes of different treatments. As an outlook we discuss the potential of using HIC-based big data and modern artificial intelligence (AI) algorithms to guide patient education and care, which could lead to the development of a learning healthcare system and support a medically relevant legislation in the future.
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Affiliation(s)
- Johannes Krefting
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- *Correspondence: Johannes Krefting
| | - Partho Sen
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Diana David-Rus
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Ulrich Güldener
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Johann S. Hawe
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Cassese
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Moritz von Scheidt
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Heribert Schunkert
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Center for Cardiovascular Research e.V. (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- Heribert Schunkert
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Beller J, Luy M, Giarelli G, Regidor E, Lostao L, Tetzlaff J, Geyer S. Trends in Activity Limitations From an International Perspective: Differential Changes Between Age Groups Across 30 Countries. J Aging Health 2022:8982643221141123. [DOI: 10.1177/08982643221141123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives: Examine trends in limitations among young (15–39), middle-aged (40–64) and older age-groups (>=65) and their socioeconomic differences. Methods: Population-based European Social Survey data ( N = 396,853) were used, covering 30 mostly European countries and spanning the time-period 2002–2018. Limitations were measured using a global activity limitations indicator. Results: Age-differential trends in limitations were found. Activity limitations generally decreased in older adults, whereas trends varied among younger and middle-aged participants, with decreasing limitations in some countries but increasing limitations in others. These age-differential trends were replicated across limitation severity and socioeconomic groups; however, stronger limitation increases occurred regarding less-severe limitations. Discussion: Functional health has improved in older adults. Contrarily, the increasing limitations in younger and middle-aged individuals seem concerning, which were mostly observed in Western and Northern European countries. Given its public health importance, future studies should investigate the reasons for this declining functional health in the young and middle-aged.
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Affiliation(s)
| | - Marc Luy
- Vienna Institute of Demography, Austrian Academy of Sciences, Austria
| | - Guido Giarelli
- Department of Health Sciences, University “MAGNA GRAECIA” Catanzaro, Italy
| | - Enrique Regidor
- Department of Public Health & Maternal and Child Health, Complutense University of Madrid, Spain
| | - Lourdes Lostao
- Department of Sociology, Public University of Navarre, Germany
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Geyer S, Eberhard S. Compression and Expansion of Morbidity. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:810-815. [PMID: 36300897 PMCID: PMC9906028 DOI: 10.3238/arztebl.m2022.0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/06/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Morbidity is said to be compressed when the interval from the onset of a disease or disability to death becomes shorter over time, or when the incidence of the disease or disability declines over time. In the reverse situation, morbidity is said to be expanded. METHODS This review is based on national and international studies retrieved by a selective literature search on secular trends in morbidity and mortality. The findings were derived from data from surveys and registries, and from the routine data of health insurance carriers. RESULTS Three different types of secular trends in morbidity were seen. For some diseases (e.g., lung cancer, stroke, and dementia), morbidity among the elderly was compressed over time. On the other hand, for multimorbidity and type 2 diabetes including comorbidities, morbidity expanded over time. Unexpectedly, a double development was seen in certain other conditions, with both compression among the elderly and expansion among the middle-aged: this was particularly so for myo - cardial infarction, grip strength, and indicators of general health. CONCLUSION The notion of morbidity being reduced by compression seems less tenable in view of the double development just mentioned. The findings suggest that the observed secular trend toward better health among the elderly has not persisted among the more recently born cohorts. This can have negative effects on social security systems, particularly with respect to retirement ages being deferred or made more flexible, as well as the cost of health care.
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Affiliation(s)
- Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hannover,*Medizinische Soziologie Medizinische Hochschule Hannover Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Association of TGFB1 rs1800469 and BCMO1 rs6564851 with coronary heart disease and IL1B rs16944 with all-cause mortality in men from the Northern Ireland PRIME study. PLoS One 2022; 17:e0273333. [PMID: 35994463 PMCID: PMC9394803 DOI: 10.1371/journal.pone.0273333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 08/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background Historically, high levels of morbidity and mortality have been associated with cardiovascular disease in the Northern Ireland population. Previously reported associations between single nucleotide polymorphisms (SNPs) and cardiovascular disease within other populations have not always been consistent. Objective To investigate associations between 33 SNPs with fatal or non-fatal incident coronary heart disease (CHD) events and all-cause mortality in the Northern Irish participants of the Prospective Epidemiological Study of Myocardial Infarction (PRIME). Method Phase 2 of the PRIME study prospectively evaluated 2,010 men aged 58–74 years in Northern Ireland for more than 10 years for incident CHD events (myocardial infarction, percutaneous coronary intervention, coronary artery bypass, and cardiac death) and more than 15 years for all-cause mortality. SNPs previously reported in association with cardiovascular outcomes were evaluated against incident CHD events and all-cause mortality using Cox’s proportional hazards models adjusted for established cardiovascular disease risk factors. Results During the follow-up period, 177 incident CHD events were recorded, and 821 men died. Both BCMO1 rs6564851 (Hazard ratio [HR] = 0.76; 95% confidence intervals [CI]: 0.60–0.96; P = 0.02) and TGFB1 rs1800469 (HR = 1.30; CI: 1.02–1.65; P = 0.04) were significantly associated with incident CHD events in adjusted models. Only IL1B rs16944 was significantly associated with all-cause mortality (HR = 1.18; CI: 1.05–1.33; P = 0.005). No associations remained significant following Bonferonni correction for multiple testing. Conclusion We report a novel association between BCMO1 rs6564851 and risk of incident CHD events. In addition, TGFB1 rs1800469 and IL1B rs16944 were associated with the risk of incident CHD events and all-cause mortality outcomes respectively, supporting previously reported associations.
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Beller J, Geyer S, Epping J. Health and study dropout: health aspects differentially predict attrition. BMC Med Res Methodol 2022; 22:31. [PMID: 35094681 PMCID: PMC8802529 DOI: 10.1186/s12874-022-01508-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Participant dropout poses significant problems in longitudinal survey studies. Although it is often assumed that a participant’s health predicts future study dropout, only a few studies have examined this topic, with conflicting findings. This study aims to contribute to the literature by clarifying the relationship between different aspects of health and study dropout.
Methods
The 2008 baseline sample of the German Aging Survey was used to predict study dropout (N = 4442). Indicators of health included physical health using the number of chronic conditions, physical functioning using the SF-36 Physical Functioning subscale, cognitive functioning using the digit symbol substitution test, and depression using the CESD-15.
Results
It was found that different aspects of health had differential associations with survey dropout: Worse physical functioning and in part worse cognitive functioning predicted increased dropout rates; contrarily, worse physical health predicted decreased dropout when controlling for other health aspects and covariates. Depression was not significantly related to study dropout.
Conclusions
Therefore, participants with chronic conditions, but minimal physical and cognitive disability were most likely to participate in the future. These findings suggest that health has a complex relationship with survey dropout and must be accounted for in longitudinal studies. Neglecting this systematic attrition due to health problems bears the risk of severely under- or overestimating health-related effects and trends.
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Beller J, Kuhlmann BG, Sperlich S, Geyer S. Secular Improvements in Cognitive Aging: Contribution of Education, Health, and Routine Activities. J Aging Health 2022; 34:807-817. [PMID: 35018846 PMCID: PMC9483682 DOI: 10.1177/08982643211065571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives Limited evidence exists regarding the reasons for secular changes in
cognitive functioning over historical time. Thus, we examined potential
explanatory factors for changes in cognitive speed, a central dimension of
cognitive functioning. Methods Population-based data of middle-aged and older adults from Germany
(N = 5443) was used with baseline participants from
2002 to 2014, comparing the time periods 2002–2014. Results Cognitive speed improved in middle-aged adults (40–65) and older adults
(66+). In both age groups, increases were partly explained by education,
employment status, volunteering status, routine activities, and physical
functioning. Changes in education were more important in explaining
increases in older than in middle-aged adults, whereas changes in health
were more important for explaining increases in middle-aged adults. Conclusions Cognitive speed increased in both age groups over historical time. Education,
employment, volunteering, routine activities, and health were all important
in explaining these changes, but their importance differed between age
groups.
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Affiliation(s)
- Johannes Beller
- Medical Sociology Unit, 9177Hannover Medical School, Hannover, Germany
| | - Beatrice G Kuhlmann
- Cognitive Psychology and Cognitive Aging, University of Mannheim, Mannheim, Germany
| | - Stefanie Sperlich
- Medical Sociology Unit, 9177Hannover Medical School, Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, 9177Hannover Medical School, Hannover, Germany
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Morbidity profiles in Europe and Israel: international comparisons from 20 countries using biopsychosocial indicators of health via latent class analysis. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01673-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Aim
I examined health/morbidity profiles across 20 countries, determined their associated demographic characteristics and risk factors and compared the distribution of these health/morbidity profiles across countries.
Subject and methods
I used population-based data drawn from the European Social Survey (N = 20092, 52% female, ages 40+) covering 20 mostly European countries (Austria, Belgium, Czechia, Denmark, Finland, France, Germany, Great Britain, Hungary, Ireland, Israel, Lithuania, Netherlands, Norway, Poland, Portugal, Slovenia, Spain, Sweden and Switzerland) from 2014. Diverse indicators of health/morbidity were used, including self-rated health, self-rated disability, self-reported health problems and mental health symptoms using the CES-D. Latent class analysis was conducted to determine health/morbidity profiles across countries.
Results
I found that four distinct health profiles best describe overall health/morbidity status in the international sample, each associated with specific demographic and behavioural risk factors: ‘healthy’ profile (62% of participants), ‘unhappy but healthy’ profile (14%), ‘high morbidity, mostly physical’ profile (16%) and ‘high morbidity, mostly psychological’ profile (8%). With few exceptions, participants from Northern Europe and Western Europe were more likely to belong to the ‘healthy’ and the ‘unhappy but healthy’ profiles, whereas participants from Eastern Europe were more likely to belong to the ‘high morbidity, mostly physical’ profile. Distribution of the ‘high morbidity, mostly psychological’ profile appeared to be more uniform across regions.
Conclusions
Distinct morbidity/health profiles could be identified across countries, and countries varied regarding the relative distribution of these profiles. Specific prevention and treatment consequences associated with each profile are discussed. Future studies should further investigate the patterns of overall health and morbidity in Europe’s populations.
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Safieddine B, Sperlich S, Epping J, Lange K, Geyer S. Development of comorbidities in type 2 diabetes between 2005 and 2017 using German claims data. Sci Rep 2021; 11:11149. [PMID: 34045564 PMCID: PMC8159920 DOI: 10.1038/s41598-021-90611-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 05/11/2021] [Indexed: 02/07/2023] Open
Abstract
Against the background of increasing life expectancy over time, several hypotheses have been proposed on the way morbidity has been developing. In type 2 diabetes (T2D), previous research suggests that morbidity compression could be ruled out due to increasing prevalence and life expectancy with T2D over time. Understanding how the health state in individuals with T2D is developing would help identify whether morbidity expansion or a dynamic equilibrium pattern applies for this disease. This study aims to answer the following questions: (1) How do the number and the prevalence of T2D concordant comorbidities develop over time? (2) What does this imply in terms of morbidity development in T2D in Germany? The study used claims data from a statutory health insurance provider in Lower Saxony, Germany. Period prevalence of T2D concordant comorbidities was examined for the periods 2005–2007, 2010–2012 and 2015–2017 in 240,241, 295,868 and 308,134 individuals with T2D respectively. The effect of time period on the number and prevalence of comorbidities was examined by means of (ordered) logistic regression. The age-adjusted predicted probabilities of more severe cardiovascular diseases (CVDs) decreased over the three periods while those of less severe CVDs and other vascular diseases increased significantly in men and women and among all examined age-groups. Predicted probability of having at least one more comorbidity over time also increased significantly among all examined groups. While less and more severe CVDs exhibited different developmental patterns, the results of the study point towards morbidity expansion in T2D. Future studies should focus on mechanisms that contribute to these trends.
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Affiliation(s)
- Batoul Safieddine
- Medical Sociology Unit OE 5420, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Stefanie Sperlich
- Medical Sociology Unit OE 5420, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jelena Epping
- Medical Sociology Unit OE 5420, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Karin Lange
- Medical Psychology Unit OE 5430, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit OE 5420, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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