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Teshale AB, Htun HL, Owen AJ, Ryan J, Baker JR, Vered M, Reid CM, Woods RL, Berk M, Tonkin A, Neumann JT, Kilkenny MF, Phyo AZZ, Nelson MR, Stocks N, Britt C, Freak-Poli R. Gender-specific aspects of socialisation and risk of cardiovascular disease among community-dwelling older adults: a prospective cohort study using machine learning algorithms and a conventional method. J Epidemiol Community Health 2024:jech-2023-221860. [PMID: 38839108 DOI: 10.1136/jech-2023-221860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Gender influences cardiovascular disease (CVD) through norms, social relations, roles and behaviours. This study identified gender-specific aspects of socialisation associated with CVD. METHODS A longitudinal study was conducted, involving 9936 (5,231 women and 4705 men) initially healthy, community-dwelling Australians aged 70 years or more from the ASPirin in Reducing Events in the Elderly (ASPREE) study and ASPREE Longitudinal Study of Older Persons, with a median follow-up time of 6.4 years. Variable categorisation, variable selection (using machine learning (ML) models; Elastic Net and extreme gradient boosting) and Cox-regression were employed separately by binary gender to identity socialisation factors (n=25 considered) associated with CVD. RESULTS Different socialisation factors were identified using the ML models. In the Cox model, for both genders, being married/partnered was associated with a reduced risk of CVD (men: HR 0.76, 95% CI 0.60 to 0.96; women: HR 0.67, 95% CI 0.58 to 0.95). For men, having 3-8 relatives they felt close to and could call on for help (HR 0.76, 95% CI 0.58 to 0.99; reference <3 relatives), having 3-8 relatives they felt at ease talking with about private matters (HR 0.70, 95% CI 0.55 to 0.90; reference <3 relatives) or playing games such as chess or cards (HR 0.82, 95% CI 0.67 to 1.00) was associated with reduced risk of CVD. For women, living with others (HR 0.71, 95% CI 0.55 to 0.91) or having ≥3 friends they felt at ease talking with about private matters (HR 0.74, 95% CI 0.58 to 0.95; reference <3 friends) was associated with a lower risk of CVD. CONCLUSIONS This study demonstrates the need to prioritise gender-specific social factors to improve cardiovascular health in older adults.
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Affiliation(s)
| | - Htet Lin Htun
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J R Baker
- Primary & Community Care Services Ltd, Thornleigh, New South Wales, Australia
| | - Mor Vered
- Department of Data Science and AI, Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health, Curtin University, Bentley, Western Australia, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael Berk
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of Medicine, Deakin University and Barwon Health, Geelong, Victoria, Australia
| | - Andrew Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Johannes T Neumann
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, University Heart & Vascular Centre, Hamburg, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Monique F Kilkenny
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Aung Zaw Zaw Phyo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Carlene Britt
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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Gaffey AE, Spatz ES. Psychological Health and Ischemic Heart Disease in Women: A Review of Current Evidence and Clinical Considerations across the Healthspan. Curr Atheroscler Rep 2024; 26:45-58. [PMID: 38240928 PMCID: PMC11219074 DOI: 10.1007/s11883-023-01185-0] [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] [Accepted: 12/20/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE OF REVIEW Psychological health encompasses a constellation of negative and positive factors-i.e., psychosocial stress, depression, anxiety, trauma, loneliness and social isolation, anger and hostility, optimism, and a sense of purpose. This narrative review presents current evidence at the intersection of psychological health, risk of ischemic heart disease (IHD), and IHD-related outcomes, with an emphasis on associations in women. RECENT FINDINGS For women, relations between psychological health and IHD reflect important sex and gender differences in biological and psychosocial factors. Although efforts devoted to understanding psychological health and IHD risk have varied by psychological factor-scientific evidence is strongest for psychosocial stress and depression, while anxiety, trauma, and positive psychological factors warrant more investigation-less optimal psychological health is consistently associated with an earlier and greater risk of IHD morbidity and mortality in women. Still, many past prospective studies of psychological factors and IHD risk had a limited representation of women, did not include analyses by sex, or failed to account for other influential, sex-specific factors. Thus, there are multiple pathways for further, rigorous investigation into psychological health-IHD associations, mechanisms, and empirically supported psychological interventions to mitigate IHD risk among women. Given the robust evidence linking psychological health with women's risk for IHD, implementing routine, brief, psychological screening is recommended. Significant life events, developmental milestones specific to women, and IHD diagnoses or events could cue further psychological assessment and referral, efforts which will mutually strengthen the evidence for integrated psychological and IHD care and delivery of such care to this vulnerable group.
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Affiliation(s)
- Allison E Gaffey
- Department of Internal Medicine (Section of Cardiovascular Medicine), Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Erica S Spatz
- Department of Internal Medicine (Section of Cardiovascular Medicine), Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA
- Department of Epidemiology, Yale School of Public Health, New Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
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Wang J, Zhang L, Wang S, Zhang L. Living arrangements, health lifestyles, and health outcomes among Chinese oldest-old. Front Public Health 2023; 11:1235768. [PMID: 37876711 PMCID: PMC10591327 DOI: 10.3389/fpubh.2023.1235768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/04/2023] [Indexed: 10/26/2023] Open
Abstract
Background Prior literature has documented a strong correlation between living arrangements and older adults' health outcomes. However, few studies have explained why this association exists. This study took the health lifestyle theory approach and brought health lifestyles into the link between living arrangements and Chinese oldest-old health outcomes. It examined (1) whether healthy lifestyle behaviors among the oldest-old varied by household contexts and (2) whether the health disparities among the Chinese oldest-old in different household contexts could be partially explained by their healthy lifestyles. Methods Using the most recent 2018 data released by the Chinese Longitudinal Healthy Longevity Survey (CLHLS), latent class analysis was applied to identify predominant health lifestyles among the Chinese oldest-old aged 85-105 years. Regression analyses were used to test the mediating effect of health lifestyles. Results Three distinct classes representing the health lifestyles of Chinese oldest-old emerged; health lifestyle patterns were found to vary by elders' living arrangements. The respondent's health lifestyles in diverse residential structures served as a mediator which can partially explain the health disparities among the oldest-old. Conclusion The results suggested that health lifestyles can serve as a mediator to explain the association between oldest-old living arrangement patterns and their health outcomes. The findings highlighted the importance of family, lifestyles, and cultural contexts to the health of the oldest-old.
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Affiliation(s)
- Jie Wang
- School of Law, Anhui Normal University, Wuhu, Anhui, China
| | - Lanxi Zhang
- Department of Sociology and Anthropology, School of Oriental and African Studies, University of London, London, United Kingdom
| | - Shen Wang
- School of International Relations, Beijing International Studies University, Beijing, China
| | - Li Zhang
- School of Sociology, China University of Political Science and Law, Beijing, China
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Zhou Q, Li Y, Gao Q, Yuan H, Sun L, Xi H, Wu W. Prevalence of Frailty Among Chinese Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis. Int J Public Health 2023; 68:1605964. [PMID: 37588041 PMCID: PMC10425593 DOI: 10.3389/ijph.2023.1605964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/20/2023] [Indexed: 08/18/2023] Open
Abstract
Objectives: To systematically review the epidemiology of frailty in China, one of the world's most populous countries, and to provide insightful guidance for countries to deal with fast population ageing. Methods: Six electronic databases were searched until November 2022. Data from cross-sectional studies with a clear definition of frailty and a mean age ≥60 years were pooled using meta-analysis. Results: 64 studies (n = 106,826 participants) from 23 (67.6%) of China's provinces were included. The overall prevalence of frailty and prefrailty among older community dwellers was 10.1% (95% CI: 8.5%-11.7%) and 43.9% (95% CI: 40.1%-47.8%), respectively. Adults over 70 years, women, unmarried, living alone, and those with less education had higher odds of being frail. Furthermore, regional disparities in frailty were observed; people in rural areas or areas with worse economic conditions had a higher prevalence of frailty. Conclusion: A great variation in frailty prevalence was observed between subgroups of older adults stratified by common risk factors. The Chinese government should pay more attentions to seniors at high risk and regions with a high prevalence of frailty.
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Affiliation(s)
- Qi Zhou
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
| | - Yao Li
- Department of Thyroid-Breast-Hernia Surgery, Department of General Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Qiang Gao
- Department of Scientific Research, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Huiping Yuan
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
| | - Liang Sun
- The Key Laboratory of Geriatrics, Beijing Institute of Geriatrics, Chinese Academy of Medical Sciences, Beijing Hospital/National Center of Gerontology of National Health Commission, Beijing, China
| | - Huan Xi
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenbin Wu
- Department of Geriatrics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Quashie NT, García C, Meltzer G, Andrade FCD, Matos-Moreno A. Neighborhood socioeconomic position, living arrangements, and cardiometabolic disease among older Puerto Ricans: An examination using PREHCO 2002-2007. PLoS One 2023; 18:e0289170. [PMID: 37527246 PMCID: PMC10393176 DOI: 10.1371/journal.pone.0289170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023] Open
Abstract
Cardiometabolic diseases are among the leading causes of mortality worldwide and are increasingly prevalent in rapidly aging populations. Neighborhood socioeconomic position (SEP) and living arrangements are increasingly recognized as important determinants of cardiometabolic health but have not been examined within Puerto Rico. This study examined the association between neighborhood SEP, living arrangements, and incidence of cardiometabolic conditions among island-dwelling older Puerto Ricans, using longitudinal data from the Puerto Rican Elderly Health Conditions Project (Waves I 2002/03 and II 2006/07) linked with 2000 Census data for neighborhood-level conditions. Our sample consists of non-institutionalized adults aged 60 and older who remained in the same residence over both waves of data collection (N = 2,769). We used multilevel multinomial logistic regression models to examine the relationship between neighborhood SEP and the prevalence and incidence of cardiometabolic disease. Findings show that residence in a socioeconomically advantaged neighborhood was positively associated with reporting having one cardiometabolic condition at baseline, but not associated with the incidence of cardiometabolic conditions at follow-up. Living without a partner was negatively associated with reporting having cardiometabolic conditions compared to living with a partner. Similar results were found for the incidence of cardiometabolic conditions. Living arrangements significantly modified the relationship between neighborhood SEP and cardiometabolic conditions. Compared to living with a partner, living alone in a socioeconomically advantaged neighborhood was associated with a reduced risk of reporting having one condition. Living with children in a socioeconomically advantaged neighborhood was associated with a reduced risk of developing one cardiometabolic condition than living with a partner. Living arrangements are more salient to cardiometabolic health than neighborhood SEP. Social programs and services focused on household composition and familial support are needed to identify older Puerto Ricans potentially at risk of underdiagnosed chronic conditions, especially as ongoing economic, demographic, environmental, and healthcare crises potentially exacerbate social inequalities.
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Affiliation(s)
- Nekehia T Quashie
- Department of Health Studies, University of Rhode Island, Kingston, RI, United States of America
| | - Catherine García
- Department of Human Development and Family Science, Aging Studies Institute, Center for Aging and Policy Studies, Lerner Center for Public Health Promotion and Population Health, Syracuse University, Syracuse, NY, United States of America
| | - Gabriella Meltzer
- Departments of Epidemiology and Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, NY, United States of America
| | - Flavia C D Andrade
- School of Social Work, University of Illinois, Urbana-Champaign, Urbana, IL, United States of America
| | - Amílcar Matos-Moreno
- Population Research Institute, The Pennsylvania State University, State College, PA, United States of America
- Clinical Psychology Department, Carlos Albizu University, San Juan, Puerto Rico
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Trends in blood pressure and hypertension among older adults and oldest-old individuals in China between 2008-2018. Hypertens Res 2023; 46:1145-1156. [PMID: 36750610 DOI: 10.1038/s41440-023-01183-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 12/25/2022] [Accepted: 12/26/2022] [Indexed: 02/09/2023]
Abstract
The aim of this study was to assess the trends in blood pressure (BP) levels and the corresponding prevalence of hypertension among elderly individuals in China from 2008 to 2018. This serial cross-sectional analysis was based on data from the last four waves of the Chinese Longitudinal Healthy Longevity Survey (N = 38086). Linear regression analyses were performed to assess linear trends in mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP). Logistic regression was used to examine trends in the prevalence of hypertension across the four waves. An ordinal regression model was used to assess risk factors for BP status. From 2008 to 2018, an increase of 0.8-3.3% in BP and at least an 8.2% increase in the prevalence of hypertension were observed among older adults and oldest-old adults (aged 65-79 years and ≥ 80 years) (all Ptrend < 0.001). Furthermore, the increasing magnitude of the prevalence of hypertension in the participants aged 65-79 years was greater than that in those aged ≥ 80 years. Region, BMI and living alone were factors associated with different BP statuses. After adjustment for demographic and behavioral characteristics, an increasing trend in mean SBP and PP was found in both men and women, whereas the mean DBP increased only in men. A significant increase occurred in hypertension prevalence, SBP and PP, whereas DBP remained stable in elderly Chinese individuals from 2008 to 2018. Comprehensive strategies need to be implemented for the prevention and management of hypertension among older adults in China.
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Jiang Y, Li M, Chung T. Living alone and all-cause mortality in community-dwelling older adults: The moderating role of perceived neighborhood cohesion. Soc Sci Med 2023; 317:115568. [PMID: 36442301 PMCID: PMC9839549 DOI: 10.1016/j.socscimed.2022.115568] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 10/23/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The adverse effect of living alone on health has been well-documented in community-dwelling older adults. A less understood topic in this research area is whether some neighborhood characteristics may mitigate the negative impact of living alone on health outcomes and mortality. This study aimed to extend the existing work on living arrangements and health by examining the potential interactive effect of living alone and perceived neighborhood cohesion on all-cause mortality among older Chinese Americans. METHODS Data were drawn from 3154 (58.0% female) participants from a prospective cohort study of community-dwelling US older Chinese adults aged 60 and older in the greater Chicago area. Living arrangements and perceived neighborhood cohesion were assessed at baseline from 2011 to 2013. Mortality status was tracked through December 2021. Covariates, including sociodemographic characteristics, health and behavioral covariates, loneliness, depression, and social engagement, were assessed at baseline. Cox proportional hazards regression model was used to test our hypotheses. RESULTS Living alone was significantly associated with an increased risk of all-cause mortality among participants reporting low levels of perceived neighborhood cohesion but not among those reporting high levels of perceived neighborhood cohesion. This protective effect of perceived neighborhood cohesion was robust to the inclusion of covariates. CONCLUSIONS Our results suggest that strong perceived neighborhood cohesion may protect against the increased risk of premature mortality associated with living alone in community-dwelling older Chinese Americans.
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Affiliation(s)
- Yanping Jiang
- Center for Population Behavioral Health, Institute for Health, Health Care Policy and Aging Research, The State University of New Jersey, New Brunswick, NJ, United States; Department of Family Medicine and Community Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States.
| | - Mengting Li
- Department of Social Security, School of Labor and Human Resources, Renmin University of China, Beijing, China
| | - Tammy Chung
- Center for Population Behavioral Health, Institute for Health, Health Care Policy and Aging Research, The State University of New Jersey, New Brunswick, NJ, United States; Department of Psychiatry, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
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