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Hu X, Jin W, Wang J, Dong H. Age, period, cohort effects in trends of depressive symptoms among middle-aged and older Chinese adults. Front Public Health 2024; 12:1383512. [PMID: 39145168 PMCID: PMC11321982 DOI: 10.3389/fpubh.2024.1383512] [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: 02/26/2024] [Accepted: 07/18/2024] [Indexed: 08/16/2024] Open
Abstract
Objectives To investigate the effects of age, period, and cohort on the trends of depression; and to examine the influence of these three temporal effects on residential disparities in depression. Methods Using data from the China Health and Retirement Longitudinal Study (CHARLS) during 2011 to 2020, involving 77,703 respondents aged 45 years old and above. The measurement of depressive symptoms was the score of 10-question version of the Center for Epidemiologic Studies Depression Scale (CES-D 10). The hierarchical age-period-cohort cross-classified random effects models were conducted to examine trends in depressive symptoms related to age, period and cohort. Results CES-D scores increased with age and slightly decreased at older age. The cohort trends mostly increased except for a downward trend among those born in 1950s. As for the period effect, CES-D scores decreased gradually from 2011 to 2013 followed by a upward trend. Rural residents were associated with higher level of depression than those live in urban area. These residence gaps in depression enlarged before the age of 80, and then narrowed. The urban-rural disparities in CES-D scores gradually diminished across cohorts, while the corresponding period-based change in urban-rural gaps was not significant. Conclusion When age, period, cohort factors are considered, the age effects on depression dominated, and the period and cohort variations were relatively small. The residence disparities in depression reduced with successive cohorts, more attention should be paid to the worsening depression condition of younger cohorts in urban areas.
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Affiliation(s)
- Xiaoqian Hu
- School of Politics and Public Administration, Qingdao University, Qingdao, China
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenxue Jin
- School of Politics and Public Administration, Qingdao University, Qingdao, China
| | - Junlei Wang
- School of Politics and Public Administration, Qingdao University, Qingdao, China
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Zhu J, Wu Y, Lin S, Duan S, Wang X, Fang Y. Identifying and predicting physical limitation and cognitive decline trajectory group of older adults in China: A data-driven machine learning analysis. J Affect Disord 2024; 350:590-599. [PMID: 38218258 DOI: 10.1016/j.jad.2024.01.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/24/2023] [Accepted: 01/07/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE This study aimed to utilize data-driven machine learning methods to identify and predict potential physical and cognitive function trajectory groups of older adults and determine their crucial factors for promoting active ageing in China. METHODS Longitudinal data on 3026 older adults from the Chinese Longitudinal Healthy Longevity and Happy Family Survey was used to identify potential physical and cognitive function trajectory groups using a group-based multi-trajectory model (GBMTM). Predictors were selected from sociodemographic characteristics, lifestyle factors, and physical and mental conditions. The trajectory groups were predicted using data-driven machine learning models and dynamic nomogram. Model performance was evaluated by area under the receiver operating characteristics curve (AUROC), area under the precision-recall curve (PRAUC), and confusion matrix. RESULTS Two physical and cognitive function trajectory groups were determined, including a trajectory group with physical limitation and cognitive decline (14.18 %) and a normal trajectory group (85.82 %). Logistic regression performed well in predicting trajectory groups (AUROC = 0.881, PRAUC = 0.649). Older adults with lower baseline score of activities of daily living, older age, less frequent housework, and fewer actual teeth were more likely to experience physical limitation and cognitive decline trajectory group. LIMITATION This study didn't carry out external validation. CONCLUSIONS This study shows that GBMTM and machine learning models effectively identify and predict physical limitation and cognitive decline trajectory group. The identified predictors might be essential for developing targeted interventions to promote healthy ageing.
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Affiliation(s)
- Junmin Zhu
- School of Public Health, Xiamen University, Xiamen, Fujian, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Yafei Wu
- School of Public Health, Xiamen University, Xiamen, Fujian, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Shaowu Lin
- School of Public Health, Xiamen University, Xiamen, Fujian, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, Fujian, China; National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, Fujian, China
| | - Siyu Duan
- School of Public Health, Xiamen University, Xiamen, Fujian, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Xing Wang
- School of Public Health, Xiamen University, Xiamen, Fujian, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Ya Fang
- School of Public Health, Xiamen University, Xiamen, Fujian, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, Xiamen, Fujian, China; National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen, Fujian, China.
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Xing M, Zhao Y, Li Z, Zhang L, Yu Q, Zhou W, Huang R, Lv X, Ma Y, Li W. Development and validation of a stacking ensemble model for death prediction in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Maturitas 2024; 182:107919. [PMID: 38290423 DOI: 10.1016/j.maturitas.2024.107919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/12/2023] [Accepted: 01/15/2024] [Indexed: 02/01/2024]
Abstract
OBJECTIVE This study aimed to develop and validate a mortality risk prediction model for older people based on the Chinese Longitudinal Healthy Longevity Survey using the stacking ensemble strategy. MATERIAL AND METHODS A total of 12,769 participants aged 65 or more at baseline were included. Ensemble machine learning models were applied to develop a mortality prediction model. We selected three base learners, including logistic regression, eXtreme Gradient Boosting, and Categorical + Boosting, and used logistic regression as the meta-learner. The primary outcome was five-year survival. Variable importance was evaluated by the SHapley Additive exPlanations method. RESULTS The mean age at baseline was 88, and 57.8 % of participants were women. The CatBoost model performed the best among the three base learners, the area under the receiver operating characteristics curve (AUC) reached 0.8469 (95%CI: 0.8345-0.8593), and the stacking ensemble model further improved the discrimination ability (AUC = 0.8486, 95%CI: 0.8367-0.8612, P = 0.046). Conventional logistic regression had comparable performance (AUC = 0.8470, 95 % CI: 0.8346-0.8595). Older age, higher scores for self-care activities of daily living, being male, higher objective physical performance capacity scores, not undertaking housework, and lower scores on the Mini-Mental State Examination contributed to higher risk. CONCLUSIONS We successfully constructed and validated a few death risk prediction models for a Chinese population of older adults. While the stacking ensemble approach had the best prediction performance, the improvement over conventional logistic regression was insubstantial.
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Affiliation(s)
- Muqi Xing
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yunfeng Zhao
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zihan Li
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Lingzhi Zhang
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Qi Yu
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Wenhui Zhou
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang 110122, China
| | - Rong Huang
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang 110122, China
| | - Xiaozhen Lv
- Peking University Institute of Mental Health (Sixth Hospital), National Clinical Research Center for Mental Disorders, NHC Key Laboratory of Mental Health, Peking University, 51 Huayuan North Road, Haidian District, Beijing 100191, China.
| | - Yanan Ma
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang 110122, China.
| | - Wenyuan Li
- Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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Zhang J, Sun X, Yao A. Use of Primary Healthcare Among Chinese Older Adults With Functional Limitations. J Appl Gerontol 2024; 43:149-159. [PMID: 37947378 DOI: 10.1177/07334648231205404] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
The aim of this study was to assess the factors associated with primary healthcare (PHC) utilization among older adults with functional limitations, providing insights for improving the effectiveness of PHC for this population. We used the China Health and Retirement Longitudinal Study (CHARLS) dataset, which encompasses 28 provinces in China. Logistic regression was used to analyze the people-related, care context-related, and linkage-related factors associated with PHC utilization. Approximately 55.61% of older adults with functional limitations utilized PHC in the past month, regardless of visit frequency or extent. Participants with lower educational attainment, those reporting more pain, and those living in rural areas had a higher likelihood of PHC utilization. Participants who received inpatient care in the past year had a lower likelihood of PHC utilization. We recommend that policymakers complement existing PHC health programs with increased health and social welfare support for this population.
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Affiliation(s)
- Jinxin Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- National Health Commission Key Lab of Health Economics and Policy Research (Shandong University), Jinan, China
| | - Aaron Yao
- Home Centered Care Institute, Schaumburg, IL, USA
- University of Virginia, Charlottesville, VA, USA
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Ma T, Liao J, Ye Y, Li J. Social support and cognitive activity and their associations with incident cognitive impairment in cognitively normal older adults. BMC Geriatr 2024; 24:38. [PMID: 38191348 PMCID: PMC10775559 DOI: 10.1186/s12877-024-04655-5] [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: 11/03/2023] [Accepted: 01/01/2024] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES To explore the associations of social support, and cognitive activity with cognitive impairment incidence, and further examine the mediation effect of cognitive activity on the association between social support and cognitive impairment incidence based on a nationwide elderly Chinese cohort. METHODS We collected the participants from an ongoing cohort of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 9394 older adults aged 65 or more years and free of cognitive impairment who participated in the CLHLS between 2008 and 2018 were included. The information on social support and cognitive activity was collected through a questionnaire. The incident cognitive impairment cases were identified through the Mini-Mental State Examination scale (MMSE). Cox proportional hazard regression models were conducted to calculate the hazard ratios (HRs) and 95% confidence interval (CI) of social support and cognitive activity associated with cognitive impairment. We used casual mediation models to assess the indirect association of cognitive activities underlying the association between social support and cognitive impairment. RESULTS The adjusted HRs (95% CI) of incident cognitive impairment were 0.956 (0.932 to 0.980), and 0.895 (0.859 to 0.933) associated with per 1 score increase in social support and cognitive activity score, respectively. Better adherence to social support was associated with a higher cognitive activity score (adjusted β = 0.046, 95% CI[0.032-0.060]). The baseline cognitive activity, as well as the mean cognitive activity at baseline and during the first follow-up wave, mediate the association between social support and the incidence of cognitive impairment, accounting for 11.4% and 12.6% of the total association, respectively. The participants who were aged 80 years or older, or those with mild daily functional limitations gained more benefits in the development of cognitive activity related to social support, leading to a reduction in the risks of cognitive impairment. CONCLUSION The results of this nationwide cohort provide consistent evidence linking social support, and cognitive activity to reduced risk of subsequent cognitive impairment incidence. These findings provide additional evidence to inform the social strategies to prevent cognitive impairment incidence in elderly people.
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Affiliation(s)
- Tianpei Ma
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jiaqiang Liao
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuguo Ye
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jiayuan Li
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
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Cao N, Zeng X, Wang P. Decomposing the change in the cognitive function gap between older men and women over time in China: The Chinese Longitudinal Healthy Longevity Survey. J Glob Health 2023; 13:04143. [PMID: 37988354 PMCID: PMC10662781 DOI: 10.7189/jogh.13.04143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
Background This study explored how modifiable social determinants of cognitive function can influence these gender gaps. Methods We utilized six waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS), including 56,127 individuals aged 65+. The Kitagawa-Oaxaca-Blinder decomposition approach was used for the analysis. Results Older women consistently had lower average levels of cognitive function than men in each period, but the gap is narrowing. From 2002 to 2018, the gender gap in cognitive function decreased by 1.45 (95% confidence interval (CI) = -1.843, -1.097) points. The coefficients for the endowment effects decreased from 0.387 (95% CI = -0.563, -0.211) to 1.789 (95% CI = -2.471, -1.107) from 2005 to 2018. Lifestyle changes, social participation, and physical health factors significantly contributed to explaining the changes in gender gaps in cognitive function. Conclusions Among these contributing factors, lifestyle, social participation, and physical health have emerged as pivotal elements in reducing the gender gap in cognitive function. Targeted interventions for these variables are essential among older women to narrow the cognitive gender gaps effectively.
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Redzovic S, Vereijken B, Bonsaksen T. Aging at home: factors associated with independence in activities of daily living among older adults in Norway-a HUNT study. Front Public Health 2023; 11:1215417. [PMID: 37860795 PMCID: PMC10583577 DOI: 10.3389/fpubh.2023.1215417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/21/2023] [Indexed: 10/21/2023] Open
Abstract
Background Maintaining independence in activities of daily living (ADL) is essential for the well-being of older adults. This study examined the relationship between demographic and living situation factors and ADL independence among community-dwelling older adults in Norway. Methods Data was collected in Norway between 2017 and 2019 as part of the fourth wave of the ongoing Trøndelag Health Study (HUNT) survey, sent to all citizens in Trøndelag county over 20 years of age, which is considered representative of the Norwegian population. Included in the current cross-sectional study were 22,504 community-living individuals aged 70 years or older who completed the survey and responded to all items constituting the ADL outcome measure. Group differences in ADL independence were examined with Chi Square tests, while crude and adjusted associations with ADL independence were examined with logistic regression analyses. Statistical significance was set at p < 0.05. Results The participants reported a high degree of independence in primary ADL and slightly lower in instrumental ADL. In the fully adjusted analyses, ADL independence was associated with lower age, female gender, higher levels of education and income, higher subjective well-being, having no chronic or disabling disease, and having someone to talk to in confidence. Surprisingly, women who were married had higher likelihood of ADL independence than unmarried women, whereas married men had lower likelihood of ADL independence than unmarried men. Conclusion In addition to known demographic and disease-related factors, the social context affects independence in ADL even in a society that offers advanced health and homecare services to all older adults equally. Furthermore, the same social setting can have differential effects on men and women. Despite the healthcare system in Norway being well-developed, it does not completely address this issue. Further improvements are necessary to address potential challenges that older adults encounter regarding their social connections and feelings of inclusion. Individuals with limited education and income are especially susceptible to ADL dependency as they age, necessitating healthcare services to specifically cater to this disadvantaged demographic.
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Affiliation(s)
- Skender Redzovic
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Beatrix Vereijken
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tore Bonsaksen
- Department of Health and Nursing Science, Inland Norway University of Applied Sciences, Elverum, Norway
- Department of Health, VID Specialized University, Stavanger, Norway
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Guo S, Zheng XY. New evidence of trends in cognitive function among middle-aged and older adults in China, 2011-2018: an age-period-cohort analysis. BMC Geriatr 2023; 23:498. [PMID: 37605117 PMCID: PMC10440902 DOI: 10.1186/s12877-023-04166-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 07/11/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Increasing evidence from high-income countries suggests the risk of cognitive impairment has been declining recently. However, related studies in China have rarely been done, and the results are inconsistent. We analyze the trends in cognitive function among middle-aged and older adults in China between 2011 and 2018. METHODS We used data from four waves of the China Health and Retirement Longitudinal Study (CHARLS), including 48918 individuals aged 45 years and older. Cognitive function was assessed using the CHARLS cognitive measures containing episodic memory, orientation, attention, and visuospatial abilities. The hierarchical age-period-cohort (APC) model was used to quantify the separate age, period, and cohort effects on trends in cognitive function. RESULTS The study sample's ages ranged from 45 to 105 years (Mean = 59.2, SD = 9.4). Cognitive function declined with age net of period and cohort effects, an apparent acceleration in the rate of cognitive decline after age 65 was found adjusting for individual characteristics. Although period effects on trends in cognitive function remained stable during the study period, hierarchical APC models demonstrated significant cohort variations. Independent of age and period effects, there was a fluctuating trend across cohorts before 1960 and an overall decline across successive cohorts. CONCLUSIONS Our study indicates that the age effect remains the most crucial factor regarding cognitive decline. Moreover, results demonstrate that cohorts living in social upheaval leading to educational deprivation and/or nutritional deficiency in early life may face a higher risk for cognitive deterioration later in life. Such findings indicate that dementia prevention from a life course perspective and cohort-specific strategies are critical to alleviating the future public-health burdens related to cognitive aging. Ongoing attention should be paid to the role of cross-cohort differences in education on cohort trends in cognition in countries like China that are aging rapidly and have a late start in educational expansion compared to other countries. Other factors, such as environmental stimulation, need to be noticed in younger cohorts.
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Affiliation(s)
- Shuai Guo
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 31, Road 3rd, Bei-Ji-Ge, Dongcheng District, Beijing, 100073, P.R. China
| | - Xiao-Ying Zheng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 31, Road 3rd, Bei-Ji-Ge, Dongcheng District, Beijing, 100073, P.R. China.
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Dai M, Song Q, Yue J, Lin T, Jie W, Wang X, Ge N. Is waist-calf circumference ratio associated with frailty in older adults? Findings from a cohort study. BMC Geriatr 2023; 23:492. [PMID: 37582717 PMCID: PMC10426214 DOI: 10.1186/s12877-023-04182-9] [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: 04/03/2023] [Accepted: 07/19/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND The waist-calf circumference ratio (WCR) has been suggested as a potential indicator of visceral adiposity. Nevertheless, the relationship between WCR and the risk of frailty remains unclear. Therefore, our study aimed to investigate the association between WCR and longitudinal changes in WCR with frailty risk in older adults. METHODS We included 2359 participants aged ≥ 65 years without frailty (frailty index [FI] ≤ 0.21) from the Chinese Longitudinal Healthy Longevity Survey in the 2014 wave. The follow-up was conducted in 2018. We investigated the relationship of WCR, waist circumference (WC), and calf circumference (CC) with frailty using both the Cox proportional hazards model and the generalized estimating equation (GEE). RESULTS During a median follow-up of 4.0 years, 668 (28.2%) frailty occurred. Those with higher WCR and WC had a significantly increased risk of frailty (fifth quintile compared with first quintile: hazard ratio [HR] = 1.59, 95% confidence interval [CI] 1.24-2.04 for WCR; HR = 1.69, 95% CI 1.27-2.24 for WC), whereas those in the fourth quintile of CC had a lower likelihood of developing frailty compared to those in the first quintile (HR = 0.67, 95% CI 0.50-0.89). Interaction analyses showed that the effects of WCR on frailty were more pronounced in females (P-interaction = 0.016). GEE analyses revealed that increased WCR and WC were associated with a higher risk of frailty (odds ratio [OR] = 1.74, 95% CI 1.43-2.12 for WCR; OR = 1.03, 95% CI 1.02-1.04 for WC), while CC showed opposite results (OR = 0.95, 95% CI 0.93-0.97). CONCLUSIONS A higher WCR and WC, as well as a lower CC, were significantly associated with higher frailty. Of these measures, WCR demonstrated the strongest association with frailty, suggesting that having a combination of high central fat and low lean body mass may increase the risk of developing frailty.
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Affiliation(s)
- Miao Dai
- Department of Geriatrics, Jiujiang First People's Hospital, Jiujiang, 332000, Jiangxi, China
| | - Quhong Song
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Taiping Lin
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Wei Jie
- Department of Geriatrics, Jiujiang First People's Hospital, Jiujiang, 332000, Jiangxi, China
| | - Xiang Wang
- Department of Cardiology, Jiujiang First People's Hospital, Jiujiang, 332000, Jiangxi, China.
| | - Ning Ge
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China.
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Jing Y, Wang W, Peng W, Wang M, Chen X, Liu X, Wang P, Yan F, Yang Y, Wang X, Sun S, Ruan Y, Wang Y. Social support and cognitive function in Chinese older adults who experienced depressive symptoms: is there an age difference? Front Aging Neurosci 2023; 15:1175252. [PMID: 37251805 PMCID: PMC10213363 DOI: 10.3389/fnagi.2023.1175252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/19/2023] [Indexed: 05/31/2023] Open
Abstract
Objective This study examined the moderating effect of overall social support and the different types of social support on cognitive functioning in depressed older adults. We also investigated whether the moderating effect varied according to age. Methods A total of 2,500 older adults (≥60 years old) from Shanghai, China were enrolled using a multistage cluster sampling method. Weighted linear regression and multiple linear regression was utilized to analyze the moderating effect of social support on the relationship between depressive symptoms and cognitive function and to explore its differences in those aged 60-69, 70-79, and 80 years and above. Results After adjusting for covariates, the results indicated that overall social support (β = 0.091, p = 0.043) and support utilization (β = 0.213, p < 0.001) moderated the relationship between depressive symptoms and cognitive function. Support utilization reduced the possibility of the cognitive decline in depressed older adults aged 60-69 years (β = 0.310, p < 0.001) and 80 years and above (β = 0.199, p < 0.001), while objective support increased the possibility of cognitive decline in depressed older people aged 70-79 years (β = -0.189, p < 0.001). Conclusion Our findings highlight the buffering effects of support utilization on cognitive decline in depressed older adults. We suggest that age-specific measures should be taken when providing social support to depressed older adults in order to reduce the deterioration of cognitive function.
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Affiliation(s)
- Yurong Jing
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment, National Health and Family Planning, Commission of the People’s Republic of China, Fudan University, Shanghai, China
| | - Wei Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Wenjia Peng
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment, National Health and Family Planning, Commission of the People’s Republic of China, Fudan University, Shanghai, China
| | - Meng Wang
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment, National Health and Family Planning, Commission of the People’s Republic of China, Fudan University, Shanghai, China
| | - Xiaoli Chen
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment, National Health and Family Planning, Commission of the People’s Republic of China, Fudan University, Shanghai, China
| | - Xinya Liu
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment, National Health and Family Planning, Commission of the People’s Republic of China, Fudan University, Shanghai, China
| | - Pengfei Wang
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment, National Health and Family Planning, Commission of the People’s Republic of China, Fudan University, Shanghai, China
| | - Fei Yan
- School of Public Health, Fudan University, Shanghai, China
| | - Yinghua Yang
- Shanghai Center for Clinical Laboratory, Shanghai, China
| | - Xinguo Wang
- College of Public Health, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Shuangyuan Sun
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Ye Ruan
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Ying Wang
- School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Health Technology Assessment, National Health and Family Planning, Commission of the People’s Republic of China, Fudan University, Shanghai, China
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Qin X, He J, He H, Yuan X, Su X, Zeng X. Long-term trends in the burden of edentulism in China over three decades: A Joinpoint regression and age-period-cohort analysis based on the global burden of disease study 2019. Front Public Health 2023; 11:1099194. [PMID: 37181712 PMCID: PMC10174210 DOI: 10.3389/fpubh.2023.1099194] [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: 11/21/2022] [Accepted: 03/22/2023] [Indexed: 05/16/2023] Open
Abstract
Background To investigate secular trends in edentulism incidence, prevalence, and years lived with disability (YLDs) rates in Chinese men and women from 1990 to 2019. Methods Data were obtained from the Global Burden of Disease Study 2019. The annual percentage change and average annual percentage change were calculated using Joinpoint regression analysis. The age-period-cohort (APC) analysis estimated the independent age, period, and cohort effects. Results From 1990 to 2019, the crude incidence, prevalence, and YLDs of edentulism in the Chinese population increased year by year, while the age-standardized incidence, prevalence, and YLDs decreased, and the latter was higher in women than in men. The APC analysis showed that the age effect increased in men and women from age 20 to 74 and decreased thereafter. The risk of tooth loss increased with age. However, the relationship was not linear. The temporal effect showed a gradual increase; the risk of missing teeth gradually increased with the changing modern living environment. The cohort effect showed a single decreasing trend, with the early birth cohort having a higher risk of tooth loss than the later birth cohort population. The age, period, and cohort effects were consistent for both sexes. Conclusion Although the standardized incidence, prevalence, and YLD rate and cohort effect of dentition loss in China are declining, they are still causing a severe burden to China due to the continued aging of the population and the rising period effect. Despite the decreasing trends of the standardized incidence and prevalence of dentition loss and the rate of YLDs, China should develop more effective oral disease prevention and control strategies to reduce the increasing burden of edentulism in the older adult, especially in older women.
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Affiliation(s)
- Xiaofeng Qin
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
| | - Jinan He
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
| | - Haoyu He
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
| | - Xihua Yuan
- Department of Dermatology and Venerology, The Second Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Xiaohui Su
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
| | - Xiaojuan Zeng
- Guangxi Key Laboratory of Oral and Maxillofacial Rehabilitation and Reconstruction, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Guangxi Health Commission Key Laboratory of Prevention and Treatment for Oral Infectious Diseases, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
- Department of Oral Health Policy Research, College of Stomatology, Hospital of Stomatology, Guangxi Medical University, Nanning, China
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12
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Chen Z, Du J, Song Q, Yang J, Wu Y. A prediction model of cognitive impairment risk in elderly illiterate Chinese women. Front Aging Neurosci 2023; 15:1148071. [PMID: 37181625 PMCID: PMC10169753 DOI: 10.3389/fnagi.2023.1148071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
Objective To establish and validate a targeted model for the prediction of cognitive impairment in elderly illiterate Chinese women. Methods 1864 participants in the 2011-2014 cohort and 1,060 participants in the 2014-2018 cohort from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) were included in this study. The Chinese version of the Mini-Mental State Examination (MMSE) was used to measure cognitive function. Demographics and lifestyle information were collected to construct a risk prediction model by a restricted cubic spline Cox regression. The discrimination and accuracy of the model were assessed by the area under the curve (AUC) and the concordance index, respectively. Results A total of seven critical variables were included in the final prediction model for cognitive impairment risk, including age, MMSE score, waist-to-height ratio (WHtR), psychological score, activities of daily living (ADL), instrumental abilities of daily living (IADL), and frequency of tooth brushing. The internal and external validation AUCs were 0.8 and 0.74, respectively; and the receiver operating characteristic (ROC) curves indicated good performance ability of the constructed model. Conclusion A feasible model to explore the factors influencing cognitive impairment in elderly illiterate women in China and to identify the elders at high risk was successfully constructed.
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Affiliation(s)
- Zhaojing Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jiaolan Du
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Qin Song
- Department of Occupational and Environmental Health, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Jun Yang
- Department of Nutrition and Toxicology, School of Public Health, Hangzhou Normal University, Hangzhou, China
| | - Yinyin Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Hangzhou Normal University, Hangzhou, China
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13
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Zhang X, Lin L, Sun X, Lei X, Liu GG, Raat H, Zeng Y. Development and Validation of the Disability Index Among Older Adults. J Gerontol A Biol Sci Med Sci 2023; 78:111-119. [PMID: 35271717 PMCID: PMC9879748 DOI: 10.1093/gerona/glac059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND With the rapid population aging, the challenge to provide care for disabled older adults is becoming bigger. This study aims to develop the Disability Index (DI) to assess disability to indicate care needs, and we evaluated the reliability and validity of the DI among older adults aged 65-105. METHODS A total of 12 559 older adults (54.0% women; mean age = 84.3; SD = 11.2) from 22 provinces in China were investigated in 2017-2018. We developed the 21-item DI covering 4 subdomains, including Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), physical performance, and cognitive function. Cronbach's alpha was used to determine internal consistency. The convergent and divergent validity were assessed by Spearman rank order correlation coefficients and Pearson correlation coefficients. The known-group validity was assessed by Mann-Whitney U tests. The concurrent validity was assessed by the area under the receiver operating characteristic curve (AUC). RESULTS In the total sample, the internal consistency of the full DI and its subdomains were satisfactory with Cronbach's alpha ≥0.70; the convergent and divergent validity of the 4 subdomains were supported by all the alternative measures; the known-group validity of the full DI and its subdomains were supported by clear discriminative ability; and the concurrent validity of the full DI was supported with all the AUCs ≥0.70. The reliability and validity of the full DI and its subdomains were additionally supported by age subgroups and sex subgroups. CONCLUSIONS The DI is a reliable and valid instrument to assess disability status among older adults.
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Affiliation(s)
- Xuxi Zhang
- Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China
| | - Lizi Lin
- Guangdong Provincial Engineering Technology Research Center of Environmental Pollution and Health Risk Assessment, Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Xinying Sun
- Public Heath School, Health Science Center, Peking University, Beijing, China
| | - Xiaoyan Lei
- Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China
| | - Gordon G Liu
- National School of Development, Peking University, Beijing, China
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yi Zeng
- Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, China.,Center for the Study of Aging and Human Development, Duke University Medical School, Durham, North Carolina, USA
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14
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Pan C, Cao N, Kelifa MO, Luo S. Age and cohort trends in disability among Chinese older adults. Front Public Health 2023; 11:998948. [PMID: 36969644 PMCID: PMC10031081 DOI: 10.3389/fpubh.2023.998948] [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: 07/20/2022] [Accepted: 02/03/2023] [Indexed: 03/29/2023] Open
Abstract
Objective This study aimed to examine age and cohort trends in disability among Chinese older adults and explore the disablement process factors that may explain the cohort trends in disability. Methods This study used data from five waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A hierarchical logistic growth model was used to analyze the A-P-C effects and the contributors of cohort trends. Results ADL, IADL, and FL among Chinese older adults showed increasing age and cohort trends. FL was more likely to result in IADL disability than ADL disability. Among the disablement process factors, gender, residence, education, health behavior, disease, and family income contributed to most of the cohort trends in disability. Conclusions As older adults face increasing disability trends, it is necessary to distinguish age and cohort trends and develop more effective interventions according to relative contributors to prevent disability among them.
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Affiliation(s)
- Chaoping Pan
- School of Public Health, Wuhan University, Wuhan, Hubei, China
| | - Na Cao
- School of Public Health, Wuhan University, Wuhan, Hubei, China
- Na Cao
| | | | - Shuren Luo
- The Second Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
- *Correspondence: Shuren Luo
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15
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Trends in activities of daily living disability among Chinese older adults from 1998 to 2018: an age-period-cohort analysis. Eur J Ageing 2022; 19:1167-1179. [PMID: 36692744 PMCID: PMC9729626 DOI: 10.1007/s10433-022-00690-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 01/26/2023] Open
Abstract
This study aims to investigate the age, period, and cohort effects on trends in activities of daily living (ADL) disability among Chinese older adults; and to explore these three temporal effects on gender and residence disparities in disability. We utilized multiple cross-sectional waves of the Chinese Longitudinal Healthy Longevity Survey data (1998-2018), including 89,511 participants aged above 65 years old. Our measurement of disability is the number of ADL items (dressing, bathing, indoor transferring, toileting, eating, and continence) participants can't perform independently. Hierarchical age-period-cohort cross-classified random effects models were conducted to investigate age, period and cohort trends in ADL disability. Results showed that ADL disability increased with age at an increasing rate. A V-shaped cohort trend and a fluctuated period trend were identified. Females and urban residents were associated with more ADL limitations. When age increased, the gender and residence gaps in disability further increased. The cohort-based gender and residence inequalities in ADL limitations converged with successive cohorts. The period-based residence gap in ADL limitations diverged throughout the 20-year period, while the corresponding period-based change in gender disparity was not significant. These findings suggested that age, period, and cohort had different and independent effects on ADL disability among Chinese older adults. The age effect on trends in ADL is stronger compared to period and cohort effects. The gender and residence disparities in disability increased with age and decreased with successive cohorts. These patterns might help inform healthcare planning and the priorities for medical resource allocation accordingly.
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Jin Y, Zhou X, Deng L, Xiong X, Li Y, Wei Q, Dong B, Qiu S. Association between the domestic use of solid cooking fuel and increased prevalence of depression and cognitive impairment in a big developing country: A large-scale population-based study. Front Public Health 2022; 10:1038573. [PMID: 36504928 PMCID: PMC9731231 DOI: 10.3389/fpubh.2022.1038573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Previous studies have suggested that air pollution affects physiological and psychological health. Using solid fuel at home is a significant source of indoor air pollution. The associations between solid fuel use and depressive symptoms and cognitive health were unclear among older adults from low- and middle-income countries (LMICs). Methods To evaluate the association of solid fuel use with depressive symptoms and cognitive health among older adults, we obtained data from the Longitudinal Aging Study in India (LASI) and excluded subjects younger than 60 years and without critical data (solid fuel use, depressive symptoms, and cognitive health). The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to assess depressive symptoms, with more than ten indicative of depression. Cognitive health was assessed using measures from the Health and Retirement Study (HRS), and subjects with the lowest 10th percentile were considered to have cognitive impairment. The participants' responses defined solid fuel use. Multivariable logistic regression, linear regression, subgroup analysis, and interaction tests were performed to appraise the relationship between solid fuel use and depression and cognitive impairment. Results A total of 29,789 participants over 60 years old were involved in this study. Almost half of the participants (47.5%) reported using solid fuel for home cooking. Compared with clean fuel use, solid fuel use was related to an increased prevalence of depression [odds ratio (OR) 1.09, 95% CI 1.03-1.16] and higher CES-D-10 scores (β 0.23, 95% CI 0.12-0.35) after fully adjusted covariables. Using solid fuel was also related to a higher risk of cognitive impairment (OR 1.21, 95% CI 1.11-1.32) and a lower cognitive score (β -0.63, 95% CI -0.79 to -0.47) compared with those who used clean fuel. In the subgroup analysis, the prevalence of depression increased in females and non-smokers. The association of solid fuel use with depression and cognitive impairment exists in subgroups of BMI, economic status, caste, living area, education, and drinking. Conclusions The use of solid fuel at home was associated with an increased prevalence of depression and cognitive impairment among older adults in India.
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Affiliation(s)
- Yuming Jin
- Department of Urology, National Clinical Research Center for Geriatrics, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Xianghong Zhou
- Department of Urology, National Clinical Research Center for Geriatrics, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Linghui Deng
- National Clinical Research Center of Geriatrics, The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xingyu Xiong
- Department of Urology, National Clinical Research Center for Geriatrics, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Yifan Li
- Department of Urology, National Clinical Research Center for Geriatrics, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, National Clinical Research Center for Geriatrics, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Birong Dong
- National Clinical Research Center of Geriatrics, The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China,Birong Dong
| | - Shi Qiu
- Department of Urology, National Clinical Research Center for Geriatrics, Institute of Urology, West China Hospital, Sichuan University, Chengdu, China,Institute of Oncology Research (IOR) and Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland,*Correspondence: Shi Qiu
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17
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da Silva LP, Moreira NB, Grando RZ, Bento PCB, Rodacki ALF. Clinical-Functional Vulnerability, Functional Capacity, and Falls in Octogenarians with Different Physical Activity Levels-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11909. [PMID: 36231209 PMCID: PMC9564968 DOI: 10.3390/ijerph191911909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
AIM To compare differences between frailty, functional capacity, and fall prevalence among community-dwelling oldest-old adults regarding their physical activity levels. METHODS Two hundred and thirty-nine octogenarians (80+ years) were allocated according to their physical activity as insufficiently active (<150 min week-1; n = 98; 84.4 ± 3.7 years), active (150 to 300 min week-1, n = 81, 83.9 ± 3.1 years), and very active (>300 min week-1, n = 60; 83.8 ± 3.4 years). Frailty (CFVI-20 questionnaire), functional capacity (Five Times Sit-to-Stand Test, Timed Up and Go, Balance, and handgrip strength), fall history, and physical activity were assessed. RESULTS The insufficiently active group was the frailest and presented the worst functional performance compared to the other groups. The fall prevalence was higher in the insufficiently active (60.9%) compared to the active (26.4%) and very active (12.7%) groups. CONCLUSIONS The group of insufficiently active octogenarians showed the greatest frailty, worst functional capacity, and higher fall prevalence than the active and very active groups. The engagement in physical activity of at least 300 min week-1 is essential to reverse or minimize the deleterious effects of aging on frailty, functional capacity, and falls in octogenarians.
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Affiliation(s)
- Letícia Pophal da Silva
- Department of Physical Education, Federal University of Paraná, Curitiba 80310-000, PR, Brazil
| | - Natália Boneti Moreira
- Department of Prevention and Rehabilitation in Physical Therapy, Federal University of Paraná, Curitiba 80310-000, PR, Brazil
| | - Renata Zacharias Grando
- Department of Physical Education, Federal University of Paraná, Curitiba 80310-000, PR, Brazil
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18
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Li Y, Zhang C, Tong Y, Zhang Y, Chen G. Prediction of the Old-Age Dependency Ratio in Chinese Cities Using DMSP/OLS Nighttime Light Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127179. [PMID: 35742427 PMCID: PMC9223023 DOI: 10.3390/ijerph19127179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 02/05/2023]
Abstract
The old-age dependency ratio (ODR) is an important indicator reflecting the degree of a regional population’s aging. In the context of aging, this study provides a timely and effective method for predicting the ODR in Chinese cities. Using the provincial ODR from the Seventh National Population Census and Defense Meteorological Satellite Program/Operational Linescan System (DMSP/OLS) nighttime light data, this study aims to predict and analyze the spatial correlation of the municipal ODR in Chinese cities. First, the prediction model of the ODR was established with curve regression. Second, the spatial structure of the municipal ODR was investigated using the Moran’s I method. The experimental results show the following: (1) the correlation between the sum of the nighttime light and ODR is greater than the mean of nighttime light in the study areas; (2) the Sigmoid model fits better than other regression models using the provincial ODR in the past ten years; and (3) there exists an obvious spatial agglomeration and dependence on the municipal ODR. The findings indicate that it is reasonable to use nighttime light data to predict the municipal ODR in large and medium-sized cities. Our approach can provide support for future regional censuses and spatial simulations.
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Affiliation(s)
- Yue Li
- Institute of Population Research, Peking University, Beijing 100871, China; (Y.L.); (C.Z.); (Y.T.)
| | - Chengmeng Zhang
- Institute of Population Research, Peking University, Beijing 100871, China; (Y.L.); (C.Z.); (Y.T.)
| | - Yan Tong
- Institute of Population Research, Peking University, Beijing 100871, China; (Y.L.); (C.Z.); (Y.T.)
| | - Yalu Zhang
- Institute of Population Research, Peking University, Beijing 100871, China; (Y.L.); (C.Z.); (Y.T.)
- Correspondence: (Y.Z.); (G.C.)
| | - Gong Chen
- Institute of Ageing Studies, Peking University, Beijing 100871, China
- Correspondence: (Y.Z.); (G.C.)
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Stephan BCM, Tang EYH, Pakpahan E, Biswas B, Gupta A, McGrattan A, Bosco A, Richardson CD, Robinson L, Siervo M. Secular Trends in Dementia Free Cognitive Function in Older Adults: A Systematic Review. J Alzheimers Dis 2022; 88:417-428. [PMID: 35662123 DOI: 10.3233/jad-220162] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although numerous studies have reported a decrease in dementia risk in the last two decades, it is unclear whether dementia-free cognitive function is also changing across generations. OBJECTIVE The objective was to systematically evaluate the published data on generational differences in cognitive function in the older population. METHODS Searches were performed on PubMed, Embase, and PsychInfo for articles published in English before 20 June 2021. Included studies were from population-based samples that reported generational differences in cognition in individuals without dementia, aged ≥60 years. RESULTS 28,101 studies were identified and 15 selected covering the period from 1971 to 2015: including studies from China, Europe, and the USA. The results show generally consistent findings of improvements or stability in dementia free cognitive function in later versus earlier born generations, but not for all cognitive domains. Prevalence of mild cognitive impairment and cognitive impairment no dementia has remained stable in the USA, UK, and China over the last two decades. RESULTS Prevalence of vascular related mild cognitive impairment has increased in China. Improvements in cognition may only partially be explained by increased educational attainment across generations. CONCLUSION This review provides evidence for generational effects in dementia-free cognitive function, predominately stability or improvements in performance, in later compared to earlier born individuals across different world regions. There is an urgent need to determine the factors driving such changes and whether they are being experienced in all world regions, particularly low- and middle-income countries where the burden of cognitive impairment is greatest and rising.
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Affiliation(s)
- Blossom C M Stephan
- Institute of Mental Health, Academic Unit 1: Mental Health & Clinical Neurosciences, University of Nottingham, Innovation Park, Jubilee Campus, Triumph Road, Nottingham, UK
| | - Eugene Y H Tang
- Population Health Sciences Institute, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Eduwin Pakpahan
- Department of Mathematics, Physics and Electrical Engineering, Ellison Building, Northumbria University, Newcastle upon Tyne, UK
| | - Bijetri Biswas
- Department of Electronic & Electrical Engineering, Computer Science and Mathematics, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alisha Gupta
- School of Medicine, The University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - Andrea McGrattan
- School of Biomedical, Nutritional and Sport Sciences, Faculty of Medical Sciences, Dame Margaret Barbour Building, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | - Alessandro Bosco
- School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Connor D Richardson
- Population Health Sciences Institute, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle Biomedical Research Building, Campus for Ageing and Vitality, Newcastle upon Tyne, UK
| | - Mario Siervo
- School of Life Sciences, Division of Physiology, Pharmacology and Neuroscience, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Wu Y, Jia M, Xiang C, Lin S, Jiang Z, Fang Y. Predicting the long-term cognitive trajectories using machine learning approaches: A Chinese nationwide longitudinal database. Psychiatry Res 2022; 310:114434. [PMID: 35172247 DOI: 10.1016/j.psychres.2022.114434] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/19/2022] [Accepted: 02/05/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study aimed to explore the long-term cognitive trajectories and its' determinants, and construct prediction models for identifying high-risk populations with unfavorable cognitive trajectories. METHODS This study included 3502 older adults aged 65-105 years at their first observations in a 16-year longitudinal cohort study. Cognitive function was measured by the Chinese version Mini Mental State Examination. The heterogeneity of cognitive function was identified through mixed growth model. Machine learning algorithms, namely regularized logistic regression (r-LR), support vector machine (SVM), random forest (RF), and super learner (SL) were used to predict cognitive trajectories. Discrimination and calibration metrics were used for performance evaluation. RESULTS Two distinct trajectories were identified according to the changes of MMSE scores: intact cognitive functioning (93.6%), and dementia (6.4%). Older age, female gender, Han ethnicity, having no schooling, rural residents, low-frequency leisure activities, and low baseline BADL score were associated with a rapid decline in cognitive function. r-LR, SVM, and SL performed well in predicting cognitive trajectories (Sensitivity: 0.73, G-mean: 0.65). Age and psychological well-being were key predictors. CONCLUSION Two cognitive trajectories were identified among older Chinese, and the identified key factors could be targeted for constructing early risk prediction models.
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Affiliation(s)
- Yafei Wu
- The State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang' an Nan Road, Xiang' an District, Xiamen, Fujian, China; National Institute for Data Science in Health and Medicine, Xiamen University, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China
| | - Maoni Jia
- The State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang' an Nan Road, Xiang' an District, Xiamen, Fujian, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China
| | - Chaoyi Xiang
- The State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang' an Nan Road, Xiang' an District, Xiamen, Fujian, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China
| | - Shaowu Lin
- The State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang' an Nan Road, Xiang' an District, Xiamen, Fujian, China; National Institute for Data Science in Health and Medicine, Xiamen University, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China
| | - Zhongquan Jiang
- The State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang' an Nan Road, Xiang' an District, Xiamen, Fujian, China
| | - Ya Fang
- The State Key Laboratory of Molecular Vaccine and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang' an Nan Road, Xiang' an District, Xiamen, Fujian, China; National Institute for Data Science in Health and Medicine, Xiamen University, China; Key Laboratory of Health Technology Assessment of Fujian Province, School of Public Health, Xiamen University, China.
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Liu D, Zhang WT, Wang JH, Shen D, Zhang PD, Li ZH, Chen PL, Zhang XR, Huang QM, Zhong WF, Shi XM, Mao C. Association between Dietary Diversity Changes and Cognitive Impairment among Older People: Findings from a Nationwide Cohort Study. Nutrients 2022; 14:1251. [PMID: 35334911 PMCID: PMC8952508 DOI: 10.3390/nu14061251] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/05/2022] [Accepted: 03/11/2022] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Little is known about the role of dietary diversity changes in affecting cognitive function among older people. Therefore, we aimed to evaluate the associations between dietary diversity scores (DDS) changes with cognitive impairment among older adults in a large prospective cohort. METHODS Cognitive function was assessed using the Mini-Mental State Examination questionnaire at baseline and follow-up. A total of 9726 participants without Parkinson's disease, dementia, or cognitive impairment were enrolled at baseline. Nine food groups were collected using simplified FFQ at baseline and follow-up surveys. Then nine food groups change patterns and DDS change patterns (overall, plant-based and animal-based) were assessed. The associations of above DDS changes patterns with subsequent cognitive impairment were evaluated. A multivariable-adjusted Cox proportional hazards model was used to estimate HRs and 95%CIs. RESULTS We documented 2805 cognitive impairments during 52,325 person-years of follow-up. Compared to high-to-high overall DDS change patterns, the multivariable adjusted HRs (95%CI) for high-to-medium, medium-to-medium, medium-to-low, low-to-medium and low-to-low DDS change patterns were 1.33 (1.12-1.57), 1.11 (0.94-1.32), 1.61 (1.39-1.86), 2.00 (1.66-2.40), 2.30 (1.90-2.78) and 2.80 (2.23-3.53), respectively. Compared with participants with stable DDS change pattern, those who in large improvement of DDS had a 13% lower risk of cognitive impairment (HRs, 0.87; 95%CI: 0.78-0.98). The associations of plant-based DDS, animal-based DDS, or nine food groups DDS change patterns with cognitive impairment were in a similar direction to the main result. CONCLUSIONS Protective associations between maintaining high DDS and a reduced risk of cognitive impairment were observed. In contrast, lowering or maintaining a lower DDS increases the risk of cognitive impairment.
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Affiliation(s)
- Dan Liu
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Wen-Ting Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Jia-Hui Wang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Dong Shen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Pei-Dong Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Zhi-Hao Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Pei-Liang Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Xi-Ru Zhang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Qing-Mei Huang
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Wen-Fang Zhong
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
| | - Xiao-Ming Shi
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing 100021, China
| | - Chen Mao
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China; (D.L.); (W.-T.Z.); (J.-H.W.); (D.S.); (P.-D.Z.); (Z.-H.L.); (P.-L.C.); (X.-R.Z.); (Q.-M.H.); (W.-F.Z.)
- Department of Laboratory Medicine, Microbiome Medicine Center, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China
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22
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Chaoping P, Cen W, Kelifa MO, Xuyang L, Wang P. Gender disparity in disability among Chinese oldest-old: Age and cohort trends. J Women Aging 2022; 35:243-258. [PMID: 35201970 DOI: 10.1080/08952841.2022.2031711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed at exploring gender disparity in disability and identifying related disablement process factors among Chinese oldest-old. Data came from eight waves of the Chinese Longitudinal Healthy Longevity Study (CLHLS). A hierarchical logistic Age-Period-Cohort (A-P-C) model was used to estimate the trend of gender disparity, and related disablement process factors were further decomposed by the Oaxaca-Blinder decomposition. Our results found that women had higher disabilities than men. The age-based trend of gender disparity in Instrumental Activities of Daily Living (IADL) continued to decline; that in Functional Limitation (FL) increased at first and then declined. The cohort-based trend of gender disparity in IADL showed a decreasing trend with each subsequent cohort; that in FL showed an increasing trend. Among the disablement process factors, health behaviors and social supports were the most important contributors to gender disparity in disability. The disability was higher for women than men, and the gender differences were attenuated at very old ages. To reduce gender disparities in disability, more attention should be paid to relevant factors of gender disparity in disability.
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Affiliation(s)
- Pan Chaoping
- School of Public Health, Wuhan University, Wuhan, China
| | - Wang Cen
- School of Public Health, Wuhan University, Wuhan, China
| | | | - Li Xuyang
- School of Public Health, Wuhan University, Wuhan, China
| | - Peigang Wang
- School of Public Health, Wuhan University, Wuhan, China
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23
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Wei Y, Liu S, Cai J, Tang X, Zhang J, Xu M, Liu Q, Wei C, Mo X, Huang S, Lin Y, Mai T, Tan D, Luo T, Gou R, Lu H, Qin J, Zhang Z. Associations of TFEB Gene Polymorphisms With Cognitive Function in Rural Chinese Population. Front Aging Neurosci 2022; 13:757992. [PMID: 34970136 PMCID: PMC8713571 DOI: 10.3389/fnagi.2021.757992] [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] [Received: 08/13/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The study aimed to investigate the relationship between transcription factor EB (TFEB) gene polymorphisms, including their haplotypes, and the cognitive functions of a selected population in Gongcheng County, Guangxi. Methods: A case-control study approach was used. The case group comprised 339 individuals with cognitive impairment, as assessed by their Mini-Mental State Examination scores; the control population also comprised 339 individuals who were matched by sex and age (± 5 years) in a 1:1 ratio. TFEB gene polymorphisms were genotyped in 678 participants (190 men and 488 women, aged 30-91 years) by using the Sequenom MassARRAY platform. Results: Multifactorial logistic regression analysis showed that in the dominant model, the risk of developing cognitive impairment was 1.547 times higher in cases with the TFEB rs14063A allele (AG + AA) than in those with the GG genotype (adjusted odds ratio [OR] = 1.547, Bonferroni correction confidence interval = 1.021-2.345). Meanwhile, the presence of the TFEB rs1062966T allele (CT + TT) was associated with a lower risk of cognitive impairment in comparison with the presence of the CC genotype (adjusted OR = 0.636, Bonferroni correction confidence interval = 0.405-0.998). In the co-dominant model, the risk of developing cognitive impairment was 1.553 times higher in carriers of the TFEB rs14063AG genotype than in carriers of the GG genotype (adjusted OR = 1.553, Bonferroni correction confidence interval = 1.007-2.397). After the Bonferroni correction and adjustment for confounding factors, the association of TFEB rs1062966 with cognitive function persisted in the analyses stratified by education level. Ethnically stratified analysis showed a significant association between TFEB rs1062966 and cognitive function in the Yao population. The multilocus linkage disequilibrium analysis indicated that the identified single nucleotide polymorphisms were not inherited independently. The haplotype analysis suggested that the rs14063A-rs1062966C-rs2278068C-rs1015149T haplotype of the TFEB gene increased the risk of cognitive impairment (P < 0.05) and that the rs14063G-rs1062966T-rs2278068C-rs1015149C haplotype was associated with a reduced risk of cognitive impairment (P < 0.05). Conclusion: TFEB rs1062966 polymorphisms and their rs14063A-rs1062966C-rs2278068C-rs1015149T and rs14063G-rs1062966T-rs2278068C-rs1015149C haplotypes are genetic factors that may affect cognitive function among the rural Chinese population.
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Affiliation(s)
- Yanfei Wei
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Shuzhen Liu
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Jiansheng Cai
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China.,Key Laboratory of Tumor Immunology and Microenvironmental Regulation, Guilin Medical University, Guilin, China
| | - Xu Tang
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Junling Zhang
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Min Xu
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Qiumei Liu
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Chunmei Wei
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Xiaoting Mo
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Shenxiang Huang
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Yinxia Lin
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Tingyu Mai
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Dechan Tan
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Tingyu Luo
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Ruoyu Gou
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Huaxiang Lu
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China
| | - Jian Qin
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China.,Key Laboratory of Longevity and Aging-Related Diseases of Chinese Ministry of Education, Nanning, China
| | - Zhiyong Zhang
- Department of Occupational and Environmental Health, School of Public Health, Guangxi Medical University, Guangxi, China.,Department of Environmental Health and Occupational Medicine, School of Public Health, Guilin Medical University, Guangxi, China
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24
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Hu X, Gu S, Zhen X, Sun X, Gu Y, Dong H. Trends in Cognitive Function Among Chinese Elderly From 1998 to 2018: An Age-Period-Cohort Analysis. Front Public Health 2021; 9:753671. [PMID: 34900900 PMCID: PMC8660074 DOI: 10.3389/fpubh.2021.753671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To investigate the effects of age, period, and cohort (APC) on trends in cognitive function among the Chinese elderly, and to explore how gender gaps in cognitive function change with age, period, and cohort. Methods: This study used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018, and included 90,432 participants aged above 65 years old. The measurement of cognitive function was the score of the Mini-Mental State Examination (MMSE). Cross-classified random-effect models were used to investigate age, period, and cohort trends in cognitive function. Results: Mini-Mental State Examination scores decreased with age at an increasing rate. While the cohort effect was nearly stable, the period effect demonstrated a downward trend from 1998 to 2002 followed by a nearly flat line. Females were associated with lower MMSE scores than males. When age increased, the gender gaps in MMSE scores further increased. The period-based gender gaps in MMSE scores diverged throughout the 20 years, while the cohort-based gender disparities in MMSE scores converged with successive cohorts. Conclusions: Age, period, and cohort had different and independent effects on cognitive function among the Chinese elderly. The effect of age was stronger than that of period and cohort. Gender disparities in cognitive function increased with age and period, and decreased with successive cohorts.
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Affiliation(s)
- Xiaoqian Hu
- School of Politics and Public Administration, Qingdao University, Qingdao, China.,Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Shuyan Gu
- Center for Health Policy and Management Studies, School of Government, Nanjing University, Nanjing, China
| | - Xuemei Zhen
- Center for Health Management and Policy, School of Public Health, Shandong University, Jinan, China.,NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xueshan Sun
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxuan Gu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.,The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, China
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25
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Bloomberg M, Dugravot A, Landré B, Britton A, Steptoe A, Singh-Manoux A, Sabia S. Sex differences in functional limitations and the role of socioeconomic factors: a multi-cohort analysis. THE LANCET. HEALTHY LONGEVITY 2021; 2:e780-e790. [PMID: 34901907 PMCID: PMC8636280 DOI: 10.1016/s2666-7568(21)00249-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Women are more likely to have functional limitations than are men, partly because of greater socioeconomic disadvantage. However, how sex differences vary by severity of functional limitations remains unclear. We examined sex differences in functional limitations, with attention to socioeconomic factors and severity of limitations. METHODS Longitudinal data on limitations in basic activities of daily living (ADL) and instrumental activities of daily living (IADL) and mobility activities were drawn from 62 375 participants from 14 countries. For ADL, IADL, and mobility, participants were categorised based on number of limited activities (0, 1, 2, or ≥3). Sex differences in limitations in four birth cohorts (1895-1929, 1930-38, 1939-45, and 1946-60) were analysed before and after adjustment for socioeconomic factors (education and labour force status). FINDINGS The prevalence of IADL and ADL limitations was higher in women than in men. After adjustment for socioeconomic factors, this sex difference was attenuated. The sex difference in IADL limitations at age 75 years (in the 1895-1929 cohort) was 3·7% before adjustment for socioeconomic factors (95% CI 2·6-4·7) and 1·7% (1·1-2·2) after adjustment. For ADL, the sex difference in limitations at age 75 years (in the 1895-1929 cohort) was 3·2% (2·3-4·1) before adjustment for socioeconomic factors and 1·4% (0·9-1·8) after adjustment. Sex differences in mobility limitations (16·1%, 95% CI 14·4-17·7) remained after adjustment for socioeconomic factors (14·3%, 12·7-15·9). After age 85 years, women were more likely to have three or more IADL or mobility limitations and men were more likely to have one or two limitations. INTERPRETATION Socioeconomic factors largely explain sex differences in IADL and ADL limitations but not mobility. Sex differences in mobility limitations in midlife are important targets for future research and interventions. FUNDING National Institute on Aging, UK National Institute for Health Research, European Commission, and US Social Security Administration.
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Affiliation(s)
- Mikaela Bloomberg
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, London, UK
| | - Aline Dugravot
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Benjamin Landré
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Annie Britton
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, London, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| | - Archana Singh-Manoux
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, London, UK
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Séverine Sabia
- Department of Epidemiology and Public Health, UCL Institute of Epidemiology and Health Care, University College London, London, UK
- Université de Paris, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
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26
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Joint trajectories of disability and related factors among older adults in China. Public Health 2021; 199:96-102. [PMID: 34583202 DOI: 10.1016/j.puhe.2021.08.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 08/07/2021] [Accepted: 08/23/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES This study aimed to identify disability trajectories and discover early disablement process factors associated with disability trajectories among older adults in China. STUDY DESIGN This is a prospective cohort study. METHODS Data were obtained from five waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS, 2005 to 2018). The multitrajectory modelling approach was used to estimate the joint trajectories of activity of daily living (ADL) disability and instrumental activity of daily living (IADL) disability. A multinomial regression model was used to investigate how baseline disablement process factors among individuals aged 65-95 years are related to joint disability trajectory groups. RESULTS We identified three typical joint ADL and IADL disability trajectories. Demographic characters, social participation, community services, disease, impairment and functional limitations can all impact the disability trajectories among older adults. CONCLUSIONS The joint ADL and IADL disability trajectories of older adults are increasing, and the Chinese government should pay more attention to disability process elements to improve disability interventions among older adults.
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27
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Environment-Stratified Age-Period-Cohort Effects on the Prevalence of Walking Among Older Adults. J Aging Phys Act 2021; 30:18-24. [PMID: 34303309 DOI: 10.1123/japa.2020-0448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 11/18/2022]
Abstract
Walking promotes active aging; however, walking prevalence changes among older adults by age and environmental conditions remain unclear. Age-period-cohort (APC) differences in walking trends among Korean older adults were examined. Data included adults aged ≥ 65 years (n = 592,235) from the nationally representative Korean Community Health Survey. Regional units examined were metropolitan cities, small- and medium-sized cities, and rural areas. Environment-stratified APC modeling was applied for walking prevalence (walking days/time during the past week). From 2008 to 2017, the walking prevalence gap between regional units widened. Decreasing trends were most apparent in rural areas, including by birth year. In all areas, walking decreased with increased age. No distinct period effects were found. Each effect's magnitude was larger in rural areas than cities. Differential APC effects by environmental conditions likely influence walking prevalence changes among older adults. Walking promotion for older adults should consider APC effects and environmental conditions.
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28
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Deng Y, Gao Q, Yang D, Hua H, Wang N, Ou F, Liu R, Wu B, Liu Y. Association between biomass fuel use and risk of hypertension among Chinese older people: A cohort study. ENVIRONMENT INTERNATIONAL 2020; 138:105620. [PMID: 32179315 DOI: 10.1016/j.envint.2020.105620] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/19/2020] [Accepted: 02/27/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUNDS Previous studies linking biomass fuel use to hypertension have been inconsistent. We investigated the association between biomass fuel use and the risk of hypertension and blood pressure measures in older Chinese people. METHODS The prospective cohort study of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) included participants aged 65 years and older in 2011/2012 who were followed up until 2014 in 23 provinces in China. We explored the association between biomass fuel use and hypertension using the Cox proportional hazards model and examined the relationship of biomass fuel use with blood pressure measures using the generalized estimating equation. Additionally, we examined the effect of switching cooking fuels on hypertension during the follow-up. RESULTS Among 3754 participants who were without hypertension at baseline, the mean age was 86 years old, and 47.5% of participants were men. Reported use of biomass fuel for cooking (50.2%) was associated with a higher risk of hypertension (incidence rate (IR) per 100 person-years: 13.15 versus 12.99, hazard ratio (HR) = 1.15, 95% confidence interval (CI) = 1.01-1.31). Biomass fuel use was related to systolic blood pressure (SBP) (β 1.10 mmHg, 95% CI: 0.48-1.72), diastolic blood pressure (DBP) (β 1.02 mmHg, 95% CI: 0.61-1.43) and mean arterial pressure (MAP) (β 1.03 mmHg, 95% CI: 0.63-1.43) elevation. Compared with persistent clean fuel users, participants who reported switching from clean to biomass fuels for cooking had a noticeably higher risk of hypertension (IR per 100 person-years: 14.27 versus 12.81, HR 1.49, 95% CI: 1.16-1.90) and higher SBP (3.71 mmHg), DBP (2.44 mmHg) and MAP (2.86 mmHg). Interaction and stratified analyses showed greater effect estimates of SBP and MAP in the oldest oldpeople (≥85). CONCLUSIONS The use of biomass fuel for cooking was associated with greater hypertension risk, and the risk may be higher among those who switched from clean fuels to biomass fuels in the Chinese elderly population. Biomass fuel use was associated with a statistically significant but small absolute increase in blood pressure measures.
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Affiliation(s)
- Yan Deng
- Department of Environmental Health, School of Public Health, China Medical University, Shenyang 110122, China
| | - Qian Gao
- Department of Environmental Health, School of Public Health, China Medical University, Shenyang 110122, China
| | - Dan Yang
- Department of Environmental Health, School of Public Health, China Medical University, Shenyang 110122, China
| | - Hui Hua
- Department of Environmental Health, School of Public Health, China Medical University, Shenyang 110122, China
| | - Nan Wang
- Department of Environmental Health, School of Public Health, China Medical University, Shenyang 110122, China
| | - Fengrong Ou
- Academic Affairs Office, China Medical University, Shenyang 110122, China
| | - Ruxi Liu
- Department of Immunology and Rheumatology, First Hospital, China Medical University, Shenyang 110001, China
| | - Bo Wu
- Department of Anal and Rectal Diseases, First Hospital, China Medical University, Shenyang 110001, China
| | - Yang Liu
- Department of Environmental Health, School of Public Health, China Medical University, Shenyang 110122, China.
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29
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Jiang Y, Yang H, Zhao J, Wu Y, Zhou X, Cheng Z. Reliability and concurrent validity of Alzheimer's disease assessment scale - Cognitive subscale, Chinese version (ADAS-Cog-C) among Chinese community-dwelling older people population. Clin Neuropsychol 2020; 34:43-53. [PMID: 32279575 DOI: 10.1080/13854046.2020.1750704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate reliability and concurrent validity of the Alzheimer's Disease Assessment Scale - Cognitive Subscale, Chinese Version (ADAS-Cog-C) among Chinese community older adults. METHOD Three groups, comprising of 1,276 community-dwelling older adults, were included in this study: a normal control (NC), a mild cognitive impairment (MCI), and an Alzheimer's disease (AD) group. All participants were assessed through ADAS-Cog-C, clinical interviews, physical examinations, Mini Mental State Examination (MMSE), and the Clinical Dementia Rating Scale (CDR). Internal consistency was assessed to evaluate the reliability of ADAS-Cog-C. Pearson and Spearman correlation coefficients were calculated to evaluate the concurrent validity between ADAS-Cog-C, MMSE, and CDR. RESULTS Overall, the Cronbach's alpha coefficients of ADAS-Cog-C for the AD and MCI groups were 0.843 and 0.554, respectively. The split-half reliability coefficients for the AD and MCI groups were 0.860 and 0.539, respectively. ADAS-Cog-C scores were negatively correlated with MMSE scores (r = -0.706, p < 0.001) and positively associated with CDR scores (r = 0.546, p < 0.001). After excluding the MCI group from the analysis, the internal consistency of ADAS-Cog-C for the total population improved (α = 0.813, r hh = 0.852, all p < 0.001), as did the correlation between ADAS-Cog-C and MMSE (r = -0.828, p < 0.001) and CDR (r = 0.429, all p < 0.001) scores. CONCLUSIONS ADAS-Cog-C has good internal consistency and concurrent validity for assessing Chinese community older adults with AD, but poor consistency, good concurrent validity with the MMSE while moderate concurrent validity with the CDR for MCI.
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Affiliation(s)
- Yan Jiang
- Department of Geriatric Psychiatry, The affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Hongyu Yang
- Department of Geriatric Psychiatry, The affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Jinfa Zhao
- Department of Psychology, Graduate School of Wannan Medical College, Wuhu, China
| | - Yue Wu
- Department of Geriatric Psychiatry, The affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Xiaoqin Zhou
- Department of Geriatric Psychiatry, The affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
| | - Zaohuo Cheng
- Department of Geriatric Psychiatry, The affiliated Wuxi Mental Health Center of Nanjing Medical University, Wuxi, China
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