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Wee LE, Yap AJW, Dickens B, Tan S, Ong B, Lye DC, Tan KB. Access to COVID-19 vaccination by socio-economic status in older Singaporean adults: a population-based cohort study. Public Health 2024; 233:38-44. [PMID: 38850601 DOI: 10.1016/j.puhe.2024.05.003] [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: 02/08/2024] [Revised: 04/09/2024] [Accepted: 05/01/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVES Socio-economic status (SES) disparities exist in the uptake of COVID-19 vaccination; however, most studies were conducted during the initial pandemic wave when vaccination was less discretionary, limiting generalizability. We aimed to determine whether differences in vaccination uptake across SES strata widened after the removal of vaccination-differentiated measures prior to the rollout of the second boosters, in a nationwide cohort of older Singaporeans at higher risk of severe-COVID-19. STUDY DESIGN Retrospective population-based cohort study. METHODS Retrospective population-based cohort study of all Singaporeans aged ≥60 years from 22nd February 2021-14th February 2023. Cox regression models controlling for demographics and comorbidities were used to estimate hazard-ratios (HRs) for the uptake of primary vaccination as well as first/second boosters, as recorded in the national vaccination registry, according to SES (housing type). RESULTS 836,170 individuals were included for completion of a primary vaccine series; 784,938 individuals for completion of the first booster and 734,206 individuals for the completion of the second booster. Differences in vaccination uptake by SES strata were observed (e.g. vaccination uptake in lowest-SES [1-2 room public-housing] versus highest-SES [private housing]: second booster, 47.6% vs. 58.1%; first booster, 93.9% vs. 98.0%). However, relative differences did not markedly widen during second booster rollout when vaccination was more discretionary (e.g. amongst those aged 60-69 years: 0.75 [95% CI = 0.73-0.76] for the first booster; 0.81 [95% CI = 0.79-0.84] for the second booster). CONCLUSION While differences in vaccination uptake across SES strata by housing type persisted during the rollout of primary vaccination and subsequent boosters in a nationwide cohort of older Singaporeans, differences did not widen substantially when vaccination was made more discretionary.
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Affiliation(s)
- L E Wee
- National Centre for Infectious Diseases, Singapore; Duke-NUS Graduate Medical School, National University of Singapore, Singapore; Department of Infectious Diseases, Singapore General Hospital, Singapore.
| | - A J W Yap
- National Centre for Infectious Diseases, Singapore
| | - B Dickens
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - S Tan
- National Centre for Infectious Diseases, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - B Ong
- Ministry of Health, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - D C Lye
- National Centre for Infectious Diseases, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - K B Tan
- National Centre for Infectious Diseases, Singapore; Duke-NUS Graduate Medical School, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Ministry of Health, Singapore
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Tan LT, Østbye T, Visaria A, Malhotra R. Derivation, and establishment of the validity and reliability, of the CASP-11-SG quality of life scale among community-dwelling older adults. Qual Life Res 2023; 32:295-306. [PMID: 36068420 DOI: 10.1007/s11136-022-03238-4] [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] [Accepted: 08/10/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE The number and proportion of older adults, aged ≥ 60 years, in Singapore is rapidly increasing. A valid and reliable quality of life (QoL) measure will enable assessment of their situation and help evaluate social and clinical interventions, potentially improving care. This study aims to evaluate the validity and reliability of the control, autonomy, self-realization, and pleasure (CASP)-12v.3 QoL scale and establish a scale suitable for use among older adults in Singapore. METHODS Data from 3526 community-dwelling older adults from a national survey was used. Measurement properties of the CASP-12v.3 scale were evaluated. Confirmatory factor analysis (CFA; testing single- and two-factor models with residual covariances for negatively worded items and a bifactor model) was performed in half of the sample and exploratory factor analysis (EFA) was performed in the other half. The results led to revised CFA models and the CASP-11-SG scale. The CASP-11-SG scale's measurement properties, convergent, and known-groups validity, and measurement equivalence/invariance (ME/I) across English and Chinese languages were evaluated. RESULTS Item 3 'I feel free to plan for the future' of the CASP-12v.3 scale had low correlation with other items of the control/autonomy subscale, low item-total correlation and high item-scale correlation. While CFA and EFA supported the two-factor model, removing item 3 improved model fit. The resulting CASP-11-SG scale (Cronbach's alpha: 0.81) demonstrated convergent and known-groups validity and partial ME/I across English and Chinese languages. CONCLUSION The CASP-11-SG scale, with satisfactory psychometric properties, can be used for assessing QoL among older adults in Singapore.
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Affiliation(s)
- Li Ting Tan
- Duke-NUS Medical School, Singapore, Singapore
| | - Truls Østbye
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Abhijit Visaria
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Rahul Malhotra
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore.
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
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Visaria A, Aithal S, Malhotra R. Digital technology use, in general and for health purposes, by older adults in Singapore. AGING AND HEALTH RESEARCH 2023. [DOI: 10.1016/j.ahr.2023.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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Prevalence and correlates of use of digital technology for managing hypertension among older adults. J Hum Hypertens 2023; 37:80-87. [PMID: 35140353 PMCID: PMC9832211 DOI: 10.1038/s41371-022-00654-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/14/2021] [Accepted: 01/04/2022] [Indexed: 01/31/2023]
Abstract
Hypertension is prevalent among older adults (60 years and above), but control of blood pressure (BP) remains suboptimal. While there is increasing interest in using digital technology for managing hypertension, information about the extent and potential correlates of such use among older adults remains scant. We assessed the prevalence and correlates of the use of digital technology for managing hypertension among older adults with hypertension. We also investigated if the use of digital technology was associated with BP or hypertension control. The use of digital technology (internet or digital apps) for information about or managing BP or hypertension was assessed among 1729 older adults diagnosed with hypertension participating in a national survey in Singapore. Regression analysis was used to assess the correlates (based on the Unified Theory of Use and Acceptance of Technology), and whether such use was associated with hypertension control or BP values. Digital technology for managing hypertension was used by 7.1% of older adults with hypertension. Those of higher age and with limitations in one or more activities or instrumental activities of daily living were less likely, while those with secondary education and above, and with stronger social network were more likely to use digital technology. There was no association between the use of digital technology and hypertension control. While users of digital technology had lower systolic (by 2.1 mmHg, adjusted p value = 0.12) and diastolic (by 1.6 mmHg, adjusted p value = 0.13) BP than non-users, the differences were not statistically significant. Given its low prevalence, there is potential for increased use of digital technology for managing hypertension among older adults with hypertension in Singapore. Initiatives to increase digital health use should target specific older adult subgroups.
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Balasubramanian I, Finkelstein E, Malhotra R, Ozdemir S, Malhotra C. Healthcare Cost Trajectories in the Last 2 Years of Life Among Patients With a Solid Metastatic Cancer: A Prospective Cohort Study. J Natl Compr Canc Netw 2022; 20:997-1004.e3. [PMID: 36075386 DOI: 10.6004/jnccn.2022.7038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most studies describe the "average healthcare cost trend" among patients with cancer. We aimed to delineate heterogeneous trajectories of healthcare cost during the last 2 years of life of patients with a metastatic cancer and to assess the associated sociodemographic and clinical characteristics and healthcare use. PATIENTS AND METHODS We analyzed a sample of 353 deceased patients from a cohort of 600 with a solid metastatic cancer in Singapore, and we used group-based trajectory modeling to identify trajectories of total healthcare cost during the last 2 years of life. RESULTS The average cost trend showed that mean monthly healthcare cost increased from SGD $3,997 during the last 2 years of life to SGD $7,516 during the last month of life (USD $1 = SGD $1.35). Group-based trajectory modeling identified 4 distinct trajectories: (1) low and steadily decreasing cost (13%); (2) steeply increasing cost in the last year of life (14%); (3) high and steadily increasing cost (57%); and (4) steeply increasing cost before the last year of life (16%). Compared with the low and steadily decreasing cost trajectory, patients with private health insurance (β [SE], 0.75 [0.37]; P=.04) and a greater preference for life extension (β [SE], -0.14 [0.07]; P=.06) were more likely to follow the high and steadily increasing cost trajectory. Patients in the low and steadily decreasing cost trajectory were most likely to have used palliative care (62%) and to die in a hospice (27%), whereas those in the steeply increasing cost before the last year of life trajectory were least likely to have used palliative care (14%) and most likely to die in a hospital (75%). CONCLUSIONS The study quantifies healthcare cost and shows the variability in healthcare cost trajectories during the last 2 years of life. Policymakers, clinicians, patients, and families can use this information to better anticipate, budget, and manage healthcare costs.
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Affiliation(s)
| | - Eric Finkelstein
- Lien Centre for Palliative Care.,Program in Health Services and Systems Research, and
| | - Rahul Malhotra
- Program in Health Services and Systems Research, and.,Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
| | - Semra Ozdemir
- Lien Centre for Palliative Care.,Program in Health Services and Systems Research, and
| | - Chetna Malhotra
- Lien Centre for Palliative Care.,Program in Health Services and Systems Research, and
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Tan SB. Changes in neighborhood environments and the increasing socioeconomic gap in child obesity risks: Evidence from Singapore. Health Place 2022; 76:102860. [PMID: 35863272 DOI: 10.1016/j.healthplace.2022.102860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/12/2022] [Accepted: 06/27/2022] [Indexed: 11/26/2022]
Abstract
Most empirical research studying the link between neighborhood environments and child obesity risks are conducted in contexts such as the U.S., with pronounced patterns of residential segregation, making it difficult to extrapolate how far built environment characteristics contribute to socioeconomic disparities in obesity risks in less segregated contexts. Using a large national dataset of almost 625,000 students' height and weight data collected at ages 7, 11 and 14, between 2004 and 2015, this paper explores whether differences in eight neighborhood characteristics measuring access to different type of food outlets, parks and other active spaces, and public transport infrastructure might be responsible for socioeconomic differences in child obesity risks in Singapore, a city-state with relatively low levels of residential segregation. Through descriptive analyses we find that socioeconomic disparities in child BMIz in Singapore widened from 2004 onwards. However, while longitudinal regression models with individual and time fixed effects suggest that family socioeconomic status modified the relationship between environmental exposures and BMIz, there does not seem to be a clear, unequivocal relationship between built environment changes and the observed widening of the socioeconomic obesity gap.
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Affiliation(s)
- Shin Bin Tan
- Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Rd, National University of Singapore, 259772, Singapore; Department of Urban Studies and Planning, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA, 02139, USA.
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Prevalence, Sociodemographic, and Health Correlates of Insufficient Physical Activity and High Sedentary Behavior Among Older Adults in Singapore. J Aging Phys Act 2022; 30:922-935. [PMID: 35203055 DOI: 10.1123/japa.2021-0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/12/2021] [Accepted: 01/14/2022] [Indexed: 11/18/2022]
Abstract
We determined the prevalence and correlates of insufficient physical activity and high sedentary behavior among a nationally representative sample of 2,240 older adults (≥60 years) in Singapore. The Global Physical Activity Questionnaire, administered through face-to-face interviews, assessed physical activity and sedentary behavior. Logistic regression identified the correlates of insufficient physical activity (<600 metabolic equivalent of task minutes/week) and high sedentary behavior (>7 hr/day). The prevalence of insufficient physical activity and high sedentary behavior was 33.7% and 17.3%, respectively. Those older, females, Malays, residing in smaller housing, living with child but no spouse, with functional limitations and sensory impairments (vision/hearing) were more likely to have insufficient physical activity whereas those with tertiary education had lower odds. High sedentary behavior was more likely among those older, with secondary education, preobesity/obesity, and with functional limitations. While policies should encourage all older adults to be physically active, at-risk subgroups identified in our study merit greater attention.
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Qin Y. Adult Children's Intergenerational Mobility and Older Adults' Self-Rated Health: A US-China Comparison. J Gerontol B Psychol Sci Soc Sci 2022; 77:1154-1163. [PMID: 35147682 DOI: 10.1093/geronb/gbac034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study examines whether and how adult children's educational mobility is associated with the self-rated health of older adults aged 50 and above in China and the United States. METHODS The analytic sample included 12,445 Chinese respondents from the 2011-2013 China Health and Retirement Longitudinal Study, and 17,121 US respondents from the 2010-2012 Health and Retirement Study. Multinomial logistic regression was employed to examine the relationship between children's educational mobility and parents' self-rated health, and the KHB-method was used for mediation analysis. RESULTS Adult children's upward mobility was associated with their parents' better health in both countries. This association was mediated by child-to-parent economic support, as well as parents' social engagement and depressive symptoms in China; in the United States, parents' depression was the only significant mediator. DISCUSSION This study is among the first to empirically show the benefit of adult children's upward mobility for their parents' health. The cross-national differences in the mediating paths suggest that the crossover effect of children's intergenerational mobility on their parents' health is embedded within specific sociocultural contexts.
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Affiliation(s)
- Yue Qin
- Department of Sociology, University of Wisconsin-Madison
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9
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Gender differences in years of remaining life by living arrangement among older Singaporeans. Eur J Ageing 2021; 18:453-466. [PMID: 34790084 DOI: 10.1007/s10433-020-00594-3] [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] [Accepted: 12/07/2020] [Indexed: 10/22/2022] Open
Abstract
Living arrangements of older adults have often been studied as a measure of the support available to them. Given the rapidly ageing and low fertility context of Singapore where the prevalence of older adults living alone and without children is expected to increase, we construct multistate life tables to estimate the number of years that older persons can expect to live in different living arrangements at a population level (population-based) as well as based on their initial living arrangement (status-based). We focus particularly on whether there are gender differences in the expected years of life in different living arrangement states. We use the Panel on Health and Ageing of Singaporean Elderly, a 2009 nationally representative survey of 4990 Singaporeans aged 60 years and older, with follow-up surveys in 2011 and 2015. In calculating the probabilities of transition between different states, we control for number of children, housing type, and time-varying ADL limitations. We find that at age 60, women can expect to spend more than twice the proportion (18%) of their remaining lives living alone compared to men (7%). Status-based estimates indicate that the proportion of remaining years living with a child is higher for women initially living alone, with a spouse only or already with a child, compared to males. Our results indicate that while older women are more likely to live alone compared to their male counterparts, older women living alone are also more likely to transition to living with children. Our research sheds light on the importance of expanding research on life expectancy beyond health, to consider analysis using other forms of social stratification, particularly gender differences in states of living arrangement. Supplementary Information The online version of this article contains supplementary material available at 10.1007/s10433-020-00594-3.
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Chung GKK, Lai FTT, Chan DC, Wong H, Yeoh EK, Chung RY. Socioeconomic disadvantages over the life-course and their influence on obesity among older Hong Kong Chinese adults. Eur J Public Health 2021; 30:1013-1018. [PMID: 32460329 DOI: 10.1093/eurpub/ckaa072] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The life-course perspective on socioeconomic inequality in health is a burgeoning field of research. Nonetheless, the three classic life-course models (i.e. sensitive period, cumulative risk and social mobility models) have rarely been simultaneously applied to studies on obesity. Therefore, this study examined the associations of socioeconomic positions (SEPs) across life stages and their associated life-course models with both general and abdominal obesity. METHODS Face-to-face interviews were conducted among 1077 community-dwelling adults aged 50 or above during 2014-15 in Hong Kong. Experiences of poverty, educational attainment and deprivation of necessities represented respondents' SEP in childhood, early adulthood and late adulthood, respectively. General and abdominal obesity were defined as body mass index ≥25 kg m-2 and waist-to-height ratio >0.5. Multivariable modified Poisson regression with a robust error variance was performed. RESULTS Respondents with low childhood SEP tended to have reduced risk of general obesity [relative risk (RR) = 0.85; 95% confidence interval (CI) = 0.72-1.00], whereas those with low childhood SEP and low late-adulthood SEP tended to have increased risk of abdominal obesity (RR = 1.10; 95% CI = 1.00-1.21 and RR = 1.14; 95% CI = 1.03-1.26, respectively). Cumulative socioeconomic disadvantages showed a dose-response relationship with abdominal obesity. Also, those with upward socioeconomic mobility had lower risk of abdominal obesity, whereas those with downward socioeconomic mobility had greater risk. CONCLUSIONS Low SEP, especially in childhood, exerted contrasting effects on general and abdominal obesity among older Hong Kong Chinese adults. The three life-course models operated simultaneously in determining the risk of abdominal obesity, while support for cumulative risk and social mobility models was weak in general obesity.
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Affiliation(s)
- Gary K K Chung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Francisco T T Lai
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Dicken C Chan
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Hung Wong
- Department of Social Work, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Roger Y Chung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
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Intergenerational social mobility and body mass index trajectories - A follow-up study from Finland. SSM Popul Health 2021; 13:100723. [PMID: 33385060 PMCID: PMC7770483 DOI: 10.1016/j.ssmph.2020.100723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 01/22/2023] Open
Abstract
Evidence remains unclear on how intergenerational social mobility is associated with body mass index (BMI) and its long-term changes. Our study identified BMI trajectories from middle to older age by intergenerational social mobility groups and stratified the analyses by gender and two birth cohorts (birth years 1940‒1947 and 1950–1962). We used questionnaire-based cohort data that consists of four survey phases: 2000–2002, 2007, 2012, and 2017. In Phase 1, participants were 40–60-year-old employees of the City of Helsinki, Finland. Our analytical sample consisted of 6,971 women and 1,752 men. Intergenerational social mobility was constructed based on self-reported parental and own education—both divided into high and low—yielding four groups: stable high socioeconomic position (SEP) (high-high), upward social mobility (low-high), downward social mobility (high-low), and stable low SEP (low-low). BMI was calculated from self-reported height and weight from all four phases. Using mixed-effects linear regression, we found increasing BMI trajectories in all four social mobility groups until the age of 65. Women and men with stable high SEP had lower BMI trajectories compared to those with stable low SEP. In the younger birth cohort, women with upward social mobility had a lower BMI trajectory than women with stable low SEP. Additionally, women and men with downward social mobility had higher BMI trajectories than those with stable high SEP. In the older birth cohort, however, the BMI trajectories of upward and downward social mobility groups were somewhat similar and settled between the BMI trajectories of stable high and stable low SEP groups. Our results indicate that the associations between intergenerational social mobility and BMI may depend on gender and birth cohort. Nevertheless, to reduce socioeconomic inequalities in unhealthy weight gain, obesity prevention actions that focus on people who are likely to remain in low SEP might be worthwhile. Few studies exist on social mobility and long-term body mass index (BMI) changes. Rising BMI trajectories were found in all social mobility groups. Stable low socioeconomic position (SEP) was related to higher BMI trajectories. Stable high SEP and upward social mobility may protect from excessive weight gain. Social mobility–BMI associations differed by gender and birth cohort.
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Wu HF. Social determination, health selection or indirect selection? Examining the causal directions between socioeconomic status and obesity in the Chinese adult population. Soc Sci Med 2020; 269:113564. [PMID: 33303291 DOI: 10.1016/j.socscimed.2020.113564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/12/2020] [Accepted: 11/26/2020] [Indexed: 10/22/2022]
Abstract
Using nationally representative longitudinal data from 2010 to 2016 in China, this paper aims to systematically investigate the dynamic relationship between socioeconomic status (SES) and obesity in the Chinese adult population. We apply maximum likelihood estimations of dynamic panel models with fixed effects to evaluate the causal directions between SES and obesity, thus providing empirical evidence of the relative importance of the "social determination" hypothesis (SES determines obesity), the "health selection" hypothesis (obesity influences SES) and the "indirect selection" hypothesis (some third factors cause obesity and SES). All analyses were conducted for women and men separately. Our analyses mostly support the contention that after two years, there are no significant causal effects of either lagged SES on Body Mass Index (BMI) or BMI on SES, after controlling for time-invariant unobserved confounders. While there is weak evidence of social determination among men, non-manual workers tend to have a higher BMI than those who are unemployed. We conclude that the indirect selection hypothesis may be the most important explanation in understanding the relationship between SES and obesity in China.
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Affiliation(s)
- Hania Fei Wu
- Fudan University, Department of Sociology, Room 925, Liberal Art Building, No. 290, Guonian Road, Yangpu District, Shanghai, China.
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13
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Park SH, Nicolaou M, Dickens BSL, Yang Q, Tan KW, van Dam RM. Ethnicity, Neighborhood and Individual Socioeconomic Status, and Obesity: The Singapore Multiethnic Cohort. Obesity (Silver Spring) 2020; 28:2405-2413. [PMID: 33064936 DOI: 10.1002/oby.22995] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/03/2020] [Accepted: 07/26/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE It remains unclear whether ethnicity has an impact on obesity independent of socioeconomic status (SES) and environmental factors. Singapore provides a unique opportunity to address this issue because three major Asian ethnic groups are represented, and government policies prevent ethnic segregation. Therefore this study examined associations between ethnicity, SES, and obesity within neighborhoods in Singapore. METHODS Cross-sectional data from 29,819 participants of the Singapore Multiethnic Cohort who were aged 21 to 75 years and of Chinese, Malay, and Indian ethnicity were used. Obesity was defined using Asian criteria. Multilevel models used obesity as the dependent variable and age, marital status, ethnicity, education level, income, and neighborhood SES as independent variables. RESULTS Education level was more strongly inversely associated with obesity than income level or neighborhood SES. The association between ethnicity and obesity was not substantially explained by measures of individual and neighborhood SES. In females, the fully adjusted odds ratio of obesity was 5.01 for Malay ethnicity and 4.81 for Indian ethnicity as compared with Chinese ethnicity. In males, these odds ratios were 2.61 and 2.07, respectively. CONCLUSIONS Ethnicity was strongly associated with obesity independent of SES and neighborhood environment. More research on sociocultural factors contributing to ethnic differences in obesity is warranted.
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Affiliation(s)
- Su Hyun Park
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Mary Nicolaou
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Qianyu Yang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Ken Wei Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
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Health-Related Difficulty in Internet Use Among Older Adults: Correlates and Mediation of Its Association With Quality of Life Through Social Support Networks. THE GERONTOLOGIST 2020; 61:693-702. [DOI: 10.1093/geront/gnaa096] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Objectives
Internet use is increasingly a necessity. However, older adults may not use the internet due to either nonhealth reasons (e.g., lack of digital literacy or internet access) or health-related reasons (e.g., visual impairment or movement difficulties). While researchers have studied internet use among older adults, most do not discriminate whether nonuse is due to health-related reasons or otherwise. We therefore examine the key correlates of health-related difficulty in internet use among older adults, and how it may affect the quality of life (QoL) through their perceived social support networks.
Research Design and Methods
Data were from a national survey of older Singaporeans (N = 3,966) conducted in 2016–2017. Multinomial logistic regression and mediation analysis were used to identify older adult subgroups more likely to experience health-related difficulty in internet use, and whether such difficulty affected older adults’ QoL through their social support networks.
Results
Those of male gender, of Malay ethnicity, with less education, and with more instrumental activity of daily living limitations were more likely to experience health-related difficulty in internet use. Social support networks mediated the relationship between health-related difficulty in internet use and QoL.
Discussion and Implications
Disparities in internet use are not just shaped by access or skill, but also health. Health-related difficulties in internet use are related to older adults’ social support networks and quality of life. As social connections become increasingly based around networked individuals due to technological advancements, more attention should be given to addressing these health-related difficulties.
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Lowry E, Rautio N, Wasenius N, Bond TA, Lahti J, Tzoulaki I, Dehghan A, Heiskala A, Ala-Mursula L, Miettunen J, Eriksson J, Järvelin MR, Sebert S. Early exposure to social disadvantages and later life body mass index beyond genetic predisposition in three generations of Finnish birth cohorts. BMC Public Health 2020; 20:708. [PMID: 32423423 PMCID: PMC7236362 DOI: 10.1186/s12889-020-08763-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/22/2020] [Indexed: 12/14/2022] Open
Abstract
Background The study aimed to explore the association between early life and life-course exposure to social disadvantage and later life body mass index (BMI) accounting for genetic predisposition and maternal BMI. Methods We studied participants of Helsinki Birth Cohort Study born in 1934–1944 (HBCS1934–1944, n = 1277) and Northern Finland Birth Cohorts born in 1966 and 1986 (NFBC1966, n = 5807, NFBC1986, n = 6717). Factor analysis produced scores of social disadvantage based on social and economic elements in early life and adulthood/over the life course, and was categorized as high, intermediate and low. BMI was measured at 62 years in HBCS1934–1944, at 46 years in NFBC1966 and at 16 years in NFBC1986. Multivariable linear regression analysis was used to explore associations between social disadvantages and BMI after adjustments for polygenic risk score for BMI (PRS BMI), maternal BMI and sex. Results The association between exposure to high early social disadvantage and increased later life BMI persisted after adjustments (β = 0.79, 95% CI, 0.33, 1.25, p < 0.001) in NFBC1966. In NFBC1986 this association was attenuated by PRS BMI (p = 0.181), and in HBCS1934–1944 there was no association between high early social disadvantage and increased later life BMI (β 0.22, 95% CI –0.91,1.35, p = 0.700). In HBCS1934–1944 and NFBC1966, participants who had reduced their exposure to social disadvantage during the life-course had lower later life BMI than those who had increased their exposure (β − 1.34, [− 2.37,-0.31], p = 0.011; β − 0.46, [− 0.89,-0.03], p = 0.038, respectively). Conclusions High social disadvantage in early life appears to be associated with higher BMI in later life. Reducing exposure to social disadvantage during the life-course may be a potential pathway for obesity reduction.
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Affiliation(s)
- Estelle Lowry
- Center for Life Course Health Research, University of Oulu, P.O.Box 5000, Fin-90014, Oulu, Finland.,Biocenter Oulu, University of Oulu, P.O.Box 8000, Fin-90014, Oulu, Finland.,School of Natural and Built Environment, Queen's University Belfast, Elmwood Avenue Belfast, Belfast, BT7 1NN, UK
| | - Nina Rautio
- Center for Life Course Health Research, University of Oulu, P.O.Box 5000, Fin-90014, Oulu, Finland. .,Unit of Primary Health Care, Oulu University Hospital, P.O.Box 10, 90029 OYS, Oulu, Finland.
| | - Niko Wasenius
- Folkhälsan Research Center, Haartmanninkatu 8, 00290, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, P.O. Box 20, 00014, Helsinki, Finland
| | - Tom A Bond
- Department of Epidemiology and Biostatistics, Imperial College, London, SW7 2AZ, UK
| | - Jari Lahti
- Department of Psychology and Logopedics, University of Helsinki, P.O.Box 63, 00014, Helsinki, Finland.,Turku Institute for Advanced Studies, University of Turku, FI-20014, Turku, Finland
| | - Ioanna Tzoulaki
- Department of Epidemiology and Biostatistics, Imperial College, London, SW7 2AZ, UK.,Department of Hygiene and Epidemiology, University of Ioannina Medical School, 45110, Ioannina, Greece
| | - Abbas Dehghan
- Department of Biostatistics and Epidemiology, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, W2 1PG, UK
| | - Anni Heiskala
- Center for Life Course Health Research, University of Oulu, P.O.Box 5000, Fin-90014, Oulu, Finland
| | - Leena Ala-Mursula
- Center for Life Course Health Research, University of Oulu, P.O.Box 5000, Fin-90014, Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, P.O.Box 5000, Fin-90014, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland
| | - Johan Eriksson
- Folkhälsan Research Center, Haartmanninkatu 8, 00290, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, P.O. Box 20, 00014, Helsinki, Finland.,Department of Obstetrics and Gynecology, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, SG, Singapore.,Singapore Institute for Clinical Sciences, Agency for Science, Technology, and Research, Singapore, Singapore
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research, University of Oulu, P.O.Box 5000, Fin-90014, Oulu, Finland.,Department of Epidemiology and Biostatistics, Imperial College, London, SW7 2AZ, UK
| | - Sylvain Sebert
- Center for Life Course Health Research, University of Oulu, P.O.Box 5000, Fin-90014, Oulu, Finland.,Biocenter Oulu, University of Oulu, P.O.Box 8000, Fin-90014, Oulu, Finland.,Department of Genomics, Imperial College London, London, SW7 2AZ, UK
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16
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Ng TKS, Matchar DB, Sultana R, Chan A. Effects of Self-Care for Older PErsons (SCOPE) on Functional and Physiological Measures: A Cluster Randomized Controlled Trial. J Clin Med 2020; 9:jcm9030885. [PMID: 32213860 PMCID: PMC7141527 DOI: 10.3390/jcm9030885] [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: 01/20/2020] [Revised: 02/21/2020] [Accepted: 03/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Population aging poses unprecedented demands on the healthcare system. There is also a scarcity of evidence on self-care intervention to improve objective measures of morbidity and aging-associated functional and physiological measures in a low-income multi-ethnic population setting. Methods: We conducted a cluster randomized controlled trial (ClinicalTrials.gov Identifier: NCT01672177) to examine the effects of the Self-Care for Older PErsons (SCOPE) program. We randomized 14 Senior Activity Centers and randomly selected older adults within these centers. Functional and physiological measurements were performed at baseline, 10-month, and 18-month periods. The primary outcome was a composite of three morbidity-specific measures, which include hemoglobin A1c (HbA1C), peak expiratory flow, and systolic blood pressure. Aging-associated functional and physiological measures were examined as secondary outcomes. Repeated-measure mixed models were employed to examine the effects of SCOPE on these measures. Results: 378 community-dwelling older adults participated in either the treatment (n= 164) or the control arm (n = 214). The primary outcome was not significantly improved. For the secondary outcomes, SCOPE participants demonstrated slower oxygen desaturation at an 18-month period (p = 0.001), improved time to complete the chair-stand test (p < 0.001) at a 10-month period with the effect persisting at the 18-month period (p < 0.001). SCOPE participants also had significantly improved vitamin B12 levels at the 18-month period (p < 0.001), increased hemoglobin concentration (p < 0.001), decreased mean corpuscular volume (p = 0.001), and decreased creatinine (p = 0.002) at the 10-month period. Conclusions: SCOPE did not improve morbidity-specific measures. However, it improved several aging-associated measures implicated in geriatric syndromes. This study highlights the potential of a self-care program in the prevention of geriatric syndromes in community-dwelling older adults, while emphasizing self-management to manage existing morbidities.
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Affiliation(s)
- Ted Kheng Siang Ng
- Center for Aging, Research and Education, Duke-National University of Singapore Medical School, Singapore 169857, Singapore;
| | - David Bruce Matchar
- Program in Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore 169857, Singapore;
- Department of Medicine (General Internal Medicine), Duke University School of Medicine, Durham, NC 27710, USA
| | - Rehena Sultana
- Center for Quantitative Medicine, Duke-National University of Singapore Medical School, Singapore 169857, Singapore;
| | - Angelique Chan
- Center for Aging, Research and Education, Duke-National University of Singapore Medical School, Singapore 169857, Singapore;
- Program in Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore 169857, Singapore;
- Department of Sociology, Faculty of Arts and Social Sciences, National University of Singapore, Singapore 117570, Singapore
- Correspondence:
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17
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Vieira LS, Bierhals IO, Vaz JDS, Meller FDO, Wehrmeister FC, Assunção MCF. Socioeconomic status throughout life and body mass index: a systematic review and meta-analysis. CAD SAUDE PUBLICA 2019; 35:e00125518. [PMID: 31618383 DOI: 10.1590/0102-311x00125518] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 04/12/2019] [Indexed: 01/27/2023] Open
Abstract
This article aimed to systematically review the association between socioeconomic status according to the life course models and the body mass index (BMI) in adults. A review was performed following the guidelines of the PRISMA. The studies were identified in the MEDLINE/PubMed, LILACS and Web of Science databases. The eligible articles investigated the association between at least one life course model (risk accumulation, critical period or social mobility) and BMI. In order to assess the quality of the selected articles, the NOS checklist was applied to each study. Eleven articles were selected for the systematic review, and seven articles were selected for the meta-analysis. The average score and the median in the NOS checklist were 6.4, within a maximum possible score of 8 points. The most used model was social mobility. Regarding meta-analysis, there was association between lower life course socioeconomic status and BMI among women. BMI mean difference (MD) was higher among those who remained with low socioeconomic status throughout life when compared with those who maintained a high socioeconomic status (MD: 2.17, 95%CI: 1.48; 2.86). Before that, the BMI MD was higher among those with upward mobility, compared with those who maintained a high socioeconomic status throughout life (MD: 1.20, 95%CI: 0.73; 1.68). The risk of overweight was also higher among women who maintained low socioeconomic status (summary RR: 1.70, 95%CI: 1.05; 2.74); however, according to the GRADE, the studies presented very low quality evidence. For men, no association was observed. Having low socioeconomic status sometime during life is associated with higher BMI in adulthood.
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18
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Tareque MI, Chan A, Saito Y, Ma S, Malhotra R. The Impact of Self-Reported Vision and Hearing Impairment on Health Expectancy. J Am Geriatr Soc 2019; 67:2528-2536. [PMID: 31411348 DOI: 10.1111/jgs.16086] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/04/2019] [Accepted: 06/26/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Vision and hearing impairment may impact both life expectancy (LE) and health expectancy, that is, duration of life with and without health problems, among older adults. We examined the impact of self-reported vision and hearing impairment on years of life with and without limitation in physical function and in activities of daily living (ADLs). DESIGN Life table analysis, using a nationally representative longitudinal survey of community-dwelling older adults aged 60 years or older, Panel on Health and Ageing of Singaporean Elderly. SETTING Singapore. PARTICIPANTS Survey participants (n = 3452) who were interviewed in 2009 and followed up in 2011-2012 and 2015. MEASUREMENTS Participants reporting difficulty with any of nine tasks involving upper or lower extremities were considered to have a limitation in physical function. Those reporting health-related difficulty with any of six basic ADLs or seven instrumental ADLs were considered to have a limitation in ADLs. We used the multistate life table method with a microsimulation approach to estimate health expectancy, considering self-reported sensory impairment status as time varying. RESULTS Either or both impairments, vs neither, were associated with less years without limitation in physical function and in ADLs and more years with limitation in physical function and in ADLs, with the greatest impact on health expectancy among those with both impairments, who also had the lowest LE. For example, at age 60, those with both impairments, vs neither, could expect not only shorter LE (4.2 [95% confidence interval [CI] = 1.9-5.7] less years; 20.7 [95% CI = 18.9-22.5] vs 24.9 [95% CI = 23.8-26.0]) but also more years of life with limitations in physical function (3.3 [95% CI = .9-5.8] more years; 12.8 [95% CI = 10.7-14.8] [about 61.7% of LE] vs 9.5 [95% CI = 8.4-10.5] [about 38.0% of LE]). CONCLUSION Timely and appropriate management of vision and hearing impairment, especially when coexisting, among older adults has the potential to reduce the years of life they live with limitation in physical function and in ADLs. J Am Geriatr Soc 67:2528-2536, 2019.
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Affiliation(s)
- Md Ismail Tareque
- Department of Population Science and Human Resource Development, University of Rajshahi, Rajshahi, Bangladesh
| | - Angelique Chan
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore.,Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
| | - Yasuhiko Saito
- College of Economics and Population Research Institute, Nihon University, Tokyo, Japan
| | - Stefan Ma
- Ministry of Health, Singapore, Singapore
| | - Rahul Malhotra
- Centre for Ageing Research and Education (CARE), Duke-NUS Medical School, Singapore, Singapore.,Health Services and Systems Research (HSSR), Duke-NUS Medical School, Singapore, Singapore
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19
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Ang S. Social Participation and Mortality Among Older Adults in Singapore: Does Ethnicity Explain Gender Differences? J Gerontol B Psychol Sci Soc Sci 2019; 73:1470-1479. [PMID: 27405935 DOI: 10.1093/geronb/gbw078] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 06/13/2016] [Indexed: 01/31/2023] Open
Abstract
Objectives Social participation has been consistently associated with lower risk of all-cause mortality, but studies have been ambivalent about how this association differs between men and women. The present study investigates if ethnicity accounts for gender differences in (a) the types of social activities older adults participate in and (b) the association between social participation and 4-year mortality. Methods Data from 4,482 Singaporean older adults who participated in a nationally representative longitudinal survey were analyzed. Stepwise logistic regressions and Cox proportional hazard models with inverse probability of treatment weights were used. Results Men were more likely to engage in social activities compared with women, but this gender difference varied by ethnicity for three activities. Whereas going out to eat was associated with a lower risk of mortality for men only, playing sports was found to be protective for women only, but these associations did not vary by ethnicity. Discussion Findings suggest that although ethnicity may account for gender differences in the content of social activity participation, it does not explain gender differences in the association between social participation and mortality. More consideration should be given to whether each activity provides an appropriate milieu for the social interaction of each gender.
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Affiliation(s)
- Shannon Ang
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore
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20
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Chan A, Saito Y, Matchar DB, Østbye T, Malhotra C, Ang S, Ma S, Malhotra R. Cohort Profile: Panel on Health and Ageing of Singaporean Elderly (PHASE). Int J Epidemiol 2019; 48:1750-1751f. [DOI: 10.1093/ije/dyz172] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Angelique Chan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Yasuhiko Saito
- College of Economics and Population Research Institute, Nihon University, Tokyo, Japan
| | - David B Matchar
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Internal Medicine (General Internal Medicine), Duke University, Durham, NC, USA
| | - Truls Østbye
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
- Family Medicine and Community Health, Duke University, Durham, NC, USA
| | - Chetna Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Shannon Ang
- Department of Sociology, University of Michigan, Ann Arbor, MI, USA
- Sociology, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Stefan Ma
- Epidemiology & Disease Control Division, Singapore Ministry of Health, Singapore
| | - Rahul Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
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21
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Years of life with and without limitation in physical function and in activities of daily living by body mass index among older adults. Int J Obes (Lond) 2019; 43:2244-2253. [PMID: 31068661 DOI: 10.1038/s41366-019-0370-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 03/19/2019] [Accepted: 03/25/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND While older adults with pre-obesity and Class I obesity have similar or lower mortality risk versus those with normal weight, a heavier body mass index (BMI) may not translate into more healthy life years. Utilizing longitudinal data on 3452 older (≥60 years) Singaporeans, we assessed the association between BMI and years of remaining life overall with and without limitation in physical function and in activities of daily living (ADLs). METHODS Difficulty in any of nine tasks involving upper or lower extremities was considered as limitation in physical function, and health-related difficulty in any basic ADL or instrumental ADL as limitation in ADLs. We utilized multistate life tables, including BMI as a time-varying covariate. RESULTS At age 60, life expectancy (LE) was similar for those with normal weight, pre-obesity and obesity. However, those with obesity, versus normal weight, had 6.3 [95% confidence interval: 3.4-9.2] more years with limitation in physical function and 4.9 [3.4-6.5] less years without limitation in physical function. Those with pre-obesity, versus normal weight, also had 3.7 [1.9-5.3] more years with limitation in physical function. The same pattern across BMI categories was observed for years of life with and without limitation in ADLs. In stratified analyses, similar associations of BMI with years of life with and without limitation in physical function and in ADLs were observed across gender, ethnicity, and educational status. CONCLUSIONS The increasing global prevalence of obesity may result in an increase in years of life with limitation in physical function and in ADLs at older ages. Older adults, their families and healthcare systems should be cognizant of this issue.
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22
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Bu EQL, Chung HJ. Barriers towards exercise and physical activity of different ethnic groups in middle-aged female Singaporeans. J Exerc Rehabil 2018; 14:739-745. [PMID: 30443518 PMCID: PMC6222159 DOI: 10.12965/jer.1836388.194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/10/2018] [Indexed: 11/22/2022] Open
Abstract
The government has collaborated with the Health Promotion Board in coming out a bountiful of initiatives for the citizens to engage in exercise. Despite the initiatives, the obesity rate in middle-aged women is still high. This study seeks to understand and identify the vast barriers that prevent middle-aged women from exercising. Purposive sampling and semi-structured interview were conducted for the participants. The analysis of the interview revealed the significance of barriers in three areas: Priority of Family and Work Commitments, Minimal Promotion of Subsidized Initiatives by the Government, and Discrimination through the Usage of Language. It highlights that racial barriers are minimal and better time management would be appropriate to engage a healthier lifestyle. The study suggested female Singaporeans to incorporate sports in the lifestyle, more aggressive promotion of subsidized initiatives and the use of common languages (English) in the exercise class.
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Affiliation(s)
- Estella Qian Lin Bu
- Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, Singapore
| | - Ho Jin Chung
- Physical Education and Sports Science, National Institute of Education, Nanyang Technological University, Singapore
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23
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Importance of social relationships in the association between sleep duration and cognitive function: data from community-dwelling older Singaporeans. Int Psychogeriatr 2018; 30:893-901. [PMID: 28615083 DOI: 10.1017/s1041610217001041] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
UNLABELLED ABSTRACTBackground:Aging is accompanied by cognitive decline that is escalated in older adults reporting extreme sleep duration. Social relationships can influence health outcomes and thus may qualify the association between sleep duration and cognitive function. The present study examines the moderating effects of marital status, household size, and social network with friends and relatives on the sleep-cognition association among older adults. METHODS Data (N = 4,169) came from the Social Isolation, Health, and Lifestyles Survey, a nationally representative survey of community-dwelling older Singaporeans (≥ 60 years). Sleep duration and social relationships were self-reported. Cognitive function was assessed with the Short Portable Mental Status Questionnaire. RESULTS Regression analysis revealed that the inverted U-shaped association between sleep duration and cognitive function was less profound among older adults who were married (vs. unmarried) and those who had stronger (vs. weaker) social networks. In contrast, it was more prominent among individuals who had more (vs. fewer) household members. CONCLUSIONS Being married and having stronger social networks may buffer against the negative cognitive impact of extreme sleep duration. But larger household size might imply more stress for older persons, and therefore strengthen the sleep duration-cognitive function association. We discuss the potential biological underpinnings and the policy implications of the findings. Although our findings are based on a large sample, replication studies using objective measures of sleep duration and other cognitive measures are needed.
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Malhotra R, Chei CL, Menon EB, Chow WL, Quah S, Chan A, Ajay S, Matchar DB. Trajectories of positive aspects of caregiving among family caregivers of stroke-survivors: the differential impact of stroke-survivor disability. Top Stroke Rehabil 2018; 25:261-268. [DOI: 10.1080/10749357.2018.1455369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Rahul Malhotra
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Choy-Lye Chei
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | | | - Wai-Leng Chow
- Health Services Research, Eastern Health Alliance, Singapore, Singapore
| | - Stella Quah
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Angelique Chan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - Shweta Ajay
- Centre for Ageing Research and Education, Duke-NUS Medical School, Singapore, Singapore
| | - David Bruce Matchar
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
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25
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Newton S, Braithwaite D, Akinyemiju TF. Socio-economic status over the life course and obesity: Systematic review and meta-analysis. PLoS One 2017; 12:e0177151. [PMID: 28510579 PMCID: PMC5433719 DOI: 10.1371/journal.pone.0177151] [Citation(s) in RCA: 203] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 04/24/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The purpose of this review was to summarize the published literature on the association of childhood, adulthood and life course socio-economic status (SES) with obesity between January 1990 and June 2015. METHODS The major medical electronic databases were searched to identify studies that examined SES over the life-course in relation to obesity. A total of 219 studies were identified through the initial search, and 35 qualified for full review. Of these, 14 publications met our inclusion criteria for the meta-analysis, all from developed or upper-middle income countries. RESULTS There was a consistent association between lower life course SES and obesity among women (summary OR: 1.35, 95% CI: 1.04, 1.76), but not among men (summary OR: 0.92, 95% CI: 0.60, 1.40). Overall, mean BMI was higher among individuals with lower life course SES compared with those with higher life course SES (summary mean BMI difference: 0.65, 95% CI: 0.59, 0.71). Mean waist circumference (WC) was higher among women with lower life course SES compared with those with higher life course SES (summary mean WC: 4.67, 95% CI: 4.15, 5.20), but lower among men (summary mean WC difference: -0.10, 95% CI: -0.11, -0.08). CONCLUSION The inverse relationship between life course SES and obesity among women was consistent, based mostly on studies in developed countries. Nevertheless, critical information gaps remain in relation to the impact of childhood and life course SES on obesity in developing countries.
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Affiliation(s)
- Suzy Newton
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Dejana Braithwaite
- Division of Cancer Epidemiology, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Tomi F. Akinyemiju
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
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Short-Term Trajectories of Depressive Symptoms in Stroke Survivors and Their Family Caregivers. J Stroke Cerebrovasc Dis 2015; 25:172-81. [PMID: 26476585 DOI: 10.1016/j.jstrokecerebrovasdis.2015.09.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/04/2015] [Accepted: 09/15/2015] [Indexed: 11/22/2022] Open
Abstract
GOAL We utilize group-based trajectory modeling (GBTM) to delineate depressive symptom trajectories among stroke survivor-caregiver dyads, to identify predictors of the delineated trajectories, and to assess the influence of time-varying covariates (stroke survivor depressive symptoms and functional disability, caregiver depressive symptoms, and foreign domestic worker [FDW] assistance) on the level of the depressive symptom trajectories. METHODS Data on 172 stroke survivor-caregiver dyads in Singapore, for whom depressive symptoms were assessed thrice (baseline/3 months/6 months), were utilized. GBTM was applied to delineate depressive symptom trajectories, and to identify their predictors and time-varying covariates. FINDINGS Three stroke survivor depressive symptom trajectories (low and decreasing [47.6%], low and increasing [43.1%], and high and increasing [9.3%]) and 2 caregiver depressive symptom trajectories (low and stable [71.5%] and high and decreasing [28.5%]) were delineated. Caregivers with chronic diseases were more likely (odds ratio [95% confidence interval]: 8.09[2.04-32.07]) and those caring for older stroke survivors (0.94[0.90-0.98]) were less likely to follow the high and decreasing than the low and stable depressive symptom trajectory. An increase in stroke survivor functional disability and caregiver depressive symptoms led to a rise (~worsening) in stroke survivor depressive symptom trajectories. Whereas an increase in stroke survivor depressive symptoms led to a rise in caregiver depressive symptom trajectories, FDW assistance led to a decline (~improvement). CONCLUSION Care professionals should be mindful of heterogeneity in depressive symptom patterns over time among stroke survivor-caregiver dyads. Reciprocal association of depressive symptoms in the stroke survivor-caregiver dyad suggests that addressing mood problems in 1 member may benefit the other member, and calls for dyadic mental health interventions.
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Liu H, Guo G. Lifetime Socioeconomic Status, Historical Context, and Genetic Inheritance in Shaping Body Mass in Middle and Late Adulthood. AMERICAN SOCIOLOGICAL REVIEW 2015; 80:705-737. [PMID: 27231400 PMCID: PMC4878452 DOI: 10.1177/0003122415590627] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
This study demonstrates body mass in middle and late adulthood as a consequence of the complex interplay among individuals' genes, lifetime socioeconomic experiences, and the historical context in which they live. Drawing on approximately 9,000 genetic samples from the Health and Retirement Study, we first investigate how socioeconomic status (SES) over the life course moderates the impact of 32 established obesity-related genetic variants on body mass index (BMI) in middle and late adulthood. Further, we consider differences across birth cohorts in the genetic influence on BMI and cohort variations in the moderating effects of life-course SES on the genetic influence. Our analyses suggest that persistently low SES over the life course or downward mobility (e.g., high SES in childhood but low SES in adulthood) amplified the genetic influence on BMI, while persistently high SES or upward mobility (e.g., low SES in childhood but high SES in adulthood) compensated for such influence. For more recent birth cohorts, while the genetic influence on BMI became stronger, the moderating effects of lifetime SES on the genetic influence were weaker compared to earlier cohorts. We discuss these findings in light of social changes during the obesity epidemic in the United States.
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Affiliation(s)
- Hexuan Liu
- Department of Sociology, the University of North Carolina at Chapel
Hill
- Carolina Population Center, the University of North Carolina at
Chapel Hill
| | - Guang Guo
- Department of Sociology, the University of North Carolina at Chapel
Hill
- Carolina Center for Genome Sciences, the University of North
Carolina at Chapel Hill
- Carolina Population Center, the University of North Carolina at
Chapel Hill
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Chan A, Matchar DB, Tsao MA, Harding S, Chiu CT, Tay B, Raman P, Pietryla Z, Klein MK, Haldane VE. Self-Care for Older People (SCOPE): A cluster randomized controlled trial of self-care training and health outcomes in low-income elderly in Singapore. Contemp Clin Trials 2015; 41:313-24. [DOI: 10.1016/j.cct.2015.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 12/27/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
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