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Zhang X, Zhang Y, Guo B, Chen G, Zhang R, Jing Q, Khan HT, Zhang L. The impact of physical activity on household out-of-pocket medical expenditure among adults aged 45 and over in urban China: The mediating role of spousal health behaviour. SSM Popul Health 2024; 25:101643. [PMID: 38449524 PMCID: PMC10915402 DOI: 10.1016/j.ssmph.2024.101643] [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: 01/15/2024] [Revised: 02/17/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
Background Increasing medical expenditure is viewed as one of the critical challenges in the context of population ageing. Physical activity (PA), as a primary prevention strategy for promoting health, is considered as an effective way to curb the excessive growth in medical expenditure. This study aimed to analyze the association between PA and the household out-of-pocket medical expenditure (HOPME) among Chinese urban adults aged 45 and over, and to explore the mediating role of spousal health behaviour. Methods This study analyzed a nationally longitudinal survey: 2014-2018 China Family Panel Studies (CFPS). Fixed effects regression model was applied to estimate the association between PA and annual HOPME. Sobel model was utilized to test the mediating effect. Results (1) PA was negatively associated with the annual HOPME among urban resident aged 45 and over in China. Exercising 1-5 times per week and maintaining the duration of each exercise session at 31-60 min were effective in reducing annual HOPME. (2) Spousal PA played a significant mediating role in the relationship between respondent's PA and annual HOPME. (3) The negative association between the respondent's PA and HOPME were found among women and those aged between 45 and 65, so was the mediating effect of spouse's PA. Conclusion Individual PA not only directly reduces HOPME but also indirectly contributes to this reduction by enhancing the PA levels of their spouses. To capitalize on these benefits, more actions should be taken to increase the availability of PA facilities, enhance the public awareness of PA's benefits, and encourage residents to consistently engage in regular PA.
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Affiliation(s)
- Xiaodong Zhang
- Institute of Population Research, Peking University, Beijing, 100871, China
- The Oxford Institute of Population Ageing, University of Oxford, OX2 6PR, United Kingdom
| | - Yanan Zhang
- The Oxford Institute of Population Ageing, University of Oxford, OX2 6PR, United Kingdom
| | - Bin Guo
- Institute of Population Research, Peking University, Beijing, 100871, China
- National Sports Industry Research Base, Peking University, Beijing, 100871, China
| | - Gong Chen
- Institute of Population Research, Peking University, Beijing, 100871, China
| | - Rui Zhang
- National Sports Industry Research Base, Peking University, Beijing, 100871, China
| | - Qi Jing
- The Oxford Institute of Population Ageing, University of Oxford, OX2 6PR, United Kingdom
- School of Management, Shandong Second Medical University, Weifang, 261053, China
| | - Hafiz T.A. Khan
- The Oxford Institute of Population Ageing, University of Oxford, OX2 6PR, United Kingdom
- College of Nursing, Midwifery and Healthcare, University of West London, TW8 9GB, United Kingdom
| | - Lei Zhang
- Institute of Population Research, Peking University, Beijing, 100871, China
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Haapanen MJ, Vetrano DL, Mikkola TM, Calderón-Larrañaga A, Dekhtyar S, Kajantie E, Eriksson JG, von Bonsdorff MB. Early growth, stress, and socioeconomic factors as predictors of the rate of multimorbidity accumulation across the life course: a longitudinal birth cohort study. THE LANCET. HEALTHY LONGEVITY 2024; 5:e56-e65. [PMID: 38103563 DOI: 10.1016/s2666-7568(23)00231-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Early growth, stress, and socioeconomic factors are associated with future risk of individual chronic diseases. It is uncertain whether they also affect the rate of multimorbidity accumulation later in life. This study aimed to explore whether early life factors are associated with the rate at which chronic diseases are accumulated across older age. METHODS In this national birth cohort study, we studied people born at Helsinki University Central Hospital, Helsinki, Finland between Jan 1, 1934, and Dec 31, 1944, who attended child welfare clinics in the city, and were living in Finland in 1971. Individuals who had died or emigrated from Finland before 1987 were excluded, alongside participants without any registry data and who died before the end of the registry follow-up on Dec 31, 2017. Early anthropometry, growth, wartime parental separation, and socioeconomic factors were recorded from birth, child welfare clinic, or school health-care records, and Finnish National Archives. International Classification of Diseases codes of diagnoses for chronic diseases were obtained from the Care Register for Health Care starting from 1987 (when participants were aged 42-53 years) until 2017. Linear mixed models were used to study the association between early-life factors and the rate of change in the number of chronic diseases over 10-year periods. FINDINGS From Jan 1, 1934, to Dec 31, 2017, 11 689 people (6064 [51·9%] men and 5625 [48·1%] women) were included in the study. Individuals born to mothers younger than 25 years (β 0·09; 95% CI 0·06-0·12), mothers with a BMI of 25-30 kg/m2 (0·08; 0·05-0·10), and mothers with a BMI more than 30 kg/m2 (0·26; 0·21-0·31) in late pregnancy accumulated chronic diseases faster than those born to older mothers (25-30 years) and those with a BMI of less than 25 kg/m2. Individuals with a birthweight less than 2·5 kg (0·17; 0·10-0·25) and those with a rapid growth in height and weight from birth until age 11 years accumulated chronic diseases faster during their life course. Additionally, paternal occupational class (manual workers vs upper-middle class 0·27; 0·23-0·30) and wartime parental separation (0·24; 0·19-0·29 for boys; 0·31; 0·25-0·36 for girls) were associated with a faster rate of chronic disease accumulation. INTERPRETATION Our findings suggest that the foundation for accumulating chronic diseases is established early in life. Early interventions might be needed for vulnerable populations, including war evacuee children and children with lower socioeconomic status. FUNDING Finska Läkaresällskapet, Liv och Hälsa rf, the Finnish Pediatric Research Foundation, and Folkhälsan Research Center. TRANSLATIONS For the Finnish and Swedish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Markus J Haapanen
- Public Health Research Program, Folkhälsan Research Center, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Davide L Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Tuija M Mikkola
- Public Health Research Program, Folkhälsan Research Center, Helsinki, Finland; Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Eero Kajantie
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Clinical Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland; Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Johan G Eriksson
- Public Health Research Program, Folkhälsan Research Center, Helsinki, Finland; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Yong Loo Lin School of Medicine, Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, National University Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Mikaela B von Bonsdorff
- Public Health Research Program, Folkhälsan Research Center, Helsinki, Finland; Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Bridger Staatz C, Gutin I, Tilstra A, Gimeno L, Moltrecht B, Moreno-Agostino D, Moulton V, Narayanan MK, Dowd JB, Gaydosh L, Ploubidis GB. Midlife Health in Britain and the US: A comparison of Two Nationally Representative Cohorts. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.21.23300366. [PMID: 38196627 PMCID: PMC10775406 DOI: 10.1101/2023.12.21.23300366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Background Older adults in the United States (US) have worse health and wider socioeconomic inequalities in health compared to Britain. Less is known about how health in the two countries compares in midlife, a time of emerging health decline, including inequalities in health. Methods We compare measures of smoking status, alcohol consumption, obesity, self-rated health, cholesterol, blood pressure, and glycated haemoglobin using population-weighted modified Poisson regression in the 1970 British Cohort Study (BCS70) in Britain (N= 9,665) and the National Longitudinal Study of Adolescent to Adult Health (Add Health) in the US (N=12,297), when cohort members were aged 34-46 and 33-43, respectively. We test whether associations vary by early- and mid-life socioeconomic position. Findings US adults had higher levels of obesity, high blood pressure and high cholesterol. Prevalence of poor self-rated health, heavy drinking, and smoking was worse in Britain. We found smaller socioeconomic inequalities in midlife health in Britain compared to the US. For some outcomes (e.g., smoking), the most socioeconomically advantaged group in the US was healthier than the equivalent group in Britain. For other outcomes (hypertension and cholesterol), the most advantaged US group fared equal to or worse than the most disadvantaged groups in Britain. Interpretation US adults have worse cardiometabolic health than British counterparts, even in early midlife. The smaller socioeconomic inequalities and better overall health in Britain may reflect differences in access to health care, welfare systems, or other environmental risk factors. Funding ESRC, UKRI, MRC, NIH, European Research Council, Leverhulme Trust.
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Affiliation(s)
| | - Iliya Gutin
- The University of Texas at Austin, Austin, Texas, USA
| | - Andrea Tilstra
- Leverhulme Centre for Demographic Science, Nuffield College, and Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Laura Gimeno
- Centre for Longitudinal Studies, University College London, London, UK
| | - Bettina Moltrecht
- Centre for Longitudinal Studies, University College London, London, UK
| | - Dario Moreno-Agostino
- Centre for Longitudinal Studies, University College London, London, UK
- ESRC Centre for Society and Mental Health, King’s College London, London, UK
| | - Vanessa Moulton
- Centre for Longitudinal Studies, University College London, London, UK
| | | | - Jennifer B. Dowd
- Leverhulme Centre for Demographic Science, Nuffield College, and Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Ashida T, Fujiwara T, Kondo K. Association between adverse childhood experiences and social integration among older people in Japan: Results from the JAGES study. Arch Gerontol Geriatr 2023; 114:105099. [PMID: 37329767 DOI: 10.1016/j.archger.2023.105099] [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: 02/26/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/19/2023]
Abstract
Social integration, network, and support are beneficial to health. However, there is little evidence of the association between adverse childhood experiences (ACEs) and social integration in later life. This study investigates the association between ACE history and social integration in older people. We used data from the Japan Gerontological Evaluation Study (JAGES) 2013, which conducted a self-reported survey of functionally independent people aged ≥ 65 years from 30 municipalities across Japan and yielded information on ACE history. We conducted a Poisson regression analysis with robust error variances to assess the association between ACE history and social integration, adjusting for sex, age, childhood economic hardship, adult socioeconomic status, health status, living status, and trust in others. The number of respondents with at least one incident of ACE was approximately 36.8%. The prevalence ratios for those who reported a history of ACEs were as follows: housebound 1.495 (95% confidence interval [CI]: 1.19-1.88), small network size 1.146 (95% CI: 1.10-1.19), low network contact 1.059 (95% CI: 1.00-1.059), non-membership sports group 1.038 (95% CI: 1.00-1.07), and non-membership hobby group 1.06 (95% CI: 1.03-1.09). Among older people in Japan, a history of ACEs is inversely associated with social integration. These findings support the life course approach and suggest that adverse events in early life may have an impact on social life in old age. In order to promote healthy aging, it is important to recognize the significant impact of early-life adversities that can extend into later life.
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Affiliation(s)
- Toyo Ashida
- Faculty of Economics, Keio University, Tokyo, Japan.
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Katsunori Kondo
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan; Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
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Zhao M, He X, Li T, Shao H, Huo Q, Li Y. Early-Life Factors and Multimorbidity Risk Later in Older Age: Evidence Based on CHARLS. Gerontology 2023; 69:1347-1357. [PMID: 37725916 DOI: 10.1159/000532060] [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: 12/14/2022] [Accepted: 07/17/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Early-life factors were reported to exert influence on the health condition of individuals in the long-term. However, limited research explored the connection between early-life factors and multimorbidity in later years. METHODS We utilized the data from the China Health and Retirement Longitudinal Study to assess this possible association in the present cross-sectional study. Multimorbidity was determined based on 14 common chronic diseases included in the study. Logistic regression was employed to examine the link between early-life factors and subsequent multimorbidity. RESULTS Out of 7,578 participants who met the inclusion criteria for analysis, 3,765 (49.68%) were females. The mean age was 68.25 ± 6.70 years. Participants who rated their health during childhood as average (odds ratio [OR] 0.78, 95% confidence interval [CI] 0.63-0.96) or better [OR 0.72, 95% CI 0.57-0.91] were significantly less likely to experience multimorbidity in older life. By contrast, experiencing violence from two of the family members was significantly associated with future multimorbidity (OR [95% CI], 1.29 [1.04-1.60]). A superior family financial situation was also negatively associated with multimorbidity, with average (OR [95% CI], 0.72 [0.63-0.83]) and better off than average (OR [95% CI], 0.76 [0.62-0.93]). DISCUSSION Individuals with poor health status, inferior family socioeconomic status, or experienced violence from family members in childhood were more likely to suffer from multimorbidity in later life. Enhanced social monitoring of potentially adverse conditions in youngsters and targeted interventions could help mitigate the progression of multimorbidity in later life.
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Affiliation(s)
- Minjun Zhao
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China,
| | - Xu He
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Tianrong Li
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Heng Shao
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Qian Huo
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
| | - Yan Li
- Department of Geriatrics, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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Hoang CT, Amin V, Behrman JR, Kohler HP, Kohler IV. Heterogenous trajectories in physical, mental and cognitive health among older Americans: Roles of genetics and life course contextual factors. SSM Popul Health 2023; 23:101448. [PMID: 37520306 PMCID: PMC10372459 DOI: 10.1016/j.ssmph.2023.101448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 04/13/2023] [Accepted: 06/08/2023] [Indexed: 08/01/2023] Open
Abstract
We investigate the roles of genetic predispositions, childhood SES and adult educational attainment in shaping trajectories for three important components of the overall health of older adults -- BMI, depressive symptoms and cognition. We use the Health & Retirement Study (HRS) and group-based trajectory modeling (GBTM) to identify subgroups of people who share the same underlying trajectories ages 51-94 years. After identifying common underlying health trajectories, we use fractional multinomial logit models to estimate associations of (1) polygenic scores for BMI, depression, ever-smoked, education, cognition and subjective wellbeing, (2) childhood SES and (3) educational attainment with the probabilities of trajectory group memberships. While genetic predispositions do play a part in predicting trajectory group memberships, our results highlight the long arm of socioeconomic factors. Educational attainment is the most robust predictor-it predicts increased probabilities of belonging to trajectories with BMI in the normal range, low depressive symptoms and very-high initial cognition. Childhood circumstances are manifested in trajectories to a lesser extent, with childhood SES predicting higher likelihood of being on the low depressive symptoms and very-high initial cognition trajectories. We also find suggestive evidence that associations of educational attainment on the probabilities of being on trajectories with BMI in the normal range, low depressive symptoms and very-high initial cognition vary with genetic predispositions. Our results suggest that policies to increase educational attainment may improve population health by increasing the likelihood of belonging to "good" aging trajectories.
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Affiliation(s)
| | | | - Jere R. Behrman
- William R. Kenan, Economics and Sociology, University of Pennsylvania, USA
| | - Hans-Peter Kohler
- Fredrick J. Warren Professor of Demography, University of Pennsylvania, USA
| | - Illiana V. Kohler
- Population Studies Center and Department of Sociology, University of Pennsylvania, USA
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Seixas BV, Macinko J. Distinct domains of childhood disadvantage and cognitive performance among older Brazilians: Evidence from ELSI-Brazil. SSM Popul Health 2023; 22:101416. [PMID: 37215155 PMCID: PMC10193012 DOI: 10.1016/j.ssmph.2023.101416] [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: 10/19/2022] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/24/2023] Open
Abstract
Objective To investigate the relationship between of distinct domains of childhood disadvantage and cognitive performance among older adults within the context of a middle-income country. Methods This study used baseline data (2015/2016) from the Brazilian Longitudinal Study of Aging (ELSI), a nationally representative cohort of 9412 adults aged 50 and over. Nine childhood exposure variables were grouped into three domains (family SES, childhood health, and cultural capital), for which scores were created. Survey-weighted Ordinary Least Squares (OLS) regressions estimated the association childhood disadvantage with cognitive performance as measured by immediate memory, late memory and semantic verbal fluency. Mediation analysis assessed whether adulthood socioeconomic status (SES) mediated this relationship of interest. Results Important disparities in cognitive performance were observed, particularly in terms of age, education, income, occupational status. Before controlling for adulthood SES in the multivariable analysis, all domains of childhood disadvantage were found to be associated with lower cognitive performance across all three measures. After inclusion of adulthood SES variables, the observed associations only remained for semantic verbal fluency. Formal mediation analysis indicated that adulthood SES mediates 47.9% (95% CI: 34.3%-78.6%) of the association between later-life verbal fluency and poor childhood health, and 49.9% (95% CI: 43.6%-57.8%) of the association between later-life verbal fluency and low childhood cultural capital. Conclusions We found that childhood disadvantage is associated with low performance in memory tests and semantic verbal fluency tests among older Brazilians. Adulthood SES fully mediated the association between all domains of childhood disadvantage and memory performance and only partially mediated its association with verbal fluency. Our findings support policy efforts to enhance early childhood development and improve adulthood SES, and guide additional research to better the mechanisms driving these relationships.
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Affiliation(s)
- Brayan V. Seixas
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
| | - James Macinko
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles (UCLA), 650 Charles E Young Dr S, Los Angeles, CA, 90095, USA
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Chowdhury P, Mohanty I, Singh A, Niyonsenga T. Informal sector employment and the health outcomes of older workers in India. PLoS One 2023; 18:e0266576. [PMID: 36812213 PMCID: PMC9946227 DOI: 10.1371/journal.pone.0266576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
A large proportion of the older population in India constitutes an undeniable share of workforce after the retirement age. This stresses the need to understand the implications of working at older ages on health outcomes. The main objective of this study is to examine the variations in health outcomes by formal/informal sector of employment of older workers using the first wave of the Longitudinal Ageing Study in India. Using binary logistic regression models, the results of this study affirm that type of work does play a significant role in determining health outcomes even after controlling socio-economic, demographic, life-style behaviour, childhood health and work characteristics. The risk of Poor Cognitive Functioning (PCF) is high among informal workers, while formal workers suffer greatly from Chronic Health Conditions (CHC) and Functional Limitations (FL). Moreover, the risk of PCF and/or FL among formal workers increases with the increase in risk of CHC. Therefore, the present research study underscores the relevance of policies focusing on providing health and healthcare benefits by respective economic activity and socio-economic position of older workers.
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Affiliation(s)
- Poulomi Chowdhury
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
- * E-mail:
| | - Itismita Mohanty
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Akansha Singh
- Department of Anthropology, Durham Research Methods Centre, Durham University, Durham, United Kingdom
| | - Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
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Jin C, Dai X, Mishra GD, Wang Y, Xu X. Childhood socioeconomic disadvantage and risk of physical multimorbidity in later life: The mediating role of depression. Maturitas 2022; 167:17-23. [DOI: 10.1016/j.maturitas.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/12/2022] [Accepted: 09/15/2022] [Indexed: 11/26/2022]
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Kwon E, Park S, Lee H. Early-Life Socioeconomic Disadvantage and Health in Late Middle-Age: Importance of Heterogeneous Income Trajectories. Res Aging 2022; 45:458-474. [PMID: 35950236 DOI: 10.1177/01640275221117304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This paper aims to investigate heterogeneous income changes and whether the income trajectories moderate effects of early socioeconomic disadvantage on health in late middle age. The sample was restricted to 9,056 middle-aged adults from the Health and Retirement Study (1998-2010). Through a latent class growth analysis, six patterns of income changes were identified: constantly low, constantly moderate, constantly high & increasing, high to low, moderate to high, and high to moderate. The Constantly low group more frequently displayed depressive symptoms if exposed to early socioeconomic disadvantage and Constantly low income mobility. Individuals who experienced early socioeconomic disadvantage and a downward income mobility in middle age tended to have multiple chronic conditions while there was no moderating effect of income changes for mobility functional limitations. These findings suggest that not all health outcomes are programmed in early life: Disadvantage can be somewhat alleviated through stable and better later-life economic status.
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Affiliation(s)
- Eunsun Kwon
- Fairleigh Dickinson University, Madison, NJ, USA
| | - Sojung Park
- 51503Washington University in Saint Louis, St.Louis, MI, USA
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Jungo KT, Cheval B, Sieber S, Antonia van der Linden BW, Ihle A, Carmeli C, Chiolero A, Streit S, Cullati S. Life-course socioeconomic conditions, multimorbidity and polypharmacy in older adults: A retrospective cohort study. PLoS One 2022; 17:e0271298. [PMID: 35917337 PMCID: PMC9345356 DOI: 10.1371/journal.pone.0271298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/27/2022] [Indexed: 11/26/2022] Open
Abstract
Socioeconomic conditions across the life course may contribute to differences in multimorbidity and polypharmacy in old age. However, whether the risk of multimorbidity changes during ageing and whether life-course socioeconomic conditions are associated with polypharmacy remain unclear. We investigated whether disadvantaged childhood socioeconomic conditions (CSCs) predict increased odds of multimorbidity and polypharmacy in older adults, whether CSCs remain associated when adjusting for adulthood socioeconomic conditions (ACSs), and whether CSCs and ACSs are associated cumulatively over the life course. We used data for 31,432 participants (multimorbidity cohort, mean [SD] age 66·2[9] years), and 21,794 participants (polypharmacy cohort, mean age 69·0[8.9] years) from the Survey of Health, Ageing, and Retirement in Europe (age range 50-96 years). We used mixed-effects logistic regression to assess the associations of CSCs, ASCs, and a life-course socioeconomic conditions score (0-8; 8, most advantaged) with multimorbidity (≥2 chronic conditions) and polypharmacy (≥5 drugs taken daily). We found an association between CSCs and multimorbidity (reference: most disadvantaged; disadvantaged: odds ratio (OR) = 0·79, 95% confidence interval (CI) 0·70-0·90; middle: OR = 0·60; 95%CI 0·53-0·68; advantaged: OR = 0·52, 95%CI 0·45-0·60, most advantaged: OR = 0·40, 95%CI 0·34-0·48) but not polypharmacy. This multimorbidity association was attenuated but remained significant after adjusting for ASCs. The life-course socioeconomic conditions score was associated with multimorbidity and polypharmacy. We did not find an association between CSCs, life-course socioeconomic conditions, and change in odds of multimorbidity and polypharmacy with ageing. Exposure to disadvantaged socioeconomic conditions in childhood or over the entire life-course could predict multimorbidity in older age.
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Affiliation(s)
| | - Boris Cheval
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
- Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), University of Geneva, Geneva, Switzerland
| | - Stefan Sieber
- Swiss NCCR “LIVES: Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Switzerland
- LIVES Centre, Swiss Centre of Expertise in Life Course Research, University of Lausanne, Lausanne, Switzerland
| | - Bernadette Wilhelmina Antonia van der Linden
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
- Population Aging Research Center and Population Studies Center, University of Pennsylvania, Philadelphia, PA, United States of America
- Population Health Laboratory, #PopHealthLab, University of Fribourg, Fribourg, Switzerland
| | - Andreas Ihle
- Swiss NCCR “LIVES: Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
- Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Cristian Carmeli
- Population Health Laboratory, #PopHealthLab, University of Fribourg, Fribourg, Switzerland
| | - Arnaud Chiolero
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory, #PopHealthLab, University of Fribourg, Fribourg, Switzerland
- School of Global and Population Health, McGill University, Montreal, Canada
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory, #PopHealthLab, University of Fribourg, Fribourg, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
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12
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Life course socioeconomic conditions and multimorbidity in old age - A scoping review. Ageing Res Rev 2022; 78:101630. [PMID: 35430301 DOI: 10.1016/j.arr.2022.101630] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/23/2022] [Accepted: 04/11/2022] [Indexed: 01/23/2023]
Abstract
Multimorbidity disproportionally affects individuals exposed to socioeconomic disadvantage. It is, however, unclear how adverse socioeconomic conditions (SEC) at different periods of the life course predict the occurrence of multimorbidity in later life. In this scoping review, we investigate the association between life course SEC and later-life multimorbidity, and assess to which extent it supports different life course causal models (critical period, sensitive period, accumulation, pathway, or social mobility). We identified four studies (25,209 participants) with the first measure of SEC in childhood (before age 18). In these four studies, childhood SEC was associated with multimorbidity in old age, and the associations were partially or fully attenuated upon adjustment for later-life SEC. These results are consistent with the sensitive period and the pathway models. We identified five studies (91,236 participants) with the first measure of SEC in young adulthood (after age 18), and the associations with multimorbidity in old age as well as the effects of adjustment for later-life SEC differed from one study to the other. Among the nine included studies, none tested the social mobility or the accumulation models. In conclusion, SEC in early life could have an effect on multimorbidity, attenuated at least partly by SEC in adulthood.
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13
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Balakrishnan S, Karmacharya I, Ghimire S, Mistry SK, Singh DR, Yadav OP, Gudi N, Rawal LB, Yadav UN. Prevalence of multimorbidity and its correlates among older adults in Eastern Nepal. BMC Geriatr 2022; 22:425. [PMID: 35570271 PMCID: PMC9109315 DOI: 10.1186/s12877-022-03115-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background The number of people with multimorbidity is surging around the world. Although multimorbidity has been introduced in policy and practice in developed countries, developing countries like Nepal have not considered it as a matter of public health urgency due to the lack of enough epidemiological data. Multimorbidity profoundly affects older adults’ wellbeing; therefore, it is crucial to estimate its prevalence and determinants. This study aimed to estimate the prevalence of multimorbidity among older adults in Eastern Nepal and identify its correlates. Methodology A community-based cross-sectional survey was conducted in three districts of Eastern Nepal. Data were collected between July and September 2020, among 847 Nepali older adults, aged 60 and older, where study participants were recruited through a multi-stage cluster sampling technique. Semi-structured interviews were conducted at the community settings to collect data. Logistic regression assessed correlates of multimorbidity. SAS 9.4 was used to run all statistical tests and analyses. Results More than half (66.5%) of the participants had at least one of the five non-communicable chronic conditions; hypertension (31.6%), osteoarthritis (28.6%), chronic respiratory disease (18.0%), diabetes (13.5%), and heart disease (5.3%). The prevalence of multimorbidity was 22.8%. In the adjusted model, increased age (for 70–79 years, OR: 3.11, 95% CI: 1.87–5.18; for 80 + years, OR: 4.19, 95% CI: 2.32–7.57), those without a partner (OR: 1.52, 95% CI: 1.00–2.30), residing in urban areas (OR: 1.71, 95% CI: 1.16–2.51), and distant from health center (OR: 1.66, 95% CI: 1.04–2.64) were significantly associated with multimorbidity. Conclusions This study found one in five study participants had multimorbidity. The findings will assist policymakers and stakeholders in understanding the burden of multimorbidity among the older population and identifying the groups in most need of health promotion intervention. Future interventions may include developing horizontal multimorbid approaches and multisectoral strategies specifically tailored to meet the needs of those populations.
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Affiliation(s)
| | - Isha Karmacharya
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Saruna Ghimire
- Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Devendra Raj Singh
- School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, UK
| | | | - Nachiket Gudi
- Public Health Evidence South Asia (PHESA), Department of Health Information, Prasanna School of Public Health, Manipal, Karnataka, India
| | - Lal Bahadur Rawal
- School of Health Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney Campus, Sydney, Australia
| | - Uday Narayan Yadav
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia. .,National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia. .,Centre for Research Policy and Implementation (CRPIN), Biratnagar, Nepal.
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14
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Zheng X, Cui Y, Xue Y, Shi L, Guo Y, Dong F, Zhang C. Adverse childhood experiences in depression and the mediating role of multimorbidity in mid-late life: A nationwide longitudinal study. J Affect Disord 2022; 301:217-224. [PMID: 35031336 DOI: 10.1016/j.jad.2022.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/07/2021] [Accepted: 01/10/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUNDS Adverse childhood experiences are co-occurring factors of multimorbidity and depression in mid-late life, but the combined effect of ACEs and multimorbidity on depression over life has not been fully studied. METHODS We used data from the China Health and Retirement Longitudinal Study which includes 4,440 middle-aged and older adults. Different types of ACEs experienced up to the age of 17 were assessed based on self-reports. We used parallel process Latent Growth Curve modelling to evaluate the longitudinal mediation role of ACEs, multimorbidity and depression. RESULTS People who had more ACEs were found to have a higher level of multimorbidity (intercept: 0.057, 95% CI: 0.031 to 0.079) and depression (intercept: 0.047, 95% CI: 0.013 to 0.076) at the baseline and a faster increase in multimorbidity (slope: 0.107, 95%CI: 0.078 to 0.136) and depression (slope: 0.074, 95%CI: 0.035 to 0.153). The mediation analysis indicated that there was a positive indirect association of ACEs via the multimorbidity intercept with the intercept of depression (0.028, 95%CI: 0.012 to 0.043), and a small negative association with the slope of depression (-0.002, 95%CI: -0.003 to -0.001). We also found a positive indirect association of ACEs via the multimorbidity slope with the intercept (0.035, 95%CI: 0.021 to 0.049) and slope (0.008, 95%CI: 0.004 to 0.011) of depression. CONCLUSIONS ACEs were related to higher depression partly via elevated multimorbidity. Public health services and behavioural interventions to prevent and reduce the occurrence of ACEs might help to lower the risk of multimorbidity and depression in later life.
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Affiliation(s)
- Xiao Zheng
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China; School of Health Management, Southern Medical University, Guangzhou, China
| | - Yuehua Cui
- Department of Statistics & Probability, Michigan State University, China
| | - Yaqing Xue
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China; School of Health Management, Southern Medical University, Guangzhou, China
| | - Lei Shi
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Yi Guo
- School of Public Health, Southern Medical University, Guangzhou, Guangdong, China; Department of Health Management, Nafang Hospital, Guangzhou, China
| | - Fang Dong
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Chichen Zhang
- School of Health Management, Southern Medical University, Guangzhou, China; Department of Health Management, Nafang Hospital, Guangzhou, China; Institute of Health Management, Southern Medical University, Guangzhou, China.
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15
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Schramm S, Møller SP, Tolstrup JS, Laursen B. Effects of individual and parental educational levels on multimorbidity classes: a register-based longitudinal study in a Danish population. BMJ Open 2022; 12:e053274. [PMID: 35197340 PMCID: PMC8867340 DOI: 10.1136/bmjopen-2021-053274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the effects of individual educational level in adulthood and parental educational level during childhood, as well as combinations of individual and parental educational levels, on multimorbidity classes. DESIGN AND SETTING In this longitudinal study, we used data from a random sample of the Danish population aged 32-56 years without multimorbidity in 2010 (n=102 818). The study population was followed until 2018. Information on individual and parental educational levels and chronic conditions was obtained from national registers. Multinomial logistic regression analyses were adjusted for sex, age and ethnicity. OUTCOME MEASURE Seven multimorbidity classes were identified using latent class analysis based on 47 chronic conditions. Persons deceased during follow-up comprised a separate class. RESULTS We found an independent effect of individual educational level on five multimorbidity groups and death, most pronounced for the multimorbidity group 'Many conditions' (OR=1.89, 95% CI 1.58 to 2.26 for medium and OR=3.22, 95% CI 2.68 to 3.87 for short compared with long educational level) and of parental education on four groups and death, most pronounced for the multimorbidity group 'Many conditions' (OR=1.36, 95% CI 1.07 to 1.73 for medium and OR=1.48, 95% CI 1.15 to 1.89 for short compared with long educational level). Odds of belonging to four multimorbidity classes increased with lower combination of individual and parental educational levels, most pronounced for the multimorbidity group 'Many conditions'. CONCLUSION As both individual and parental educational levels contribute to the risk of multimorbidity, it is important to address inequality throughout the life course to mitigate multimorbidity. Future studies could adopt a life course approach to investigate the mediating role of behavioural, clinical, environmental and other social factors.
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Affiliation(s)
- Stine Schramm
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Sanne Pagh Møller
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Bjarne Laursen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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16
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Associations between Early-Life Food Deprivation and Risk of Frailty of Middle-Age and Elderly People: Evidence from the China Health and Retirement Longitudinal Study. Nutrients 2021; 13:nu13093066. [PMID: 34578943 PMCID: PMC8472025 DOI: 10.3390/nu13093066] [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: 07/12/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The association between childhood food deprivation (FD) and health in later life has been extensively studied; however, studies on the association between childhood food deprivation and frailty are scarce. This study assessed the associations between childhood FD and the risk of frailty at middle-age and old age. METHODS Three waves of the China Health and Retirement Longitudinal Study (CHARLS), including 11,615 individuals aged over 45 years, were used for this research. Frailty was operationalized according to the FRAIL scale as a sum of fatigue, resistance, ambulation, illness, and the loss of weight. Childhood FD experiences and levels were measured by self-reported FD and historical content. Logistic mixed-effects models and proportional odds ordered logistic regression models were used to analyse the association between childhood FD and frailty. FINDINGS Childhood FD increased the odds of frailty at old age (1.30, 95% CI: 1.26-1.36). Compared with subjects with mild FD, those with extreme FD experiences had increased risks of frailty (1.34, 95% CI: 1.26-1.43). Subjects exposed to hunger at different ages all had an increased risk of frailty, and subjects who had FD during ages 6-12 (1.15, 95% CI: 1.09-1.22) were more likely to have an increased risk of frailty than those who had experienced FD in younger ages. The interaction of experience of FD at ages 0-6 and the experience of FD at ages 6-12 is not statistically significant after adjusting all covariates. CONCLUSIONS Our findings suggest that childhood FD exerts long-lasting effects on frailty among older adults in China. The prevention of childhood FD may delay or even avert the emergence of frailty in people of middle-age and old age.
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17
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Mustillo S, Li M, Ferraro KF. Evaluating the Cumulative Impact of Childhood Misfortune: A Structural Equation Modeling Approach. SOCIOLOGICAL METHODS & RESEARCH 2021; 50:1073-1109. [PMID: 34744209 PMCID: PMC8570259 DOI: 10.1177/0049124119875957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Most studies of the early origins of adult health rely on summing dichotomously measured negative exposures to measure childhood misfortune (CM), neglect, adversity, or trauma. There are several limitations to this approach, including that it assumes each exposure carries the same level of risk for a particular outcome. Further, it often leads researchers to dichotomize continuous measures for the sake of creating an additive variable from similar indicators. We propose an alternative approach within the structural equation modeling (SEM) framework that allows differential weighting of the negative exposures and can incorporate dichotomous and continuous observed variables as well as latent variables. Using the Health and Retirement Study data, our analyses compare the traditional approach (i.e., adding indicators) with alternative models and assess their prognostic validity on adult depressive symptoms. Results reveal that parameter estimates using the conventional model likely underestimate the effects of CM on adult health outcomes. Additionally, while the conventional approach inhibits testing for mediation, our model enables testing mediation of both individual CM variables and the cumulative variable. Further, we test whether cumulative CM is moderated by the accumulation of protective factors, which facilitates theoretical advances in life course and social inequality research. The approach presented here is one way to examine the cumulative effects of early exposures while attending to diversity in the types of exposures experienced. Using the SEM framework, this versatile approach could be used to model the accumulation of risk or reward in many other areas of sociology and the social sciences beyond health.
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Affiliation(s)
| | - Miao Li
- University of Notre Dame, IN, USA
- Clemson University, SC, USA
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18
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Calvo E, Azar A, Shura R, Staudinger UM. A New Path to Address Multimorbidity? Longitudinal Analyses of Retirement Sequences and Chronic Diseases in Old Age. J Appl Gerontol 2021; 41:952-961. [PMID: 34271835 DOI: 10.1177/07334648211031038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Chronic disease and multimorbidity are growing health challenges for aging populations, often coinciding with retirement. We examine late-life predictors of multimorbidity, focusing on the association between retirement sequences and number of chronic diseases. We modeled the number of chronic diseases as a function of six types of previously identified 10-year retirement sequences using Health and Retirement Study (HRS) data for 7,880 Americans observed between ages 60 to 61 and 70 to 71. Our results show that at baseline, the adjusted prevalence of multimorbidity was lowest in sequences characterized by late retirement from full-time work and highest in sequences characterized by early labor-force disengagement. Age increases in multimorbidity varied across retirement sequences, though overall differences in prevalence persisted at age 70 to 71. Earlier life disadvantages did not moderate these associations. Findings suggest further investigation of policies that target health limitations affecting work, promote continued beneficial employment opportunities, and ultimately leverage retirement sequences as a novel path to influence multimorbidity in old age.
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Affiliation(s)
- Esteban Calvo
- Columbia University, New York, NY, USA.,Universidad Mayor, Santiago, Chile
| | - Ariel Azar
- Universidad Mayor, Santiago, Chile.,University of Chicago, IL, USA
| | - Robin Shura
- Kent State University at Stark, North Canton, OH, USA
| | - Ursula M Staudinger
- Columbia University, New York, NY, USA.,Technical University of Dresden, Germany
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19
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Ersig AL, Brown RL, Malecki K. Association Between Food Allergy, Psychological Stress, and Allostatic Load. West J Nurs Res 2021; 44:946-954. [PMID: 34060963 DOI: 10.1177/01939459211019042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Allostatic load (AL), the cumulative biological burden of persistently high stress exposure, influences adult health and well-being across the lifespan, and can be measured with clinical indicators, such as BMI, blood pressure (BP), and waist-hip ratio. Adverse childhood events and other stressors contribute to AL, but stress from other sources, such as previously diagnosed chronic health conditions, has been overlooked. We hypothesized that adults with these conditions would have more stress exposures, higher perceived stress, worse mental health, and higher AL, compared to controls. A secondary analysis of deidentified data from cases with self-reported food allergies and controls found that individuals with chronic health conditions reported more stress exposures, higher levels of perceived stress, and had higher AL, compared to controls. However, other results did not support the study hypotheses. Future studies should examine additional AL measures, such as biomarkers of stress response, in individuals with existing chronic health conditions.
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Affiliation(s)
- Anne L Ersig
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Roger L Brown
- School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Kristen Malecki
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA
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20
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Kudesia P, Salimarouny B, Stanley M, Fortin M, Stewart M, Terry A, Ryan BL. The incidence of multimorbidity and patterns in accumulation of chronic conditions: A systematic review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2021; 11:26335565211032880. [PMID: 34350127 PMCID: PMC8287424 DOI: 10.1177/26335565211032880] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/24/2021] [Indexed: 12/17/2022]
Abstract
Multimorbidity, the presence of 1+ chronic condition in an individual, remains one of the greatest challenges to health on a global scale. Although the prevalence of multimorbidity has been well-established, its incidence is not fully understood. This systematic review determined the incidence of multimorbidity across the lifespan; the order in which chronic conditions accumulate to result in multimorbidity; and cataloged methods used to determine and report accumulation of chronic conditions resulting in multimorbidity. Studies were identified by searching MEDLINE, Embase, CINAHL, and Cochrane electronic databases. Two independent reviewers evaluated studies for inclusion and performed quality assessments. Of 36 included studies, there was high heterogeneity in study design and operational definitions of multimorbidity. Studies reporting incidence (n = 32) reported a median incidence rate of 30.7 per 1,000 person-years (IQR 39.5 per 1,000 person-years) and a median cumulative incidence of 2.8% (IQR 28.7%). Incidence was notably higher for persons with older age and 1+ chronic conditions at baseline. Studies reporting patterns in accumulation of chronic conditions (n = 5) reported hypertensive and heart diseases, and diabetes, as among the common starting conditions resulting in later multimorbidity. Methods used to discern patterns were highly heterogenous, ranging from the use of latent growth trajectories to divisive cluster analyses, and presentation using alluvial plots to cluster trajectories. Studies reporting the incidence of multimorbidity and patterns in accumulation of chronic conditions vary greatly in study designs and definitions used. To allow for more accurate estimations and comparison, studies must be transparent and consistent in operational definitions of multimorbidity applied.
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Affiliation(s)
- Prtha Kudesia
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
| | - Banafsheh Salimarouny
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
| | - Meagan Stanley
- Allyn & Betty Taylor Library, University of Western
Ontario, London, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
| | - Amanda Terry
- Schulich Interfaculty Program in Public Health, University of Western
Ontario, London, Ontario, Canada
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
| | - Bridget L Ryan
- Centre for Studies in Family Medicine & Department of Family
Medicine, Schulich School of Medicine & Dentistry, University of Western
Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of
Medicine & Dentistry, University of Western Ontario, London, Ontario,
Canada
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21
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Ellis KR, Hecht HK, Young TL, Oh S, Thomas S, Hoggard LS, Ali Z, Olawale R, Carthron D, Corbie-Smith G, Eng E. Chronic Disease Among African American Families: A Systematic Scoping Review. Prev Chronic Dis 2020; 17:E167. [PMID: 33416471 PMCID: PMC7784550 DOI: 10.5888/pcd17.190431] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Chronic diseases are common among African Americans, but the extent to which research has focused on addressing chronic diseases across multiple members of African American families is unclear. This systematic scoping review summarizes the characteristics of research addressing coexisting chronic conditions among African American families, including guiding theories, conditions studied, types of relationships, study outcomes, and intervention research. METHODS The literature search was conducted in PsycInfo, PubMed, Social Work Abstracts, Sociological Abstracts, CINAHL, and Family and Society Studies Worldwide to identify relevant articles published from January 2000 through September 2016. We screened the title and abstracts of 9,170 articles, followed by full-text screening of 530 articles, resulting in a final sample of 114 articles. Fifty-seven percent (n = 65) of the articles cited a guiding theory/framework, with psychological theories (eg, social cognitive theory, transtheoretical model) being most prominent. The most common conditions studied in families were depression (70.2%), anxiety (23.7%), and diabetes (22.8%), with most articles focusing on a combination of physical and mental health conditions (47.4%). RESULTS In the 114 studies in this review, adult family members were primarily the index person (71.1%, n = 81). The index condition, when identified (79.8%, n = 91), was more likely to be a physical health condition (46.5%, n = 53) than a mental health condition (29.8%, n = 34). Among 343 family relationships examined, immediate family relationships were overwhelmingly represented (85.4%, n = 293); however, extended family (12.0%, n = 41) and fictive kin (0.6%, n = 2) were included. Most (57.0%, n = 65) studies focused on a single category of outcomes, such as physical health (eg, obesity, glycemic control), mental health (eg, depression, anxiety, distress), psychosocial outcomes (eg, social support, caregiver burden), or health behaviors (eg, medication adherence, disease management, health care utilization); however, 43.0% (n = 49) of studies focused on outcomes across multiple categories. Sixteen intervention articles (14.0%) were identified, with depression the most common condition of interest. CONCLUSION Recognizing the multiple, simultaneous health issues facing families through a lens of family comorbidity and family multimorbidity may more accurately mirror the lived experiences of many African American families and better elucidate intervention opportunities than previous approaches.
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Affiliation(s)
- Katrina R Ellis
- University of Michigan, School of Social Work, Room 3849, Ann Arbor, MI 48109.
| | - Hillary K Hecht
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, North Carolina
| | - Tiffany L Young
- University of North Carolina at Chapel Hill, North Carolina Translational Research and Clinical Sciences Institute, Chapel Hill, North Carolina
- Lenell and Lillie Consulting, LLC, New Bern, North Carolina
| | - Seyoung Oh
- University of Michigan, School of Social Work, Ann Arbor, Michigan
| | - Shikira Thomas
- University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina
| | - Lori S Hoggard
- Rutgers University-New Brunswick, Department of Psychology, New Brunswick, New Jersey
| | - Zaire Ali
- Rutgers University-New Brunswick, Department of Psychology, New Brunswick, New Jersey
| | - Ronke Olawale
- University of Michigan, School of Social Work, Ann Arbor, Michigan
| | - Dana Carthron
- North Carolina Central University, College of Behavioral Sciences, Durham, North Carolina
| | - Giselle Corbie-Smith
- University of North Carolina at Chapel Hill, School of Medicine, Department of Social Medicine, Chapel Hill, North Carolina
| | - Eugenia Eng
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, Chapel Hill, North Carolina
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22
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Yang L, Hu Y, Silventoinen K, Martikainen P. Childhood adversity and trajectories of multimorbidity in mid-late life: China health and longitudinal retirement study. J Epidemiol Community Health 2020; 75:jech-2020-214633. [PMID: 33293288 DOI: 10.1136/jech-2020-214633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 10/28/2020] [Accepted: 11/23/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND The association between childhood adversity and an individual's health in later life has been extensively studied in Western societies; however, little is known about this association for the development of multimorbidity in China. METHODS Three waves (2011-2012, 2013 and 2015) of the China Health and Retirement Longitudinal Study were used for adults aged 45-101 years. Multimorbidity was assessed by the summed scores of self-reported physician diagnoses of 14 chronic diseases. Childhood adversity was measured by the incidence of childhood abuse and neglect, negative caregiver's characteristics and low socioeconomic status. Latent growth curve modelling was used to investigate the trajectory of multimorbidity by childhood adversity. RESULTS Parental physical abuse was associated with increased number of chronic diseases (intercept: 0.119; 95% CI: 0.033 to 0.205 for men and 0.268: 95% CI: 0.188 to 0.348 for women) and a higher rate of increase (slope: 0.013: 95% CI: 0.000 to 0.027 for men and 0.022: 95% CI: 0.008 to 0.036 for women) in multimorbidity. Adequacy of food was associated with a lower number chronic diseases at baseline (men: -0.171: 95% CI: -0.245 to -0.097; women: -0.223: 95% CI: -0.294 to -0.152) and a slower rate of change in multimorbidity (men: -0.015 per year: 95% CI: -0.027 to -0.003; women: -0.012 per year: 95% CI: -0.024 to -0.001). CONCLUSIONS The results demonstrate that childhood adversity exerts long-lasting effects on multimorbidity among older adults in China. Prevention of childhood maltreatment may delay or even avert the emergence of multimorbidity in later life.
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Affiliation(s)
- Lei Yang
- School of Ethnology and Sociology, Minzu University of China, Beijing, China
| | - Yaoyue Hu
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Karri Silventoinen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Laboratory of Population Health, Max-Planck-Institute for Demographic Research, Rostock, Germany
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23
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Early-Life Conditions and Cognitive Function in Middle-and Old-Aged Chinese Adults: A Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103451. [PMID: 32429157 PMCID: PMC7277849 DOI: 10.3390/ijerph17103451] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 12/22/2022]
Abstract
A range of previous studies have suggested that early-life conditions (ELCs) are associated with various health problems throughout life in Western societies. The aim of this study was to investigate whether, and how, early-life conditions predicted the level and trajectory of cognitive function in middle- and old-aged Chinese adults. Data were obtained from China Health and Retirement Longitudinal Study which comprised 16,258 adults at baseline. Cognitive function was assessed using mental intactness and episodic memory and ELCs were measured by early parental death, childhood socioeconomic status (SES), food deprivation, and childhood health. Growth curve modeling was used to examine the trajectory of cognitive function (three waves in a 6-year period)with particular attention paid to the effects of ELCs on cognition. The results show that early maternal death is associated with the baseline cognitive level among middle- and old-aged Chinese adults (β range between −0.44 and −0.35, p < 0.05), but that this association is also largely attenuated by adulthood education. Higher childhood SES predicts an enhanced level of baseline cognition in both age groups (β range between 0.08 and 1.27, p < 0.001), but only protects against cognitive decline at baseline in middle-aged adults. Participants who were less healthy during childhood tended to have lower cognitive performance than those who had enjoyed good health (β range between −0.36 and −0.14, p < 0.05). The results of this study highlight the detrimental impact of deleterious ELCs on cognitive function throughout later life.
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Pei Y, Cong Z, Wu B. Education, adult children's education, and depressive symptoms among older adults in rural China. Soc Sci Med 2020; 253:112966. [PMID: 32247217 DOI: 10.1016/j.socscimed.2020.112966] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 01/29/2020] [Accepted: 03/25/2020] [Indexed: 12/15/2022]
Abstract
This study examines whether children's education amplifies the effect of older adults' own education on their later life depressions in rural China. Data derives from six waves of panel data (2001, 2003 2006, 2009, 2012 and 2015) from the Longitudinal Study of Older Adults in Anhui Province, China. Random effect models showed that both older adults' own education and adult children's education had direct effects on depressive symptoms of older adults. Older adults' education influenced children's education, and in turn influenced intergenerational support from children, which consequently influenced depressive symptoms of older adults. Taken together, children's education amplifies the effect of older adults' own education on their depressive symptoms in rural China. This process increases health inequalities among older adults as a result of associated educational achievements in two generations. Educational policy should promote the equality of educational attainment of individuals in the future.
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Affiliation(s)
- Yaolin Pei
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, USA.
| | - Zhen Cong
- School of Social Work, University of Texas at Arlington, Arlington, TX, USA
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, USA
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Dekhtyar S, Vetrano DL, Marengoni A, Wang HX, Pan KY, Fratiglioni L, Calderón-Larrañaga A. Association Between Speed of Multimorbidity Accumulation in Old Age and Life Experiences: A Cohort Study. Am J Epidemiol 2019; 188:1627-1636. [PMID: 31274148 DOI: 10.1093/aje/kwz101] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 04/16/2019] [Accepted: 04/17/2019] [Indexed: 11/14/2022] Open
Abstract
Rapidly accumulating multiple chronic conditions (multimorbidity) during aging are associated with many adverse outcomes. We explored the association between 4 experiences throughout life-childhood socioeconomic circumstances, early-adulthood education, midlife occupational stress, and late-life social network-and the speed of chronic disease accumulation. We followed 2,589 individuals aged ≥60 years from the Swedish National Study on Aging and Care in Kungsholmen for 9 years (2001-2013). Information on life experiences was collected from detailed life-history interviews. Speed of disease accumulation was operationalized as the change in the count of chronic conditions obtained from clinical examinations, medical histories, laboratory data, drug use, and register linkages over 9 years. Linear mixed models were used to analyze the data. Speed of disease accumulation was lower in individuals with more than elementary education (for secondary, β × time = -0.065, 95% CI: -0.126, -0.004; for university, β × time = -0.118, 95% CI: -0.185, -0.050); for active occupations compared with high-strain jobs (β × time = -0.078, 95% CI: -0.138, -0.017); and for richer social networks (for moderate tertile, β × time = -0.102, 95% CI: -0.149, -0.055; for highest tertile, β × time = -0.135, 95% CI: -0.182, -0.088). The association between childhood circumstances and speed of disease accumulation was attenuated by later-life experiences. Diverse experiences throughout life might decelerate chronic disease accumulation during aging.
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Affiliation(s)
- Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Geriatrics, Università Cattolica del Sacro Cuore, Rome, Italy
- Centro di Medicina dell’Invecchiamento, Istituto Di Ricovero e Cura a Carattere Scientifico Fondazione Policlinico “A. Gemelli”, Rome, Italy
| | - Alessandra Marengoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Hui-Xin Wang
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Kuan-Yu Pan
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
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Clay OJ, Perkins M, Wallace G, Crowe M, Sawyer P, Brown CJ. Associations of Multimorbid Medical Conditions and Health-Related Quality of Life Among Older African American Men. J Gerontol B Psychol Sci Soc Sci 2019; 73:258-266. [PMID: 28658936 DOI: 10.1093/geronb/gbx090] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 06/06/2017] [Indexed: 01/31/2023] Open
Abstract
Background African American (AA) men battling multiple morbidities are tasked with managing the components of each condition and are at greater risk for adverse outcomes such as poor health-related quality of life (QOL), disability, and higher mortality rates. Method Baseline data for AA men from the University of Alabama at Birmingham Study of Aging were utilized. Factor analysis was used to categorize medical conditions and create factor scores. Covariate-adjusted regression models assessed the relationships between categories of conditions and physical and mental health-related QOL as assessed by the SF-12. Results The mean age of the sample of 247 AA men was 75.36 years and 49% lived in rural areas. Medical conditions fit into three factors: metabolic syndrome, kidney failure and neurological complications, and COPD and heart disease. Covariate-adjusted models revealed that low education, higher levels of income difficulty, and higher scores on metabolic syndrome and COPD and heart disease factors were associated with lower scores on physical health-related QOL, p's < .05. Higher levels of income difficulty were also associated with lower scores on mental health-related QOL. Discussion These findings suggest the importance of examining clusters of comorbid medical conditions and their relationships to outcomes within older African American men.
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Affiliation(s)
- Olivio J Clay
- Department of Psychology, University of Alabama at Birmingham
| | | | - Gail Wallace
- Department of Mental Health, Johns Hopkins University, Baltimore, Maryland
| | - Michael Crowe
- Department of Psychology, University of Alabama at Birmingham
| | - Patricia Sawyer
- UAB Comprehensive Center for Healthy Aging, Department of Medicine, University of Alabama at Birmingham.,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham
| | - Cynthia J Brown
- Birmingham/Atlanta VA Geriatric Research Education and Clinical Center (GRECC).,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham
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Bhatta TR, Albert JM, Kahana E, Lekhak N. Early Origins of Later Life Psychological Well-Being? A Novel Application of Causal Mediation Analysis to Life Course Research. J Gerontol B Psychol Sci Soc Sci 2019; 73:160-170. [PMID: 28329853 DOI: 10.1093/geronb/gbx022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 02/20/2017] [Indexed: 02/04/2023] Open
Abstract
Objectives This study employs a novel approach to mediation analysis to clarify the influence of interrelated indicators of life course socioeconomic status (SES) on later life psychological well-being in India. Contrary to traditional approaches (i.e., use of product and difference-in-coefficients), we recognize the role of confounders in the estimation of total, direct, and indirect effects of parental education on respondents' psychological well-being. Method Drawing from the first wave (2007-2010) of the Study on Global Ageing and Adult Health (SAGE) and adopting a counterfactual approach, we estimate both natural direct and indirect effects of parental education through individual educational attainment (secondarily, through household assets as an additional mediator) on respondents' life-satisfaction and quality of life (QOL). Results Findings document a statistically not significant positive total effect of parental education on life satisfaction and QOL. While lower for women, significant indirect effects suggest that the positive influence of parental education operates primarily through the individual's education. Notably, we found negative direct effect of parental education on psychological well-being outcomes. Discussion Contrary to prior literature, we found no positive direct influence of parental education on later life psychological well-being, but established its influence through socioeconomic positioning over the life course.
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Affiliation(s)
- Tirth R Bhatta
- Department of Sociology, Case Western Reserve University, Cleveland, Ohio
| | - Jeffrey M Albert
- Department of Epidemiology & Biostatistics, Case Western Reserve University, Cleveland, Ohio
| | - Eva Kahana
- Department of Sociology, Case Western Reserve University, Cleveland, Ohio
| | - Nirmala Lekhak
- FPB School of Nursing, Case Western Reserve University, Cleveland, Ohio
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Chen F, Lin Z, Bao L, Zimmer Z, Gultiano S, B Borja J. Time-use Profiles, Chronic Role Overload, and Women's Body Weight Trajectories from Middle to Later Life in the Philippines. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:119-136. [PMID: 30724626 PMCID: PMC7451413 DOI: 10.1177/0022146519827612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although chronic life strain is often found to be associated with adverse health outcomes, empirical research is lacking on the health implications of persistent role overload that many women around the world are subject to, the so-called double burden of work and family responsibilities. Using data from the Cebu Longitudinal Health and Nutrition Survey (1994-2012), we examined the linkage between time-use profiles and body mass index (BMI) trajectories for Filipino women over an 18-year span. Out of the four classes of women with differential levels of a combination of work and family duties, the group with the heaviest double burden has the highest average BMI. In addition, those who have remained in this class for three or more waves of data not only have higher BMI on average but also have experienced the steepest rate of increase in BMI upon transition from midlife to old age.
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Affiliation(s)
- Feinian Chen
- 1 University of Maryland, College Park, MD, USA
- 5 Fudan University, Shanghai, China
| | - Zhiyong Lin
- 1 University of Maryland, College Park, MD, USA
| | - Luoman Bao
- 2 California State University-Los Angeles, Los Angeles, CA, USA
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Williams MM, Kemp BR, Ferraro KF, Mustillo SA. Avoiding the Major Causes of Death: Does Childhood Misfortune Reduce the Likelihood of Being Disease Free in Later Life? J Gerontol B Psychol Sci Soc Sci 2019; 74:170-180. [PMID: 29617874 PMCID: PMC6294238 DOI: 10.1093/geronb/gby039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/02/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives Although previous research reveals the detrimental effects of early misfortune on the development of chronic diseases in later life, few studies have investigated its effects on remaining disease free. This study draws on cumulative inequality theory to investigate whether experiencing childhood misfortune reduces the likelihood of remaining disease free over time. Method This study utilizes five waves of data from the Health and Retirement Study to test whether five domains of childhood misfortune predict being disease free at baseline (2004) and developing disease over time (2004-2012). Results Respondents reporting risky parental behaviors during childhood were less likely to be disease free at baseline and had an increased risk of disease onset over time, the latter driven by having a guardian who smoked in combination with more pack-years smoked in adulthood. Furthermore, we find that adult resources, that is wealth, help to mitigate the noxious effects of other misfortunes, notably poor socioeconomic conditions. Discussion Consistent with cumulative inequality theory, these findings reveal that experiencing multiple types of misfortune during childhood decreases the likelihood of remaining disease free in later life, but engaging in health behaviors, such as physical activity, can help to ameliorate some of the noxious effects of early misfortune.
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Affiliation(s)
- Monica M Williams
- Department of Sociology, Purdue University, West Lafayette, Indiana
- Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana
| | - Blakelee R Kemp
- Department of Sociology, Purdue University, West Lafayette, Indiana
- Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana
| | - Kenneth F Ferraro
- Department of Sociology, Purdue University, West Lafayette, Indiana
- Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana
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Laditka JN, Laditka SB. Lifetime Disadvantages after Childhood Adversity: Health Problems Limiting Work and Shorter Life. THE ANNALS OF THE AMERICAN ACADEMY OF POLITICAL AND SOCIAL SCIENCE 2018; 680:259-277. [PMID: 31031404 PMCID: PMC6481962 DOI: 10.1177/0002716218795436] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We examine how childhood adversity relates to work disability and life expectancy, using 1999-2015 data from the Panel Study of Income Dynamics. We estimate the probabilities of work disability and death, adjusting for age, sex, race/ethnicity, and education in a nationally representative sample of African American, Hispanic, and white women and men. We find that people in all these groups who experienced high adversity childhoods (individuals with four or more of six adversity indicators) had significantly more work disability and shorter lives than those who experienced no adversity. These findings provide evidence that childhood adversity is associated with substantial disability, and a reduction in life expectancy of at least a decade. Childhood adversity was generally associated with more lost years of life for men than for women, and more disability for women than for men. The results are robust, even when controlling for diabetes, heart disease, depression, obesity, and sedentary behavior.
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Affiliation(s)
- James N Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223,
| | - Sarah B Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223,
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Henchoz Y, Seematter-Bagnoud L, Nanchen D, Büla C, von Gunten A, Démonet JF, Santos-Eggimann B. Childhood adversity: A gateway to multimorbidity in older age? Arch Gerontol Geriatr 2018; 80:31-37. [PMID: 30336372 DOI: 10.1016/j.archger.2018.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/27/2018] [Accepted: 10/05/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Multimorbidity, or co-occurrence of several chronic diseases, has major consequences in terms of function, quality of life and mortality. Recent advances suggest that the aetiology of multimorbidity includes a life-long process. The purpose of this study was to determine the association between childhood adversity and multimorbidity in community-dwelling older adults, and to investigate variation in participants born immediately before, during and at the end of the Second World War. METHODS Participants were 4731 community-dwelling older adults who enrolled in the Lausanne cohort 65+ study (Switzerland) at age 65-70 years in 2004/2009/2014. A baseline questionnaire provided several indicators of childhood adversity including premature birth, food restrictions, child labour, family economic environment, serious illness/accident, and stressful life events. Multimorbidity at age 67-72 years was defined as ≥2 active chronic diseases at the 2-year follow-up questionnaire. RESULTS All childhood adversity indicators except premature birth were significantly associated with multimorbidity. Odds ratio (OR) ranged from 1.23 (P = 0.034) for poor family economic environment to 1.74 (P < 0.001) for stressful life events. In a multivariable model adjusted for socioeconomic status, health behaviours and stressful life events in adulthood (>16 years), a history of serious illness/accident (OR = 1.45; P < 0.001) and stressful life events (OR = 1.42; P = 0.001) in childhood remained significantly associated with multimorbidity. Comparisons between cohorts indicated substantial variations in the prevalence of childhood adversity indicators but similar associations with multimorbidity. CONCLUSION There was an independent association between childhood adversity and multimorbidity after age 65. This study encourages a comprehensive life-course perspective to better understand and potentially prevent multimorbidity.
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Affiliation(s)
- Yves Henchoz
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland.
| | - Laurence Seematter-Bagnoud
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland.
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland.
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Centre, Lausanne, Switzerland.
| | - Armin von Gunten
- Service of Geriatric Psychiatry, Department of Psychiatry, University of Lausanne Hospital Centre, Lausanne, Switzerland.
| | - Jean-Francois Démonet
- Leenaards Memory Centre, University of Lausanne Hospital Centre, Lausanne, Switzerland.
| | - Brigitte Santos-Eggimann
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland.
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Tilles-Tirkkonen T, Nuutinen O, Sinikallio S, Poutanen K, Karhunen L. Theory-informed nutrition education curriculum Tools For Feeling Good promotes healthy eating patterns among fifth grade pupils: cross-sectional study. J Hum Nutr Diet 2018; 31:647-657. [PMID: 29888471 DOI: 10.1111/jhn.12568] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The eating patterns of school-aged children rarely meet recommendations: meal frequency is irregular and the consumption of vegetables is lower and sugar-sweetened products higher than recommended. Although school is an excellent arena for nutrition education to support pupils eating patterns, teachers usually lack efficient tools. The present study aimed to develop a curriculum for nutrition education to be used by teachers and to examine its efficacy in the school environment with respect to the eating patterns of pupils. METHODS The curriculum was developed in collaboration with school teachers using self-determination theory as a theoretical standpoint. The Health at Every Size concept and sensory-based food education were utilised in the curriculum. Self-reported questionnaires were used to assess the feasibility and impact of the curriculum. Fourteen teachers implemented the curriculum during 2012-2013 with 194 pupils aged 10-13 years (fifth and sixth grades). The control schools included 140 pupils of the same age not following the curriculum. RESULTS The teachers reported that the curriculum was easy to integrate in the school environment. The fifth graders improved their breakfast frequency, increased their consumption of vegetables and reduced their consumption of ice cream, sweets and sugar-sweetened drinks. No improvement was found in the fifth graders at the control schools. In the sixth graders, no dietary changes were detected in the intervention or control schools. CONCLUSIONS The pupils in the fifth grade appeared to comprise a responsive target group for nutrition education at schools. The curriculum offers a promising approach for developing healthy eating patterns among fifth graders. Collaboration with teachers in developing the curriculum likely enhanced its feasibility and teacher commitment for implementation.
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Affiliation(s)
- T Tilles-Tirkkonen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - O Nuutinen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - S Sinikallio
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - K Poutanen
- VTT - Technical Research Centre of Finland Ltd, Finland
| | - L Karhunen
- Department of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Institute of Clinical Medicine, Internal Medicine, Kuopio University Hospital, Kuopio, Finland
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Humphreys J, Jameson K, Cooper C, Dennison E. Early-life predictors of future multi-morbidity: results from the Hertfordshire Cohort. Age Ageing 2018; 47:474-478. [PMID: 29438452 DOI: 10.1093/ageing/afy005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Indexed: 11/13/2022] Open
Abstract
Background multi-morbidity is an increasing challenge in western medicine and has the potential to impact patients' quality of life, treatment options and compliance with medications. The aim of this study was to identify the early-life predictors of long-term multi-morbidity in an historical cohort, the Hertfordshire Cohort Study (HCS). Methods perinatal and infant health records were kept on all children born in Hertfordshire between 1931 and 1939. Participants who were still alive in 1998 were recruited to the HCS and data collected on major chronic diseases. They were subsequently followed up in the Clinical Outcomes Study (COS), and data recorded on all major illnesses since HCS, as well as current medications. Ordinal logistic regression analysed the association between early-life factors and the number of morbidities in these two surveys as well as medication count. Results a total of 2299 participants had data in COS, 1131 (49%) were female, median age (interquartile range) at recruitment to HCS was 66 (64-68) years. Higher rates of childhood illnesses were significantly associated with future multi-morbidity (multivariate odds ratio (OR) (95% confidence interval (CI)) 1.15 (1.06, 1.25)) and higher medication counts at COS (multivariate OR (95%CI) 1.14 (1.06, 1.23)). Conclusions children who experience more illnesses at a young age may be prone to develop multi-morbidity in later life.
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Affiliation(s)
- Jenny Humphreys
- Arthritis Research UK Centre for Epidemiology, University of Manchester, UK
| | - Karen Jameson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
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Abstract
The association between low socioeconomic status (SES) and obesity is well documented. In the current research, a life history theory (LHT) framework provided an explanation for this association. Derived from evolutionary behavioral science, LHT emphasizes how variability in exposure to unpredictability during childhood gives rise to individual differences in a range of social psychological processes across the life course. Consistent with previous LHT research, the current findings suggest that exposure to unpredictability during childhood (a characteristic common to low SES environments) is associated with the adoption of a fast life-history strategy, one marked by impulsivity and a focus on short-term goals. We demonstrate that a fast life-history strategy, in turn, was associated with dysregulated weight-management behaviors (i.e., eating even in the absence of hunger), which were predictive of having a high body mass index (BMI) and being obese. In both studies, findings held while controlling for participants' current socioeconomic status, suggesting that obesity is rooted in childhood experiences. A serial mediation model in study 2 confirmed that effects of childhood SES on adult BMI and obesity can be explained in part by exposure to unpredictability, the adoption of a fast life-history strategy, and dysregulated-eating behaviors. These findings suggest that weight problems in adulthood may be rooted partially in early childhood exposure to unpredictable events and environments. LHT provides a valuable explanatory framework for understanding the root causes of obesity.
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Schiøtz ML, Stockmarr A, Høst D, Glümer C, Frølich A. Social disparities in the prevalence of multimorbidity - A register-based population study. BMC Public Health 2017; 17:422. [PMID: 28486983 PMCID: PMC5424300 DOI: 10.1186/s12889-017-4314-8] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 04/26/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Prevalences of multimorbidity vary between European studies and several methods and definitions are used. In this study we examine the prevalence of multimorbidity in relation to age, gender and educational attainment and the association between physical and mental health conditions and educational attainment in a Danish population. METHODS A cross-sectional design was used to study the prevalence of multimorbidity, defined as two or more chronic conditions, and of comorbid physical and mental health conditions across age groups and educational attainment levels among 1,397,173 individuals aged 16 years and older who lived in the Capital Region of Denmark on January 1st, 2012. After calculating prevalence, odds ratios for multimorbidity and mental health conditions were derived from logistic regression on gender, age, age squared, education and number of physical conditions (only for odds ratios for mental health conditions). Odds ratios for having multimorbidity and mental health conditions for each variable were adjusted for all other variables. RESULTS Multimorbidity prevalence was 21.6%. Half of the population aged 65 and above had multimorbidity, and prevalence was inversely related to educational attainment: 26.9% (95% CI, 26.8-26.9) among those with lower secondary education versus 13.5% (95% CI, 13.5-13.6) among people with postgraduate education. Adjusted odds ratios for multimorbidity were 0.50 (95% CI, 0.49-0.51) for people with postgraduate education, compared to people with lower secondary education. Among all population members, 4.9% (95% CI, 4.9-4.9) had both a physical and a mental health condition, a proportion that increased to 22.6% of people with multimorbidity. Physical and mental health comorbidity was more prevalent in women (6.33%; 95% CI, 6.3-6.4) than men (3.34%; 95% CI, 3.3-3.4) and approximately 50 times more prevalent among older persons than younger ones. Physical and mental health comorbidity was also twice as prevalent among people with lower secondary education than among those with postgraduate education. The presence of a mental health condition was strongly associated with the number of physical conditions; those with five or more physical conditions had an adjusted odds ratio for a mental health condition of 3.93 (95% CI, 3.8-4.1), compared to those with no physical conditions. CONCLUSION Multimorbidity prevalence and patterns in the Danish population are comparable to those of other European populations. The high prevalence of mental and physical health conditions highlights the need to ensure that healthcare systems deliver care that takes physical and mental comorbidity into account. Further, the higher prevalence of multimorbidity among persons with low educational attainment emphasizes the importance of having a health care system providing care that is beneficial to all regardless of socioeconomic status.
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Affiliation(s)
- Michaela L. Schiøtz
- Intersectoral Research Unit for Health Services, The Danish Capital Region, Bispebjerg Bakke 23, Building 20D, 2nd Floor, DK, -2400 Copenhagen, NV Denmark
- Research Unit for Chronic Conditions, Bispebjerg University Hospital, Bispebjerg Bakke 23, Building 20D, 2nd Floor, DK, -2400 Copenhagen, NV Denmark
| | - Anders Stockmarr
- Department of Applied Mathematics and Computer Science, Technical University of Denmark Richard Petersens Plads, Building 324, 2800 Kongens Lyngby, Denmark
| | - Dorte Høst
- Research Unit for Chronic Conditions, Bispebjerg University Hospital, Bispebjerg Bakke 23, Building 20D, 2nd Floor, DK, -2400 Copenhagen, NV Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, The Capital Region, Rigshospitalet, Copenhagen University, Nordre Ringvej 57 Building 84-85, 2600 Glostrup, DK Denmark
- Department of Health Science and Technology, Aalborg University, Frederik Bajers Vej 5, Aalborg, 9220 Denmark
| | - Anne Frølich
- Research Unit for Chronic Conditions, Bispebjerg University Hospital, Bispebjerg Bakke 23, Building 20D, 2nd Floor, DK, -2400 Copenhagen, NV Denmark
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Pavela G. Is Childhood Socioeconomic Status Independently Associated with Adult BMI after Accounting for Adult and Neighborhood Socioeconomic Status? PLoS One 2017; 12:e0168481. [PMID: 28095430 PMCID: PMC5241009 DOI: 10.1371/journal.pone.0168481] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 12/01/2016] [Indexed: 01/03/2023] Open
Abstract
Childhood socioeconomic status (SES) is inversely associated with adult weight in high income countries. Whether the influence of childhood SES on adult weight is best described using a critical period model or an accumulation of risk model is not yet settled. This research tests whether childhood SES is associated with adult BMI and likelihood of obesity independent of adult socioeconomic status and neighborhood characteristics. Data on individual childhood and adult characteristics come from the Health and Retirement Study (N = 13,545). Data on neighborhood characteristics come from the 2000 Decennial Census and American Community Survey (2005-2009). In the fully adjusted models, perceived financial hardship before the age of sixteen and having a father who was unemployed are associated with higher BMI among males and, among females, paternal education remains associated with adult BMI. However, childhood SES is not associated with likelihood of obesity after fully adjusting for adult SES and neighborhood characteristics, suggesting that the direct effects of early childhood SES on BMI are small relative to the other factors associated with obesity in adulthood.
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Affiliation(s)
- Gregory Pavela
- School of Public Health, University of Alabama, Birmingham, Alabama, United States of America
- * E-mail:
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McLaughlin SJ. Healthy Aging in the Context of Educational Disadvantage: The Role of “Ordinary Magic”. J Aging Health 2016; 29:1214-1234. [DOI: 10.1177/0898264316659994] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective: The objective of this study is to examine the correlates of healthy aging in the context of educational disadvantage and the extent to which identified correlates are shared with the wider, more educationally advantaged population. Method: Data are from the 2012 Health and Retirement Study. The analytic sample included 17,484 self-respondents ≥50 years of age. Educational disadvantage was defined as having less than a high school diploma. Using logistic regression, healthy aging was regressed on demographic, early-life, and health-related factors by educational status. Results: Among educationally disadvantaged adults, demographic characteristics (e.g., age), health practices (e.g., physical activity), and the presence of health conditions were independently correlated with healthy aging. With few exceptions, correlates of healthy aging were similar among educationally advantaged and disadvantaged adults. Discussion: Ordinary factors are associated with healthy aging among adults without a high school diploma, suggesting that healthy aging is possible for larger numbers of adults aging in the context of educational disadvantage.
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Sheikh MA, Abelsen B, Olsen JA. Clarifying Associations between Childhood Adversity, Social Support, Behavioral Factors, and Mental Health, Health, and Well-Being in Adulthood: A Population-Based Study. Front Psychol 2016; 7:727. [PMID: 27252668 PMCID: PMC4879780 DOI: 10.3389/fpsyg.2016.00727] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/29/2016] [Indexed: 11/13/2022] Open
Abstract
Previous studies have shown that socio-demographic factors, childhood socioeconomic status (CSES), childhood traumatic experiences (CTEs), social support and behavioral factors are associated with health and well-being in adulthood. However, the relative importance of these factors for mental health, health, and well-being has not been studied. Moreover, the mechanisms by which CTEs affect mental health, health, and well-being in adulthood are not clear. Using data from a representative sample (n = 12,981) of the adult population in Tromsø, Norway, this study examines (i) the relative contribution of structural conditions (gender, age, CSES, psychological abuse, physical abuse, and substance abuse distress) to social support and behavioral factors in adulthood; (ii) the relative contribution of socio-demographic factors, CSES, CTEs, social support, and behavioral factors to three multi-item instruments of mental health (SCL-10), health (EQ-5D), and subjective well-being (SWLS) in adulthood; (iii) the impact of CTEs on mental health, health, and well-being in adulthood, and; (iv) the mediating role of adult social support and behavioral factors in these associations. Instrumental support (24.16%, p < 0.001) explained most of the variation in mental health, while gender (21.32%, p < 0.001) explained most of the variation in health, and emotional support (23.34%, p < 0.001) explained most of the variation in well-being. Psychological abuse was relatively more important for mental health (12.13%), health (7.01%), and well-being (9.09%), as compared to physical abuse, and substance abuse distress. The subjective assessment of childhood financial conditions was relatively more important for mental health (6.02%), health (10.60%), and well-being (20.60%), as compared to mother's and father's education. CTEs were relatively more important for mental health, while, CSES was relatively more important for health and well-being. Respondents exposed to all three types of CTEs had a more than two-fold increased risk of being mentally unhealthy (RR Total Effect = 2.75, 95% CI: 2.19-3.10), an 89% increased risk of being unhealthy (RR Total Effect = 1.89, 95% CI: 1.47-1.99), and a 42% increased risk of having a low level of well-being in adulthood (RR Total Effect = 1.42, 95% CI: 1.29-1.52). Social support and behavioral factors mediate 11-18% (p < 0.01) of these effects. The study advances the theoretical understanding of how CTEs influence adult mental health, health, and well-being.
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Affiliation(s)
- Mashhood A Sheikh
- Department of Community Medicine, University of Tromsø Tromsø, Norway
| | - Birgit Abelsen
- Department of Community Medicine, University of Tromsø Tromsø, Norway
| | - Jan A Olsen
- Department of Community Medicine, University of Tromsø Tromsø, Norway
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