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Kanesamoorthy S, Sheron VA, Uruthirakumar P, Kodippily C, Kumarendran B, Gooden TE, Thomas GN, Nirantharakumar K, Lip GYH, Guruparan M, Haniffa R, Surenthirakumaran R, Beane A, Subaschandran K. Prevalence of atrial fibrillation in Northern Sri Lanka: a study protocol for a cross-sectional household survey. BMJ Open 2022; 12:e056480. [PMID: 36418134 PMCID: PMC9685242 DOI: 10.1136/bmjopen-2021-056480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common arrhythmia globally. It is associated with a fivefold risk in stroke, but early diagnosis and effective treatment can reduce this risk. AF is often underdiagnosed, particularly in low-income and middle-income countries (LMICs) where screening for AF is not always feasible or considered common practice in primary care settings. Epidemiological data on AF in LMICs is often incomplete particularly in vulnerable populations. This LMIC research collaborative aims to identify the prevalence of AF in the Northern Sri Lankan community. METHODS AND ANALYSIS A cross-sectional household survey piloted and codesigned through a series of community engagement events will be administered in all five districts in Northern Province, Sri Lanka. A multistage cluster sampling approach will be used starting at district level, then the Divisional Secretariats followed by Grama Niladhari divisions. Twenty households will be selected from each cluster. The study aims to recruit 10 000 participants aged 50 years or older, 1 participant per household. Demographic and socioeconomic characteristics, well-being and lifestyle and anthropometric measurements will be collected using a digital data platform (REDCap, Research Electronic Data Capture) by trained data collectors. Participants will be screened for AF using a fingertip single-lead ECG via a smartphone application (AliveCor) with rhythm strips reviewed by a consultant cardiologist. Prevalence of AF and risk factors will be established at province and district-levels. Adjusted ORs and population attributable fractions for AF risk factors will be determined. ETHICS AND DISSEMINATION This study was approved by the Ethics Review Committee of Faculty of Medicine at University of Jaffna. Written informed consent will be obtained from all participants. Findings will be disseminated through publication in a peer-reviewed journal and presentations at conferences. The findings will enable early treatment for new AF diagnoses and inform interventions to improve community-based management of AF in LMICs.
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Affiliation(s)
- Shribavan Kanesamoorthy
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka
| | | | - Powsiga Uruthirakumar
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka
| | - Chamira Kodippily
- National Intensive Care Surveillance-Mahidol Oxford Tropical Medicine Research Unit, Jaffna, Sri Lanka
| | - Balachandran Kumarendran
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka
| | - Tiffany E Gooden
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK
| | - Graham Neil Thomas
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK
| | | | - Gregory Y H Lip
- Department of Public Health and Epidemiology, University of Birmingham, Birmingham, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, Merseyside, UK
| | - Mahesan Guruparan
- Department of Cardiology, Jaffna Teaching Hospital, Jaffna, Sri Lanka
| | - Rashan Haniffa
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | | | - Abi Beane
- Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | - Kumaran Subaschandran
- Department of Community and Family Medicine, University of Jaffna, Jaffna, Northern Province, Sri Lanka
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Sun C, Zhang WS, Jiang CQ, Jin YL, Deng XQ, Woo J, Cheng KK, Lam TH, Thomas GN, Xu L. Low-Carbohydrate Diets and Mortality in Older Asian People: A 15-Year Follow-Up from a Prospective Cohort Study. Nutrients 2022; 14:nu14071406. [PMID: 35406019 PMCID: PMC9002516 DOI: 10.3390/nu14071406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 11/25/2022] Open
Abstract
The long-term effects of a low-carbohydrate diet (LCD) on mortality, accounting for the quality and source of the carbohydrate, are unclear. Hence, we examined the associations of LCDs with all-cause and cause-specific mortality in a prospective cohort study. A total of 20,206 participants (13.8% diabetes) aged 50+ years were included. Overall, vegetable-based and meat-based LCD scores were calculated based on the percentage of energy as total and subtypes of carbohydrates, fat, and protein. Cox regression analysis was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). During 294,848 person-years of follow-up, 4624 deaths occurred, including 3661 and 963 deaths in participants without and with diabetes, respectively. In all participants, overall LCD score was not associated with all-cause and cause-specific mortality, after multivariable adjustment. However, for the highest versus the lowest quartiles of vegetable-based LCD, the adjusted HRs (95%CIs) of all-cause and CVD mortality were 1.16 (1.05–1.27) and 1.39 (1.19–1.62), respectively. The corresponding values for highest versus lowest quartiles of meat-based LCD for all-cause and CVD mortality were 0.89 (0.81–0.97) and 0.81 (0.70–0.93), respectively. Similar associations were found in participants without diabetes. In patients with diabetes, the adjusted HR (95%CI) of CVD mortality for the highest versus the lowest quartiles of vegetable-based LCD was 1.54 (1.11–2.14). Although there were no significant associations with overall LCD score, we found that the vegetable-based LCD score was positively, whereas the meat-based LCD score was negatively, associated with all-cause and CVD mortality in older Asian people.
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Affiliation(s)
- Ce Sun
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (C.S.); (X.-Q.D.)
| | - Wei-Sen Zhang
- Guangzhou Twelfth People’s Hospital, Guangzhou 510620, China; (W.-S.Z.); (C.-Q.J.); (Y.-L.J.); (T.-H.L.)
| | - Chao-Qiang Jiang
- Guangzhou Twelfth People’s Hospital, Guangzhou 510620, China; (W.-S.Z.); (C.-Q.J.); (Y.-L.J.); (T.-H.L.)
| | - Ya-Li Jin
- Guangzhou Twelfth People’s Hospital, Guangzhou 510620, China; (W.-S.Z.); (C.-Q.J.); (Y.-L.J.); (T.-H.L.)
| | - Xue-Qing Deng
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (C.S.); (X.-Q.D.)
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China;
| | - Kar-Keung Cheng
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK;
| | - Tai-Hing Lam
- Guangzhou Twelfth People’s Hospital, Guangzhou 510620, China; (W.-S.Z.); (C.-Q.J.); (Y.-L.J.); (T.-H.L.)
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - G. Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK;
- Correspondence: (G.N.T.); (L.X.); Tel.: +86-44-(0)121-414-8696 (G.N.T.); +86-20-87335523 (L.X.); Fax: +44-(0)121-414-7878 (G.N.T.); +86-20-87330446 (L.X.)
| | - Lin Xu
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China; (C.S.); (X.-Q.D.)
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK;
- School of Public Health, The University of Hong Kong, Hong Kong, China
- Correspondence: (G.N.T.); (L.X.); Tel.: +86-44-(0)121-414-8696 (G.N.T.); +86-20-87335523 (L.X.); Fax: +44-(0)121-414-7878 (G.N.T.); +86-20-87330446 (L.X.)
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Kwak JH, Park CH, Eun CS, Han DS, Kim YS, Song KS, Choi BY, Kim HJ. Dietary Intake of Soy Products, Vegetables, and Dairy Products and Gastric Cancer Survival according to Histological Subtype: a Long-term Prospective Cohort Study. J Gastric Cancer 2021; 21:403-417. [PMID: 35079442 PMCID: PMC8753285 DOI: 10.5230/jgc.2021.21.e36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/16/2021] [Accepted: 12/16/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Owing to differences in the general characteristics of gastric cancer (GC) according to histological type, the association of GC risk factors, such as diet, may also differ depending on the histological type. We investigated the associations between individual and combined intake of soy products, vegetables, and dairy products and GC mortality by following up cases of death among Korean GC cases and whether these associations differ according to the histological type. MATERIALS AND METHODS A total of 508 GC cases were enrolled from two hospitals between 2002 and 2006. Their survival or death was prospectively followed up until December 31, 2016, through a review of medical records and telephonic surveys. Finally, 300 GC cases classified as intestinal- or diffuse-type GC cases were included. The median follow-up period was 7.1 years. RESULTS In the fully adjusted model, a high intake of soy products (hazard ratio [HR], 0.43; 95% confidence interval [CI], 0.19-0.96) and the combination of soy products and vegetables (HR, 0.34; 95% CI, 0.12-0.96) or soy products and dairy products (HR, 0.37; 95% CI, 0.14-0.98) decreased the mortality from intestinal-type GC. In particular, patients consuming various potentially protective foods (HR, 0.23; 95% CI, 0.06-0.83) showed a highly significant association with a lower mortality from intestinal-type GC. However, no significant association was found with diffuse-type GC. CONCLUSIONS High intake of potentially protective foods, including soy products, vegetables, and dairy products, may help increase survival in intestinal-type GC.
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Affiliation(s)
- Jung Hyun Kwak
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung, Korea
| | - Chan Hyuk Park
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Chang Soo Eun
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Dong Soo Han
- Division of Gastroenterology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Yong Sung Kim
- Funtional Genomics Institute, PDXen Biosystems Co., ETRI Convergence Commercialization Center, Daejeon, Korea
| | - Kyu Sang Song
- Department of Pathology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Bo Youl Choi
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyun Ja Kim
- Department of Food and Nutrition, Gangneung-Wonju National University, Gangneung, Korea
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Mai ZM, Ho SY, Lo CM, Wang MP, Peto R, Lam TH. Mortality reduction from quitting smoking in Hong Kong: population-wide proportional mortality study. Int J Epidemiol 2018; 47:752-759. [PMID: 29438481 DOI: 10.1093/ije/dyx267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/23/2017] [Accepted: 12/11/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The effects of smoking cessation might be different in different populations. Proportional mortality studies of all deaths, relating the certified cause to retrospectively determined smoking habits, have helped assess the hazards of smoking in Hong Kong, and further analyses can help assess the effects of prolonged cessation (although not of recent cessation, as life-threatening disease can itself cause cessation, particularly in old age). METHODS The LIMOR study sought the certified causes of all deaths in 1998, and interviewed 81% of families at death registries to determine the decedent's smoking history. Cases were deaths from pre-defined diseases of interest (N = 15 356); controls were deaths from pre-defined non-smoking-related diseases (N = 5023). Case vs control odds ratios for ex-smokers vs smokers were calculated by age-, sex- and education-standardized logistic regression. These are described as mortality rate ratios (RRs), with a group-specific confidence interval (CI). RESULTS For the aggregate of all deaths from any of the diseases of interest at ages 35-69 years, the RRs for current smoking, quitting 0-4, 5-9 or 10+ years ago and never-smoking were, respectively, RR = 1 (95% CI 0.86-1.17), 0.91 (0.73-1.14), 0.71 (0.49-1.02), 0.66 (0.50-0.87) and 0.43 (0.37-0.48). Younger age of quitting (25-44 or 45-64) appeared to be associated with greater protection: RR = 0.58 (0.38-0.88) and 0.71 (0.54-0.93), respectively. These patterns were less clear at older ages, particularly for death from emphysema. CONCLUSIONS Longer durations of smoking cessation are associated with progressively lower mortality rates from the diseases of interest. For sustainable monitoring of tobacco-attributed mortality, approximate years since last smoked should be recorded during death registration.
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Affiliation(s)
- Zhi-Ming Mai
- School of Public Health, The University of Hong Kong, Hong Kong S.A.R., China
| | - Sai-Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong S.A.R., China
| | - Ching-Man Lo
- School of Public Health, The University of Hong Kong, Hong Kong S.A.R., China.,Department for International Trade, British Consulate-General, Hong Kong S.A.R., China
| | - Man-Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong S.A.R., China
| | - Richard Peto
- CTSU, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tai-Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong S.A.R., China
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Thomas GN, Wang MP, Ho SY, Mak KH, Cheng KK, Lam TH. Adverse lifestyle leads to an annual excess of 2 million deaths in China. PLoS One 2014; 9:e89650. [PMID: 24586936 PMCID: PMC3935915 DOI: 10.1371/journal.pone.0089650] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 01/24/2014] [Indexed: 11/26/2022] Open
Abstract
Background Adverse lifestyle factors have been associated with increased mortality, but data are lacking on their combined effect in developing populations, which we address in the present study. Methods In a death registry-based, case-control study among Hong Kong Chinese aged 30+y, proxy-reported lifestyle factors 10 y ago were collected for 21,363 cases (81% of all deaths) and 12,048 living controls. Risks associated with poor diet, inactivity, heavy alcohol intake, and smoking for all-cause and cause-specific mortality, adjusting for potential confounders, were determined, and excess deaths for the Chinese population were calculated. Results Adjusted odds ratios for all-cause mortality were 1.15 (95% CI 1.09, 1.23), 1.34 (1.27, 1.43), 1.36 (1.21, 1.52), and 1.58 (1.46, 1.70) for poor diet, inactivity, heavy alcohol intake and smoking, respectively. Increasing numbers of adverse lifestyle factors were associated with a dose-dependent increase in adjusted odds ratios of 1.30 (1.20, 1.40), 1.67 (1.54, 1.81), 2.32 (2.08, 2.60), and 3.85 (3.12, 4.75) for 1, 2, 3, and 4 risk factors relative to those with none. The population attributable fraction for all-cause, all-CVD and all-cancer mortality were 26.6%, 15.0%, and 32.1%, resulting in an excess of 2,017,541; 489,884; and 607,517 deaths annually, respectively. Although smoking was associated with the greatest excess loss of life (867,530), heavy drinking (680,466), and physical inactivity (678,317) were similarly important. Conclusion Adverse lifestyle factors contribute to one quarter of all deaths in China. Improving lifestyle practices, particularly focussing on moderating alcohol intake and increasing activity, and smoking cessation are critical to reducing the lifestyle-associated health burden.
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Affiliation(s)
- G. Neil Thomas
- Public Health, Epidemiology, and Biostatistics, University of Birmingham, Birmingham, United Kingdom
- Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong SAR, China
| | - Sai Yin Ho
- School of Public Health, University of Hong Kong, Hong Kong SAR, China
- * E-mail:
| | - Kwok Hang Mak
- Department of Health, Hong Kong SAR Government, Hong Kong SAR, China
| | - Kar Keung Cheng
- Public Health, Epidemiology, and Biostatistics, University of Birmingham, Birmingham, United Kingdom
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong SAR, China
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The role of dairy products and milk in adolescent obesity: evidence from Hong Kong's "Children of 1997" birth cohort. PLoS One 2012; 7:e52575. [PMID: 23285099 PMCID: PMC3527590 DOI: 10.1371/journal.pone.0052575] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 11/20/2012] [Indexed: 11/19/2022] Open
Abstract
Background Observational studies, mainly from Western populations, suggest dairy consumption is inversely associated with adiposity. However, in these populations the intake range is limited and both diet and obesity may share social patterning. Evidence from non-Western developed settings with different social patterning, is valuable in distinguishing whether observed associations are biologically mediated or socially confounded. Objective To examine the associations of milk or other dairy product consumption with adolescent obesity. Methods We used multivariable linear regression models to examine the associations of milk or other dairy product consumption, obtained from a food frequency questionnaire, at 11 years with body mass index (BMI) z-scores at 13 years and waist hip ratio (WHR) at 11 years, in 5,968 adolescents from a Chinese birth cohort, comprising 88% of births in April and May 1997. We used multiple imputation for missing exposures and confounders. Results Only 65.7% regularly consumed milk and 72.4% other dairy products. Milk and other dairy product consumption was positively associated with socio-economic position but not with BMI z-score or WHR, with or without adjustment for sex, mother’s birthplace, parental education, physical activity and other food consumption. Conclusions The lack of association of milk and other dairy product consumption with adiposity in a non-Western setting was not consistent with the majority of evidence from Western settings. Observed anti-obesigenic effects in Western settings may be due to socially patterned confounding.
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Fish consumption and mortality in Hong Kong Chinese--the LIMOR study. Ann Epidemiol 2010; 21:164-9. [PMID: 21109449 DOI: 10.1016/j.annepidem.2010.10.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2010] [Revised: 10/07/2010] [Accepted: 10/13/2010] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate the association between fish consumption and mortality in 36,003 Chinese. METHODS A case-control study collected 81% of all deaths of those aged 30+ from all four Hong Kong death registries in 1998. Relatives registering the deaths provided demographic, dietary and other lifestyle data for the deceased (case) and a similarly aged living person (control). Causes of death were provided by the Department of Health. Logistic regression was used to calculate the mortality odds ratios (ORs) for fish consumption adjusting for potential confounders in the 23,608 cases and 12,395 controls. RESULTS Compared with the lowest fish consumption of less than or equal to three times a month, higher consumption of one to three times a week was associated with lower mortality ORs (95% confidence interval [CI]) of 0.75 (0.62-0.89) for all-cause, 0.66 (0.48-0.92) for ischemic heart disease (IHD), 0.70 (0.50-0.98) for stroke, 0.66 (0.53-0.82) for cancer, but not for injury and poisoning. The highest level of fish consumption of greater than or equal to four times a week also reduced mortality with ORs (95% CI) of 0.80 (0.68-0.94) for all-cause and 0.63 (0.47-0.85) for IHD. CONCLUSIONS Fish consumption significantly reduced mortality from several causes in this sample. Further longitudinal studies to confirm the association are needed.
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González S, Huerta JM, Fernández S, Patterson AM, Lasheras C. Differences in overall mortality in the elderly may be explained by diet. Gerontology 2008; 54:232-7. [PMID: 18503250 DOI: 10.1159/000135069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 02/27/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although a relationship between diet and mortality is well recognized, there is little information on the extent to which different food sources contribute to survival in elderly people. OBJECTIVE To examine the effect of individual food groups on mortality in institutionalized elderly people from Asturias (Northern Spain) after 6 years of follow-up. METHOD The dietary intake of 288 elderly people aged 60-85 years was assessed using a semiquantitative food frequency questionnaire (FFQ). Age, gender, energy intake, chewing ability, hyperglycemia, hypercholesterolemia, physical activity, smoking habit, self-perceived health, education level and the institution from which participants were recruited were covariates in Cox regression models analyzing the effect of food on survival. RESULTS Fruit intake was found to be inversely associated with overall mortality. Multivariate adjusted mortality rate ratio (95% CI) per 1 SD increase in fruit intake was 0.714 (0.519-0.981). On the contrary, each 1 SD of potato intake led to a 32% higher risk of death (RR (95% CI) = 1.319 (1.033-1.685)). CONCLUSION A high intake of fruit late in life was associated with a longer survival. An inverse association between potato intake and survival was also observed, but further research is necessary before any firm conclusions about the possible harmful aspects of potato consumption can be drawn.
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Affiliation(s)
- Sonia González
- Departamento de Biología Funcional, Area de Fisiología, Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain
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Wong CM, Lai HK, Ou CQ, Ho SY, Chan KP, Thach TQ, Yang L, Chau YK, Lam TH, Hedley AJ, Peiris JSM. Is exercise protective against influenza-associated mortality? PLoS One 2008; 3:e2108. [PMID: 18461130 PMCID: PMC2329855 DOI: 10.1371/journal.pone.0002108] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 03/16/2008] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about the effect of physical exercise on influenza-associated mortality. METHODS AND FINDINGS We collected information about exercise habits and other lifestyles, and socioeconomic and demographic status, the underlying cause of death of 24,656 adults (21% aged 30-64, 79% aged 65 or above) who died in 1998 in Hong Kong, and the weekly proportion of specimens positive for influenza A (H3N1 and H1N1) and B isolations during the same period. We assessed the excess risks (ER) of influenza-associated mortality due to all-natural causes, cardiovascular diseases, or respiratory disease among different levels of exercise: never/seldom (less than once per month), low/moderate (once per month to three times per week), and frequent (four times or more per week) by Poisson regression. We also assessed the differences in ER between exercise groups by case-only logistic regression. For all the mortality outcomes under study in relation to each 10% increase in weekly proportion of specimens positive for influenza A+B, never/seldom exercise (as reference) was associated with 5.8% to 8.5% excess risks (ER) of mortality (P<0.0001), while low/moderate exercise was associated with ER which were 4.2% to 6.4% lower than those of the reference (P<0.001 for all-natural causes; P = 0.001 for cardiovascular; and P = 0.07 for respiratory mortality). Frequent exercise was not different from the reference (change in ER -0.8% to 1.7%, P = 0.30 to 0.73). CONCLUSION When compared with never or seldom exercise, exercising at low to moderate frequency is beneficial with lower influenza-associated mortality.
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Affiliation(s)
- Chit-Ming Wong
- Department of Community Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Hak-Kan Lai
- Department of Community Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Chun-Quan Ou
- Department of Community Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Sai-Yin Ho
- Department of Community Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - King-Pan Chan
- Department of Community Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Thuan-Quoc Thach
- Department of Community Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Lin Yang
- Department of Community Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Yuen-Kwan Chau
- Department of Community Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Tai-Hing Lam
- Department of Community Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Anthony Johnson Hedley
- Department of Community Medicine, School of Public Health, The University of Hong Kong, Hong Kong, China
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Schooling CM, Lam TH, Ho SY, Mak KH, Leung GM. Does economic development contribute to sex differences in ischaemic heart disease mortality? Hong Kong as a natural experiment using a case-control study. BMC Public Health 2008; 8:32. [PMID: 18221504 PMCID: PMC2245924 DOI: 10.1186/1471-2458-8-32] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Accepted: 01/25/2008] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The male excess risk of premature ischemic heart disease (IHD) mortality may be partially due to an unknown macro-environmental influence associated with economic development. We examined whether excess male risk of IHD mortality was higher with birth in an economically developed environment. METHODS We used multivariable logistic regression in a population-based case-control study of all adult deaths in Hong Kong Chinese in 1998 to compare sex differences in IHD mortality (1,189 deaths in men, 1,035 deaths in women and 20,842 controls) between Hong Kong residents born in economically developed Hong Kong or in contemporaneously undeveloped Guangdong province in China. RESULTS Younger (35-64 years) native-born Hong Kong men had a higher risk of IHD death than such women (odds ratio 2.91, 95% confidence interval 1.66 to 5.13), adjusted for age, socio-economic status and lifestyle. There was no such sex difference in Hong Kong residents who had migrated from Guangdong. There were no sex differences in pneumonia deaths by birth place. CONCLUSION Most of these people migrated as young adults; we speculate that environmentally mediated differences in pubertal maturation (when the male disadvantage in lipids and fat patterning emerges) may contribute to excess male premature IHD mortality in developed environments.
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Affiliation(s)
- C Mary Schooling
- Dept of Community Medicine and School of Public Health, University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
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