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He YY, Ding KR, Tan WY, Ke YF, Hou CL, Jia FJ, Wang SB. The Role of Depression and Anxiety in the Relationship Between Arthritis and Cognitive Impairment in Chinese Older Adults. Am J Geriatr Psychiatry 2024; 32:856-866. [PMID: 38383225 DOI: 10.1016/j.jagp.2024.01.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Mental disorders and cognitive impairment are common in older patients with arthritis. While it is recognized that mental conditions may play a role in the connection between arthritis and cognitive impairment, the precise underlying relationship remains uncertain. METHODS The data was derived from the baseline survey of the Guangdong Mental Health Survey in South China, involving a sample of 3,764 citizens aged 65 and older. An array of aspects were explored, including socio-demographics, lifestyle behaviors, self-reported chronic conditions, depression, anxiety, and cognitive impairment. Logistic regression analyses examined the association between arthritis and cognitive impairment after adjustment for potential confounders. Serial mediation models were used to examine whether depression or anxiety played a mediating role in the arthritis-cognitive impairment linkage. RESULTS The prevalence rates of cognitive impairment and arthritis of the older adults were 28.9% and 12.1%, respectively. Compared to those without arthritis, participants with arthritis were at a higher risk of cognitive impairment (OR = 1.322, 95%CI: 1.022-1.709) after adjustment for socio-demographics, lifestyle behaviors, and mental health conditions. Serial mediation analyses indicated that depressive and anxiety symptoms co-played a serial mediating role in the association between arthritis and cognitive impairment (B1 = 0.025, 95%CI: 0.005-0.052; B2 = 0.050, 95%CI: 0.021-0.086). CONCLUSIONS Arthritis may heighten cognitive impairment risk in Chinese older adults, and the relationship was potentially mediated by depressive and anxiety symptoms. Future interventions should be considered, integrating mental health assessments into arthritis care frameworks and being alert to possible cognitive impairment.
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Affiliation(s)
- Yong-Yi He
- Department of Psychology, School of Public Health (Y-YH, K-RD, F-JJ), Southern Medical University, Guangzhou, China; Guangdong Mental Health Center (Y-YH, K-RD, W-YT, Y-FK, C-LH, F-JJ, S-BW), Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Kai-Rong Ding
- Department of Psychology, School of Public Health (Y-YH, K-RD, F-JJ), Southern Medical University, Guangzhou, China; Guangdong Mental Health Center (Y-YH, K-RD, W-YT, Y-FK, C-LH, F-JJ, S-BW), Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Wen-Yan Tan
- Guangdong Mental Health Center (Y-YH, K-RD, W-YT, Y-FK, C-LH, F-JJ, S-BW), Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yun-Fei Ke
- Guangdong Mental Health Center (Y-YH, K-RD, W-YT, Y-FK, C-LH, F-JJ, S-BW), Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Cai-Lan Hou
- Guangdong Mental Health Center (Y-YH, K-RD, W-YT, Y-FK, C-LH, F-JJ, S-BW), Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Fu-Jun Jia
- Department of Psychology, School of Public Health (Y-YH, K-RD, F-JJ), Southern Medical University, Guangzhou, China; Guangdong Mental Health Center (Y-YH, K-RD, W-YT, Y-FK, C-LH, F-JJ, S-BW), Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Shi-Bin Wang
- Guangdong Mental Health Center (Y-YH, K-RD, W-YT, Y-FK, C-LH, F-JJ, S-BW), Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China; School of Health, Zhuhai College of Science and Technology (S-BW), Zhuhai, China.
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Shang Q, Zhou J, Yao J, Feng C, Lou H, Cong D. Sleep duration and the risk of new-onset arthritis in middle-aged and older adult population: results from prospective cohort study in China. Front Public Health 2024; 12:1321860. [PMID: 38873298 PMCID: PMC11169742 DOI: 10.3389/fpubh.2024.1321860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/21/2024] [Indexed: 06/15/2024] Open
Abstract
Background The pain and sleep disorders caused by arthritis are health issues that have been re-emphasized with the aging population. However, the majority of research on arthritis and sleep disorders has focused on cases that have already been diagnosed with arthritis. This research aims to explore the correlation between sleep duration and new-onset arthritis in middle-aged and older adult individuals. Methods Utilizing data from the China Health and Retirement Longitudinal Study from baseline (2011) to the Wave 3 follow-up (2018), we conducted a 7-year longitudinal investigation targeting populations with valid sleep questionnaire records and without arthritis. Sleep duration was assessed from nighttime sleep and daytime nap records. The new-onset of arthritis was determined based on self-reported diagnosis. We employed different logistic regression models to consider the potential impact of sleep duration on arthritis and conducted mediation analyses to assess the involvement of BMI in the association between sleep duration and the new-onset risk of arthritis. Results Out of the 6,597 individuals analyzed in the cohort, 586 (8.9%) were diagnosed with new-onset arthritis. Median sleep duration was notably shorter in the new-onset arthritis group (6.63 vs. 6.41 h, p < 0.05). There was a notable negative correlation found between new-onset risk of arthritis and sleep duration, with each Interquartile Range (IQR) increment in sleep leading to a 16% risk reduction (OR: 0.864; 95% CI: 0.784-0.954). Stratified analyses revealed BMI as a potential modifier in the sleep-arthritis relationship (P for interaction = 0.05). Mediation analyses further showed that about 3.5% of the association was mediated by BMI. Additionally, the inclusion of sleep duration improved the arthritis predictive power of our model, with an IDI of 0.105 (0.0203, 0.1898) and an NRI of 0.0013 (0.0004, 0.0022) after adding sleep duration to the basic model. Conclusion In the middle-aged and older adult demographic of China, increased sleep duration is associated with a decreased new-onset risk of arthritis, with BMI potentially playing a role in mediating this connection.
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Affiliation(s)
- Qiangqiang Shang
- Department of Tuina, The First Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Jie Zhou
- Department of Anorectal, The First Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Junjie Yao
- College of Acupuncture and Tuina, Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Chaoqun Feng
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Huijuan Lou
- Department of Tuina, The First Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Deyu Cong
- Department of Tuina, The First Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, China
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Qiu F, Li J, Gan L, Legerlotz K. Arthritis prevalence is associated with metabolic syndrome risk factors but not with physical activity in middle-aged and older patients - a cross-sectional study. BMC Geriatr 2024; 24:242. [PMID: 38459429 PMCID: PMC10924363 DOI: 10.1186/s12877-024-04859-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/01/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND In light of the aging population, increasingly suffering from the metabolic syndrome (MS), strategies need to be developed to address global public health challenges known to be associated with MS such as arthritis. As physical activity (PA) may play a crucial role in tackling those challenges, this study aimed to determine the association between the number of MS risk factors, PA and arthritis in people ≥ 50 years old. METHODS Data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) were used to estimate the prevalence of arthritis and MS risk factors in the European population ≥ 50 years and to evaluate the associations between MS risk factors, PA and arthritis. Binary logistic regression was performed to calculate the odds ratio of different factors. RESULTS 73,125 participants were included in the analysis. 55.75% of patients stated at least one of the three MS risk factors. The prevalence of rheumatoid arthritis (RA) and osteoarthritis (OA)/other rheumatism among ≥ 50 years population was 10.19% and 19.32% respectively. Females showed a higher prevalence of arthritis than males. Prevalence did not differ between groups with different levels of PA. Arthritis prevalence was positively correlated with the number of MS risk factors (P < 0.01) but not with PA (P > 0.05). CONCLUSION Middle-aged and older Europeans with multiple comorbidities suffered from RA, OA or other rheumatism more frequently than participants with fewer comorbidities, while the level of physical activity was not associated with the number of metabolic risk factors in patients with RA and OA/other rheumatism.
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Affiliation(s)
- Fanji Qiu
- Movement Biomechanics, Institute of Sport Sciences, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany.
| | - Jinfeng Li
- Department of Kinesiology, Iowa State University, 50011, Ames, USA, IA
| | - Liaoyan Gan
- Alberta International School of Recreation, Sport and Tourism of Beijing Sport University, Beijing Sport University, 572423, Lingshui, China
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, T6G2R3, Edmonton, Canada
| | - Kirsten Legerlotz
- Movement Biomechanics, Institute of Sport Sciences, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany
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Ma K, Liu H, Guo L, Li J, Lei Y, Li X, Sun L, Yang L, Yuan T, Wang C, Zhang D, Li J, Liu M, Hua Y, Zhang L. Comparison of metabolic syndrome prevalence and characteristics using five different definitions in China: a population-based retrospective study. Front Public Health 2024; 12:1333910. [PMID: 38439751 PMCID: PMC10909998 DOI: 10.3389/fpubh.2024.1333910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 03/06/2024] Open
Abstract
Background Metabolic syndrome (MetS) is on the rise in developing countries and is characterized by a series of indications of metabolic disturbance. However, the prevalence of MetS varies under different definitions. The study aimed to compare five definitions of MetS in the China adult population, to explore their prevalence, characteristics and agreement. Methods The data for the retrospective study came from the China Health and Retirement Longitudinal Study (CHARLS), consisting of 9,588 participants (≥45). MetS definitions from International Diabetes Federation (IDF) (2006), National Cholesterol Education Program Adult Treatment Panel III (ATPIII) (2005), National Cholesterol Education Program Adult Treatment Panel III (ATPIII) (2001), Chinese Diabetes society (CDS) (2004) and the World Health Organization (WHO) (1999). We used binary and multivariable logistic analysis to explore factors connected with MetS. Results The five definitions of MetS led to different prevalence of MetS:34.52% by IDF (2006), 38.63% by ATP (2005), 25.94% by ATP (2001), 26.31% by CDS (2004), 21.57% by WHO (1999). According to the definition of IDF (2006) (22.32% vs. 45.06%), ATPIII (2005) definition (27.99% vs. 47.82%), ATPIII (2001) definition (15.37% vs. 35.07%), CDS (2004) definition (19.96% vs. 31.80%), and WHO (1999) definition (17.44% vs. 25.14%), the prevalence of MetS in men was low but in women was high. The agreement between the five definitions for men was good except for the IDF (2006) definition and ATPIII (2001) definition (kappa = 0.51), with kappa values from 0.64 to 0.85. For women, the agreement between the five definitions was good ranging from 0.67 to 0.95, however, except for the definition of CDS (2004) and the definition of IDF (2006) (kappa = 0.44), the definition of WHO (1999) and the definition of IDF (2006) (kappa = 0.55), and the definition of WHO (1999) and the definition of ATPIII (2005) (kappa = 0.54). Binary logistic analysis indicated that although the impact and relevance varied by sex and definition, age, education, marital status, current residence, current smoking, alcohol using, taking activities and number of chronic diseases were factors connected to MetS. Conclusion the prevalence and characteristics of the five definitions of MetS are different in the Chinese population. Therefore, it is vital to use the same definition for a country to diagnose MetS. On the other side, a lower prevalence in men than in women and the consistency of five MetS definitions are good in men but relatively poor in women.
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Affiliation(s)
- Keli Ma
- Department of Graduate School, Wannan Medical College, Wuhu, Anhui, China
| | - Haiyang Liu
- Student Health Center, Wannan Medical College, Wuhu, Anhui, China
| | - Leilei Guo
- Department of Surgical Nursing, School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Jinlong Li
- Key Laboratory of Occupational Health and Safety for Coal Industry in Hebei Province, Department of Occupational and Environmental Health, School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Yunxiao Lei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Xiaoping Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Lu Sun
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Liu Yang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Ting Yuan
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Congzhi Wang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Dongmei Zhang
- Department of Pediatric Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Jing Li
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Mingming Liu
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Ying Hua
- Rehabilitation Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
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Yan Z, Luan X, Meng L, Wu Y, Qu W, Zhang S, Wei H, Wu S. Longitudinal relationship between social participation, depressive symptoms, and activity impairment among older patients with arthritis: a moderated mediation analysis. BMC Geriatr 2024; 24:139. [PMID: 38326792 PMCID: PMC10851568 DOI: 10.1186/s12877-024-04735-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Arthritis primarily affects older people and is a prominent cause of their activity impairment. This study aimed to examine the mediating role of depressive symptoms in the relationship between social participation and activity impairment, as well as to determine whether sex moderated the mediating effect. METHODS A total of 2247 older patients with arthritis were included from the China Health and Retirement Longitudinal Study between 2015 and 2018. We first examined a simple mediation model where depressive symptoms were a mediator between social participation and activity impairment. Furthermore, sex was systematically integrated into the model as a moderator. The mediation model and moderated mediation model were analyzed using PROCESS macro. RESULTS Mediation analysis revealed that the association between social participation and activity impairment was partially mediated by depressive symptoms (B = -0.10, 95% CI = [-0.14, -0.06]) with intermediary effect of 28.6%. Moderated mediation analysis indicated that mediation model was moderated by sex. The indirect effect of social participation on activity impairment among female patients (B = -0.15, 95% CI = [-0.21, -0.09]) was stronger than male patients (B = -0.04, 95% CI = [-0.09, -0.01]). CONCLUSION Social participation was the key protective factor associated with depressive symptoms and activity impairment among arthritis patients. Encouraging arthritis patients to social participation and improving the depressive symptoms might avoid activity impairment, especially for female patients.
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Affiliation(s)
- Zeping Yan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
| | | | - LiJun Meng
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
| | - Yu Wu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
| | - Wenran Qu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Simeng Zhang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Huimin Wei
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shicai Wu
- Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China.
- University of Health and Rehabilitation Sciences, Qingdao, China.
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Li Y, Li Q, Cao Z, Wu J. Causal association between sleep traits and autoimmune arthritis: Evidence from a bidirectional Mendelian randomization study. Sleep Health 2024; 10:149-159. [PMID: 38245477 DOI: 10.1016/j.sleh.2023.11.014] [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: 07/23/2023] [Revised: 11/20/2023] [Accepted: 11/30/2023] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To explore whether there is a genetic causal relationship between sleep traits and the risk of autoimmune arthritis (AA). METHODS Univariable and multivariable Mendelian randomization was employed using genome-wide association studies data to assess sleep traits' associations with AAs, including rheumatoid arthritis (RA), ankylosing spondylitis, and psoriatic arthritis. The inverse-variance weighted method served as the primary analysis, supplemented by the CAUSE method to improve power and mitigate false positives. Mediation Mendelian randomization was used to quantify direct and indirect effects. RESULTS Significant associations were shown between insomnia symptoms and increased risk of overall RA (odds ratio = 2.75, 95% confidence interval 1.45-5.22) and seronegative RA (odds ratio = 6.95, 95% confidence interval 2.47-19.56). CAUSE results revealed an association of insomnia symptoms with overall RA and seronegative RA, as well as the sleep duration with overall RA. After the adjustment for body mass index, alcohol status, smoking status, and physical activity levels, multivariable analyses revealed that genetic predisposition to insomnia symptoms and prolonged sleep duration showed independent negative associations with the risk of overall RA and seropositive RA. In the reversed multivariable analyses, a borderline negative association was shown in the overall RA-sleep duration and a positive association of seropositive RA with the risk of insomnia symptoms. CONCLUSION This study demonstrated a potential bidirectional causal relationship that genetic predisposition to insomnia symptoms and shorter sleep duration was associated with the risk of AA, especially RA. Genetic predisposition to RA was also associated with decreased sleep duration, as well as increased insomnia symptom risk.
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Affiliation(s)
- Yajia Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiangxiang Li
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Ningxia Geriatric Disease Clinical Research Center, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia Hui Autonomous Region, China; Hunan Provincial People's Hospital, Department of Hunan Institute of Geriatrics, Changsha, Hunan, China
| | - Ziqin Cao
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
| | - Jianhuang Wu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China; Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Huang M, Guo Y, Zhou Z, Xu C, Liu K, Wang Y, Guo Z. Development and validation of a risk prediction model for arthritis in community-dwelling middle-aged and older adults in China. Heliyon 2024; 10:e24526. [PMID: 38298731 PMCID: PMC10828688 DOI: 10.1016/j.heliyon.2024.e24526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024] Open
Abstract
Background Considering its high prevalence, estimating the risk of arthritis in middle-aged and older Chinese adults is of particular interest. This study was conducted to develop a risk prediction model for arthritis in community-dwelling middle-aged and older adults in China. Methods Our study included a total of 9599 participants utilising data from the China Health and Retirement Longitudinal Study (CHARLS). Participants were randomly assigned to training and validation groups at a 7:3 ratio. Univariate and multivariate binary logistic regression analyses were used to identify the potential predictors of arthritis. Based on the results of the multivariate binary logistic regression, a nomogram was constructed, and its predictive performance was evaluated using the receiver operating characteristic (ROC) curve. The accuracy and discrimination ability were assessed using calibration curve analysis, while decision curve analysis (DCA) was performed to evaluate the net clinical benefit rate. Results A total of 9599 participants were included in the study, of which 6716 and 2883 were assigned to the training and validation groups, respectively. A nomogram was constructed to include age, hypertension, heart diseases, gender, sleep time, body mass index (BMI), residence address, the parts of joint pain, and trouble with body pains. The results of the ROC curve suggested that the prediction model had a moderate discrimination ability (AUC >0.7). The calibration curve of the prediction model demonstrated a good predictive accuracy. The DCA curves revealed a favourable net benefit for the prediction model. Conclusions The predictive model demonstrated good discrimination, calibration, and clinical validity, and can help community physicians and clinicians to preliminarily assess the risk of arthritis in middle-aged and older community-dwelling adults.
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Affiliation(s)
- Mina Huang
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
- School of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Yue Guo
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Zipeng Zhou
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Chang Xu
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Kun Liu
- School of Medical College, Jinzhou Medical University, Jinzhou, China
| | - Yongzhu Wang
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
| | - Zhanpeng Guo
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
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He D, Fan Y, Qiao Y, Liu S, Zheng X, Zhu J. Depressive symptom trajectories and new-onset arthritis in a middle-aged and elderly Chinese population. J Psychosom Res 2023; 172:111422. [PMID: 37379786 DOI: 10.1016/j.jpsychores.2023.111422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/11/2023] [Accepted: 06/20/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE Previous studies reported that depression was associated with a high risk of arthritis. However, the effect of different long-term depressive symptom trajectory patterns on the risk of arthritis has not been evaluated. Our study aimed to explore the association between depressive symptom trajectories and the risk of arthritis. METHODS A total of 5583 participants from the China Health and Retirement Longitudinal Study from 2011 to 2018 were included in this analysis. Group-based trajectory modeling was used to identify depressive symptom trajectories, and a multivariable competitive Cox regression model was used to examine the association of depressive symptom trajectories with arthritis during follow-up. RESULTS Five depressive symptom trajectories were identified in our research: stable-high, decreasing, increasing, stable-moderate and stable-low. Compared with participants in the stable-low trajectory group, those in the stable-moderate, increasing, decreasing and stable-high trajectory groups had a higher cumulative risk of arthritis, with HRs (95% CIs) for arthritis of 1.64 (1.30, 2.07), 1.86 (1.30, 2.66), 1.99 (1.41, 2.80) and 2.19 (1.38, 3.48), respectively. Participants with the stable-high symptoms trajectory had the highest cumulative risk of arthritis. There was still a high risk of arthritis, although the depression state was reduced and remained at a level that is generally considered reasonable. CONCLUSIONS The higher depressive symptoms trajectories were significantly associated with the increased risk of arthritis, and the long-term depressive symptoms trajectories may be a strong predictor of having arthritis.
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Affiliation(s)
- Dingliu He
- Department of Clinical Nutrition, Yancheng No.1 People's Hospital, Affiliated Hospital of Medical School, Nanjing University, Yancheng, 224001, PR China
| | - Yayun Fan
- Department of Clinical Nutrition, Yancheng No.1 People's Hospital, Affiliated Hospital of Medical School, Nanjing University, Yancheng, 224001, PR China
| | - Yanan Qiao
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China
| | - Siyuan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou 215123, PR China
| | - Xiaowei Zheng
- Department of Public Health and Preventive Medicine, Wuxi School of Medicine Jiangnan University, 1800 Lihu Road, Binhu District, Wuxi, Jiangsu Province 214122, PR China.
| | - Juanjuan Zhu
- Department of Clinical Nutrition, Yancheng Third People's Hospital, The Sixth Affiliated Hospital of Nantong University, Yancheng, 224001, PR China.
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Li Y, Gui J, Liu H, Guo LL, Li J, Lei Y, Li X, Sun L, Yang L, Yuan T, Wang C, Zhang D, Wei H, Li J, Liu M, Hua Y, Zhang L. Predicting metabolic syndrome by obesity- and lipid-related indices in mid-aged and elderly Chinese: a population-based cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1201132. [PMID: 37576971 PMCID: PMC10419183 DOI: 10.3389/fendo.2023.1201132] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Objective To predict the optimal cut-off values for screening and predicting metabolic syndrome(MetS) in a middle-aged and elderly Chinese population using 13 obesity and lipid-related indicators, and to identify the most suitable predictors. Methods The data for this cross-sectional investigation came from the China Health and Retirement Longitudinal Study (CHARLS), including 9457 middle-aged and elderly people aged 45-98 years old. We examined 13 indicators, including waist circumference (WC), body mass index (BMI), waist-height ratio (WHtR), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), lipid accumulation product index (LAP), conicity index (CI), Chinese visceral adiposity index (CVAI), triglyceride-glucose index (TyG-index) and their combined indices (TyG-BMI, TyG-WC, TyG-WHtR). The receiver operating characteristic curve (ROC) was used to determine the usefulness of indicators for screening for MetS in the elderly and to determine their cut-off values, sensitivity, specificity, and area under the curve (AUC). Association analysis of 13 obesity-related indicators with MetS was performed using binary logistic regression analysis. Results A total of 9457 middle-aged and elderly Chinese were included in this study, and the overall prevalence of the study population was 41.87% according to the diagnostic criteria of NCEP ATP III. According to age and gender, the percentage of males diagnosed with MetS was 30.67% (45-54 years old: 30.95%, 55-64 years old: 41.02%, 65-74 years old: 21.19%, ≥ 75 years old: 6.84%). The percentage of females diagnosed with MetS was 51.38% (45-54 years old: 31.95%, 55-64 years old: 39.52%, 65-74 years old: 20.43%, ≥ 75 years old: 8.10%). The predictive power of Tyg-related parameters was more prominent in both sexes. In addition, LAP and CVAI are also good at predicting MetS. ABSI had a poor prediction ability. Conclusions Among the middle-aged and elderly population in China, after adjusting for confounding factors, all the indicators except ABSI had good predictive power. The predictive power of Tyg-related parameters was more prominent in both sexes. In addition, LAP and CVAI are also good at predicting MetS.
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Affiliation(s)
- Yuqing Li
- Department of Graduate School, Wannan Medical College, Wuhu, An Hui, China
| | - Jiaofeng Gui
- Department of Graduate School, Wannan Medical College, Wuhu, An Hui, China
| | - Haiyang Liu
- Health Center, Wannan Medical College, Wuhu, An Hui, China
| | - Lei-lei Guo
- Department of Surgical Nursing, School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Jinlong Li
- Department of Occupational and Environmental Health, Key Laboratory of Occupational Health and Safety for Coal Industry in Hebei Province, School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Yunxiao Lei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Xiaoping Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Lu Sun
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Liu Yang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Ting Yuan
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Congzhi Wang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Dongmei Zhang
- Department of Pediatric Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Huanhuan Wei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Jing Li
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Mingming Liu
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Ying Hua
- Rehabilitation Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, An Hui, China
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Liu R, Zhou Y, Liu Y, Guo R, Gao L. Association between living environmental quality and risk of arthritis in middle-aged and older adults: a national study in China. Front Public Health 2023; 11:1181625. [PMID: 37397775 PMCID: PMC10313337 DOI: 10.3389/fpubh.2023.1181625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Background The association between combined environmental factors and the risk of arthritis is still scarcely studied. The present study performed cross-sectional and cohort studies to explore the association between risk score of living environment quality and the risk of arthritis in middle-aged and older adults in China. Methods The study was based on China Health and Retirement Longitudinal Study (CHARLS), and it recruited 17,218 participants in the cross-sectional study and 11,242 participants in the seven-year follow-up study. The living environment quality was measured by household fuel types, household water sources, room temperature, residence types, and ambient concentration of PM2.5. Logistic regression and Cox proportional hazard regression models were utilized to examine the association between the living environment quality and the risk of arthritis. Competing risk models and stratified analyses were applied to further verify our results. Results Compared with individuals in the suitable environment group, people who lived in moderate (OR:1.28, 95%CI: 1.14-1.43) and unfavorable environments (OR:1.49, 95%CI:1.31-1.70) showed higher risks of arthritis when considering the multiple living environmental factors (P for trend <0.001) in the cross-sectional analysis. In the follow-up study, similar results (P for trend = 0.021), moderate environment group (HR:1.26, 95%CI:1.01-1.56) and unfavorable environment group (HR: 1.36, 95%CI: 1.07-1.74), were founded. Conclusion Inferior living environment might promote the development of arthritis. It is necessary for the public, especially old people, to improve the living environment, which may be the key to the primary prevention of arthritis.
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Affiliation(s)
- Ri Liu
- Department of Orthopedics, The Second Hospital of Tangshan, Tangshan, Hebei, China
| | - Yuefei Zhou
- Department of Orthopedics, The First Hospital of China Medical University, Shenyang, China
| | - Yang Liu
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Run Guo
- Department of General Practice, Beijing Friendship Hospital of Capital Medical University, Beijing, China
| | - Lishu Gao
- Department of Endocrinology, Tangshan People’s Hospital, Tangshan, Hebei, China
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11
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Li Y, Gui J, Zhang X, Wang Y, Mei Y, Yang X, Liu H, Guo LL, Li J, Lei Y, Li X, Sun L, Yang L, Yuan T, Wang C, Zhang D, Wei H, Li J, Liu M, Hua Y, Zhang L. Predicting hypertension by obesity- and lipid-related indices in mid-aged and elderly Chinese: a nationwide cohort study from the China Health and Retirement Longitudinal Study. BMC Cardiovasc Disord 2023; 23:201. [PMID: 37081416 PMCID: PMC10120116 DOI: 10.1186/s12872-023-03232-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/09/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Currently, the study outcomes of anthropometric markers to predict the risk of hypertension are still inconsistent due to the effect of racial disparities. This study aims to investigate the most effective predictors for screening and prediction of hypertension (HTN) in the Chinese middle-aged and more elderly adult population and to predict hypertension using obesity and lipid-related markers in Chinese middle-aged and older people. METHODS The data for the cohort study came from the China Health and Retirement Longitudinal Study (CHARLS), including 4423 middle-aged and elderly people aged 45 years or above. We examined 13 obesity- and lipid-related indices, including waist circumference (WC), body mass index (BMI), waist-height ratio (WHtR), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), lipid accumulation product index (LAP), conicity index (CI), Chinese visceral adiposity index (CVAI), triglyceride-glucose index (TyG-index) and their combined indices (TyG-BMI, TyG-WC, TyG-WHtR). To compare the capacity of each measure to forecast the probability of developing HTN, the receiver operating characteristic curve (ROC) was used to determine the usefulness of anthropometric indices for screening for HTN in the elderly and determining their cut-off value, sensitivity, specificity, and area under the curve (AUC). Association analysis of 13 obesity-related anthropometric indicators with HTN was performed using binary logistic regression analysis. RESULTS During the four years, the incident rates of HTN in middle-aged and elderly men and women in China were 22.08% and 17.82%, respectively. All the above 13 indicators show a modest predictive power (AUC > 0.5), which is significant for predicting HTN in adults (middle-aged and elderly people) in China (P < 0.05). In addition, when WHtR = 0.501 (with an AUC of 0.593, and sensitivity and specificity of 63.60% and 52.60% respectively) or TYg-WHtR = 4.335 (with an AUC of 0.601, and sensitivity and specificity of 58.20% and 59.30% respectively), the effect of predicting the incidence risk of men is the best. And when WHtR = 0.548 (with an AUC of 0.609, and sensitivity and specificity of 59.50% and 56.50% respectively) or TYg-WHtR = 4.781(with an AUC of 0.617, and sensitivity and specificity of 58.10% and 60.80% respectively), the effect of predicting the incidence risk of women is the best. CONCLUSIONS The 13 obesity- and lipid-related indices in this study have modest significance for predicting HTN in Chinese middle-aged and elderly patients. WHtR and Tyg-WHtR are the most cost-effective indicators with moderate predictive value of the development of HTN.
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Affiliation(s)
- Yuqing Li
- Department of Graduate School, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Jiaofeng Gui
- Department of Graduate School, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Xiaoyun Zhang
- Department of Graduate School, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Ying Wang
- Department of Graduate School, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Yujin Mei
- Department of Graduate School, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Xue Yang
- Department of Graduate School, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Haiyang Liu
- Student Health Center, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Lei-Lei Guo
- Department of Surgical Nursing, School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, People's Republic of China
| | - Jinlong Li
- Department of Occupational and Environmental Health, Key Laboratory of Occupational Health and Safety for Coal Industry in Hebei Province, School of Public Health, North China University of Science and Technology, Tangshan, Hebei Province, People's Republic of China
| | - Yunxiao Lei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Xiaoping Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Lu Sun
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Liu Yang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Ting Yuan
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Congzhi Wang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Dongmei Zhang
- Department of Pediatric Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Huanhuan Wei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Jing Li
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Mingming Liu
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Ying Hua
- Rehabilitation Nursing, School of Nursing, Wanna Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China.
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Pengpid S, Peltzer K. Prevalence and associated factors of cross-sectional and incident self-reported arthritis or rheumatism among a national community sample of middle-aged and older adults in Thailand. Front Public Health 2023; 11:1064751. [PMID: 36817934 PMCID: PMC9929555 DOI: 10.3389/fpubh.2023.1064751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/11/2023] [Indexed: 02/04/2023] Open
Abstract
Background The study aimed to assess the prevalence and associated factors of cross-sectional and incident arthritis or rheumatism among a national community sample of middle-aged and older adults in Thailand. Methods We analyzed cross-sectional and longitudinal data from two consecutive waves (2015 and 2017) of the Health, Aging, and Retirement in Thailand (HART) study. Arthritis or rheumatism (SRA) was assessed by self-reported health care provider diagnosis. Results The cross-sectional (baseline) sample included 5,616 participants (≥45 years, median age 66 years, interquartile range 57 to 76 years) and the incident (follow-up) sample included 3,545 participants. The prevalence of SRA in the cross-sectional sample (baseline) was 4.0% and in the incident (follow-up) sample 5.3%. In the cross-sectional multivariable model, obesity class I (aOR: 1.78, 95% CI: 1.19 to 2.67), obesity class II (aOR: 1.82, 95% CI: 1.02 to 3.25), hypertension (aOR: 1.90, 95% CI: 1.35 to 2.66), brain disease and/or psychiatric problems (aOR: 4.79, 95% CI: 2.27 to 10.62), sleep problem (aOR: 1.45, 95% CI: 1.01 to 2.07) and prescription drug use (aOR: 1.63, 95% CI: 1.14 to 2.33) were positively associated, and not in the labor force (aOR: 0.53, 95% CI: 0.34 to 0.84), and employed (aOR: 0.63, 95% CI: 0.41 to 0.99) were negatively associated with SRA. In the incident multivariable model, obesity class I (aOR: 1.78, 95% CI: 1.17 to 3.61), obesity class II (aOR: 2.01, 95% CI: 1.12 to 3.61), poor mental health (aOR: 1.69, 95% CI: 1.19 to 2.41), and functional disability (aOR: 2.04, 95% CI: 1.01 to 4.13) were positively associated, and current alcohol use (aOR: 0.50, 95% CI: 0.25 to 0.99) was negatively associated with SRA. Conclusion The middle and older Thai adults had a low prevalence and incidence of SRA, and several physical and mental risk factors for cross-sectional and/or incident SRA were identified.
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Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand,Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand,Department of Psychology, University of the Free State, Bloemfontein, South Africa,Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan,*Correspondence: Karl Peltzer ✉
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Jingmeng C, Qiqi X, Jian P, Guixing Y, Siman L, Yuying J, Yuru H, Qu S. Effects of WeChat platform-based continuing care on self-management and quality of life in patients with arthritis: A quasi-experimental study. Digit Health 2023; 9:20552076231197104. [PMID: 37732135 PMCID: PMC10508053 DOI: 10.1177/20552076231197104] [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: 09/22/2022] [Accepted: 08/08/2023] [Indexed: 09/22/2023] Open
Abstract
Objective To assess the effects of WeChat platform-based continuing care for arthritis on patients' self-management, self-efficiency, quality of life (QoL), and medication compliance. Methods A study was conducted on arthritis patients recruited between December 2017 and February 2018 and divided into two groups. The intervention group received continuing care from the WeChat platform and regular follow-ups, while the control group only received regular follow-ups. The outcomes in both groups were assessed using questionnaires twice: before the study (T0) and eight weeks after T0 (T1), which consists of the evaluation of self-management, QoL, self-efficacy, and medication compliance. Results There were 23 people in each of the intervention and control groups completed two outcome measures. At eight weeks, participants in the intervention group showed an improvement in psychological QoL, cognitive symptom management, and self-efficacy, compared to the control group (QoL scores: mean difference in change between groups was 12.29, 95% CI: 4.51, 20.07, p < 0.001; cognitive symptom management: mean difference in change between groups was 0.65, 95% CI: 0.24, 1.05, p < 0.001; self-efficacy: mean difference in change between groups was 0.69, 95% CI: 0.14, 1.24, p < 0.05). Self-management, self-efficacy, and psychological quality of life were significantly improved in the intervention group before and after the intervention (p < 0.05). Conclusion Using the WeChat platform for continuing care is useful in improving the psychological state, self-efficacy, and self-management ability of patients with arthritis. The study is relevant to Clinical Practice.
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Affiliation(s)
- Chen Jingmeng
- School of Medicine, Xiamen University, Xiamen City, Fujian Province, China
| | - Xu Qiqi
- Department of Nursing, School of Medicine, Xiamen University, Xiamen City, Fujian Province, China
| | - Peng Jian
- School of Nursing, Fudan University, Shanghai, China
| | - Yu Guixing
- Department of Nursing, School of Medicine, Xiamen University, Xiamen City, Fujian Province, China
| | - Lv Siman
- School of Nursing, China Medical University, Shenyang City, Liaoning Province, China
| | - Jiang Yuying
- Department of Nursing, School of Medicine, Xiamen University, Xiamen City, Fujian Province, China
| | - Hu Yuru
- School of Medicine, Xiamen University, Xiamen City, Fujian Province, China
| | - Shen Qu
- Department of Nursing, School of Medicine, Xiamen University, Xiamen City, Fujian Province, China
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Liu C, Cao G, Li J, Lian S, Zhao K, Zhong Y, Xu J, Chen Y, Bai J, Feng H, He G, Dong X, Yang P, Zeng F, Lin Z, Zhu S, Zhong X, Ma W, Liu T. Effect of long-term exposure to PM 2.5 on the risk of type 2 diabetes and arthritis in type 2 diabetes patients: Evidence from a national cohort in China. ENVIRONMENT INTERNATIONAL 2023; 171:107741. [PMID: 36628860 DOI: 10.1016/j.envint.2023.107741] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/15/2022] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND It remains unclear whether type 2 diabetes and the complication of arthritis are causally related to the PM2.5 pollutant. Therefore, we aimed to investigate the associations of long-term PM2.5 exposure with type 2 diabetes and with arthritis in type 2 diabetes patients. MATERIALS AND METHODS This study used data from the China Health and Retirement Longitudinal Survey (CHARLS) implemented during 2011-2018. The associations were analyzed by Cox proportional hazards regression models, and the population-attributable fraction (PAF) was calculated to assess the burden of type 2 diabetes and arthritis-attributable to PM2.5. RESULTS A total of 21,075 participants were finally included, with 19,121 analyzed for PM2.5 and type 2 diabetes risk and 12,427 analyzed for PM2.5 and arthritis risk, of which 1,382 with newly-diagnosed type 2 diabetes and 1,328 with arthritis during the follow-up. Overall, each 10 μg/m3 increment in PM2.5 concentration was significantly associated with an increase in the risk of type 2 diabetes (HR = 1.26, 95 %CI1.22 to 1.31), and the PAF of type 2 diabetes attributable to PM2.5 was 13.54 %. In type 2 diabetes patients, each 10 μg/m3 increment in PM2.5 exposure was associated with an increase in arthritis (HR = 1.42, 95 %CI: 1.28 to 1.57), and the association was significantly greater than that (H = 1.23, 95 %CI: 1.19 to 1.28) in adults without type 2 diabetes. The PAFs of arthritis-attributable to PM2.5 in participants with and without type 2 diabetes were 18.54 % and 10.69 %, respectively. CONCLUSION Long-term exposure to PM2.5 may increase the risk of type 2 diabetes and make type 2 diabetes patients susceptible to arthritis.
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Affiliation(s)
- Chaoqun Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Ganxiang Cao
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510080, China; Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Jieying Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Shaoyan Lian
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Ke Zhao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Ying Zhong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Jiahong Xu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Yumeng Chen
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510080, China; Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou 511430, China
| | - Jun Bai
- Foshan Women and Children Hospital Affiliated to Southern Medical University, Foshan 528000, China
| | - Hao Feng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Guanhao He
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Xiaomei Dong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Pan Yang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Fangfang Zeng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Ziqiang Lin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Sui Zhu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China
| | - Xinqi Zhong
- Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, Guangdong, China
| | - Wenjun Ma
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China.
| | - Tao Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou 510080, China; China Greater Bay Area Research Center of Environmental Health, School of Medicine, Jinan University, Guangzhou 510632, China.
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Zhang Q, Han X, Zhao X, Wang Y. Multimorbidity patterns and associated factors in older Chinese: results from the China health and retirement longitudinal study. BMC Geriatr 2022; 22:470. [PMID: 35641904 PMCID: PMC9158229 DOI: 10.1186/s12877-022-03154-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background This study aimed to investigate multimorbidity patterns and their associated factors among elderly population in China. Methods A total of 10,479 participants aged at least 60 years were drawn from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS). Latent class analysis (LCA) was performed to identify distinct multimorbidity classes based on 14 self-reported chronic conditions. The multinomial logit model was used to analyze the associated factors of multimorbidity patterns, focusing on individuals' demographic characteristics, socioeconomic status (SES), and health behaviors. Results Among the 10,479 participants (mean age [SD]: 69.1 [7.1]), 65.6% were identified with multimorbidity. Five multimorbidity clusters were identified by LCA: relatively healthy class (49.8%), vascular class (24.7%), respiratory class (5.6%), stomach-arthritis class (14.5%), and multisystem morbidity class (5.4%). Multinomial logit analysis with the relatively healthy class as the reference showed that participants of older age and female sex were more likely to be in the vascular class and multisystem morbidity class. The probability of being in the vascular class was significantly higher for those with high SES. Ever smoking was associated with a higher probability of being in the respiratory class and multisystem morbidity class. Physical activity was associated with lower odds of being assigned to the vascular class, respiratory class, and multisystem class. Conclusion The distinct multimorbidity patterns imply that the prevention and care strategy should target a group of diseases instead of a single condition. Prevention interventions should be paid attention to for individuals with risk factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03154-9.
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Affiliation(s)
- Quan Zhang
- National School of Development, Peking University, No.5 Yiheyuan Road, Beijing, 100872, China
| | - Xiao Han
- School of Health Humanities, Peking University, No. 38 Xueyuan Road, Beijing, 100191, China
| | - Xinyi Zhao
- School of Health Humanities, Peking University, No. 38 Xueyuan Road, Beijing, 100191, China.
| | - Yue Wang
- School of Health Humanities, Peking University, No. 38 Xueyuan Road, Beijing, 100191, China.
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Zhang L, Yang L, Wang C, Yuan T, Zhang D, Wei H, Li J, Lei Y, Sun L, Li X, Hua Y, Che H, Li Y. Mediator or moderator? The role of obesity in the association between age at menarche and blood pressure in middle-aged and elderly Chinese: a population-based cross-sectional study. BMJ Open 2022; 12:e051486. [PMID: 35618334 PMCID: PMC9137347 DOI: 10.1136/bmjopen-2021-051486] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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
OBJECTIVE We investigated the moderation/mediation between the age of menarche and obesity parameters in predicting blood pressure (BP) in middle-aged and elderly Chinese. DESIGN Our study is a population-based cross-sectional study. SETTING Participants in this study came from the China Health and Retirement Longitudinal Study (CHARLS). PARTICIPANTS The analytical sample included 4513 participants aged 45-96 years. MAIN OUTCOME MEASUREMENTS Data were selected from the CHARLS, a cross-sectional study. Between-group differences were evaluated using χ2, t-test and one-way analysis of variance. The trend of related variables by characteristics was also tested using contrast analysis, as appropriate. Then, correlations between characteristics, moderator, mediator, and independent and dependent variables were used by Spearman's correlation test and Pearson's correlation test. Finally, the mediation analysis was performed by model 4 in PROCESS V3.3 macro for SSPSS, and moderation analysis was used by model 1 for assessment. All covariates were adjusted in the moderation or mediation models. RESULTS In the correlation analysis, body mass index (BMI) and waist circle (WC) level were positively correlated with both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in women (BMI and DBP: r=0.221, p<0.001; WC and DBP: r=0.183, p<0.001; BMI and SBP: r=0.129, p<0.001; WC and SBP: r=0.177, p<0.001). Age of menarche was negatively correlated with DBP (r=-0.060, p<0.001). However, the age of menarche was not significantly correlated with SBP (r=-0.014, p=0.335). In the moderator analysis, after controlling for the potential confounders, the interaction term of obesity parameters×age of menarche was not significant for predicting either DBP (BMI: B=0.0260, SE=0.0229, p=0.2556, 95% CI -0.0189 to 0.071; WC: B=0.0099, SE=0.0074, p=0.1833, 95% CI -0.0047 to 0.0244) or SBP (BMI: B=0.0091, SE=0.0504, p=0.8561, 95% CI -0.0897 to 0.108; WC: B=-0.0032, SE=0.0159, p=0.8427, 95% CI -0.0343 to 0.028). All correlations were significant correlation between age of menarche, obesity parameters and BP except the path of the menarche age→SBP (with the addition of the BMI indicator: β=-0.0004, B=-0.0046, p=0.9797, 95% CI -0.3619 to 0.3526; with the addition of the WC indicator: β=0.0004, B=0.0044, p=0.9804, 95% CI -0.3439 to 0.3526) in crude model. In general, after controlling for potential confounders, BMI (DBP: β=-0.0471, B= -0.2682, p=0.0021, 95% CI -0.4388 to -0.0976; SBP: β=-0.0515, B=-0.6314, p<0.001, 95% CI -0.9889 to -0.2739) and WC (DBP: β=-0.0474, B= -0.2689, p<0.001, 95% CI -0.4395 to -0.0984; SBP: β=-0.0524, B=-0.6320, p<0.001, 95% CI -0.9832 to -0.2807) partly mediated the relationship between age of menarche and BP. CONCLUSIONS The interaction term of obesity parameters×age of menarche was not significant for predicting either DBP or SBP in women. Moreover, obesity parameters partly mediated the relationship between the age of menarche and BP.
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Affiliation(s)
- Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Liu Yang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Congzhi Wang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Ting Yuan
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Dongmei Zhang
- Department of Pediatric Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Huanhuan Wei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Jing Li
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Yunxiao Lei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
- School of Nursing, Henan University of Science and Technology, Luoyang, Henan, China
| | - Lu Sun
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Xiaoping Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Ying Hua
- Rehabilitation Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Hengying Che
- Department of Nursing, Yijishan Hospital, the First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Yuanzhen Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
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Yue S, Bo L. Formulation and Development of Prednisolone Loaded Nanoparticulate Injection for the Treatment of Arthritis. INT J PHARMACOL 2022. [DOI: 10.3923/ijp.2022.611.617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zhou R, Zheng YJ, Yun JY, Wang HM. The Effects of Urban Green Space on Depressive Symptoms of Mid-Aged and Elderly Urban Residents in China: Evidence from the China Health and Retirement Longitudinal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020717. [PMID: 35055539 PMCID: PMC8775628 DOI: 10.3390/ijerph19020717] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/29/2021] [Accepted: 01/06/2022] [Indexed: 02/04/2023]
Abstract
The aim of this study is to assess the impacts of urban green space on depressive symptoms among Chinese urban residents aged 45 and older. In total, 7397 urban respondents were included in this study. Each respondent participated in the China Health and Retirement Longitudinal Study Wave 3 (2015). Environmental-level variables were retrieved from the National Bureau of Statistics database. Both unadjusted and adjusted methods were used in the multilevel regression analysis. Almost one-third of the sample population suffered from depressive symptoms (31.20%). The multilevel logistic regression model showed that green coverage ratio of city-built districts is negatively associated with the prevalence of depressive symptoms among urban mid-aged (OR = 0.79, p < 0.05) and elderly (OR = 0.75, p < 0.05) residents, and the public recreational green space helps to reduce elderly people’s depressive symptoms (OR = 0.77, p < 0.05). This study adds insights about the impact of green space and other environmental factors on depressive symptoms among mid-aged and elderly urban dwellers. It is important to provide enough and accessible overall urban green spaces; additionally, attention should also be paid to specific green space forms such as public recreational green space.
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Jeong SH, Kim SH, Park M, Kwon J, Lee HJ, Park EC. Arthritis status changes and depressive symptoms among middle-aged and older Koreans: Analysis of data from the Korean Longitudinal Study of Aging survey. J Psychosom Res 2021; 151:110662. [PMID: 34739945 DOI: 10.1016/j.jpsychores.2021.110662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/27/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Arthritis can negatively affect physical and mental health, especially among middle-aged and older people. This study investigated the longitudinal association between changes in arthritis status and depressive symptoms among Korean adults aged ≥45 years. METHODS We analyzed data from the Korean Longitudinal Study of Aging 2008-2018, using a generalized estimating equation model to investigate associations between arthritis status change and depressive symptoms, which were assessed using five categories according to measurements based on the Center for Epidemiological Studies Depression Scale (CES-D-10). RESULTS Both men and women whose arthritis status changed to "worse" or remained "same" scored higher for depressive symptoms than those who reported "no symptoms of arthritis" (men, worse = β: 1.07, P ≤ .001, same = β: 0.25 P = .031; women, worse = β: 0.99, P ≤ .001, same = β: 0.13, P = .049). Conversely, men with a "better" arthritis status (β: -0.71, P ≤ .001) and women with a "recovered" arthritis status (β: -0.56, P = .031) scored lower for depressive symptoms than those who reported "no symptoms of arthritis." CONCLUSIONS Arthritis status changes are associated with depressive symptoms in middle-aged and older Koreans. Therefore, mental health evaluation and management interventions are recommended for patients with arthritis and changes in disease status.
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Affiliation(s)
- Sung Hoon Jeong
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Seung Hoon Kim
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Minah Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Junhyun Kwon
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Hyeon Ji Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Liu W, Yang X, Jin X, Xiu P, Wen Y, Wu N, Zhao J, Zhou D, Pan XF. Prospective Evaluation of the Association Between Arthritis and Cognitive Functions in Middle-Aged and Elderly Chinese. Front Aging Neurosci 2021; 13:687780. [PMID: 34776923 PMCID: PMC8579809 DOI: 10.3389/fnagi.2021.687780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/07/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Assessing the relation between arthritis and cognitive impairment could expand the understanding of health consequences of arthritis. The aim was to prospectively examine the association between arthritis and cognitive functions among middle-aged and elderly Chinese. Methods: Our analyses were based on data from the nationwide China Health and Retirement Longitudinal Study (2011–2016). Arthritis was ascertained by self-reported doctor diagnosis during the baseline survey. Cognitive functions were evaluated in three domains including episodic memory, mental status, and global cognition. Linear mixed models were employed to assess the association between baseline arthritis and cognition functions. Results: Of 7,529 Chinese adults, 49.79% were men, and mean age was 57.53 years. During a follow-up of 4 years, participants with baseline arthritis showed lower scores of episodic memory [β = −0.08; 95% confidence interval (CI): −0.14, −0.03], mental status (β = −0.14; 95% CI: −0.22, −0.05), and global cognition (β = −0.22; 95% CI: −0.34, −0.11), compared to those without arthritis. In addition, participants with arthritis showed increased rates of decline in mental status and global cognition by 0.04 (95% CI: 0.01, 0.08) and 0.05 (95% CI: 0.01, 0.09) units per year, respectively. Conclusion: Arthritis was associated with subsequent risk of poorer cognitive functions and slightly faster declines in cognitive functions among Chinese middle-aged and elderly adults. Our findings should be confirmed in future large prospective studies in Chinese and other populations.
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Affiliation(s)
- Wenyu Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xue Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xingzhong Jin
- Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Peng Xiu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Wen
- Department of Communicable Diseases Control and Prevention, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Nianwei Wu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jian Zhao
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,MRC Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiong-Fei Pan
- Ministry of Education Key Laboratory of Environment and Health and State Environmental Protection Key Laboratory of Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States.,Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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Zhang L, Yang L, Wang C, Yuan T, Zhang D, Wei H, Li J, Lei Y, Sun L, Li X, Hua Y, Che H, Li Y. Combined Effect of Famine Exposure and Obesity Parameters on Hypertension in the Midaged and Older Adult: A Population-Based Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5594718. [PMID: 34604385 PMCID: PMC8486537 DOI: 10.1155/2021/5594718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/07/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Undernutrition early in life may increase the incidence of adverse effects on adult health. The relations between undernutrition and obesity parameters (body mass index (BMI) and WC (waist circle)) and hypertension were often contradictory. Our study is aimed at identifying the combined effects of famine exposure and obesity parameters on hypertension in middle-aged and older Chinese. DESIGN A population-based cross-sectional study. Setting. Data were selected from the China Health and Retirement Longitudinal Study Wave2011 (CHARLS Wave2011). Participants. The sample included 12945 individuals aged 45 to 96. Main Outcome Measurements. The study analyzed data from 12945 middle-aged and older Chinese selected from CHARLS Wave2011. Differences between baseline characteristics and famine exposure/BMI levels/WC levels were evaluated using the t-, Chi-square- (χ 2-), and F-test. Then, the difference in the prevalence of hypertension between baseline characteristics was estimated by the t- and χ 2-test. Finally, multivariable-adjusted logistic regression models were used to explore the associations of famine exposure and obesity parameters with odds of prevalence of hypertension. RESULTS Among the 12945 participants, 1548 (11.96%) participants had been exposed to the Chinese famine during the fetal group, whereas 5101 (39.41%) participants and 4362 (33.70%) participants had been exposed to the famine during childhood and adolescence/adult group, respectively. Regarding the participants with BMI levels, 3746 (28.94%) were overweight, and 1465 (11.32%) were obese, whereas 5345 (41.29%) of the participants with WC levels were obese, respectively. Furthermore, 1920 (31.17%) had hypertension in males and 2233 (32.91%) in females. In multivariable-adjusted models, famine exposure and obesity parameters were related with prevalence of hypertension independently in total populations ((1) model threec, famine exposure with prevalence of hypertension: the fatal-exposed vs. no-exposed group (OR1.27; 95% CI 1.08, 1.49); childhood-exposed vs. no-exposed group (OR1.64; 95% CI 1.44, 1.87); the adolescence/adult-exposed vs. no-exposed group (OR3.06; 95% CI 2.68, 3.50); P for trend < 0.001; (2) model threee, famine exposure with prevalence of hypertension: the fatal-exposed vs. no-exposed group (OR1.25; 95% CI 1.06, 1.47); childhood-exposed vs. no-exposed group (OR1.52; 95% CI 1.34, 1.73); the adolescence/adult-exposed vs. no-exposed group (OR2.66; 95% CI 2.33, 3.03); P for trend < 0.001; (3) model threeg, BMI levels with prevalence of hypertension: overweight vs. normal (OR1.75; 95% CI 1.60, 1.91); obesity vs. normal (OR2.79; 95% CI 2.48, 3.15); P for trend < 0.001; (4) WC levels with prevalence of hypertension: overweight vs. normal (OR1.42; 95% CI 1.36, 1.48)). When stratified by sex, results in both males and females were mostly similar to those in the total population. In general, interaction analysis in the multivariable-adjusted model, compared with the combination of normal BMI/WC levels and no-exposed famine group, all groups trended towards higher odds of prevalence of hypertension (the greatest increase in odds, adolescence/adult-exposed group with obesity in BMI levels: (OR8.13; 95% CI 6.18, 10.71); adolescence/adult-exposed group with obesity in WC levels: (OR6.36; 95% CI 5.22, 7.75); P for interaction < 0.001). When stratified by sex, the results in both males and females were also similar to those in the total population. CONCLUSION Our data support a strongly positive combined effect of famine exposure and obesity parameters on hypertension in middle-aged and elderly Chinese.
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Affiliation(s)
- Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, China
| | - Liu Yang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, China
| | - Congzhi Wang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, China
| | - Ting Yuan
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, China
| | - Dongmei Zhang
- Department of Pediatric Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, China
| | - Huanhuan Wei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, China
| | - Jing Li
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, China
| | - Yunxiao Lei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, China
| | - Lu Sun
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, China
| | - Xiaoping Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, China
| | - Ying Hua
- Rehabilitation Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, China
| | - Hengying Che
- Department of Nursing, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Zheshan West Road, Yijishan District, Wuhu City, Anhui Province, China
| | - Yuanzhen Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, Anhui Province, China
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Zhang L, Yang L, Wang C, Yuan T, Zhang D, Wei H, Li J, Lei Y, Sun L, Li X, Hua Y, Che H, Li Y. Individual and combined association analysis of famine exposure and serum uric acid with hypertension in the mid-aged and older adult: a population-based cross-sectional study. BMC Cardiovasc Disord 2021; 21:420. [PMID: 34488649 PMCID: PMC8420034 DOI: 10.1186/s12872-021-02230-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/30/2021] [Indexed: 01/02/2023] Open
Abstract
Background Malnutrition in early life may affect health in later life. The associations between malnutrition and serum uric acid (SUA) and hypertension were inconsistent. The present study aimed to investigate the individual and combined association between famine exposure and serum uric acid and hypertension in middle-aged and older Chinese. Methods Data were selected from the China Health and Retirement Longitudinal Study (CHARLS) Wave2011. The analytic sample included 9368 individuals aged 45 to 90. Differences between baseline characteristics and famine exposure/SUA level were evaluated using the Chi-square test, t-test, and F-test. Then, the differences in the prevalence of hypertension between characteristic groups was also estimated by the Chi-square and t-test. Finally, multivariable-adjusted logistic regression models examined association of famine exposure and serum uric acid with odds of prevalence of hypertension. Results A total of 9368 individuals were enrolled in the study, 4366 (46.61%) and 5002 (53.39%) were male and female, respectively. Among males, 459 (10.51%) had been exposed to the Chinese famine during the fetal stage, whereas 1760 (40.31%) and 1645 (37.68%) had been exposed to the famine during childhood and adolescence/adult stage, respectively. Among females, 635 (12.69%) had been exposed to the Chinese famine during the fetal stage, whereas 1988 (39.74%) and 1569 (31.37%) had been exposed to the famine during childhood and adolescence/adult stage, respectively. Regarding the participants with SUA level measurements, 290 (6.64%) reported having Hyperuricemia (HUA) in males and 234 (4.68%) in the females. Furthermore, 1357 (31.08%) reported having hypertension in male and 1619 (32.37%) in the female. In multivariable-adjusted model, famine exposure and serum uric acid were associated with prevalence of hypertension independently in total populations [(1) Model fourd, fatal exposed group vs non-exposed group: 1.25 (95% CI 1.03, 1.52); childhood-exposed group vs non-exposed group:1.60 (95% CI 1.37, 1.87); adolescence/adult exposed group vs non-exposed group: 2.87 (95% CI 2.44, 3.37), P for trend < 0.001; (2) Model four e, high vs normal:1.73 (95% CI 1.44, 2.08)]. When stratified by sex, the results in both males and females were similar to those in the total population. In general, interaction analysis in the multivariable-adjusted model, compared with the combination of normal SUA level and no-exposed famine stage, all groups trended towards higher odds of prevalence of hypertension [the greatest increase in odds, adolescence/adult exposed stage and high SUA level in total participants: OR4.34; 95%CI 3.24, 5.81; P for interaction < 0.001]. When stratified by sex, the results in both males and females were also similar to those in the total population. Conclusion Our data support a strongly positive individual and combined association of famine exposure and serum uric acid with hypertension in middle-aged and elderly Chinese.
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Affiliation(s)
- Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Liu Yang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Congzhi Wang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Ting Yuan
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Dongmei Zhang
- Department of Pediatric Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Huanhuan Wei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Jing Li
- Department of Surgical Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Yunxiao Lei
- Obstetrics and Gynecology Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Lu Sun
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Xiaoping Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Ying Hua
- Rehabilitation Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China
| | - Hengying Che
- Department of Nursing, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Zheshan West Road, Yijishan District, Wuhu City, Anhui Province, People's Republic of China.
| | - Yuanzhen Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, 22 Wenchang West Road, Higher Education Park, Wuhu City, An Hui Province, People's Republic of China.
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Ke C, Qiao Y, Liu S, Rui Y, Wu Y. Longitudinal research on the bidirectional association between depression and arthritis. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1241-1247. [PMID: 33221928 DOI: 10.1007/s00127-020-01994-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 11/10/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Studies evaluating the mutual relation between depression and arthritis have been limited and yielded inconsistent results. The aim of this study was to investigate the bidirectional relationship between depression and arthritis in a middle-aged and elderly Chinese population. METHODS Participants ≥ 45 years of age were included from the China Health and Retirement Longitudinal Study (CHARLS). In stage I, we assessed the association of baseline depression with follow-up arthritis. In stage II, we examined whether the onset of arthritis predicted future depression. Logistic regression analyses were conducted to estimate the odds ratios (ORs) and confidence intervals (CIs) in stage I and stage II, respectively. RESULTS In stage I, 24.3% (679/2794) of the depression group and 15.4% (1000/6482) of the non-depression group developed new arthritis cases. Compared with non-depression individuals, the risk of developing arthritis in depression patients was significantly higher (OR: 1.56, 95% CI 1.37-1.79). In stage II, 39.7% (973/2453) subjects in the arthritis group and 26.7% (1667/6236) subjects in the non-arthritis group developed depressive symptoms. The adjusted OR (95% CI) for depression in the arthritis group was 1.64 (1.45-1.86) times higher than that in the non-arthritis group. In the subgroup analyses according to sex, age, household income, residence, body mass index, smoking and drinking, all sub-groups yielded consistent associations. CONCLUSION The onset of depression increased the risk of incident arthritis; in addition, baseline arthritis predicted future depression in middle-aged and elderly Chinese adults.
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Affiliation(s)
- Chaofu Ke
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, People's Republic of China
| | - Yanan Qiao
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, People's Republic of China
| | - Siyuan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, People's Republic of China
| | - Yuqi Rui
- School of Public Health, Medical College of Soochow University, 199 Renai Road, Suzhou, 215123, People's Republic of China
| | - Ying Wu
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, People's Republic of China.
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Deng Y, Gao Q, Yang T, Wu B, Liu Y, Liu R. Indoor solid fuel use and incident arthritis among middle-aged and older adults in rural China: A nationwide population-based cohort study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 772:145395. [PMID: 33578144 DOI: 10.1016/j.scitotenv.2021.145395] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/08/2021] [Accepted: 01/19/2021] [Indexed: 05/26/2023]
Abstract
BACKGROUND Many households in developing countries, including China, rely on the traditional use of solid fuels for cooking and heating. Arthritis is highly prevalent in middle-aged and older adults and is a major cause of disability. However, evidence linking indoor solid fuel use with arthritis is scarce in this age group (≥45 years) in developing countries. OBJECTIVES To investigate whether exposure to indoor solid fuel for cooking and heating is associated with arthritis in middle-aged and older adults in rural China. METHODS Data for the present study were extracted from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal national prospective study of adults aged 45 years and older enrolled in 2010 and followed up through 2015. We included 7807 rural participants without arthritis at baseline, of whom 1548 living in a central heating area in winter were included in the heating analysis (taking the Qinling-Huaihe line as the heating boundary). Cox proportional hazards models were used to examine the association between indoor solid fuel use and arthritis, controlling for age, sex, education, marital status, smoking status, drinking status, self-reported socioeconomic status, BMI, sleep time, napping time, independent cooking, hypertension, diabetes, dyslipidemia, heart problems and stroke. We also investigated the effect of switching primary fuels and using solid fuels for both cooking and heating on arthritis risk. RESULTS The mean (SD) age of the study participants was 59.2 (10.0) years old, and 48.0% of participants were women. A total of 64.8% and 63.0% of the participants reported primarily using solid fuel for cooking and heating, respectively. Arthritis incidence rates were lower among clean fuel users than solid fuel users. Compared to those using clean fuels, cooking and heating solid fuel users had a higher risk of arthritis, with hazard ratios (HRs) of 1.22 (95% confidence interval (CI): 1.01, 1.49) and 1.76 (95% CI: 1.07, 2.89), respectively. Switching from clean fuels to solid fuels for heating (HR: 3.28, 95% CI: 1.21, 7.91) and using solid fuels for both cooking and heating (HR, 1.71, 95% CI, 1.01-2.79) increased the risk of arthritis. CONCLUSIONS Long-term solid fuel use for indoor cooking and heating is associated with an increased risk of arthritis events among adults aged 45 years and older in rural China. The potential benefits of reducing indoor solid fuel use in groups at high risk for arthritis merit further exploration.
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Affiliation(s)
- Yan Deng
- Department of Environmental Health, School of Public Health, China Medical University, Shenyang 110122, China
| | - Qian Gao
- Department of Environmental Health, School of Public Health, China Medical University, Shenyang 110122, China
| | - Tianyao Yang
- Department of Environmental Health, School of Public Health, China Medical University, Shenyang 110122, China
| | - Bo Wu
- Department of Anal and Rectal Diseases, First Hospital, China Medical University, Shenyang 110001, China
| | - Yang Liu
- Department of Environmental Health, School of Public Health, China Medical University, Shenyang 110122, China
| | - Ruxi Liu
- Department of Immunology and Rheumatology, First Hospital, China Medical University, Shenyang 110001, China.
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Wen Y, Liao J, Yin Y, Liu C, Gong R, Wu D. Risk of falls in 4 years of follow-up among Chinese adults with diabetes: findings from the China Health and Retirement Longitudinal Study. BMJ Open 2021; 11:e043349. [PMID: 34103310 PMCID: PMC8190046 DOI: 10.1136/bmjopen-2020-043349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This study was to determine the incidence of falls and identify baseline factors increased risk for incident falls over time among people with diabetes. DESIGN This study was a secondary analysis using the baseline and 4 years of follow-up data from the China Health and Retirement Longitudinal Study (CHARLS). SETTING A nationally representative survey of 17 500 Chinese residents aged 45 years and older were recruited in the baseline national survey in 2011. These participants were followed up every 2 years. PARTICIPANTS A total of 1238 middle-aged and older adults with diabetes and no history of falls at baseline were included in the current study. PRIMARY AND SECONDARY OUTCOME MEASURES Information on incidence of falls and medical treatment resulting from falls were determined by self-report. RESULTS The findings showed that the incidence of falls was 29.4% during 4 years of follow-up. Participants with incident falls were younger, were more likely to be women, had lower education level and were less likely to be current drinkers. In addition, former drinkers were 2.22 times more likely to fall. Socially active individuals were 47% less likely to fall compared with those without social activities. Every 5 kg increase in grip strength was associated with a 13% lower risk of falls. A 10 mg/dL higher total cholesterol and 1 mg/dL higher blood urea nitrogen were associated with a 4% and 6% higher risk of falls. Finally, participants with depressive symptoms were 1.47 times more likely to fall compared with those without depressive symptoms. CONCLUSIONS These findings underscore the importance of developing a fall prevention programme for those with diabetes, and this programme should address potentially modifiable risk factors, including levels of total cholesterol, blood urea nitrogen, social activity, depressive symptoms and grip strength.
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Affiliation(s)
- Yue Wen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Liao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yiqiong Yin
- Gastrointestinal Department, West China Hospital, Sichuan University, Chengdu, China
| | - Chunjuan Liu
- West China School of Nursing, Sichuan University/ West China Hospital, Sichuan University, Chengdu, China
| | - Renrong Gong
- Department of Surgery, West China Hospital, Sichuan University/ Department of Surgery, West China School of Nursing, Sichuan University /Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Dongmei Wu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- Department of Nursing, The Fourth People's Hospital of Chengdu & Chengdu Mental Health Center, Chengdu, China
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Li W, Gamber M, Han J, Sun W, Yu T. The Association Between Pain and Fall Among Middle-Aged and Older Chinese. Pain Manag Nurs 2020; 22:343-348. [PMID: 33272831 DOI: 10.1016/j.pmn.2020.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 08/28/2020] [Accepted: 10/15/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Falls and fall-induced injuries in elderly people are common worldwide. However, few reports have examined the association between body pain and fall in middle-aged and older Chinese adults. The objective of this study is to access the association between pain and fall among middle-aged and older Chinese. METHODS Data were drawn from the 2011 China Health and Retirement Longitudinal Study (CHARLS) from respondents who were middle-aged and older (over 45 years old). A logistic regression model was used to estimate the odds ratios (AOR) and 95% confidence interval (95% CI) of the association between body pain and fall, after controlling for confounders. RESULTS After adjusting for demographic characteristics, socioeconomic status, lifestyle, health status and comorbidity, those participants who had pain were 73% more likely to report falls than those who did not have pain (AOR = 1.73, 95% CI 1.56-1.92). Elder age was associated with a higher risk of fall (AOR = 1.77, 95% CI 1.47-2.13). Comparing to female, male was associated with a lower risk of fall (AOR = 0.64, 95% CI 0.56-0.74). Lifestyle such as drinking status, self-reported health status, chronic diseases, vision impairment and disability were significantly associated with fall. CONCLUSION Body pain is significantly associated with fall among middle-aged and older Chinese adults. Appropriate pain management programs and policies are needed in fall prevention.
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Affiliation(s)
- Wei Li
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida
| | - Michelle Gamber
- School of Health Professions, Shenandoah University, Winchester, Virginia
| | - Jingnan Han
- Department of Medicine, The University of Alabama at Birmingham Hospital, Birmingham, Alabama
| | - Wenjie Sun
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, Florida
| | - Tong Yu
- Department of Medical Insurance, School of Humanities and Management, Wannan Medical College, Wuhu, China.
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Yang R, Wang J, Wang H, Tracy EL, Tracy CT. A cross-lagged model of depressive symptoms and mobility disability among middle-aged and older Chinese adults with arthritis. Geriatr Gerontol Int 2020; 20:873-877. [PMID: 32827228 DOI: 10.1111/ggi.13993] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 06/15/2020] [Accepted: 07/02/2020] [Indexed: 12/27/2022]
Abstract
AIM To examine the reciprocal and longitudinal associations between depressive symptoms and mobility disability in middle-aged and older Chinese adults with arthritis. METHODS We used three waves of the China Health and Retirement Longitudinal Study. The analytic sample included 4682 community-dwelling adults aged ≥45 years with arthritis who completed the self-report measurement of depressive symptoms and mobility disability every 2 years over a 4-year study period. Analysis involved an autoregressive cross-lagged model. RESULTS The prevalence rates of comorbid depressive symptoms and mobility disability were 38.9%, 33.2% and 38.9%, respectively across three waves. There was a significant bidirectional and longitudinal relationship between depressive symptoms and mobility disability among middle-aged and older Chinese adults with arthritis. A higher level of depressive symptoms in previous waves was associated with a subsequent increase in mobility disability over time. A similar pattern was also shown in the opposite direction from mobility disability to depressive symptoms over time. CONCLUSIONS This study demonstrates that depressive symptoms and mobility disability are reciprocally related in Chinese adults with arthritis over time. In addition, it highlights the importance of early interventions aimed at reversing the downward spiral of depressive symptoms and mobility disability to improve the health of Chinese adults with arthritis. Geriatr Gerontol Int 2020; 20: 873-877.
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Affiliation(s)
- Rumei Yang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Jingxia Wang
- School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Haocen Wang
- Department of Health and Kinesiology, Texas A&M University, College Station, Texas, USA
| | - Eunjin Lee Tracy
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Cory T Tracy
- Independent Researcher, Salt Lake City, Utah, USA
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Labasangzhu L, Zhang R, Qi Y, Shen L, Luobu O, Dawa Z, Li C. The U-shaped association of altitudes with prevalence of hypertension among residents in Tibet, China. J Hum Hypertens 2020; 35:546-555. [PMID: 32572273 DOI: 10.1038/s41371-020-0367-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 11/09/2022]
Abstract
We aimed to evaluate the association of altitudes with the prevalence of hypertension among residents aged 15 years and above in Tibet, China. Data for 11,407 Tibetan residents from the National Health Services Survey in 2013 were analyzed. Association between altitudes and prevalence of physician-diagnosed hypertension was assessed by two logistic regression models as follows: (i) a base model adjusted for age and gender, and (ii) a full model additionally adjusted for body mass index, education, marital status, area of residence, distance to the nearest medical institute, smoking, drinking, and exercise. Nonlinear relationship between altitudes and prevalence of hypertension was explored by restricted cubic spline analyses. Sensitivity analyses were conducted by restricting to residents of rural and/or nomadic areas. The prevalence of hypertension was estimated to be 37.6%. We found a U-shaped association between altitudes and prevalence of physician-diagnosed hypertension with a turning point at around 3800 m (12,467 ft). For residents living above 3800 m, a 1000 m increase in altitudes was associated with 2.05 (95% confidence interval [CI]: 1.62-2.61) times higher odds of having physician-diagnosed hypertension, after adjusting for age and gender. When further controlling for all covariates, the odds ratio (OR) dropped to 1.87 (95% CI: 1.46-2.41). For residents living below 3800 m, a 1000 m increase was associated with 0.29 (95% CI: 0.19-0.44) times less likelihood of having physician-diagnosed hypertension in the full model. Sensitivity analyses among residents in rural and/or nomadic areas showed similar associations. To conclude, altitudes were in a U-shaped association with prevalence of hypertension.
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Affiliation(s)
- Labasangzhu Labasangzhu
- Department of Preventive Medicine, Tibet University Medical College, Lhasa, Tibet, China.,High Altitude Medical Research Center of Tibet University, Lhasa, Tibet, China
| | - Ruiyuan Zhang
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA, USA.
| | - Yanling Qi
- Department of Health Care Administration, College of Health and Human Services, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA, USA
| | - Luqi Shen
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA, USA
| | - Ouzhu Luobu
- Department of Clinical Medicine, Tibet University Medical College, Lhasa, Tibet, China.,Fukang Hospital, Lhasa, Tibet, China
| | - Zhaxi Dawa
- Department of Preventive Medicine, Tibet University Medical College, Lhasa, Tibet, China
| | - Changwei Li
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, Athens, GA, USA.
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Bayes-Marin I, Fernández D, Lara E, Martín-María N, Miret M, Moreno-Agostino D, Ayuso-Mateos JL, Sanchez-Niubo A, Haro JM, Olaya B. Trajectories of Immediate and Delayed Verbal Memory in the Spanish General Population of Middle-aged and Older Adults. Brain Sci 2020; 10:brainsci10040249. [PMID: 32331406 PMCID: PMC7226341 DOI: 10.3390/brainsci10040249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 01/01/2023] Open
Abstract
(1) Cognitive decline differs among individuals and cognition function domains. We sought to identify distinct groups of immediate and delayed verbal memory in two age subsamples (50–64, 65+ years), and to analyze associated factors. (2) Latent class mixed models were used to identify verbal memory trajectories in a sample of Spanish community-dwelling individuals over 8 years’ follow up. Chi-square and Kruskal–Wallis tests were used to assess differences among trajectories. (3) Different trajectories were identified. In the case of immediate verbal memory, these were: very low/decline (6.3%), low/stable (38.2%), medium/slow decline (43.4%), and high/slow decline (12.2%) in the middle-aged group, and low/decline (20.4%), medium/slow decline (60.4%), and high/slow decline (19.2%) in the older subsample. In delayed verbal memory, more distinct patterns were found: very low/decline (12.4%), low/stable (51.4%), medium/accelerated decline (24.7%), and high/slow increase (11.4%) in the younger group, and low/slow decline (34.4%), medium/decline (52.7%), and high/slow decline (12.9%) in the older group. (4) Overall, low initial performance and decline were associated with older age, lower education, and higher diabetes/stroke prevalence. Differences found suggests heterogeneity in cognitive ageing. The high prevalence of cardiovascular diseases in those with worse cognition suggests that early interventions to prevent those conditions should be targeted in midlife to delay cognitive decline.
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Affiliation(s)
- Ivet Bayes-Marin
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (I.B.-M.); (A.S.-N.); (J.M.H.); (B.O.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain; (N.M.-M.); (M.M.); (D.M.-A.); (J.L.A.-M.)
- Department of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Daniel Fernández
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (I.B.-M.); (A.S.-N.); (J.M.H.); (B.O.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain; (N.M.-M.); (M.M.); (D.M.-A.); (J.L.A.-M.)
- Serra Húnter fellow, Department of Statistics and Operations Research, Polytechnic University of Catalonia-BarcelonaTech, 08028 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-640-63-50
| | - Elvira Lara
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain;
| | - Natalia Martín-María
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain; (N.M.-M.); (M.M.); (D.M.-A.); (J.L.A.-M.)
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain;
- Department of Psychiatry, Universidad Autónoma de Madrid, 28029 Madrid, Spain
| | - Marta Miret
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain; (N.M.-M.); (M.M.); (D.M.-A.); (J.L.A.-M.)
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain;
- Department of Psychiatry, Universidad Autónoma de Madrid, 28029 Madrid, Spain
| | - Darío Moreno-Agostino
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain; (N.M.-M.); (M.M.); (D.M.-A.); (J.L.A.-M.)
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain;
- Department of Psychiatry, Universidad Autónoma de Madrid, 28029 Madrid, Spain
| | - José Luis Ayuso-Mateos
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain; (N.M.-M.); (M.M.); (D.M.-A.); (J.L.A.-M.)
- Department of Psychiatry, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), 28006 Madrid, Spain;
| | - Albert Sanchez-Niubo
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (I.B.-M.); (A.S.-N.); (J.M.H.); (B.O.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain; (N.M.-M.); (M.M.); (D.M.-A.); (J.L.A.-M.)
| | - Josep Maria Haro
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (I.B.-M.); (A.S.-N.); (J.M.H.); (B.O.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain; (N.M.-M.); (M.M.); (D.M.-A.); (J.L.A.-M.)
- Department of Medicine, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Beatriz Olaya
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, 08830 Barcelona, Spain; (I.B.-M.); (A.S.-N.); (J.M.H.); (B.O.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, 28029 Madrid, Spain; (N.M.-M.); (M.M.); (D.M.-A.); (J.L.A.-M.)
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Zhang L, Li JL, Guo LL, Li H, Li D, Xu G. The interaction between serum uric acid and triglycerides level on blood pressure in middle-aged and elderly individuals in China: result from a large national cohort study. BMC Cardiovasc Disord 2020; 20:174. [PMID: 32293295 PMCID: PMC7160924 DOI: 10.1186/s12872-020-01468-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 04/05/2020] [Indexed: 12/19/2022] Open
Abstract
Background The purpose of the research was to explore the extent of interaction between triglycerides (TG) and serum uric acid (SUA) level with blood pressure (BP) in middle-aged and elderly individuals in China. Methods Data were selected from the China Health and Retirement Longitudinal Study (CHARLS), a cross-sectional study. 3345(46.99%) men with average ages of 60.24 ± 9.24 years and 3774 (53.01%) women with average ages of 59.91 ± 9.95 years were included in the study. Differences between gender, or between categories of blood pressure levels were evaluated by t-test or chi-square test. The adjusted associations between various characteristics and BP status were first compared using linear regression models, as appropriate. Then, A general linear model adjusted for confounding factors (socio-demographic characteristics [age, educational levels, marital status, place of residence], health behaviors [cigarette smoking, alcohol drinking, eating habits, social and leisure activities, accidental injury, physical activities], medical history [history of cardiovascular diseases, hepatitis history, antidiabetic drugs, history of antilipidemic medication, anti-hypertensive therapy], metabolic measures [C-reactive protein (CRP), hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), estimated glomerular filtration rate (eGFR), body mass index (BMI)]) was used to examine the synergistic effect of SUA and TG level on BP in middle-aged and elderly individuals in China. Results Age-adjusted partial Pearson’s correlation coefficient showed that SUA and TG level positively correlated with both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in both men and women. Multiple linear regression analysis showed the TG level was significantly and positively associated with SBP and DBP in both men (SBP: β =0.068, P = 0.001; DBP: β =0.064, P = 0.002) and women (SBP: β =0.061, P = 0.002; DBP: β =0.084, P = 0.000), but SUA were significantly and positively associated with SBP in both men (SBP: β =0.047, P = 0.013) and women (SBP: β =0.040, P = 0.028), regardless of other confounding factors. After adjusting for related potential confounders, evidence of interaction between SUA and TG level on SBP (men: β = − 1.090, P = 0.726; women: β = − 0.692, P = 0.861) and DBP (men: β = − 1.026, P = 0.572; women: β = − 0.794, P = 0.842) was not observed. Conclusion The interaction effect of SUA and TG level on BP was not observed in our study. Moreover, high SUA level was significantly associated with SBP, while high TG level was strongly related to both DBP and SBP.
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Affiliation(s)
- Lin Zhang
- Department of Surgical Nursing, School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, People's Republic of China
| | - Jin-Long Li
- Department of Occupational and Environmental Health, Key Laboratory of Occupational Health and Safety for Coal Industry in Hebei Province, School of Public Health, North China University of Science and Technology, Tangshan, Hebei Province, People's Republic of China
| | - Lei-Lei Guo
- Department of Surgical Nursing, School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, People's Republic of China
| | - Hong Li
- Department of Surgical Nursing, School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, People's Republic of China
| | - Dan Li
- Experimental Center for Nursing, School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District, Jinzhou City, Liaoning Province, People's Republic of China
| | - Guang Xu
- Department of Radiotherapy, Third Affiliated Hospital of Jinzhou Medical University, No.2, Section 5, Heping Road, Linghe District, Jinzhou City, Liaoning Province, People's Republic of China.
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Association between childhood conditions and arthritis among middle-aged and older adults in China: the China Health and Retirement Longitudinal Study. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20000343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThis study examined the association between childhood conditions and arthritis among middle-aged and older adults in China. The data were derived from the 2015 wave and the life-history module of the China Health and Retirement Longitudinal Study. Face-to-face interviews were conducted with respondents age 45 and over across China. Multiple imputation was used to handle the missing data, generating a final analytic sample of 19,800. Doctor-diagnosed arthritis was the main outcome variable. Random-effects logistic regression models were used to test the proposed models. Approximately 8 per cent of the respondents had better family financial status in childhood than their neighbours. Close to 8 per cent had been hospitalised or encountered similar conditions (e.g. confined to bed or home) for at least one month in childhood. Around one-third reported better subjective health in childhood than their peers. The majority of the respondents (80%) reported that they had stable health resources, and that their mothers were illiterate during their childhood. Childhood family financial status, subjective health, mother's education, access to health care and medical catastrophic events were found to be significant factors associated with arthritis in later life, after controlling for adulthood and older-age conditions (family financial status: odds ratio (OR) = 0.885, 95 per cent confidence interval (95% CI) = 0.848–0.924; subjective health: OR = 0.924, 95% CI = 0.889–0.960; mother's education: OR = 0.863, 95% CI = 0.750–0.992; access to health care: OR = 0.729, 95% CI = 0.552–0.964; medical catastrophic events: OR = 1.266, 95% CI = 1.108–1.446). The study results highlight an important role that childhood conditions play in affecting the onset of arthritis in late life in China. Health-care providers may consider childhood conditions as a valuable screening criterion to identify risk populations, which could be used to guide health promotion and prevention programmes, and promote healthy ageing.
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Ding L, Gao YH, Li YR, Huang YF, Wang XY, Qi X. Metabolic Score for Insulin Resistance Is Correlated to Adipokine Disorder and Inflammatory Activity in Female Knee Osteoarthritis Patients in a Chinese Population. Diabetes Metab Syndr Obes 2020; 13:2109-2118. [PMID: 32606869 PMCID: PMC7310993 DOI: 10.2147/dmso.s249025] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/26/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE This study was to evaluate the metabolic score for insulin resistance (METS-IR) in female knee osteoarthritis (KOA) patients in a Chinese population. The associations between METS-IR and adipokines, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were investigated. PATIENTS AND METHODS This study included 4686 women from the 2011 China Health and Retirement Longitudinal Study (CHARLS) and 108 women who underwent arthroplasty of KOA at a university hospital. The clinical data were collected, and adipokines were evaluated. METS-IR was calculated in the KOA patients and compared with the national baseline. Logistic regression analyses were applied to explore the associations of METS-IR with adipokines, ESR, and CRP. RESULTS Receiver operating characteristic curve analysis of METS-IR and metabolic syndrome (MetS) in national baseline showed an area under the curve value of 0.851, with sensitivity of 0.777 and specificity of 0.772. The METS-IR of KOA was higher than the national baseline level (40.29 ± 6.98 vs 36.20 ± 8.50, P < 0.01), even after adjusting age. In addition, the METS-IR was higher in patients with KOA who had MetS than in those without metabolic syndrome (nMetS), even after adjusting body mass index (BMI). After adjusting for age and BMI, METS-IR was associated with CRP (OR 1.238, 95% confidence interval (CI) 1.088, 1.409, P < 0.01), ESR (OR 1.124, 95% CI 1.008, 1.254, P = 0.036), plasma leptin (OR 1.123, 95% CI 1.052, 1.199, P < 0.01), plasma resistin (OR 1.134, 95% CI 1.011, 1.271, P = 0.031), and plasma adiponectin (OR 0.865, 95% CI 0.771, 0.971, P = 0.014). CONCLUSION METS-IR in female KOA was higher than that of the national baseline. The METS-IR was related to adipokine disorder and inflammatory activity. These findings suggest that METS-IR can be used to evaluate the degree of involvement of MetS in KOA.
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Affiliation(s)
- Lu Ding
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Jilin University, Chang Chun, People’s Republic of China
| | - Yu-Hang Gao
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Jilin University, Chang Chun, People’s Republic of China
| | - Ye-Ran Li
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Jilin University, Chang Chun, People’s Republic of China
| | - Yi-Fan Huang
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Jilin University, Chang Chun, People’s Republic of China
| | - Xin-Yu Wang
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Jilin University, Chang Chun, People’s Republic of China
| | - Xin Qi
- Department of Orthopaedic Surgery, The First Hospital of Jilin University, Jilin University, Chang Chun, People’s Republic of China
- Correspondence: Xin Qi Department of Orthopaedic Surgery, The First Hospital of Jilin University, Jilin University, Xinmin St 71, Chang Chun,People’s Republic of ChinaTel +8615843073202Fax +86043181875600 Email
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Galvin CR, Perriman DM, Lynch JT, Pickering MR, Newman P, Smith PN, Scarvell JM. Age has a minimal effect on knee kinematics: A cross-sectional 3D/2D image-registration study of kneeling. Knee 2019; 26:988-1002. [PMID: 31427245 DOI: 10.1016/j.knee.2019.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 07/19/2019] [Accepted: 07/20/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Kneeling is an activity of daily living which becomes difficult with knee pathology and increasing age. This study aimed to capture kneeling kinematics in six-degrees-of-freedom in healthy adults as a function of age. METHODS 67 healthy knee participants aged from 20 to 90 years were categorised into four 20-year age-groups. 3D knee kinematics were captured using 3D/2D image-registration of CT scan and fluoroscopy during kneeling. Kinematic variables of position, displacement and rate-of-change in six-degrees-of-freedom were compared between age-groups while controlling for University of California Los Angeles activity scale and the Assessment of Quality of Life physical score. RESULTS Over the entire kneeling cycle there were few differences between the age-groups. Results are reported as pairwise contrasts. At 110° flexion, 80+ knees were more varus than 20-39 and 40-69 (4.9° (95%CI: 0.6°, 9.1°) and 6.4° (2.1°, 10.7°), respectively). At 120° flexion, the 80+ age-group femur was 5.5 (0.0, 11.0) mm more anterior than 20-39. Between 120° to maximum flexion, 80+ knees rotated into valgus more than 20-39, 40-59 and 60-79 (5.5° (1.2°, 9.8°); 5.5° (1.1°, 9.8°); and 4.5° (0.9°, 7.5°), respectively). CONCLUSION This is the first study to report kneeling knee kinematics of ageing using 3D/2D image registration. We found that ageing does not change knee kinematics under 80 years, and there are minimal changes between 120° and maximum flexion between the younger and 80+ age-groups. Thus, difficulty kneeling should not be considered to be an inevitable consequence of ageing.
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Affiliation(s)
- Catherine R Galvin
- Research School of Electrical, Energy and Materials Engineering, Australian National University, Ian Ross Building 31, North Road, Acton, ACT, 2601; Faculty of Health, University of Canberra, Locked Bag 1, 2601, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital. Woden, ACT, 2606, Australia.
| | - Diana M Perriman
- The Australian National University, Acton, ACT, 2601, Australia; Faculty of Health, University of Canberra, Locked Bag 1, 2601, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital. Woden, ACT, 2606, Australia.
| | - Joseph T Lynch
- The Australian National University, Acton, ACT, 2601, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital. Woden, ACT, 2606, Australia.
| | - Mark R Pickering
- University of New South Wales Canberra at ADFA, PO Box 7916, Canberra BC, ACT 2610, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital. Woden, ACT, 2606, Australia.
| | - Phillip Newman
- Faculty of Health, University of Canberra, Locked Bag 1, 2601, Australia.
| | - Paul N Smith
- The Australian National University, Acton, ACT, 2601, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital. Woden, ACT, 2606, Australia.
| | - Jennie M Scarvell
- Faculty of Health, University of Canberra, Locked Bag 1, 2601, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital. Woden, ACT, 2606, Australia.
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Wen Y, Liu C, Liao J, Yin Y, Wu D. Incidence and risk factors of depressive symptoms in 4 years of follow-up among mid-aged and elderly community-dwelling Chinese adults: findings from the China Health and Retirement Longitudinal Study. BMJ Open 2019; 9:e029529. [PMID: 31501114 PMCID: PMC6738713 DOI: 10.1136/bmjopen-2019-029529] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The purpose of this study was to examine the incidence of depressive symptoms, and determine if baseline risk factors conferred a risk for incident depressive symptoms in nationally representative sample of mid-aged and elderly Chinese adults. DESIGN This study was a secondary analysis of a prospective cohort from a nationally representative sample. SETTING Community samples were recruited from the baseline survey of the China Health and Retirement Longitudinal Study. A four-stage, stratified, cluster probability sampling strategy was used, which included 10 257 households with members aged 45 years or older and their spouse. PARTICIPANTS A total of 11 533 participants free of depressive symptoms at baseline were identified, and 10 288 were re-examined in either the first and/or the second follow-up surveys. The current analysis was conducted among the 10 288 participants. PRIMARY AND SECONDARY OUTCOME MEASURES Depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale short form. RESULTS The findings showed that the incidence of depressive symptoms in a 4-year follow-up was as high as 22.3%. The incidence was much higher in rural areas (25.7%) and in women (27.9%). Furthermore, participants with 1 hour longer of night-time sleep had a 10% lower risk of developing depressive symptoms. Compared with individuals who perceived their health status as poor, those who perceived their health status as excellent had a 62% lower risk of developing depressive symptoms. In addition, having diabetes (OR=1.19), chronic kidney disease (OR=1.32), chronic digestive disorders (OR=1.15) and arthritis (OR=1.43) at baseline increased the risk of depressive symptoms. However, baseline body mass index was not associated with the subsequent depressive symptoms in this population. CONCLUSIONS This study highlights the importance of developing an appropriate screening test to identify depressive symptoms for those who are vulnerable and ensure these individuals can receive early interventions for depressive symptoms.
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Affiliation(s)
- Yue Wen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Chunjuan Liu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Liao
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yiqiong Yin
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Dongmei Wu
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
- Psychiatric Research Laboratory, The Fourth People's Hospital of Chengdu and Chengdu Mental Health Center, Chengdu, China
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Zhang L, Li JL, Zhang LL, Guo LL, Li H, Yan W, Li D. Relationship between adiposity parameters and cognition: the "fat and jolly" hypothesis in middle-aged and elderly people in China. Medicine (Baltimore) 2019; 98:e14747. [PMID: 30855469 PMCID: PMC6417533 DOI: 10.1097/md.0000000000014747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The association between adiposity parameters and cognition is complex. The purpose of this study was to assess the relationship between adiposity parameters and cognition in middle-aged and elderly people in China.Data were obtained from a cross-sectional study. Cognitive function was evaluated in 5 domains, and adiposity parameters were measured. The association between adiposity parameters and cognition was analyzed using multiple linear and binary logistic regression analyses.After controlling for confounders, men with overweight and obesity had better scores in TICS-10 ([1] total, overweight vs normal: P = .006, β = 0.04; obesity vs normal: P = .005, β = 0.04. [2] stratification by age, with age ≥ 59 years, overweight vs normal: P = .006, β = 0.05; obesity vs normal: P = .014, β = 0.05. [3] stratification by educational levels, with less than elementary education, overweight vs normal: P = .011, β = 0.05; obesity vs normal: P = .005, β = 0.05), immediate word recall ([1] total, overweight vs normal: P = .015, β = 0.04. [2] stratification by age, with age 45-58 years, overweight vs normal: P = .036, β = 0.05. [3] stratification by educational levels, with less than elementary education, overweight vs normal: P = .044, β = 0.04; above high school, overweight vs normal: P = .041, β = 0.09), self-rated memory ([1] stratification by age, with age ≥ 59 years, overweight vs normal: P = .022, β = 0.05. [2] stratification by educational levels, with less than elementary education, overweight vs normal: P = .023, β = 0.04), and drawing a picture ([1] total, overweight vs normal: OR = 1.269, 95% CI = 1.05-1.53. [2] stratification by educational levels, with less than elementary education, overweight vs normal: OR = 1.312, 95% CI = 1.06-1.63); obesity vs normal: OR = 1.601, 95% CI = 1.11-2.31 than the normal weight; women with overweight and obesity had better measure scores in the TICS-10 ([1] total, overweight vs normal: P < .0001, β = 0.06; obesity vs normal: P < .0001, β = 0.05. [2] stratification by age, with age 45-58 years, obesity vs normal: P = .007, β = 0.05; with age ≥ 59 years: overweight vs normal: P < .0001, β = 0.07, obesity vs normal: P = .002, β = 0.06. [3] stratification by educational levels, with illiterate, overweight vs normal: P = .001, β = 0.08; obesity vs normal: P = .004, β = 0.06; with less than elementary education, overweight vs normal: P < .0001, β = 0.07; obesity vs normal: P = .010, β = 0.05), immediate word recall ([1] total, overweight vs normal: P = .011, β = 0.04; obesity vs normal: P = .002, β = 0.04. [2] stratification by age, with age 45-58 years, obesity vs normal: P = .021, β = 0.05; with age ≥ 59 years: overweight vs normal: P = .003, β = 0.06. [3] stratification by educational levels, with illiterate, obesity vs normal: P = .028, β = 0.05; with less than elementary education, obesity vs normal: P = .016, β = 0.05), delay word recall ([1] total, overweight vs normal: P = .015, β = 0.03; obesity vs normal: P = .031, β = 0.03. [2] stratification by age, with age ≥ 59 years: overweight vs normal: P = .004, β = 0.06. [3] stratification by educational levels, with less than elementary education, obesity vs normal: P = .043, β = 0.04), self-rated memory ([1] total, obesity vs normal: P = .026, β = 0.03. [2] stratification by age, with age ≥ 59 years, overweight vs normal: P = .044, β = 0.04; obesity vs normal: P = .018, β = 0.05), and drawing a picture ([1] total, overweight vs normal: OR = 1.226, 95% CI = 1.06-1.42. [2] stratification by age, with age 45-58 years: overweight vs normal: OR = 1.246, 95% CI = 1.02-1.53) than the normal weight. Regarding the association between WC and cognitive function, the obesity demonstrated better mental capacity ([1] total, men: P < .0001, β = 0.06; women: P < .0001, β = 0.05. [2] stratification by age, men with age 45-58 years: P < .0001, β = 0.08; men with ≥ 59 years: P = .006, β = 0.05. women with age 45-58 years: P = .001, β = 0.06; women with ≥ 59 years: P = .012, β = 0.04. [3] stratification by educational levels, men with illiterate: P = .045, β = 0.09; men with less than elementary education: P < .0001, β = 0.08; women with illiterate: P < .0001, β = 0.09), ability to recall immediately ([1] total, men: P = .030, β = 0.03; women: P = .001, β = 0.05. [2] stratification by age, women with age 45-58 years: P = .028, β = 0.04; women with ≥ 59 years: P = .007, β = 0.05. [3] stratification by educational levels, men with less than elementary education: P = .007, β = 0.05; women with illiterate: P = .027, β = 0.05; women with less than elementary education: P = .002, β = 0.06), delay word recall ([1] total, women: P = .044, β = 0.03. [2] stratification by educational levels, men with less than elementary education: P = .023, β = 0.04), self-rated memory (stratification by educational levels, women with less than elementary education: P = .030, β = 0.04), and draw a picture ([1] total, men: OR = 1.399, 95% CI = 1.17-1.67; women: OR = 1.273, 95% CI = 1.12-1.45. [2] stratification by age, men with age 45-58 years: OR = 1.527, 95% CI = 1.15-2.03; men with age ≥ 59 years: OR = 1.284, 95% CI = 1.02-1.61; women with age 45-58 years: OR = 1.320, 95% CI = 1.10-1.58; women with age ≥ 59 years: OR = 1.223, 95% CI = 1.01-1.49. [3] stratification by educational levels, men with less than elementary education: OR = 1.528, 95% CI = 1.25-1.87; women with illiterate: OR = 1.404, 95% CI = 1.14-1.73) than the participants with normal weight after the multivariate adjustment.Our study demonstrated a significant relationship between adiposity parameters and cognition that supports the "jolly fat" hypothesis.
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Affiliation(s)
- Lin Zhang
- Department of Community Nursing, School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District Jinzhou City, Liaoning Province
| | - Jin-Long Li
- Department of Occupational and Environmental Health, Key Laboratory of Occupational Health and Safety for Coal Industry in Hebei Province, School of Public Health, North China University of Science and Technology, Tangshan, Hebei Province
| | - Li-Li Zhang
- Department of Surgery, Third Affiliated Hospital of Jinzhou Medical University, No.28, Section 2, Chongqing Road
| | - Lei-Lei Guo
- Department of Community Nursing, School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District Jinzhou City, Liaoning Province
| | - Hong Li
- Department of Community Nursing, School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District Jinzhou City, Liaoning Province
| | - Wenzhu Yan
- Department of anatomy, School of Basic Medical Sciences, Jinzhou Medical University, No.40, Section 3, Songpo Road
| | - Dan Li
- Experimental Center for Nursing, School of Nursing, Jinzhou Medical University, No.40, Section 3, Songpo Road, Linghe District Jinzhou City, Liaoning Province, PR China
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Shen L, Wang L, Hu Y, Liu T, Guo J, Shen Y, Zhang R, Miles T, Li C. Associations of the ages at menarche and menopause with blood pressure and hypertension among middle-aged and older Chinese women: a cross-sectional analysis of the baseline data of the China Health and Retirement Longitudinal Study. Hypertens Res 2019; 42:730-738. [DOI: 10.1038/s41440-019-0235-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 10/11/2018] [Accepted: 10/15/2018] [Indexed: 11/09/2022]
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He P, Hu Y, Li C, Wu D, Ge S, Liu T. Predictors of Depressive Symptoms Among Mid-Aged and Older Men With Diabetes in China. Res Theory Nurs Pract 2019; 33:6-22. [DOI: 10.1891/1541-6577.33.1.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background and Purpose:Although mounting evidence has consistently shown that depressive symptoms are more common among diabetic women than among diabetic men, diabetic men are frequently overlooked in diabetes-related mental health studies, and research on predicators of depressive symptoms among diabetic men remains scarce. Therefore, the purpose of this study was to examine the gender-specific characteristics that predict depressive symptoms among mid-aged and elderly men with diabetes.Methods:A secondary data analysis was performed using the baseline data from the China and Health Retirement Longitudinal Study. A total of 824 men aged 45 years or older with diabetes were included in the analysis. Depressive symptoms were measured with the Center for Epidemiological Studies Depression Scale short form. Age, education level, marital status, nighttime sleep duration, smoking status, duration of diabetes, treatment with insulin, and pain were based on self-reports. Information on hemoglobin A1c (HbA1c), functional impairment, weight, height, and blood lipids was also collected.Results:The prevalence of depressive symptoms was 22.7%. Male-specific significant predictors of depressive symptoms included nighttime sleep duration (short sleepers [p = .019], normal sleepers [p = .001], and long sleepers [p = .000]), instrumental activities of daily living (p = .001), and pain (mild pain [p = .003], moderate pain [p = .024], and severe pain [p = .017]).Implications for Practice:This study provides important findings about nighttime sleep duration, pain, and functional impairment and their relationships with presence of depressive symptoms in mid-aged and older men with diabetes. Screening tools should include these items to enable early detection and depression treatment for vulnerable men who may be otherwise missed.
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Zhang M, Liu T, Li C, Wang J, Wu D. Physical performance and cognitive functioning among individuals with diabetes: Findings from the China Health and Retirement Longitudinal Study Baseline Survey. J Adv Nurs 2018; 75:1029-1041. [PMID: 30397937 DOI: 10.1111/jan.13901] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 08/31/2018] [Accepted: 10/08/2018] [Indexed: 01/21/2023]
Abstract
AIMS The purpose of this study was to examine individual associations of each physical performance measure with domains of cognitive functioning and to determine best physical performance measures strongly associated with each domain of cognitive functioning among middle-aged and older adults with diabetes. BACKGROUND Tests of physical performance are strongly correlated with cognitive decline in general elderly population. However, far less is known about individual associations of each individual physical performance measure with domains of cognitive functioning among individuals with diabetes. DESIGN The study employed a retrospective, cross-sectional design. METHODS Baseline data from a national baseline survey collected from May 2011-March 2012 were used. A total of 17,314 individuals aged ≥45 years completed the baseline survey. Diabetes was confirmed for 1,905 participants and these individuals were included in this study. RESULTS When grip strength, walking speed, repeated chair stands and standing balance test were added in the regression models, walking speed was the only variable that was significantly associated with figure drawing and grip strength was the only variable that was significantly associated with episodic memory, orientation/attention and overall cognitive score. CONCLUSION Since grip strength was the most important factor associated with several domains of cognitive functioning, strategies that improve grip strength in patients with diabetes are prudent. Early interventions to increase levels of physical activity may be important to improve both grip strength and cognitive functioning in this growing population with diabetes.
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Affiliation(s)
- Meng Zhang
- Nursing Department, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China
| | - Tingting Liu
- Eleanor Mann School of Nursing, University of Arkansas, Fayetteville, Arkansas
| | - Changwei Li
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia
| | - Jing Wang
- School of Nursing, The Office of Nursing Research and Scholarship, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Dongmei Wu
- Department of Nursing, The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China
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Yang R, Tracy EL, Wang H. Longitudinal associations of depressive symptoms, subjective memory decline, and cognitive functioning among Chinese older adults: Between-person and within-person perspective. Arch Gerontol Geriatr 2018; 81:105-110. [PMID: 30529803 DOI: 10.1016/j.archger.2018.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 12/01/2018] [Accepted: 12/02/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We examined between- and within-person associations between depressive symptoms and cognitive functioning among Chinese older adults (aged 60+) over time. Furthermore, we also investigated whether subjective memory decline (SMD) is uniquely associated with cognitive functioning above and beyond depressive symptoms for both between-person and within-person associations. METHODS About 7385 older adults from the China Health and Retirement Longitudinal Study reported their demographic and health status, and completed self-report measures of depressive symptoms and SMD, as well as a battery of cognitive tests, every two years at three times between 2011 and 2015. RESULTS There were significant between-person and within-person associations between depressive symptoms and cognitive functioning. Furthermore, SMD was uniquely associated with cognitive functioning for both within-person and between-person associations after controlling for depressive symptoms. CONCLUSIONS The results highlight the importance of careful screening and monitoring of depressive symptoms and SMD for the benefits of cognitive functioning among Chinese older adults. More importantly, SMD has practical implications for the care of Chinese older adults given significant cultural stigma attached to mental illness within Chinese culture.
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Affiliation(s)
- Rumei Yang
- University of Utah College of Nursing, Salt Lake City, UT, United States.
| | - Eunjin Lee Tracy
- University of Utah Department of Psychology, Salt Lake City, UT, United States
| | - Haocen Wang
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave., Madiosn, WI, 53705, United States
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Association and Interaction Analysis of Body Mass Index and Triglycerides Level with Blood Pressure in Elderly Individuals in China. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8934534. [PMID: 30596101 PMCID: PMC6282155 DOI: 10.1155/2018/8934534] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 09/11/2018] [Accepted: 10/04/2018] [Indexed: 01/18/2023]
Abstract
Objectives To assess the extent of interaction between body mass index (BMI) and triglyceride (TG) level and its effects on blood pressure (BP) in elderly individuals in China. Design Cross-sectional study. Setting Data were taken from a cross-sectional study called the China Health and Retirement Longitudinal Study. Participants The analytic sample included 3629 subjects aged 45 to 96 years. Main Outcome Measurements Data were obtained from the China Health and Retirement Longitudinal Study, which is a cross-sectional study. Age-adjusted partial Pearson's correlation test was used to compare various characteristics and BP. Adjusted associations were first used as linear regression models, as appropriate. Then, general linear models adjusted for related potential confounders were used to examine the synergistic effects of BMI and TG level on BP. Finally, a binary logistic regression model adjusted for confounding factors was used to examine the association between BMI or TG level and hypertension. Results Age-adjusted partial Pearson's correlation coefficient showed that the TG level was positively correlated with both systolic blood pressure (SBP) and diastolic blood pressure (DBP) in both men and women with BMI < 24.0 kg/m2; however, TG level was positively correlated with DBP in women with BMI ≥ 24.0 kg/m2 but not with DBP in men with BMI ≥ 24.0 kg/m2. Multiple linear regression analysis showed that BMI level was significantly and positively associated with both SBP and DBP in men and women with BMI < 24.0 kg/m2, and TG level was significantly and positively associated with SBP in women with BMI < 24.0 kg/m2, independent of other confounding factors. A general linear model analysis with adjustment for confounding factors (age, educational level, marital status, current residence, smoking, eating habits, taking activities, antidiabetic medication, antihypertensive therapy, fasting plasma glucose [FPG], low-density lipoprotein cholesterol [LDL-C], estimated glomerular filtration rate [eGFR], and serum uric acid [SUA]) showed no interaction between BMI and TG level and SBP (men, β = 0.572, P = 0.845; women, β = 0.122, P = 0.923) and DBP (men, β = -0.373, P = 0.810; women, β = 0.272, P = 0.828). A binary logistic regression model analysis with adjustment for confounding factors (age, educational level, marital status, current residence, smoking, drinking, eating habits, taking activities, major accidental injury, physical activity, history of cardiovascular disease, history of liver disease, antilipidemic medication, antidiabetic medication, antihypertensive therapy, FPG, LDL-C, high-density lipoprotein cholesterol [HDL-C], eGFR, and SUA) showed that overweight and obese men and women were more likely to have hypertension (men: odds ratio [OR] = 1.781, 95% confidence interval [CI] = 1.393–2.277; women: OR = 1.653, 95% CI = 1.330–2.055) and women with high TG were more likely to have hypertension (OR = 1.558, 95% CI = 1.219–1.992). Conclusion An interactive effect of BMI and TG level on BP was not observed in either men or women; however, independent effects of BMI on BP were observed in both men and women, and an association between TG level and hypertension was observed in women.
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Yan M, Fu Z, Qin T, Wu N, Lv Y, Wei Q, Jiang H, Yin P. Associations of sleep duration and prediabetes prevalence in a middle-aged and elderly Chinese population with regard to age and hypertension: The China Health and Retirement Longitudinal Study baseline survey. J Diabetes 2018; 10:847-856. [PMID: 29573578 DOI: 10.1111/1753-0407.12662] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 03/04/2018] [Accepted: 03/17/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The aim of the present study was to examine the age-specific associations between self-reported sleep duration and prevalent prediabetes in middle-aged and elderly Chinese with or without hypertension. METHODS In all, 2985 Chinese adults aged ≥45 years from the China Health and Retirement Longitudinal Study (CHARLS) baseline survey were selected for analysis. Sleep duration was assessed by structured questionnaires and then categorized into three groups (≤6, 6-8, and >8 h). The prevalence of prediabetes was defined using fasting plasma glucose (100-125 mg/dL) and/or HbA1c (5.7%-6.4%) in conjunction with no previous diabetes diagnosis and no antidiabetic medication. Relationships between self-reported sleep duration and prevalent prediabetes were examined according to age (45-60 years, middle-aged; ≥60 years, elderly) and hypertension groups using Poisson regression models to estimate prevalence ratios (PRs) and 95% confidence intervals (CI). RESULTS Compared with the reference group of 6-8 h sleep/night, short sleep (≤6 h/night) was associated with an increased risk of prediabetes in the whole sample (PR 1.09, 95% CI 1.01-1.17) after adjusting for confounders. This association was more pronounced in elderly participants without hypertension (PR 1.27, 95% CI 1.07-1.51). CONCLUSION This study suggests that participants with a short sleep period are at a moderately increased risk of prediabetes, particularly in elderly subjects without hypertension. Aging and hypertension may be important in the relationship between short sleep and impaired glucose metabolism.
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Affiliation(s)
- Mingming Yan
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhen Fu
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingting Qin
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nanjin Wu
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yalan Lv
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qinyun Wei
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongwei Jiang
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Yin
- Department of Epidemiology and Biostatistics and State Key Laboratory of Environment Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Li C, Miles T, Shen L, Shen Y, Liu T, Li S, Huang C, Huang C. Early-life exposure to severe famine and subsequent risk of depressive symptoms in late adulthood: the China Health and Retirement Longitudinal Study. Br J Psychiatry 2018; 213:579-586. [PMID: 30160644 PMCID: PMC6815226 DOI: 10.1192/bjp.2018.116] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Chinese Great Famine caused widespread starvation in 1959-1961. Its long-term association with depressive symptoms has not been studied.AimsTo estimate the burden of depressive symptoms and the association of famine exposure with depressive symptoms. METHOD The China Health and Retirement Longitudinal Study is a nationwide representative survey of 17 708 Chinese adults aged ≥45. Propensity score matching and modified Poisson regression were used to evaluate the association between self-reported famine exposure in early life and depressive symptoms among the overall participants. Such associations were also assessed by developmental stage using modified Poisson regression and logistic regression. RESULTS The prevalence of depressive symptoms was 26.2% (95% CI 25.1-27.3%) in 2011. As defined by loss of family members because of starvation, 11.6% (95% CI 10.1-13.1%) of this population experienced severe famine. When compared with participants who did not experience starvation, those who had experienced severe famine during fetal, mid-childhood, young-teenage and early-adulthood stages had 1.87 (95% CI 1.36-2.55), 1.54 (95% CI 1.23-1.94), 1.47 (95% CI 1.09-2.00) and 1.77 (95% CI 1.42-2.21) times higher odds of having depressive symptoms in late adulthood, respectively. The first two trimesters of pregnancy were a critical time window during the fetal stage when severe famine had a stronger association with depressive symptoms. Famine during infant, toddler, preschool or teenage stages was not associated with depressive symptoms. Overall, famine contributed to 13.6% of the depressive symptom burden in this population. CONCLUSIONS The Chinese Great Famine contributed substantially to the burden of depressive symptoms in China.Declaration of interestNone.
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Affiliation(s)
- Changwei Li
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, 101 Buck Rd, Athens, GA 30602, USA,Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street Suite 2000, New Orleans, LA 70112, USA
| | - Toni Miles
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, 101 Buck Rd, Athens, GA 30602, USA
| | - Luqi Shen
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, 101 Buck Rd, Athens, GA 30602, USA
| | - Ye Shen
- Department of Epidemiology and Biostatistics, University of Georgia College of Public Health, 101 Buck Rd, Athens, GA 30602, USA
| | - Tingting Liu
- Department of Nursing, University of Arkansas College of Education and Health Professions
| | - Shengxu Li
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street Suite 2000, New Orleans, LA 70112, USA
| | - Cheng Huang
- School of Economics and Management, Harbin Institute of Technology (Shenzhen), Building E Room 412, Nanshan District, Shenzhen 518055, Guangdong, China,Department of Global Health, George Washington University Milken Institute School of Public Health, 2175K Street, Suite 200, Washington, DC 20037, USA
| | - Cheng Huang
- Professor of Health Economics, School of Economics and Management,Harbin Institute of Technology (Shenzhen),China and Department of Global Health,George Washington University,USA
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Essien SK, Feng CX, Sun W, Farag M, Li L, Gao Y. Sleep duration and sleep disturbances in association with falls among the middle-aged and older adults in China: a population-based nationwide study. BMC Geriatr 2018; 18:196. [PMID: 30153791 PMCID: PMC6114492 DOI: 10.1186/s12877-018-0889-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/21/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Falls pose major health problems to the middle-aged and older adults and may potentially lead to various levels of injuries. Sleep duration and disturbances have been shown to be associated with falls in literature; however, studies of the joint and distinct effects of those sleep problems are still sparse. To fill this gap, we aimed to determine the association between sleep duration, sleep disturbances and falls among middle-aged and older adults in China controlling for psychosocial, lifestyle, socio-demographical factors and comorbidity. METHODS Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) based on multi-stage sampling designs, with respondents aged 50 and older. Associations were evaluated by using multiple logistic regression adjusting for confounders and complex survey design. To further determine if the association of sleep duration/disturbance and falls depends on age groups, the study data were divided into two samples (age 50-64 vs. age 65+) and comparison was made between the two age groups. RESULTS Of the 12,759 respondents, 2172 (17%) had falls within the last 2 years. Our findings indicated that the participants who had nighttime sleep duration ≤5 were more likely to report falls than those who had nighttime sleep duration ≥6 h; whereas no association between nighttime sleep duration > 8 h and falls. Participants having sleep disturbances 1-2 days, or 3-4 days, and 5-7 days per week were also more likely to report falls than those who had no sleep disturbance. The nap sleep duration was not significantly associated with falls. Although the combined sample found both sleep duration and sleep disturbance to be strongly associated with falls after adjusting for various confounders, sleep disturbance was not significantly related to falls among participants aged 65 + . CONCLUSIONS Our study suggested that there is an independent association between falls and short sleep duration and disturbed sleep among middle-aged and older adults in China. Findings underscore the need for evidence-based prevention and interventions targeting sleep duration and disturbance among this study population.
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Affiliation(s)
- Samuel Kwaku Essien
- School of Public Health, University of Saskatchewan, Health Sciences Building E-Wing, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Cindy Xin Feng
- School of Public Health, University of Saskatchewan, Health Sciences Building E-Wing, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Wenjie Sun
- Robert Stempel College of Public and Social Work, Florida international University, Miami, FL 33199 USA
- School of Food Science, Guangdong Pharmaceutical University, Zhongshan, 528458 China
| | - Marwa Farag
- School of Public Health, University of Saskatchewan, Health Sciences Building E-Wing, 104 Clinic Place, Saskatoon, SK S7N 2Z4 Canada
| | - Longhai Li
- Department of Mathematics and Statistics, University of Saskatchewan, Saskatoon, SK S7N 5E6 Canada
| | - Yongqing Gao
- School of Food Science, Guangdong Pharmaceutical University, Zhongshan, 528458 China
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Ge S, Wei Z, Liu T, Wang J, Li H, Feng J, Li C. Alcohol Use and Cognitive Functioning Among Middle-Aged and Older Adults in China: Findings of the China Health and Retirement Longitudinal Study Baseline Survey. Alcohol Clin Exp Res 2018; 42:2054-2060. [DOI: 10.1111/acer.13861] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 07/30/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Song Ge
- Department of Natural Sciences/Nursing; University of Houston-Downtown; Houston Texas
| | - Zhe Wei
- Department of Statistics; The George Washington University; Washington District of Columbia
| | - Tingting Liu
- Eleanor Mann School of Nursing; University of Arkansas; Fayetteville Arkansas
| | - Jinjiao Wang
- School of Nursing; University of Rochester; Rochester New York
| | - Hongjin Li
- School of Nursing; University of Pittsburgh; Pittsburgh Pennsylvania
| | - Juan Feng
- School of Nursing; The University of Texas Medical Branch; Galveston Texas
| | - Changwei Li
- Department of Epidemiology and Biostatistics; University of Georgia College of Public Health; Athens Georgia
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Zuo M, Gan C, Liu T, Tang J, Dai J, Hu X. Physical Predictors of Cognitive Function in Individuals With Hypertension: Evidence from the CHARLS Basline Survey. West J Nurs Res 2018; 41:592-614. [PMID: 29742988 DOI: 10.1177/0193945918770794] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of the study was to examine the independent associations of each individual physical performance measure (i.e., grip strength, walking speed, repeated chair stands, and balance test) with subdomains of cognitive function and to determine predictors for each subdomain of cognitive function. A secondary data analysis was performed using a nationally representative middle-aged and older sample of hypertensive population. The findings showed that after adding all four physical performance measures, stronger grip strength was significantly associated with better visuospatial abilities, episodic memory, orientation/attention, and overall cognitive function. In addition, faster walking speed and faster repeated chair stands were strongly associated with better episodic memory and overall cognitive function, respectively. Because grip strength was significantly associated with several subdomains of cognitive functioning, it seems conceivable that increasing physical activity would improve both grip strength and cognitive function in patients with hypertension.
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Affiliation(s)
- Manhua Zuo
- Hubei University for Nationalities Medical College, Enshi, Hubei Province, China
- Sichuan University, Chengdu, Sichuan Province, China
| | - Changping Gan
- Sichuan University, Chengdu, Sichuan Province, China
| | - Tingting Liu
- University of Arkansas Eleanor Mann School of Nursing, Fayetteville, AR, USA
| | - Jun Tang
- The Central Hospital of Enshi Autonomous Prefecture, Enshi, Hubei Province, China
| | - Jianping Dai
- The Central Hospital of Enshi Autonomous Prefecture, Enshi, Hubei Province, China
| | - Xiuying Hu
- Sichuan University, Chengdu, Sichuan Province, China
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Wang Z, Zou Z, Dong B, Ma J, Arnold L. Association between the Great China Famine exposure in early life and risk of arthritis in adulthood. J Epidemiol Community Health 2018; 72:790-795. [PMID: 29680802 DOI: 10.1136/jech-2017-210334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/05/2018] [Accepted: 04/06/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND The association between famine exposure in early life and risk of arthritis (combination of osteoarthritis and inflammatory arthritis) in adulthood is unclear. The aim of this study is to explore the association. METHODS A total of 4124 subjects were selected from the national data of the China Health and Retirement Longitudinal Study in 2011-2012. Doctor-diagnosed arthritis was self-reported in participants' questionnaire. Birthdates were used to categorise participants into famine-exposed and non-exposed groups. Logistic regression model was used to explore the association of famine exposure in early life with the risk of arthritis in adulthood. RESULTS The prevalence of arthritis in both infant-exposed and preschool-exposed groups was significantly higher than those in the non-exposed group (35.0% and 30.6% vs 27.3%; p<0.05). Compared with the non-exposed group, the infant-exposed group showed a significantly elevated risk of arthritis in adulthood after adjusting for confounding factors (OR=1.65; 95% CI 1.29 to 2.11; p<0.001). In the stratified analysis, we found that participants who lived in severely affected areas (OR=1.91; 95% CI 1.41 to 2.59; p<0.001), who are female (OR=2.21; 95% CI 1.57 to 3.11; p<0.001) and those with a body mass index ≥24.0 kg/m2 (OR=2.46; 95% CI 1.70 to 3.55; p<0.001) in the infant-exposed group had increased risk of arthritis in adulthood. Similar results were additionally observed when age-balanced control group was used. CONCLUSION Great China Famine exposure in infancy may be associated with an elevated risk of arthritis in adulthood, particularly in women and participants with adiposity. These findings suggest nutrition intervention in infancy and weight control in later life may reduce the risk of arthritis in adulthood.
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Affiliation(s)
- Zhenghe Wang
- School of Public Health and Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
| | - Zhiyong Zou
- School of Public Health and Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
| | - Bin Dong
- School of Public Health and Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
| | - Jun Ma
- School of Public Health and Institute of Child and Adolescent Health, Peking University Health Science Center, Beijing, China
| | - Luke Arnold
- Population Health, South Western Sydney Primary Health Network, Sydney, New South Wales, Australia
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Rao Y, Xu X, Liu D, Reis C, Newman IM, Qin L, Sharma M, Shen J, Zhao Y. Health-Related Quality of Life in Patients with Arthritis: A Cross-Sectional Survey among Middle-Aged Adults in Chongqing, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040768. [PMID: 29659544 PMCID: PMC5923810 DOI: 10.3390/ijerph15040768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/29/2018] [Accepted: 04/12/2018] [Indexed: 12/28/2022]
Abstract
Background: Arthritis is a common disease in China, but few studies have been conducted to explore the associated health-related quality of life (HRQoL) and its influencing factors in Chongqing, China. This study aimed to explore the association of arthritis and HRQoL and probe factors affecting HRQoL among arthritis patients. Methods: A cross-sectional survey was conducted in Chongqing, China. A total of 1224 adults were included in the analysis. Medical Outcomes Study Short Form 36 Health Survey (SF-36) was used to measure HRQoL. Multiple linear regression models (stepwise) and covariance analysis models were used to examine the association of arthritis with HRQoL and analyze factors associated with HRQoL among arthritis patients. Results: Participants with arthritis had poorer HRQoL than those without. Among arthritis patients, the female was associated with a poorer state of physical functioning (p < 0.05); unemployed patients had a poorer state of role-physical than employed patients (p < 0.05); low average monthly income was associated with a poorer state of physical functioning (p < 0.01); childhood non-breastfeeding history was associated with a poorer state of social functioning (p < 0.01); average or dissatisfied attitude to current living conditions was associated with a poorer state of vitality and mental health (p < 0.05 for all); moreover, poor or general appetite was associated with a poorer state of role-physical, general health, social functioning, bodily pain, and role-emotional (p < 0.01 for all). Conclusions: Arthritis patients have worse HRQoL than those without in the Chinese population. Female, low socioeconomic status, childhood non-breastfeeding history, average or dissatisfied attitude to current living conditions and poor or general appetite were associated with poorer state of HRQoL among Chinese arthritis patients.
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Affiliation(s)
- Yunshuang Rao
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- The Fourth Student Office of the School of Nursing, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
| | - Xianglong Xu
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Dengyuan Liu
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing 400016, China.
| | - Cesar Reis
- Department of Preventive Medicine, Loma Linda University Medical Center, 24785 Stewart Street, Suite 204, Loma Linda, CA 92354, USA.
| | - Ian M Newman
- Department of Educational Psychology, University of Nebraska-Lincoln, P.O. Box 880345, Lincoln, NE 68588-0345, USA.
| | - Liqiang Qin
- School of Public Health, Soochow University, Suzhou 215000, China.
| | - Manoj Sharma
- Department of Behavioral and Environmental Health, Jackson State University, Jackson, MS 39213, USA.
- School of Health Sciences, Walden University, 100 Washington Avenue South, Suite 900, Minneapolis, MS 55401, USA.
| | - Jun Shen
- The Fourth Student Office of the School of Nursing, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing 400016, China.
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China.
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing 400016, China.
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Depression among Chinese older adults: A perspective from Hukou and health inequities. J Affect Disord 2017; 223:115-120. [PMID: 28753468 DOI: 10.1016/j.jad.2017.07.032] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/07/2017] [Accepted: 07/17/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous studies have suggested that socioeconomic status is linked to health status. However, most of these studies have been conducted in developed countries, whose social settings are different from those in China. Hukou (household registration) status, one of China's main socioeconomic indicators, has received limited attention in the literature. OBJECTIVES The objective of this study was to examine the relationship between different Hukou statuses, and depression, among older adults in China. METHODS The data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). In total, 7409 Chinese older adults aged 60 and over were included in the survey. The Center for Epidemiologic Studies Depression Scale (CESD-10) was used to assess depressive symptoms. The various Hukou statuses were coded into four categories: villager, temporary rural-to-urban migrant, permanent rural-to-urban migrant and urban local citizen. RESULTS The results indicated that the level of depressive symptoms was significantly higher among villagers (beta [ß] 1.40, 95%CI 0.83-1.96), temporary migrants (beta [ß] 0.97 95%CI 0.38-1.56) and permanent migrants (beta [ß] 0.52 95%CI 0.04-1.00) than among urban local citizens. In addition, people who had experienced changes in their Hukou status before age 16 were more likely to have depressive symptoms (beta [ß] 1.39, 95% CI 0.20-2.58). LIMITATIONS Being cross-sectional, this study is insufficient for determining causal relationships between Hukou status and depression. CONCLUSIONS Our findings suggest that deeper reform of the Hukou system, and greater efforts to eliminate the health disparities associated with that system, are needed in China.
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Xu X, Liu L, Xie W, Zhang Y, Zeng H, Zhang F, Reis C, Cao X, Zhao Y. Increase in the prevalence of arthritis in adulthood among adults exposed to Chinese famine of 1959 to 1961 during childhood: A cross-sectional survey. Medicine (Baltimore) 2017; 96:e6496. [PMID: 28353598 PMCID: PMC5380282 DOI: 10.1097/md.0000000000006496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The developmental origins hypothesis postulates that under-nutrition in the early stage of life is associated with an increased risk of disease in adulthood. This study aimed to examine the association of exposure to the Chinese famine of 1959 to 1961 in early life with the risk of arthritis in adulthood.From July to September 2009, the study adopted multistage stratified random sampling cross-sectional survey to recruit 1224 eligible adults in Chongqing. Famine exposure groups were categorized into 3 groups: (1) childhood exposure, (2) fetal exposure, and (3) nonexposure. Self-reported arthritis of physician diagnosis was obtained. A total of 1224 eligible respondents were interviewed, including 299 individuals exposed during childhood, 455 exposed when fetal, and 470 without exposure.The prevalence of arthritis in adulthood among individuals exposed to famine during childhood was significantly higher than those not exposed (17.39% vs 11.28%, odds ratio [OR] = 1.573 with a 95% confidence interval of [CI] [1.020, 2.424]). Persons exposed to famine during the fetal period did not significantly contribute to a higher rate of arthritis in adulthood than those who were not exposed to famine (13.19% vs 11.28%, OR = 1.072, 95% CI = 0.713, 1.613). In addition, education level, the average monthly income, sleep status, and satisfaction of the present living condition were associated with the risk of arthritis in adulthood.Exposure to the Chinese famine during childhood may be associated with an increased risk of arthritis in adulthood. This study suggests that early life nutrition may have an effect on the risk of arthritis in adulthood.
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Affiliation(s)
- Xianglong Xu
- School of Public Health and Management
- Research Center for Medicine and Social Development
- The Innovation Center for Social Risk Governance in Health
| | - Lingli Liu
- School of Public Health and Management
- Research Center for Medicine and Social Development
- The Innovation Center for Social Risk Governance in Health
| | - Wenxi Xie
- School of the Second Clinical, Chongqing Medical University, Chongqing, China
| | - Yong Zhang
- School of Public Health and Management
- Research Center for Medicine and Social Development
- The Innovation Center for Social Risk Governance in Health
| | - Huan Zeng
- School of Public Health and Management
- Research Center for Medicine and Social Development
- The Innovation Center for Social Risk Governance in Health
| | - Fan Zhang
- School of Public Health and Management
- Research Center for Medicine and Social Development
- The Innovation Center for Social Risk Governance in Health
| | - Cesar Reis
- Department of Preventive Medicine, Loma Linda University Medical Center, CA
| | - Xianqing Cao
- School of Public Health and Management
- Research Center for Medicine and Social Development
- The Innovation Center for Social Risk Governance in Health
| | - Yong Zhao
- School of Public Health and Management
- Research Center for Medicine and Social Development
- The Innovation Center for Social Risk Governance in Health
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