Associations of consuming specific fruit and vegetable subgroups with LDL-C status in early postmenopausal Chinese women

Gender-specific trends of educational inequality in diagnosed diabetes from 1999 to 2014 in Hong Kong: a serial cross-sectional study of 97,481 community-dwelling Chinese adults

Background

Gender differences in the trend of educational inequality in diabetes have been widely observed in the Western populations, indicating the increasing importance of educational attainment as a social determinant of diabetes among women. Nonetheless, relevant evidence is scarce in developed Asian settings for comparisons. This study examined the gender-specific trends of educational inequality in diagnosed diabetes in Hong Kong between 1999 and 2014.

Methods

A series of eight territory-wide population-representative samples of 97,481 community-dwelling Hong Kong Chinese adults aged 45 or above were surveyed between 1999 and 2014. Regression-based Relative Index of Inequality (RII) and age-standardized Slope Index of Inequality (SII) were adopted to examine the extent and trend of gender-specific educational inequality in self-reported physician-diagnosed diabetes.

Results

Age-standardized prevalence of diabetes increased in both genders over time, with a steeper surge among men. In addition, educational inequalities in diabetes, in both relative and absolute terms, significantly widened among women over the study period (annual RII change = 1.04; 95% CI = 1.02–1.07, annual SII change = 0.36%; 95% CI = 0.16–0.56%), with the peak in 2011 (RII = 2.44; 95% CI = 1.83–3.24, SII = 9.21%; 95% CI = 6.47–11.96%). However, no significant widening inequality was found among men. Further adjustment for household income level did not attenuate the observed educational inequality.

Conclusions

Despite a greater increase in diabetes prevalence among men, disparity in diabetes substantially widened across education levels among women in the past decade in Hong Kong. The gender perspective should be taken into considerations for policy making to alleviate the prevalence surge and rising educational inequality in diabetes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12963-021-00268-x.

Accelerated progression of waist-to-hip ratio but not body mass index associated with lower socioeconomic position: a cohort study of nonobese early postmenopausal Chinese women

OBJECTIVE

Menopausal changes are linked to increase in body fat mass and central fat distribution; nonetheless, the impact of socioeconomic position on such changes has rarely been examined. This cohort study assessed the temporal associations of socioeconomic position with changes in body mass index (BMI) and waist-to-hip ratio (WHR) among early postmenopausal women.

METHODS

Between 2002 and 2004, 518 Hong Kong Chinese women aged 50 to 64 and within 10 years since menopause were recruited and followed up at 3 and 5 years. Weight, height, and waist and hip circumferences were measured by trained interviewers at baseline and follow-up interviews. Socioeconomic positions including educational attainment, economic activity status and household income level, and other baseline demographic characteristics, lifestyle behaviors, and mental health status were collected based on a structured questionnaire. In total, 287 and 267 women with no general and abdominal obesity, respectively, at baseline were included in multiple regression analyses.

RESULTS

Mean intrapersonal increases in BMI and WHR between baseline and 5-year interview were 0.46 kg/m and 2.80%, respectively. Women with no secondary education were 75% more likely to have a greater than-mean WHR increase than their more educated counterparts (P = 0.039). Also, having no secondary education (P = 0.041) and being a homemaker (P = 0.034) had accelerated surge in WHR. Nonetheless, baseline socioeconomic positions were not significantly associated with BMI changes.

CONCLUSIONS

Socioeconomic patterning was observed for the progression of WHR among nonobese Chinese women soon after menopause. Early postmenopausal stage may be a critical window for prevention of abdominal obesity among women with a lower educational attainment.

Prospective Association of Obesity Patterns with Subclinical Carotid Plaque Development in Early Postmenopausal Chinese Women

OBJECTIVE

This study aimed to examine the prospective associations of general and abdominal obesity patterns with carotid plaque development among early postmenopausal Chinese women.

METHODS

A total of 518 postmenopausal women aged 50 to 64 years were recruited between 2002 and 2004 and were followed up at 3 years and 5 years. Carotid plaque was measured using B-mode ultrasonography, whereas general and abdominal obesity were defined as BMI ≥ 25 kg/m² and waist-hip ratio ≥ 0.85, respectively. Sociodemographic, lifestyle, mental health, disease history, and clinical measurements were also assessed for confounding control. Multivariable binary logistic regression analyses on plaque development at 5 years were performed among 322 women with no carotid plaque at baseline.

RESULTS

Over the 5-year follow-up period, 70 women (21.7%) developed carotid plaque. Baseline abdominal obesity independently predicted plaque development (adjusted odds ratio = 2.30; 95% CI: 1.15-4.60), but general obesity did not. Women with normal-weight abdominal obesity were more than twice as likely to develop carotid plaque (adjusted odds ratio = 2.43; 95% CI: 1.02-5.75) compared with women with no obesity, with their risk comparable to women with both general and abdominal obesity.

CONCLUSIONS

Abdominal obesity was a critical predictor of subclinical carotid plaque development among early postmenopausal Chinese women. Policy makers should recognize the need to identify high-risk midlife women with normal-weight abdominal obesity in public health and clinical practice.

Perceived poverty and health, and their roles in the poverty-health vicious cycle: a qualitative study of major stakeholders in the healthcare setting in Hong Kong

BACKGROUND

Poverty and ill-health are closely inter-related. Existing studies on the poverty-health vicious cycle focus mainly on less developed countries, where the identified mechanisms linking between poverty and ill-health may not fit the situations in developed Asian regions. This study aims to qualitatively explore the perceived mechanisms and drivers of the poverty-health vicious cycle among major stakeholders in the healthcare setting in Hong Kong.

METHODS

Data were collected via focus group interviews with social workers (n = 8), chronically ill patients (n = 8), older adults (n = 6), primary care doctors (n = 7) and informal caregivers (n = 10). The transcribed data were then closely read to capture key themes using thematic analyses informed by social constructivism.

RESULTS

In this highly developed Asian setting with income inequality among the greatest in the world, the poverty-health vicious cycle operates. Material and social constraints, as a result of unequal power and opportunities, appear to play a pivotal role in creating uneven distribution of social determinants of health. The subsequent healthcare access also varies across the social ladder under the dual-track healthcare system in Hong Kong. As health deteriorates, financial hardship is often resulted in the absence of sufficient and coordinated healthcare, welfare and labour policy interventions. In addition to the mechanisms, policy drivers of the cycle were also discussed based on the respondents' perceived understanding of the nature of poverty and its operationalization in public policies, as well as of the digressive conceptions of disease among different stakeholders.

CONCLUSIONS

The poverty-health vicious cycle has remained a great challenge in Hong Kong despite its economic prosperity. To break the cycle, potential policy directions include the adoption of proportionate universalism, social integration and the strengthening of medical-social collaboration.

Educational inequality in physician-diagnosed hypertension widened and persisted among women from 1999 to 2014 in Hong Kong

Gender differences in the trend of educational inequality in hypertension have been observed especially in the Asian populations, indicating the increasing importance of education as a social determinant of hypertension among women. This study examined the gender-specific trends of educational inequality in physician-diagnosed hypertension in Hong Kong between 1999 and 2014. Based on a series of eight government-led territory-wide household surveys conducted between 1999 and 2014, 97,481 community-dwelling Hong Kong Chinese adults aged 45 or above were analysed. The extent and trend of gender-specific educational inequality in self-reported physician-diagnosed hypertension were estimated by regression-based Relative Index of Inequality and age-standardised Slope Index of Inequality. Over the study period, age-standardised prevalence of self-reported hypertension increased in both genders, with the greatest prevalence among the least educated women. Educational inequalities in hypertension significantly widened in female from 1999 to 2009 and persisted thereafter; nonetheless, the respective inequality was negligible in male. Further adjustment for household income did not attenuate the observed inequality. To conclude, a widened and then persistent discrepancy in hypertension across education levels was observed among women, but not among men, in Hong Kong. The gender perspective should be carefully considered when designing hypertension prevention strategies and related health policies.

Sex-specific intergenerational trends in morbidity burden and multimorbidity status in Hong Kong community: an age-period-cohort analysis of repeated population surveys

OBJECTIVES

Prevalence of multimorbidity has been increasing worldwide. While population ageing undoubtedly contributes, secular trends have seldom been decomposed into age, period and cohort effects to investigate intergenerational differences. This study examines the birth cohort effect on morbidity burden and multimorbidity in Hong Kong community.

DESIGN

Sex-specific age-period-cohort analysis with repeated cross-sectional surveys.

SETTING

A territory-wide population survey database.

PARTICIPANTS

69 636 adults aged 35 or above who participated in the surveys in 1999, 2001, 2005 or 2008.

MAIN OUTCOME MEASURES

Morbidity burden was operationalised as number of chronic conditions from a list of 14, while multimorbidity was defined as a dichotomous status of whether participants had two or more conditions.

RESULTS

For both sexes, there was an upward inflection (positive change) of risk of increased morbidity burden starting from cohort 1955-1959. For men born after 1945-1954, there was a trend of lower risk (relative risk=0.63, 95% CI 0.50 to 0.80 for 1950-1954 vs 1935-1939) which continued through subsequent cohorts but with no further declines. In women, there had been a gradual increase of risk, although only significant for cohort 1970-1974 (relative risk=1.90, 95% CI 1.08 to 1.34 vs 1935-1939). Similar results were found for dichotomous multimorbidity status.

CONCLUSIONS

The trend of lower risk starting from men born in 1945-1954 may be due to a persistent decline in smoking rates since the 1980s. On the other hand, the childhood obesity epidemic starting from the late 1950s coincided with the observed upward inflection of risk for both sexes, that is, notably more drastic increase of risk in women and the levelling-off of the decline of risk in men. These findings highlight that the cohort effects on morbidity burden and multimorbidity may be sex-specific and contextual. By examining such effects in different world populations, localised sex-specific and generation-specific risk factors can be identified to inform policy-making.