Self-Rated Health and Inflammation: A Test of Depression and Sleep Quality as Mediators

Self-Rated Health Status and the Risk of Incident Type 2 Diabetes: A Prospective Cohort Study of Middle-Aged and Older Chinese

Objectives

Evidence on the relationship between self-rated health status and incident type 2 diabetes (T2DM) in China is scarce. This study aims to examine the prospective association of self-rated health status with the subsequent risk of T2DM among middle-aged and older Chinese subjects.

Methods

Data were obtained from the China Health and Retirement Longitudinal Study of 9844 Chinese individuals aged 45 years or older. Cox proportional hazards models were used to yield hazard ratios (HRs) relating self-rated health status to the 7-year incidence of T2DM, adjusting for conventional risk factors.

Results

Compared to those with very good or good self-rated health, individuals with poor health had a significantly higher risk of developing T2DM in the multivariable-adjusted model [HR = 1.36 (1.07, 1.73)]. Subgroup analysis by sex showed stronger associations in women [HR = 1.53 (1.11, 2.12)]. Interaction analyses indicated that factors such as age, sex, obesity, smoking status, drinking status, history of hypertension and history of dyslipidemia did not modify the association (all P-interaction >0.05).

Conclusion

Poor self-rated health status is associated with a higher risk of developing T2DM in middle-aged and older Chinese people.

Self-rated health and its bidirectional relationship with burnout, sleep quality and somatic symptoms in a general adult population

The aim of this study was to investigate how self-rated health (SRH) reflects ongoing ill-health and how SRH is associated with previous ill-health and/or predicts future ill-health such as burnout, disturbed sleep, and somatic symptoms. The study used two waves from the population-based Västerbotten Environmental and Health Study in which 2 336 adult persons participated by answering a questionnaire at two time points three years apart. Hierarchical and logistic regression analyses were conducted, thus treating all variables both continuously (degree) and categorically (case). The analyses were performed both cross-sectionally and longitudinally. The results showed bidirectionality between suboptimal SRH and burnout, disturbed sleep and somatic severity caseness. Moreover, degree of poor SRH was more likely to occur simultaneously to high degrees of burnout and somatic severity than to degree of poor sleep quality. Also, caseness of burnout, disturbed sleep and somatic severity increased the risk of simultaneous suboptimal SRH. Finally, the results showed that degree of burnout three years earlier, predicted degree of poor SRH, and that degree of poor SRH predicted degree of sleep three years later. In conclusion, in a population-based, normal adult sample there is a bidirectional relationship between suboptimal SRH and caseness of burnout, disturbed sleep quality and somatic symptoms, but not between degree of these symptoms. The results can have implications for health care meeting patients complaining about poor general health.

Working Around the Clock: The Association between Shift Work, Sleep Health, and Depressive Symptoms among Midlife Adults

Shift work is an integral part of living in a 24-hour society. However, shift work can disrupt circadian rhythms, negatively impacting health. Guided by the Stress Process Model (SPM), this study examines the association between shift work and depressive symptoms and investigates whether sleep health (duration, quality, and latency) mediates this relationship among midlife adults. Utilizing data from the National Longitudinal Survey of Youth 1979 cohort (N = 6,372), findings show that working evening, night, and irregular shifts is associated with increased depressive symptoms. The results also show that part of the association between shift work and depressive symptoms among night and irregular shift workers, is indirect, operating through short sleep during the week and on the weekend. Although shift work can negatively affect mental health, getting more restorative sleep may mitigate part of the harmful mental health consequences of non-standard work schedules.

What Predict Self-rated Health: A Cross-sectional Study Among Men and Women with Non-cardiac Chest Pain

The study aimed to determine different lifestyle and clinical factors that predict self-rated health (SRH) in non-cardiac chest pain (NCCP) patients. In this cross-sectional study, 360 NCCP patients filled out questionnaires about depression, somatization, body sensation, type D personality, and pain intensity. In addition, participants' lifestyle and socio-demographic data were obtained. Multiple regression analyses revealed that among men, pain intensity (OR 1.07; 95% CI 1.03, 1.12), depression (3.10; 1.38, 9.18), somatization (1.18; 1.08, 1.29) and sleep quality (6.23; 1.42, 27.27) were associated with self-rated health. In women NCCP patients, depression (2.44; 1.05, 6.82) pain intensity (1.05; 1.01, 1.10), and physical activity (2.21; 1.07, 5.55) were associated with SRH. The results on the predicting factors of SRH in NCCP patients provide potential insights for more advanced clinical management of NCCP. In addition, they can be applied to improve health policies and promote healthy behaviors among NCCP patients.

Men and Women as Differential Social Barometers: Gender Effects of Perceived Friend Support on the Neuroticism-Loneliness-Well-Being Relationship in a Younger Adult Population

Loneliness and social isolation are well known to have detrimental effects on mental and physical health, and the perception of social support is frequently viewed as a protective factor. Yet, the beneficial effect varies when perceived support is considered with respect to gender and personality. We examined the mechanism of loneliness as a mediator of personality on health and moderation of this relationship by perceived social support and gender. Five hundred and thirty young adults (325 women) aged 18–32 years (Mage = 25.42, SD = 4.13) provided self-report assessments of personality, loneliness, perceived social support, general health and psychological impact of the COVID-19 pandemic on well-being. Using a series of regression-based mediation and moderated mediation models, we found higher scores on extraversion to be associated with lower loneliness and better general health and well-being; higher neuroticism with greater loneliness and poorer general health. Being male and perceiving greater friend support moderated the neuroticism–loneliness–well-being relationship. Men higher on neuroticism were less able to benefit from lower loneliness when the perception of support from friends was greater, yet were less sensitive to the negative impact on the well-being of perceiving low levels of friend support. Effects suggest important gender differences with the potential to inform health interventions.

Association of plant-based diet index with inflammatory markers and sleep quality in overweight and obese female adults: A cross-sectional study

BACKGROUND

Inflammation and sleep disturbances increase the risk of multiple diseases, including cardiovascular disease, type 2 diabetes and dementia. Since diet plays a significant role in inflammatory responses and sleep quality, this study aimed to investigate the association of a plant-based diet index (PDI) with sleep quality and inflammatory markers in overweight and obese women.

METHODS

390 overweight and obese women aged 18-48 years participated in this cross-sectional study. A validated food frequency questionnaire (FFQ) was used to create an overall PDI, healthful plant-based diet index (hPDI) and unhealthful plant-based diet index (uPDI). Sleep quality was assessed by Pittsburgh Sleep Quality Index (PSQI). Higher scores on the PSQI were indicative of poor sleep. Anthropometric measurements and serum concentrations of high-sensitivity C-reactive protein (hs-CRP), interleukin 1 beta (IL-1β) and transforming growth factor-beta (TGF-β) were evaluated. Linear regression models were used to determine the association between exposure and outcomes.

RESULTS

After taking potential confounders into account, we found a significant inverse association between adherence to hPDI and hs-CRP (β = -0.14, 95% confidence interval [CI]: -0.22,0.06, P = .001) and a significant positive association between uPDI and hs-CRP (β = 0.13, 95% CI: 0.05,0.21, P = .001). Overall, PDI was significantly associated with TGF-β (β = 2.04, 95% CI: 0.54,3.55, P = .008). No association was detected between PDI indices and IL-1β. Higher adherence to uPDI was significantly associated with higher PSQI score (lower sleep quality) (β= 0.20, 95% CI:0.007,0.40, P = .04). A significant positive association was found between TGF-β (β = 0.05, 95% CI:0.005,0.10, P = .03) and hs-CRP (β = 0.32, 95% CI:0.02,0.62, P = .03) with PSQI.

CONCLUSION

Our findings indicated a significant association between adherence to a plant-based diet with inflammation and sleep quality in obese and overweight females. WHAT IS ALREADY KNOWN ABOUT THIS TOPIC?: Sleep is an essential part of life, and sleep quality has a significant impact on individual well-being and performance. There is a bidirectional relationship between disturbed sleep and elevated levels of inflammatory markers. Diet plays a major part in sleep quality and its related health consequences. Plant-based diets are associated with lower risk of chronic diseases such as coronary artery disease (CAD), type 2 diabetes, obesity and reduced level of inflammation. WHAT DOES THIS ARTICLE ADD?: Adherence to a healthful plant-based diet is associated with lower level of hs-CRP, while adherence to an unhealthful plant-based diet is associated with higher concentrations of hs-CRP. Adherence to an unhealthful plant-based diet is associated with lower sleep quality.

Association of mentally-passive and mentally-active sedentary behaviors with device-measured bouts and breaks of sedentary time in adolescents

Background: Our aim was to analyze the association of self-reported mentally-passive and mentally-active sedentary behaviors with different patterns (bouts and breaks) of device-measured sedentary time in adolescents.

Methods: This was a cross-sectional study conducted among 375 adolescents (177 boys) aged 1015 years. Total time, bouts and breaks of sedentary time were measured through accelerometers. Self-reported sedentary behavior in different activities was summed and divided into mentally-active (playing electronic games, studying and reading) and mentally-passive (watching TV, watching DVD, and using computer for leisure). Bayesian linear regression models were used for association analyses.

Results: Only mentally-passive sedentary behaviors were positively associated with longer bouts [1-4 minutes: mean posterior distribution: -0.431 (95% credible interval: -0.745 to -0.114); =15 minutes: 0.641 (0.122 to 1.222)] and lower number of breaks [-0.138 (-0.228 to -0.044)] of device-measured sedentary time.

Conclusion: Self-reported mentally-passive sedentary behaviors are associated with longer bouts and lower breaks of device-measured sedentary time.

Sex differences in the association between self-rated health and high-sensitivity C-reactive protein levels in Koreans: a cross-sectional study using data from the Korea National Health and Nutrition Examination Survey

BACKGROUND

No studies have investigated the association between self-rated health (SRH) and high-sensitivity C-reactive protein (hs-CRP) levels in South Koreans. We explored this association and analyzed differences between sexes.

METHODS

Using cross-sectional data from the 2015-2017 Korea National Health and Nutrition Examination Survey, we analyzed the association between SRH and high hs-CRP levels (> 1.0 mg/L) in 14,544 Koreans aged ≥ 19 years who responded to the SRH survey and had available hs-CRP test results. Differences in sociodemographic factors were analyzed using the Pearson's chi-square test for categorical variables or the Mann-Whitney U test for continuous variables. Multiple logistic regression analysis was used to measure the association between hs-CRP levels and SRH according to sex while adjusting for other possible confounders.

RESULTS

The percentage of very poor to poor SRH was higher in the high hs-CRP group (22.4%) than in the low hs-CRP group (17.66%). Among men, the risk of a high hs-CRP level increased with worse SRH (adjusted for confounders; P for trend < 0.001). After adjusting for all confounders, including chronic diseases, men with very poor SRH showed a higher odds ratio (OR) for high hs-CRP levels than those with very good SRH (fully adjusted OR, 1.74; 95% CI, 1.04-2.90). Significant correlations were absent among women.

CONCLUSIONS

Poor SRH was correlated with low-grade inflammation (high hs-CRP levels) among Korean male adults. These findings could be useful for developing health improvement programs and in goal setting at a national scale.

The role of inflammation in the relationship of self-rated health with mortality and implications for public health: Data from the English Longitudinal Study of Aging (ELSA)

Self-rated health (SRH) predicts mortality after adjustment for potential confounders, including measures of health status. Prodromal disease might lead to worsened SRH and higher mortality. But no study of SRH and mortality has focussed on inflammation. The objective of this study is to investigate the influence of inflammation upon the association between SRH and mortality in a British cohort. The English Longitudinal Study of Ageing (ELSA) involves interviewing participants aged over 50 every two years. We analysed data for 3405 men and 4139 women. Mortality for consenting members was detected by linkage with UK National Health Care registry up to March 2012. Demographic, clinical, and health behaviours at wave 2 were treated as confounders, as well as inflammation-related disease and C-reactive protein (CRP). A five-step hierarchical multivariable logistic regression was estimated. An association was observed between SRH and mortality after adjusting for all variables. In men, compared to those with excellent health, CRP only, and CRP and inflammation-related disease combined, could explain 7.03% and 24.35% of increased risk of dying associated with poor health, respectively. For women, the corresponding figures were 8.95% and 24.28%, respectively. Inflammation is associated with increased risk of death, and may help to explain approximately a quarter of the association between SRH and mortality. Individuals with relatively poor SRH may be aware of underlying inflammation that increases the risk of illness and death, and this may lead to increased use of services, for example. Identifying the cause and treating inflammation in those without a diagnosis may help to increase survival and life quality among those who perceive their health to be relatively poor.

•

Poor self-rated health (SRH) is associated with increased risk of death.

•

In a prospective study, inflammation explained 1/4 of the association.

•

Identifying inflammation early may improve survival and life quality.

•

SRH can assist management, inform policy and guide research.

Self-Rated Health and Age-Related Differences in Ambulatory Blood Pressure: The Mediating Role of Behavioral and Affective Factors

OBJECTIVE

Despite the well-established association between self-rated health (SRH) and health, little is known about the potential psychobiological mechanisms responsible for such links and if these associations differ by age. The main goals of this study were to investigate the links between SRH and ambulatory blood pressure (ABP), if age moderated the risk, and the health behavior/affective mechanisms responsible for such links.

METHODS

A total of 188 men and women (94 married couples; ages, 18-63 years) completed a standard measure of SRH and a 1-day ABP assessment. Multilevel models were run to examine whether SRH was associated with daily ABP and whether these links were moderated by age. The Monte Carlo method was used to construct confidence intervals for mediation analyses.

RESULTS

Results indicated that poor SRH was associated with higher ambulatory systolic blood pressure (SBP; b = 3.14, SE = 0.68, p < .001) and diastolic blood pressure (DBP; b = 1.34, SE = 0.43, p = .002) levels. Age also moderated the links between SRH and ambulatory SBP (b = 0.19, SE = 0.08, p = .011) and DBP (b = 0.14, SE = 0.05, p = .004), with links being stronger in relatively older individuals. However, only daily life negative affect significantly mediated the age by SRH interaction for both ambulatory SBP and DBP.

CONCLUSIONS

These results highlight the potential psychobiological mechanisms linking SRH to longer-term health outcomes. Such work can inform basic theory in the area as well as intervention approaches that target such pathways.

Educational inequalities in health after work exit: the role of work characteristics

Background

Educational inequalities in health have been widely reported. A low educational level is associated with more adverse working conditions. Working conditions, in turn, are associated with health and there is evidence that this association remains after work exit. Because many countries are raising the statutory retirement age, lower educated workers have to spend more years working under adverse conditions. Therefore, educational health inequalities may increase in the future. This study examined (1) whether there were educational differences over time in health after work exit and (2) whether work characteristics mediate these educational inequalities in health.

Methods

Data from five prospective cohort studies were used: The Netherlands (Longitudinal Aging Study Amsterdam), Denmark (Danish Longitudinal Study of Aging), England (English Longitudinal Study of Ageing), Germany (German Aging Study), and Finland (Finnish Longitudinal Study on Municipal Employees). In each dataset we used Generalized Estimating Equations to examine the relationship between education and self-rated health after work exit with a maximum follow-up of 15 years and possible mediation of work characteristics, including physical demands, psychosocial demands, autonomy, and variation in activities.

Results

The low educated reported significantly poorer health after work exit than the higher educated. Lower educated workers had a higher risk of high physical demands and a lower risk of high psychosocial demands, high variation in tasks, and high autonomy at work, compared to higher educated workers. These work characteristics were found to be mediators of the relationship between education and health after work exit, consistent across countries.

Conclusion

Educational inequalities in health are still present after work exit. If workers are to spend an extended part of their lives at work due to an increase in the statutory retirement age, these health inequalities may increase. Improving working conditions will likely reduce these inequalities in health.