Pollinosis and all-cause mortality among middle-aged and elderly Japanese: a population-based cohort study

Association between short-term pollen exposure and blood pressure in adults: A repeated-measures study

BACKGROUND

Recent studies have related high pollen concentrations to increased cardiovascular morbidity and mortality, yet very little research concerns pre-clinical cardiovascular health, including effects on blood pressure (BP). The EPOCHAL panel study investigated the exposure-response relationship between ambient pollen exposure and systolic and diastolic BP in adults.

METHODS

BP was measured in 302 adults with and in 94 without pollen allergy during the pollen season, on approximately 16 days per person (6253 observations). Average individually-relevant pollen exposure in the 96 h prior to each BP measurement was calculated by summing up the averages of all ambient pollen concentrations to which the individual was found to be sensitized in a skin prick test, and which originated from seven highly allergenic pollen types (hazel, alder, birch, ash, grasses, mugwort and ragweed). Generalized additive mixed models were used to study the association between mean individually-relevant pollen exposure in the last 96 h and BP, adjusting for individual and environmental time-varying covariates. Effect modification by pollen allergy status, sex and BMI was evaluated.

RESULTS

Positive non-linear associations between individually-relevant pollen exposure and both systolic and diastolic BP were found in the allergic but not in the non-allergic group. BP increased sharply for exposures from zero to 60/80 pollen/m3 (diastolic/systolic BP), followed by a tempered further increase at higher concentrations. Increases of 2.00 mmHg [95% confidence interval (CI): 0.80-3.19] in systolic and 1.51 mmHg [95% CI: 0.58-2.45] in diastolic BP were associated with 96-h average pollen exposure of 400 pollen/m3, compared to no exposure. Obesity and female sex were associated with larger BP increases.

CONCLUSIONS

The finding that short-term pollen concentration is associated with increased systolic and diastolic BP in persons with pollen allergy strengthens the evidence that pollen may cause systemic health effects and trigger cardiovascular events.

Efficacy and safety of stapokibart (CM310) in uncontrolled seasonal allergic rhinitis (MERAK): an investigator-initiated, placebo-controlled, randomised, double-blind, phase 2 trial

Background

There is no trial to assess the benefits of periodically using biologics during the pollen season in patients with uncontrolled seasonal allergic rhinitis (SAR), who have moderate-to-severe symptoms even after standard-of-care. This trial aimed to evaluate the efficacy and safety of the add-on administration of stapokibart, a humanised monoclonal antibody that targets interleukin-4 receptor alpha, in patients with uncontrolled SAR.

Methods

In this investigator-initiated, randomised, double-blind, placebo-controlled trial, eligible patients received either stapokibart 600-300 mg weekly (QW), every 2 weeks (Q2W), or placebo QW for 4 weeks. All patients were given mometasone furoate nasal spray and loratadine throughout the trial. The primary endpoint was the mean change from baseline in daily reflective total nasal symptom score (rTNSS) during 2-week treatment. Secondary efficacy outcomes included: the mean change from baseline in daily rTNSS during 4-week treatment; the mean changes and the mean percentage changes from baseline during 2-week and 4-week treatment in 1) daily rTNSS and reflective total ocular symptom score (rTOSS), 2) morning (AM)/evening (PM) rTNSS and rTOSS, 3) AM instantaneous total nasal symptom score (iTNSS) and instantaneous total ocular symptom score (iTOSS), 4) individual nasal and ocular symptoms; the change from baseline in Rhinoconjunctivitis Quality of-Life Questionnaire score during 4-week treatment. Exploratory endpoints included the change of prespecified markers related to type 2 inflammation pre- and post-treatment. Safety, immunogenicity, and pharmacokinetics were also evaluated. This study is registered with www.clinicaltrials.gov (NCT05470647).

Findings

Between August 17, 2022, and December 28, 2022, 92 patients with uncontrolled SAR were enrolled from 4 centres in China and randomly assigned to receive stapokibart 600-300 mg QW (n = 31), stapokibart 600-300 mg Q2W (n = 30), or placebo QW (n = 31), of whom 86 (93%) completed the study. Both stapokibart Q2W and QW did not significantly improve mean change from baseline in daily rTNSS compared with placebo in 2 weeks. The least-squares (LS) mean differences (97.5% confidence interval [CI]) compared with placebo were -1.0 (-2.3, 0.2) in stapokibart Q2W group (p = 0.065) and -0.2 (-1.5, 1.0) in stapokibart QW group (p = 0.67). For the secondary outcomes, compared with placebo, stapokibart Q2W presented significant improvements in the mean percentage change from baseline in daily rTNSS in 2 weeks (LS mean difference -12.9%, 95% CI -25.3%, -0.4%, p = 0.043), as well as AM iTNSS over 2 weeks (LS mean difference -17.4%, 95% CI -31.0%, -3.8%, p = 0.013) and 4 weeks (LS mean difference -15.4%, 95% CI -29.0%, -1.9%, p = 0.026). Additionally, the nasal congestion score was significantly lower in stapokibart Q2W than placebo during 2-week (LS mean difference -0.4, 95% CI -0.7, -0.1, p = 0.014) and 4-week (LS mean difference -0.4, 95% CI -0.7, -0.04, p = 0.028) treatment. Treatment-emergent adverse events (TEAEs) occurred in 48% (15/31), 33% (10/30), and 61% (19/31) of patients receiving stapokibart QW, Q2W, and placebo, respectively. Most reported TEAEs were sinus bradycardia, hyperlipidaemia, and blood uric acid increased.

Interpretation

In this phase 2 trial, both stapokibart regimens had an acceptable safety and tolerability profile but did not significantly improve daily rTNSS in patients with uncontrolled SAR. The efficacy of stapokibart in patients with uncontrolled SAR is being further investigated in ongoing phase 3 trials (clinicaltrials.gov, NCT05908032).

Funding

Ministry of Science and Technology of the People's Republic of China; Ministry of Education of the People's Republic of China; National Natural Science Foundation of China; Chinese Academy of Medical Sciences.

Relative Income Deprivation and All-Cause Mortality in Japan: Do Life Priorities Matter?

BACKGROUND/PURPOSE

Relative deprivation (RD) is proposed to affect health through psychosocial stress stemming from upward social comparisons. This study hypothesized that prioritizing values, such as social engagement and personal growth (as opposed to prioritizing work), would inoculate against the toxic effects of upward social comparisons.

METHODS

Prospective data of 9,533 subjects (4,475 men and 5,058 women) participating in the Komo-Ise study answering a baseline questionnaire in 1993 and a follow-up survey in 2000 were analyzed. Associations between RD-using Yitzhaki Index (YI) and Income Rank (IR)-and mortality were evaluated using Cox proportional-hazard regression models. At follow-up, people were also asked about what they prioritized in life: work, social engagement, or personal growth.

RESULTS

1,168 deaths (761 men and 407 women) occurred during follow-up (to the end of 2011). Controlling for sociodemographic factors, the hazard ratio (HR) for mortality was 1.22 (95% confidence interval [CI] = 1.08-1.38) per a standard deviation (SD) increase in YI and 1.18 (95% CI = 1.03-1.35) per an SD decrease in IR. Life priorities (LP) were not statistically significantly associated with mortality. In women, the interaction between LP and YI was statistically significant. In fully adjusted models, women who endorsed only work as very important in their lives had a 2.66 (95% CI = 1.23-5.77) times higher HR for mortality per SD increase in YI compared to women who valued social engagement/personal growth. An interaction between LP and RD was not found in men.

CONCLUSIONS

Increased relative income deprivation was associated with a higher risk of all-cause mortality independently of absolute income. Focusing on social engagement/personal growth (as opposed to work) appears to inoculate women against the toxic effects of relative deprivation.

Self-Reported Hearing/Visual Loss and Mortality in Middle-Aged and Older Adults: Findings From the Komo-Ise Cohort, Japan

BACKGROUND

The association of sensory loss with mortality remains unclear. We aimed to explore the associations of hearing loss (HL), visual loss (VL), and dual sensory loss (DSL) with survival.

METHODS

Data came from the Komo-Ise study cohort in Gunma Prefecture, Japan, where the community-dwelling residents aged 40-69 years were followed up from 1993 to 2010. We analyzed 9,522 individuals who answered the follow-up questionnaires in 2000 (average age 64 [range, 47 to 77] years in 2000). The primary exposures were "HL only," "VL only," or "DSL", with "no HL/VL" as the reference. These sensory loss statuses were assessed by asking the difficulty in hearing conversation or reading newspaper even with aids in the follow-up questionnaires in 2000. All-cause and cause-specific mortality were ascertained from linkage to death certificate data. Cox proportional hazards models adjusting for confounders, including demographic factors, socioeconomic status, and health status, were used. Potential mediators (depression, walking disability, and social participation) were additionally adjusted for.

RESULTS

There were 1,105 deaths over the 10-year follow-up. After adjustment for the potential confounders, HL and DSL were associated with increased all-cause mortality (hazard ratios of 1.74 [95% CI, 1.18-2.57] and 1.63 [95% CI, 1.09-2.42], respectively). Potential mediators explained a modest portion of the association. As for cause-specific mortality, HL was associated with increased cancer mortality, while VL and DSL were associated with increased cardiovascular disease mortality.

CONCLUSIONS

Self-reported HL and DSL may be risk factors of mortality among middle-aged or elderly Japanese populations.

Cedar Pollinosis and Mortality: A Population-Based Prospective Cohort Study in Japan

BACKGROUND

Cedar pollinosis is one of the most prevalent forms of seasonal allergic reaction in Japan. Only one prospective study has examined the association between cedar pollinosis and mortality. Using a symptom-based questionnaire on cedar pollinosis, we investigated the association of cedar pollinosis with all-cause and cause-specific mortality.

METHODS

Data came from the Takayama Study, which recruited residents aged ≥35 years in 1992 from Takayama city in Gifu Prefecture, Japan. The current study used information on cedar pollinosis that was obtained from the second survey in 2002. A total of 12,471 persons who were 45-80 years old and had no history of cancer, coronary heart disease, or stroke responded to a questionnaire asking about four symptoms related to cedar pollinosis. Mortality and migration data were obtained throughout the follow-up period up to March 2013. Cox proportional hazard models were used to examine the relation between cedar pollinosis and mortality.

RESULTS

A total of 1,276 persons died during follow-up period. Among these, there were 504 neoplasm, 278 cardiovascular, and 181 respiratory deaths. After adjusting for potential confounders, cedar pollinosis was associated with significantly lower all-cause mortality (hazard ratio [HR] 0.79; 95% confidence interval [CI], 0.65-0.95) and respiratory mortality (HR 0.38; 95% CI, 0.18-0.82). There was no significant association between cedar pollinosis and mortality due to neoplasm or cardiovascular disease.

CONCLUSIONS

We found an inverse association between cedar pollinosis and the risk of all-cause and respiratory mortality. Further research is needed to elucidate the association between cedar pollinosis and mortality.

Relationship of relative poverty and social relationship on mortality around retirement: a 10-year follow-up of the Komo-Ise cohort

Background

As society is aging, retirement takes on increasing importance for individuals in the later life. This study aimed to describe mortality before and after retirement in the Japanese middle-aged/elderly with special attention to socioeconomic position and social relationships.

Methods

We conducted a 10-year follow-up study (the Komo-Ise cohort study) and assessed mortality according to socioeconomic positions (relative poverty and occupation) and social relationships (e.g., marital status, living alone, and social support) in workers and the retired. Relative poverty was defined as a household equivalent income of 12,700 US dollars (1.37 million Japanese Yen) or less in 2000. Stratified analyses were conducted according to sex in two groups of employment status: the workers and the retired. Adjusted hazard ratios (HRs) were calculated using the Cox proportional hazard model.

Results

We included 5534 individuals. Of these, 3360 were men (working, 2499; retired, 861) and 2174 were women (working, 1306; retired, 868). We observed 610 deaths (475 in men and 135 in women) during the study period. Relative poverty was a significant risk factor for death (HR 1.52, 95% confidence interval [CI] 1.07–2.14) among retired men but not among working men (HR 1.20, 95% CI 0.79–1.83). Among workers, self-employed men showed a significantly higher hazard of death (HR 1.57, 95% CI 1.09–2.25) than white-collar employees. Retired men who lacked participation in social activities were more likely to die than those who did not (HR 1.44, 95% CI 1.06–1.94). All results, except marital status, indicated non-significant associations in women.

Conclusions

Relative poverty and lack of social engagement may be related to high mortality risk in retired men. Further studies are needed to assess the health status among the middle-aged/elderly population around retirement.