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Neubert M, Süssenbach P, Rief W, Euteneuer F. Does subjective social status affect pain thresholds? - an experimental examination. PSYCHOL HEALTH MED 2024; 29:754-764. [PMID: 37195214 DOI: 10.1080/13548506.2023.2214868] [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: 02/01/2022] [Accepted: 05/11/2023] [Indexed: 05/18/2023]
Abstract
Past research regarding the relationship between different constructs of social status and different aspects of pain has yielded divergent results. So far, there are few experimental studies to investigate the causal relationship between social status and pain. Therefore, the present study aimed to examine the effect of perceived social status on pain thresholds by experimentally manipulating participants' subjective social status (SSS). 51 female undergraduates were randomly assigned to a low- or high-status condition. Participants' perceived social standing was temporarily elevated (high SSS condition) or reduced (low SSS condition). Before and after experimental manipulation participants' pressure pain thresholds were assessed. The manipulation check confirmed that participants in the low-status condition reported significantly lower SSS than participants in the high-status condition. A linear mixed model revealed a significant group x time interaction for pain thresholds: Whereas participants' pain thresholds in the low SSS condition increased post manipulation, pain thresholds of participants in the high SSS condition decreased post manipulation (β = 0.22; 95% CI, 0.002 to 0.432; p < .05). Findings suggest that SSS may have a causal effect on pain thresholds. This effect could either be due to a change in pain perception or a change in pain expression. Future research is needed to determine the mediating factors.
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Affiliation(s)
- Marie Neubert
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Siegen, Germany
| | - Philipp Süssenbach
- Department for Human Resources/Health/Social Sciences, Fachhochschule des Mittelstands (University of Applied Sciences) Bielefeld, Bielefeld, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany
| | - Frank Euteneuer
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany
- Department of Psychology, Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
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van Zwieten A, Dai J, Blyth FM, Wong G, Khalatbari-Soltani S. Overadjustment bias in systematic reviews and meta-analyses of socio-economic inequalities in health: a meta-research scoping review. Int J Epidemiol 2024; 53:dyad177. [PMID: 38129958 PMCID: PMC10859162 DOI: 10.1093/ije/dyad177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Overadjustment bias occurs when researchers adjust for an explanatory variable on the causal pathway from exposure to outcome, which leads to biased estimates of the causal effect of the exposure. This meta-research review aimed to examine how previous systematic reviews and meta-analyses of socio-economic inequalities in health have managed overadjustment bias. METHODS We searched Medline and Embase until 16 April 2021 for systematic reviews and meta-analyses of observational studies on associations between individual-level socio-economic position and health outcomes in any population. A set of criteria were developed to examine methodological approaches to overadjustment bias adopted by included reviews (rated Yes/No/Somewhat/Unclear). RESULTS Eighty-four reviews were eligible (47 systematic reviews, 37 meta-analyses). Regarding approaches to overadjustment, whereas 73% of the 84 reviews were rated as Yes for clearly defining exposures and outcomes, all other approaches were rated as Yes for <55% of reviews; for instance, 5% clearly defined confounders and mediators, 2% constructed causal diagrams and 35% reported adjusted variables for included studies. Whereas only 2% included overadjustment in risk of bias assessment, 54% included confounding. Of the 37 meta-analyses, 16% conducted sensitivity analyses related to overadjustment. CONCLUSIONS Our findings suggest that overadjustment bias has received insufficient consideration in systematic reviews and meta-analyses of socio-economic inequalities in health. This is a critical issue given that overadjustment bias is likely to result in biased estimates of health inequalities and accurate estimates are needed to inform public health interventions. There is a need to highlight overadjustment bias in review guidelines.
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Affiliation(s)
- Anita van Zwieten
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia
| | - Jiahui Dai
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Fiona M Blyth
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, NSW, Australia
| | - Germaine Wong
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Centre for Kidney Research, Children’s Hospital at Westmead, Westmead, NSW, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Saman Khalatbari-Soltani
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, NSW, Australia
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Boos CJ, Haling U, Schofield S, Cullinan P, Bull AMJ, Fear NT, Bennett AN. Relationship between combat-related traumatic injury and its severity to predicted cardiovascular disease risk: ADVANCE cohort study. BMC Cardiovasc Disord 2023; 23:581. [PMID: 38012542 PMCID: PMC10680223 DOI: 10.1186/s12872-023-03605-0] [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: 04/11/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND This study investigated the relationship between combat-related traumatic injury (CRTI) and its severity and predicted cardiovascular disease (CVD) risk. MATERIAL AND METHODS This was an analysis of comparative 10-year predicted CVD risk (myocardial infarction, stroke or CVD-death) using the QRISK®3 scoring-system among adults recruited into the Armed Services Trauma Rehabilitation Outcome (ADVANCE) cohort study. Participants with CRTI were compared to uninjured servicemen frequency-matched by age, sex, rank, deployment (Afghanistan 2003-2014) and role. Injury severity was quantified using the New Injury Severity Score (NISS). RESULTS One thousand one hundred forty four adult combat veterans were recruited, consisting of 579 injured (161 amputees) and 565 uninjured men of similar age ethnicity and time from deployment/injury. Significant mental illness (8.5% vs 4.4%; p = 0.006) and erectile dysfunction (11.6% vs 5.8%; p < 0.001) was more common, body mass index (28.1 ± 3.9 vs 27.4 ± 3.4 kg/m2; p = 0.001) higher and systolic blood pressure variability (median [IQR]) (1.7 [1.2-3.0] vs 2.1 [1.2-3.5] mmHg; p = 0.008) lower among the injured versus uninjured respectively. The relative risk (RR) of predicted CVD (versus the population expected risk) was higher (RR:1.67 [IQR 1.16-2.48]) among the injured amputees versus the injured non-amputees (RR:1.60 [1.13-2.43]) and uninjured groups (RR:1.52 [1.12-2.34]; overall p = 0.015). After adjustment for confounders CRTI, worsening injury severity (higher NISS, blast and traumatic amputation) were independently associated with QRISK®3 scores. CONCLUSION CRTI and its worsening severity were independently associated with increased predicted 10-year CVD risk.
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Affiliation(s)
- Christopher J Boos
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Near Loughborough, LE12 5QW, Nottinghamshire, UK.
- The Academic Department of Military Mental Health, King's College London, London, SE5 9RJ, UK.
- Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, BH1 3LT, UK.
- Department of Cardiology, University Hospitals Dorset, Poole Hospital, Longfleet Rd, Poole, BH15 2JB, Dorset, UK.
| | - Usamah Haling
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, SW3 6LR, UK
| | - Susie Schofield
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, SW3 6LR, UK
| | - Paul Cullinan
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, SW3 6LR, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, SW7 2AZ, UK
| | - Nicola T Fear
- The Academic Department of Military Mental Health, King's College London, London, SE5 9RJ, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall Estate, Near Loughborough, LE12 5QW, Nottinghamshire, UK
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, SW3 6LR, UK
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Hester N, Hehman E. Dress is a Fundamental Component of Person Perception. PERSONALITY AND SOCIAL PSYCHOLOGY REVIEW 2023; 27:414-433. [PMID: 36951208 PMCID: PMC10559650 DOI: 10.1177/10888683231157961] [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] [Indexed: 03/24/2023]
Abstract
ACADEMIC ABSTRACT Clothing, hairstyle, makeup, and accessories influence first impressions. However, target dress is notably absent from current theories and models of person perception. We discuss three reasons for this minimal attention to dress in person perception: high theoretical complexity, incompatibility with traditional methodology, and underappreciation by the groups who have historically guided research in person perception. We propose a working model of person perception that incorporates target dress alongside target face, target body, context, and perceiver characteristics. Then, we identify four types of inferences for which perceivers rely on target dress: social categories, cognitive states, status, and aesthetics. For each of these, we review relevant work in social cognition, integrate this work with existing dress research, and propose future directions. Finally, we identify and offer solutions to the theoretical and methodological challenges accompanying the psychological study of dress. PUBLIC ABSTRACT Why is it that people often agonize over what to wear for a job interview, a first date, or a party? The answer is simple: They understand that others' first impressions of them rely on their clothing, hairstyle, makeup, and accessories. Many people might be surprised, then, to learn that psychologists' theories about how people form first impressions of others have little to say about how people dress. This is true in part because the meaning of clothing is so complex and culturally dependent. We propose a working model of first impressions that identifies four types of information that people infer from dress: people's social identities, mental states, status, and aesthetic tastes. For each of these, we review existing research on clothing, integrate this research with related work from social psychology more broadly, and propose future directions for research.
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Pai M, Muhammad T. Subjective social status and functional and mobility impairments among older adults: life satisfaction and depression as mediators and moderators. BMC Geriatr 2023; 23:685. [PMID: 37872470 PMCID: PMC10591391 DOI: 10.1186/s12877-023-04380-5] [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: 05/10/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND While functional and mobility impairments (FMIs) have garnered the attention of health researchers in low and middle-income countries (LMICs), including India, research has yet to explore whether and to what extent the perception of one's social status is associated with FMIs. We fill this gap in the literature by examining (1) the association between subjective social status (SSS) and FMIs among older adults in India and (2) whether this association between SSS and FMIs is mediated and moderated by life satisfaction and depression. METHODS Data come from the 2017-18 wave 1 of the Longitudinal Aging Study in India (LASI) with a sample of 31,464 older adults aged 60 years and above. FMIs were assessed using established scales on impairments in activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility. SSS was assessed using the Macarthur scale. Life satisfaction was measured using responses to five statements gauging respondent's overall satisfaction with life. Depression was calculated using the shortened version of the Composite International Diagnostic Interview (CIDI-SF). Multivariable regression was employed to examine the association between variables, and the interaction terms and Karlson-Holm-Breen (KHB) method were used separately to test the mediation and moderation effects. RESULTS 39.11% of the sample had a low SSS, 8.26% were depressed, and 32.07% reported low life satisfaction. A total of 8.74%, 10.91%, and 8.45% of the study population reported at least one impairment in ADL, IADL, and mobility, respectively. Older adults in the higher SSS group were less likely to have ADL impairment (beta: -0.017, CI: -0.030, -0.0032) and mobility impairment (beta: -0.044, CI: -0.076, -0.013). Depression moderated the association between SSS and mobility impairment (p-value: 0.025), and life satisfaction moderated the association between SSS and ADL impairments (p-value: 0.041) and SSS and IADL impairments (p-value: 0.037). Depression mediated 20.28%, 31.88%, and 18.39% of the associations of SSS with ADL, IADL, and mobility impairments, respectively. Similarly, life satisfaction mediated 23.24%, 52.69%, and 27.22% of the associations of SSS with ADL, IADL, and mobility impairments. CONCLUSIONS That SSS is associated with FMIs among older Indians, even after considering their objective socioeconomic status (SES), suggests that the use of SSS is relevant to the study of health inequalities in India. The finding that life satisfaction and depression mediate and moderate this association is crucial in pinpointing those older Indians at risk of the functional and mobility-related repercussions of lower SSS.
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Affiliation(s)
- Manacy Pai
- Department of Sociology and Criminology, Kent State University, Kent, OH, 44242, USA
| | - T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, India.
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Jones EJ, Marsland AL, Kraynak TE, Votruba-Drzal E, Gianaros PJ. Subjective Social Status and Longitudinal Changes in Systemic Inflammation. Ann Behav Med 2023; 57:951-964. [PMID: 37549189 PMCID: PMC10578390 DOI: 10.1093/abm/kaad044] [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] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Subjective social status (SSS) refers to a person's perception of their social rank relative to others and is cross-sectionally linked to systemic inflammation independently of objective socioeconomic status. PURPOSE We test the extent to which SSS relates to multiyear changes in inflammation, or if associations differ by race or sex. METHODS Healthy adults (N = 331; 30-51 years) completed a baseline visit and 278 participants returned for a second visit 2.85 years later. At both visits, participants underwent a fasting blood draw and completed community (SSSC) and US (SSSUS) versions of the MacArthur Scale. Multiple linear regression analyses examined change in interleukin-6 (IL-6) and C-reactive protein (CRP) predicted by each type of SSS, adjusting for time between visits, sex, race, age, body mass index, smoking, baseline inflammation, and objective socioeconomic status. Additional analyses further adjusted for hopelessness and depressive symptoms. Interactions examined moderations by sex and race. RESULTS Lower SSSC was longitudinally associated with greater IL-6 independently of all covariates, including education and income (β = -0.06), hopelessness (β = -0.06), and depressive symptoms (β = -0.06). Lower SSSUS was longitudinally associated with greater IL-6 independently of demographic covariates including education and income (β = -0.06), but was slightly attenuated after adjusting for hopelessness (β = -0.06) and depressive symptoms (β = -0.06). There were no associations for CRP or moderation by race or sex. CONCLUSIONS Lower SSS may be associated with greater circulating markers of inflammation over time as suggested by increases in IL-6.
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Affiliation(s)
- Emily J Jones
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anna L Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas E Kraynak
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
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Richards L, Maharani A, Präg P. Subjective social status and allostatic load among older people in England: A longitudinal analysis. Soc Sci Med 2023; 320:115749. [PMID: 36738654 DOI: 10.1016/j.socscimed.2023.115749] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/14/2022] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND Subjective social status has a known association with health, whereby better health outcomes are observed for those with higher perceived status. In this research, we offer new evidence on the status-health relationship using a rigorous methodological approach that considers both observed and unobserved confounders. METHODS We use 5 waves of data spanning 15 years from the English Longitudinal Study of Ageing and derive a measure of allostatic load with biomarkers as an objective measure of health. We apply 'within-between' panel regression models. RESULTS Models reveal the expected association between subjective status and health when comparing participants (the 'between' estimate), but no association when examining temporal variation within participants (the 'within' estimate). When controlling for personality traits including optimism, and parental education, the 'between' association between subjective status and allostatic load is reduced but does not disappear. CONCLUSIONS Person-level confounders play some role in explaining the observed link between subjective status and health. The exact nature of the link, including the role of psychological pathways and early-life confounders, remains a question for future research.
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Affiliation(s)
- Lindsay Richards
- University of Oxford, Department of Sociology, 42-43 Park End Street, Oxford, OX1 1JD, United Kingdom.
| | - Asri Maharani
- Manchester Metropolitan University, Department of Nursing, Faculty of Health and Education, Bonsall St, Manchester, M15 6GX, United Kingdom.
| | - Patrick Präg
- CREST, ENSAE, Institut Polytechnique de Paris, 5 Av. Le Chatelier, 91120, Palaiseau, France.
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Lailler G, Grave C, Gabet A, Regnault N, Deneux-Tharaux C, Kretz S, Tsatsaris V, Plu-Bureau G, Blacher J, Olié V. Recurrence of hypertensive disorders of pregnancy: results from a nationwide prospective cohort study (CONCEPTION). BJOG 2023. [PMID: 36802131 DOI: 10.1111/1471-0528.17424] [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: 07/22/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 02/20/2023]
Abstract
OBJECTIVE To assess the risk of gestational hypertension (GH) and pre-eclampsia (PE) during a second pregnancy after occurrence during a first pregnancy. DESIGN Prospective cohort study. SETTING CONCEPTION is a French nationwide cohort study that used data from the National Health Data System (SNDS) database. METHODS We included all women who gave birth for the first time in France in 2010-2018 and who subsequently gave birth. We identified GH and PE through hospital diagnoses and the dispensing of anti-hypertensive drugs. The incidence rate ratios (IRR) of all hypertensive disorder of pregnancy (HDP) during the second pregnancy were estimated using Poisson models adjusted for confounding. MAIN OUTCOME MEASURES Incidence rate ratios of HDP during the second pregnancy. RESULTS Of the 2 829 274 women included, 238 506 (8.4%) were diagnosed with HDP during their first pregnancy. In women with GH during their first pregnancy, 11.3% (IRR 4.5, 95% confidence interval [CI] 4.4-4.7) and 3.4% (IRR 5.0, 95% CI 4.8-5.3) developed GH and PE during their second pregnancy, respectively. In women with PE during their first pregnancy, 7.4% (IRR 2.6, 95% CI 2.5-2.7) and 14.7% (IRR 14.3, 95% CI 13.6-15.0) developed GH and PE during their second pregnancy, respectively. The more severe and earlier the PE during the first pregnancy, the stronger the likelihood of having PE during the second pregnancy. Maternal age, social deprivation, obesity, diabetes and chronic hypertension were all associated with PE recurrence. CONCLUSION These results can guide policymaking that focuses on improving counselling for women who wish to become pregnant more than once, by identifying those who would benefit more from tailored management of modifiable risk factors, and heightened surveillance during post-first pregnancies.
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Affiliation(s)
- G Lailler
- Santé Publique France, Saint-Maurice, France.,Université Paris Est, Créteil, France
| | - C Grave
- Santé Publique France, Saint-Maurice, France
| | - A Gabet
- Santé Publique France, Saint-Maurice, France
| | - N Regnault
- Santé Publique France, Saint-Maurice, France
| | - C Deneux-Tharaux
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France.,Université Paris Cité, Paris, France
| | - S Kretz
- Centre de Diagnostic et de Thérapeutique, Paris, France
| | - V Tsatsaris
- Université Paris Cité, Paris, France.,Maternité Port-Royal, FHU PREMA, Assistance Publique Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - G Plu-Bureau
- Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, Paris, France.,Université Paris Cité, Paris, France.,Unité de Gynécologie Médicale, APHP, Hôpital Port-Royal Cochin, Paris, France
| | - J Blacher
- Université Paris Cité, Paris, France.,Centre de Diagnostic et de Thérapeutique, Paris, France
| | - V Olié
- Santé Publique France, Saint-Maurice, France
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Wang Y, Hu M, Ding R, He P. The dynamic relationship between subjective social status and health: Evidence from a Chinese cohort study. Br J Health Psychol 2023; 28:1-21. [PMID: 35707905 DOI: 10.1111/bjhp.12608] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/23/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Using nationally representative longitudinal data from 2010 to 2018 in China, this study systematically investigates the relationship between Subjective Social Status (SSS) and health (physical health and mental health) in the Chinese adult population. METHODS By applying between-within model, we disentangle the relationship between health outcomes and: (1) between-individual differences in SSS and (2) within-individual variations of SSS across time. In addition, to explore SSS mobility and trajectory, we further decomposed SSS into lagged SSS and the change between the current and lagged SSS (mobility). RESULTS We find that there is significantly positive and unique relationship (independent of Objective Social Status (OSS)) between SSS and physical and mental health. However, for physical health, we observed an Inverse-U effect of average SSS, after some point (SSS = 3.93), higher average SSS is associated with a score decrease. Through heterogeneity analysis, we find that for physical health, within- and between-effects decreases with age and for mental health, the within effect is only significant among the urban population. Individuals with high expected mobility are also found to have significantly better health. CONCLUSIONS These findings show that the personal relative deprivation has negative, particularly salient and unique effects on the health of the Chinese population, and it is important to consider the dynamic nature of SSS.
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Affiliation(s)
- Yanshang Wang
- School of Public Health, Peking University, Beijing, China.,China Center for Health Development Studies, Peking University, Beijing, China
| | - Mingzheng Hu
- School of Public Health, Peking University, Beijing, China.,China Center for Health Development Studies, Peking University, Beijing, China
| | - Ruoxi Ding
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Ping He
- China Center for Health Development Studies, Peking University, Beijing, China
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10
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Chen H, Zhang X. Influences of temperature and humidity on cardiovascular disease among adults 65 years and older in China. Front Public Health 2023; 10:1079722. [PMID: 36699927 PMCID: PMC9868618 DOI: 10.3389/fpubh.2022.1079722] [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: 10/25/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Background The burden of cardiovascular disease (CVD) on the current aging society in China is substantial. Climate change, including extreme temperatures and humidity, has a detrimental influence on health. However, epidemiological studies have been unable to fully identify the association between climate change and CVD among older adults. Therefore, we investigated the associations between temperature and relative humidity and CVD among older adults in China. Methods We used cohort data from the China Longitudinal Health and Longevity Survey (CLHLS) conducted in 2002, 2005, 2008, 2011, 2014, and 2018. A total of 39,278 Chinese adults 65 years and older participated in the analyses. The average annual temperatures and relative humidity during 2001 and 2017 (before the survey year) at the city level in China were used as the exposure measures. We selected patients with hypertension, heart disease, and stroke to create a sample of CVD patients. The associations between temperature and relative humidity and CVD were analyzed using the generalized estimation equation (GEE) model. Covariates included sociodemographic factors, health status, lifestyle, and cognitive function. Results The average annual temperature was negatively correlated with the prevalence of CVD. Every 1°C increase in the average annual temperature reduced the rates of hypertension by 3% [odds ratio (OR): 0.97; 95% confidence interval (CI): 0.96-0.97], heart disease by 6% (OR: 0.94; 95% CI: 0.92-0.95), and stroke by 5% (OR: 0.95; 95% CI: 0.94-0.97). The results of the analyses stratified by sex, urban/rural residence, and educational level were robust. The average annual relative humidity was inversely associated with the likelihood of CVD among older adults. Every 1% increase in the average annual relative humidity reduced the rates of hypertension by 0.4% (OR: 0.996; 95% CI: 0.99-1.00), heart disease by 0.6% (OR: 0.994; 95% CI: 0.99-1.00), and stroke by 0.08% (OR: 0.992; 95% CI: 0.98-1.00). However, the effects were more obvious with higher humidity levels (>70). Conclusion Our findings suggest that higher temperatures and relative humidity may reduce the risk of CVD among older adults.
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Affiliation(s)
- Huashuai Chen
- Department of International Trade, Business School of Xiangtan University, Xiangtan, China,*Correspondence: Huashuai Chen ✉
| | - Xuebin Zhang
- School of Urban and Regional Science, Shanghai University of Finance and Economics, Shanghai, China
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11
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Schuch HS, Peres KG, Haag DG, Boing AF, Peres MA. The independent and joint contribution of objective and subjective socioeconomic status on oral health indicators. Community Dent Oral Epidemiol 2022; 50:570-578. [PMID: 34882815 DOI: 10.1111/cdoe.12715] [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: 06/02/2021] [Revised: 10/14/2021] [Accepted: 11/24/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVES The understanding of how subjective socioeconomic status (SSS) relates to objective socioeconomic status (OSS), and how both conditions act together in oral health outcomes is still unclear. This study aims to test the independent and joint association between OSS and SSS with oral health, to assess the role of socioeconomic status discrepancies, and to evaluate the role of SSS in the association between OSS and oral health. METHODS Data from 1140 adults from a population-based study in Southern Brazil were used. We applied diagonal reference models DRM to disentangle the effects of OSS (education) and SSS (MacArthur Scale) to oral health outcomes. The outcomes were functional dentition clinically evaluated (FD ≥20 teeth) and self-reported oral health SROH. We also examined the discrepancy between OSS and SSS to oral health indicators and the effect measure modification (EMM) of SSS on the association between OSS and oral health. RESULTS Subjective socioeconomic status and OSS contributed equally to SROH, while OSS explained a substantially higher amount of FD than SSS (0.85 vs 0.15). An EMM of SSS was found on the association between OSS and fair/poor SROH, with a relative excess risk due to interaction (RERI) of 1.08. Less evidence of EMM was found for FD (RERI = 0.14). Individuals with lower SSS and OSS had four times the risk of the outcomes than the reference group. CONCLUSIONS Adults with concordant lower SSS and OSS have a worse oral health than those with concordant higher status. There was evidence that the association between OSS and SROH is modified by SSS.
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Affiliation(s)
- Helena S Schuch
- Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, Brazil
| | - Karen G Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore, Singapore.,Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Dandara G Haag
- Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Antonio F Boing
- Department of Public Health, Federal University of Santa Catarina, Florianopolis, Brazil
| | - Marco A Peres
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore, Singapore.,Oral Health ACP, Health Services and Systems Research Programme, Duke-NUS Medical School, Singapore, Singapore
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12
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Neubert M, Süssenbach P, Euteneuer F. Subjective social status and nocturnal blood pressure dipping. J Psychosom Res 2022; 163:111065. [PMID: 36327531 DOI: 10.1016/j.jpsychores.2022.111065] [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: 02/08/2022] [Revised: 10/15/2022] [Accepted: 10/15/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Low social status has been linked to cardiovascular disease. Subjective social status (SSS), which represents one's perceived position in a social hierarchy, has been suggested to predict health outcomes beyond objective measures of socioeconomic status. The present study examined if lower SSS is related to reduced nocturnal blood pressure (BP) dipping, a risk factor for cardiovascular disease. METHODS In this cross-sectional study, a community sample of 53 healthy adults underwent 24-h ambulatory BP monitoring. All participants provided information on SSS and objective measures of socioeconomic status (i.e., education, occupation, and income). SSS was measured in comparison to others in the country (national SSS) as well as in comparison to one's social environment (local SSS) using the German versions of the MacArthur Scales. RESULTS Analyses found that participants with low local SSS exhibited attenuated nocturnal diastolic blood pressure dipping (β = 0.29, 95% CI [0.01, 0.57], p = .043) and mean arterial pressure dipping (β = 0.29, 95% CI [0.01, 0.57], p = .041). These associations remained significant after adjusting for objective socioeconomic status. No significant associations between national SSS and cardiovascular measures were observed. CONCLUSION In conclusion, one's perceived social position in the social environment (i.e., local SSS) is associated with nocturnal BP dipping. Therefore, local SSS may be an important psychosocial factor linking social inequality and cardiovascular health.
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Affiliation(s)
- Marie Neubert
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany; Department of Clinical Psychology, University of Siegen, Siegen, Germany.
| | - Philipp Süssenbach
- Department for Human Resources/Health/Social Sciences, Fachhochschule des Mittelstands (University of Applied Sciences), Bielefeld, Bielefeld, Germany
| | - Frank Euteneuer
- Department of Clinical Psychology and Psychotherapy, Philipps University, Marburg, Germany; Department of Psychology, Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
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13
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Verburgh M, Verdonk P, Appelman Y, Brood-van Zanten M, Hulshof C, Nieuwenhuijsen K. Workplace Health Promotion Among Ethnically Diverse Women in Midlife With a Low Socioeconomic Position. HEALTH EDUCATION & BEHAVIOR 2022; 49:1042-1055. [PMID: 35125009 PMCID: PMC9574907 DOI: 10.1177/10901981211071030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Workplace health promotion (WHP) may be an appropriate way to support women with a low socioeconomic position (SEP) during midlife. Little is known about reaching and engaging women in WHP, particularly not at the intersection of midlife, low SEP, and ethnicity. We initiated the ProudWoman project, in which we implemented a WHP intervention aimed at supporting midlife women as a pilot in an academic hospital. We qualitatively evaluated the implementation using the RE-AIM framework. The pilot comprised multiple steps: tailoring the intervention to the needs of ethnically diverse group of midlife women with a low SEP, developing an implementation protocol, implementing the tailored intervention, and evaluating the implementation process. The main findings of our study are: (1) due to a wide range of recruitment activities that were actively deployed, we were able to reach an ethnically diverse group of midlife women with a low SEP; (2) regarding adoption, awareness of the relevance of this topic as an occupational health challenge was not self-evident at the organizational level; (3) according to our participants, various facilitators and barriers should be taken into account in the implementation of the work-life program; and (4) our focus group discussion revealed as maintenance is relevant to these levels in different ways, awareness of midlife and menopause as an occupational health challenge should be raised at four professional levels. We conclude that elements, such as an active and personal recruitment approach, are important in the implementation of WHP for ethnically diverse midlife women with an SEP.
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Affiliation(s)
| | - Petra Verdonk
- Vrije Universiteit Amsterdam,
Amsterdam, The Netherlands
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14
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Abstract
Since the identification of sickle cell trait as a heritable form of resistance to malaria, candidate gene studies, linkage analysis paired with sequencing, and genome-wide association (GWA) studies have revealed many examples of genetic resistance and susceptibility to infectious diseases. GWA studies enabled the identification of many common variants associated with small shifts in susceptibility to infectious diseases. This is exemplified by multiple loci associated with leprosy, malaria, HIV, tuberculosis, and coronavirus disease 2019 (COVID-19), which illuminate genetic architecture and implicate pathways underlying pathophysiology. Despite these successes, most of the heritability of infectious diseases remains to be explained. As the field advances, current limitations may be overcome by applying methodological innovations such as cellular GWA studies and phenome-wide association (PheWA) studies as well as by improving methodological rigor with more precise case definitions, deeper phenotyping, increased cohort diversity, and functional validation of candidate loci in the laboratory or human challenge studies.
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Affiliation(s)
- Kyle D Gibbs
- Department of Molecular Genetics and Microbiology, School of Medicine, Duke University, Durham, North Carolina, USA;
| | - Benjamin H Schott
- Department of Molecular Genetics and Microbiology, School of Medicine, Duke University, Durham, North Carolina, USA; .,Duke University Program in Genetics and Genomics, Duke University, Durham, North Carolina, USA
| | - Dennis C Ko
- Department of Molecular Genetics and Microbiology, School of Medicine, Duke University, Durham, North Carolina, USA; .,Duke University Program in Genetics and Genomics, Duke University, Durham, North Carolina, USA.,Division of Infectious Diseases, Department of Medicine, School of Medicine, Duke University, Durham, North Carolina, USA
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15
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Shanahan MJ, Cole SW, Ravi S, Chumbley J, Xu W, Potente C, Levitt B, Bodelet J, Aiello A, Gaydosh L, Harris KM. Socioeconomic inequalities in molecular risk for chronic diseases observed in young adulthood. Proc Natl Acad Sci U S A 2022; 119:e2103088119. [PMID: 36252037 PMCID: PMC9621370 DOI: 10.1073/pnas.2103088119] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/31/2022] [Indexed: 12/14/2022] Open
Abstract
Many common chronic diseases of aging are negatively associated with socioeconomic status (SES). This study examines whether inequalities can already be observed in the molecular underpinnings of such diseases in the 30s, before many of them become prevalent. Data come from the National Longitudinal Study of Adolescent to Adult Health (Add Health), a large, nationally representative sample of US subjects who were followed for over two decades beginning in adolescence. We now have transcriptomic data (mRNA-seq) from a random subset of 4,543 of these young adults. SES in the household-of-origin and in young adulthood were examined as covariates of a priori-defined mRNA-based disease signatures and of specific gene transcripts identified de novo. An SES composite from young adulthood predicted many disease signatures, as did income and subjective status. Analyses highlighted SES-based inequalities in immune, inflammatory, ribosomal, and metabolic pathways, several of which play central roles in senescence. Many genes are also involved in transcription, translation, and diverse signaling mechanisms. Average causal-mediated effect models suggest that body mass index plays a key role in accounting for these relationships. Overall, the results reveal inequalities in molecular risk factors for chronic diseases often decades before diagnoses and suggest future directions for social signal transduction models that trace how social circumstances regulate the human genome.
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Affiliation(s)
- Michael J. Shanahan
- Jacobs Center for Productive Youth Development, University of Zürich, Zürich, CH 8050
- Department of Sociology, University of Zürich, Zürich, CH 8050
| | - Steven W. Cole
- School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095
| | - Sudharshan Ravi
- Jacobs Center for Productive Youth Development, University of Zürich, Zürich, CH 8050
| | - Justin Chumbley
- Jacobs Center for Productive Youth Development, University of Zürich, Zürich, CH 8050
| | - Wenjia Xu
- Jacobs Center for Productive Youth Development, University of Zürich, Zürich, CH 8050
| | - Cecilia Potente
- Jacobs Center for Productive Youth Development, University of Zürich, Zürich, CH 8050
| | - Brandt Levitt
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516
| | - Julien Bodelet
- Jacobs Center for Productive Youth Development, University of Zürich, Zürich, CH 8050
| | - Allison Aiello
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516
| | - Lauren Gaydosh
- Department of Sociology, University of Texas at Austin, Austin, TX 78712
| | - Kathleen Mullan Harris
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3210
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16
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Zhang X, Zhao Q, Wang M, Yang M, Fan X. Fear of movement and its associated psychosocial factors in heart failure patients: A cross-sectional study. Eur J Cardiovasc Nurs 2022; 22:273-281. [PMID: 35989416 DOI: 10.1093/eurjcn/zvac075] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/13/2022] [Accepted: 08/17/2022] [Indexed: 11/13/2022]
Abstract
AIMS Fear of movement is a significant obstacle to daily activities, which may lead to adverse outcomes in patients with heart failure. This study aimed to examine the prevalence of fear of movement and to identify psychosocial factors associated with fear of movement in heart failure patients. METHODS AND RESULTS In this cross-sectional study, a total of 305 heart failure patients were recruited from three cardiovascular units of a university hospital. Self-reported questionnaires were used to measure fear of movement, cardiac anxiety, depressive symptoms, subjective social status, education, monthly income, and employment status. The results showed that 178 (58.4%) patients were accompanied with fear of movement. Hierarchical linear regression analysis showed that scores for cardiac anxiety (β=0.254, p < 0.001) and depressive symptoms (β=0.308, p < 0.001), as well as being employed (β=0.186, p < 0.001) were positively associated with fear of movement score, while the score for subjective social status (β=-0.101, p = 0.038) was negatively associated with fear of movement score. The four independent variables accounted for 30.3% of the variance in fear of movement. CONCLUSIONS Fear of movement is common in patients with heart failure. Cardiac anxiety, depressive symptoms, subjective social status, and employment status were associated with patients' fear of movement. This indicates that measures should be taken to screen and manage patients' fear of movement. Furthermore, alleviating cardiac anxiety and depressive symptoms may be important to consider in relieving fear of movement in heart failure patients, especially for those who are employed and with low subjective social status.
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Affiliation(s)
- Xiuting Zhang
- Candidate, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Qiuge Zhao
- Candidate, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Mei Wang
- Master Candidate, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Mei Yang
- Master Candidate, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiuzhen Fan
- Professor and Associate Dean, School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
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17
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Perner MS, Alazraqui M, Amorim LD. Social inequalities between neighborhoods and cardiovascular disease: a multilevel analysis in a Latin American city. CIENCIA & SAUDE COLETIVA 2022; 27:2597-2608. [PMID: 35730831 DOI: 10.1590/1413-81232022277.21662021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/05/2022] [Indexed: 11/21/2022] Open
Abstract
Studies analyzing relations between cardiovascular diseases (CVDs) and environmental aspects in Latin American cities are relatively recent and limited, since most of them are conducted in high-income countries, analyzing mortality outcomes, and comprising large areas. This research focuses on adults with diabetes and/or hypertension under clinical follow-up who live in deprived areas. At the individual level we evaluated sociodemographic and cardiovascular risk factors from patient's records, and at the neighborhood level, socioeconomic conditions from census data. A multilevel analysis was carried out to study CVD. More women than men were under clinical follow-up, but men had higher frequency, higher odds, and shorter time to CVD diagnosis. Multilevel analysis showed that residing in neighborhoods with worst socioeconomic conditions leads to higher odds of CVDs, even after controlling for individual variables: OR (CI95%) of CVD in quartile 2 (Q2) 3.9 (1.2-12.1); Q3 4.0 (1.3-12.3); Q4 2.3 (0.7-8.0) (vs. highest socioeconomic level quartile). Among individuals living in unequal contexts, we found differences in CVD, which makes visible inequalities within inequalities. Differences between women and men should be considered through a gender perspective.
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Affiliation(s)
- Mónica Serena Perner
- Instituto de Salud Colectiva, Universidade Nacional de Lanús. CONICET (National Scientific and Technical Research Council - Argentina). 29 de Septiembre 3901, B1824PJU, Remedios de Escalada. Lanús Argentina.
| | - Marcio Alazraqui
- Instituto de Salud Colectiva, Universidade Nacional de Lanús. Lanús Argentina
| | - Leila D Amorim
- Instituto de Matemática e Estatística, Universidade Federal da Bahia. Salvador BA Brasil
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18
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Cheon BK, Lee LL. Subjective socioeconomic disadvantage is indirectly associated with food portion selection through perceived disruption of personal resources during a nationwide COVID-19 stay-at-home order. Appetite 2022; 178:106158. [PMID: 35780937 PMCID: PMC9245368 DOI: 10.1016/j.appet.2022.106158] [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: 10/14/2021] [Revised: 06/18/2022] [Accepted: 06/28/2022] [Indexed: 11/29/2022]
Abstract
In addition to its public health implications, the global COVID-19 pandemic has also produced significant disruptions to individuals' socioeconomic resources and opportunities. Prior research has suggested that low subjective socioeconomic status (SSES) may stimulate appetite and motivate increased energy intake. Here, we tested whether individuals experiencing lower levels of SSES (SSES disadvantage) during a nationwide stay-at-home order for COVID-19 exhibited preferences for larger food portion sizes through perceived disruptions to personal financial and material resources. Data was collected near the conclusion of a nationwide partial lockdown (Singapore's “Circuit-Breaker” from April to June 2020). Participants (N = 295) completed an online survey involving a measure of SSES, the Coronavirus Impacts Questionnaire, and a food portion selection task where participants estimated the portion size they prefer to consume for a range of common foods. SSES disadvantage was associated with selection of smaller average portion sizes. Yet, a significant indirect effect of coronavirus impact was observed in this relationship, such that participants experiencing greater SSES disadvantage selected larger portion sizes through the effect of greater perceived impacts of COVID-19 to one's financial/material resources (controlling for one's actual level of income). These findings further support the idea that perceived deprivation and insecurity of important resources (financial, social, material) may influence intentions to consume greater amounts of energy. Consequently, systematic societal disruptions to such resources may reinforce and perpetuate potentially obesogenic eating behaviors of populations that are especially vulnerable to such shocks (i.e., people experiencing SSES disadvantage).
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Affiliation(s)
- Bobby K Cheon
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
| | - Li Ling Lee
- School of Social Sciences (Psychology), Nanyang Technological University, Singapore
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19
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Mental Stress and Cardiovascular Health-Part I. J Clin Med 2022; 11:jcm11123353. [PMID: 35743423 PMCID: PMC9225328 DOI: 10.3390/jcm11123353] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 12/30/2022] Open
Abstract
Epidemiological studies have shown that a substantial proportion of acute coronary events occur in individuals who lack the traditional high-risk cardiovascular (CV) profile. Mental stress is an emerging risk and prognostic factor for coronary artery disease and stroke, independently of conventional risk factors. It is associated with an increased rate of CV events. Acute mental stress may develop as a result of anger, fear, or job strain, as well as consequence of earthquakes or hurricanes. Chronic stress may develop as a result of long-term or repetitive stress exposure, such as job-related stress, low socioeconomic status, financial problems, depression, and type A and type D personality. While the response to acute mental stress may result in acute coronary events, the relationship of chronic stress with increased risk of coronary artery disease (CAD) is mainly due to acceleration of atherosclerosis. Emotionally stressful stimuli are processed by a network of cortical and subcortical brain regions, including the prefrontal cortex, insula, amygdala, hypothalamus, and hippocampus. This system is involved in the interpretation of relevance of environmental stimuli, according to individual’s memory, past experience, and current context. The brain transduces the cognitive process of emotional stimuli into hemodynamic, neuroendocrine, and immune changes, called fight or flight response, through the autonomic nervous system and the hypothalamic–pituitary–adrenal axis. These changes may induce transient myocardial ischemia, defined as mental stress-induced myocardial ischemia (MSIMI) in patients with and without significant coronary obstruction. The clinical consequences may be angina, myocardial infarction, arrhythmias, and left ventricular dysfunction. Although MSIMI is associated with a substantial increase in CV mortality, it is usually underestimated because it arises without pain in most cases. MSIMI occurs at lower levels of cardiac work than exercise-induced ischemia, suggesting that the impairment of myocardial blood flow is mainly due to paradoxical coronary vasoconstriction and microvascular dysfunction.
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20
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Liu CH, Koire A, Erdei C, Mittal L. Subjective social status, COVID-19 health worries, and mental health symptoms in perinatal women. SSM Popul Health 2022; 18:101116. [PMID: 35582494 PMCID: PMC9098429 DOI: 10.1016/j.ssmph.2022.101116] [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: 10/16/2021] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Pregnant women and those who have recently given birth are considered an at-risk population during the COVID-19 pandemic with regards to the impact of both general stress and pandemic-related stressors. The extent to which subjective social status (SSS), one's perception of relative standing compared to others in a social hierarchy, might mitigate the effects of COVID-19-related health worries on mental health has not yet been reported, despite SSS often outperforming socioeconomic status as a predictor of various health outcomes including depression. This cross-sectional survey study tested the moderating effect of SSS on association between COVID-19- related health worries and mental health symptoms (depressive and generalized anxiety) among a sample of 1,637 perinatal women from the United States who took part in the Perinatal Experiences and COVID-19 Effects (PEACE) Study between May 2020 and June 2021. We found that high subjective social status was protective against depressive symptoms when self-reported COVID-19-related worry was low. When COVID-19-related worry was high, subjective social status was no longer influential. Higher levels of COVID-19-related health worries were associated with more anxiety symptoms, and higher subjective social status did not moderate anxiety symptomatology at either level of COVID-19-related worry. Although higher SSS has historically been protective against mental health decline, in the context of the COVID-19 pandemic it may not be sufficiently protective against anxiety, or against depression for those who experience high levels of worry regarding the effects of COVID-19 on health.
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Affiliation(s)
- Cindy H. Liu
- Department of Newborn Medicine, Brigham and Women's Hospital, 221 Longwood Ave., Boston, MA, 02115, USA
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Amanda Koire
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Carmina Erdei
- Department of Newborn Medicine, Brigham and Women's Hospital, 221 Longwood Ave., Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Leena Mittal
- Department of Psychiatry, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
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21
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Johansson MS, Holtermann A, Marott JL, Prescott E, Schnohr P, Korshøj M, Søgaard K. The physical activity health paradox and risk factors for cardiovascular disease: A cross-sectional compositional data analysis in the Copenhagen City Heart Study. PLoS One 2022; 17:e0267427. [PMID: 35446893 PMCID: PMC9022831 DOI: 10.1371/journal.pone.0267427] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/09/2022] [Indexed: 12/03/2022] Open
Abstract
Background Studies indicate that physical activity during leisure and work have opposite associations with cardiovascular disease (CVD) risk factors, referred to as the physical activity health paradox. We investigated how sedentary behaviour and physical activity types during leisure and work are associated with systolic blood pressure (SBP), waist circumference (WC), and low-density lipoprotein cholesterol (LDL-C) in an adult general population sample using compositional data analysis. Methods Participants wore accelerometers for 7 days (right thigh and iliac crest; 24 h/day) and had their SBP, WC, and LDL-C measured. Accelerometer data was analysed using the software Acti4 to derive daily time spent in sedentary behaviour and physical activity types. The measure of association was quantified by reallocating time between sedentary behaviour and 1) walking, and 2) high-intensity physical activity (HIPA; sum of climbing stairs, running, cycling, and rowing), during both domains. Results In total, 652 participants were included in the analyses (median wear time: 6 days, 23.8 h/day). During leisure, the results indicated that less sedentary behaviour and more walking or more HIPA was associated with lower SBP, while during work, the findings indicated an association with higher SBP. During both domains, the findings indicated that less sedentary behaviour and more HIPA was associated with a smaller WC and lower LDL-C. However, the findings indicated less sedentary behaviour and more walking to be associated with a larger WC and higher LDL-C, regardless of domain. Conclusions During leisure, less sedentary behaviour and more walking or HIPA seems to be associated with a lower SBP, but, during work, it seems to be associated with a higher SBP. No consistent differences between domains were observed for WC and LDL-C. These findings highlight the importance of considering the physical activity health paradox, at least for some risk factors for CVD.
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Affiliation(s)
- Melker S. Johansson
- Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- * E-mail:
| | - Andreas Holtermann
- Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jacob L. Marott
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Eva Prescott
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Mette Korshøj
- Musculoskeletal Disorders and Physical Workload, National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Occupational and Social Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Karen Søgaard
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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22
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Sasko B, Jaehn P, Müller R, Andresen H, Müters S, Holmberg C, Ritter O, Pagonas N. Understanding the importance of social determinants and rurality for the long-term outcome after acute myocardial infarction: study protocol for a single-centre cohort study. BMJ Open 2022; 12:e056888. [PMID: 35428636 PMCID: PMC9013987 DOI: 10.1136/bmjopen-2021-056888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Acute myocardial infarction (AMI) is a major public health issue in Germany with considerable regional differences in morbidity and mortality. Possible reasons for regional differences include a higher prevalence of cardiovascular risk factors, infrastructural deficits, different levels of healthcare quality or social determinants. We aim to study associations of social determinants and of rural infrastructure with the quality of medical care (eg, time to reperfusion or medication adherence) and on the long-term outcome after myocardial infarction. METHODS AND ANALYSIS We will employ a prospective cohort study design. Patients who are admitted with AMI will be invited to participate. We aim to recruit a total of 1000 participants over the course of 5 years. Information on outpatient care prior to AMI, acute healthcare of AMI, healthcare-related environmental factors and social determinants will be collected. Baseline data will be assessed in interviews and from the electronic data system of the hospital. Follow-up will be conducted after an observation period of 1 year via patient interviews. The outcomes of interest are cardiac and all-cause mortality, changes in quality of life, changes in health status of heart failure, major adverse cardiovascular events and participation in rehabilitation programmes. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethics Committee of Brandenburg Medical School (reference: E-01-20200923). Research findings will be disseminated and shared in different ways and include presenting at international and national conferences, publishing in peer-reviewed journals and facilitating dissemination workshops within local communities with patients and healthcare professionals. TRIALS REGISTRATION NUMBER DRKS00024463.
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Affiliation(s)
- Benjamin Sasko
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Philipp Jaehn
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Rhea Müller
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Henrike Andresen
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Stephan Müters
- Department of Epidemiology and Health Monitoring, Robert Koch Institut, Berlin, Germany
| | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Oliver Ritter
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Nikolaos Pagonas
- Department of Cardiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
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23
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Sasaki Y, Shobugawa Y, Nozaki I, Takagi D, Nagamine Y, Funato M, Chihara Y, Shirakura Y, Lwin KT, Zin PE, Bo TZ, Sone T, Win HH. Association between Happiness and Economic Status among Older Adults in Two Myanmar Regions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3216. [PMID: 35328904 PMCID: PMC8951419 DOI: 10.3390/ijerph19063216] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 12/04/2022]
Abstract
Few studies have examined whether objective or subjective economic status (ES) has a greater association with the happiness of older adults, despite concerns regarding the growing economic cost of morbidity and their functional dependence in developing countries with aging populations. Thus, this study examined whether objective/subjective ES was associated with happiness in older adults in two Myanmar regions. A multistage random sampling procedure and face-to-face interviews were conducted in the urban and rural areas of Myanmar. The happiness of 1200 participants aged >60 years was evaluated using a single happiness score ranging from 0 (very unhappy) to 10 (very happy). The wealth index, used as an objective ES, was calculated from 17 household asset items, such as radio, washing machines, and television. Subjective ES was assessed by asking “Which of the following best describes your current financial situation in light of general economic conditions?” Responses ranged from “very difficult” to “very comfortable”. Both low objective and subjective ES were negatively associated with happiness, after adjusting for confounding variables and stratification by region (urban and rural areas). Although objective and subjective ES had similar associations with happiness in urban areas, subjective ES had a stronger association in rural areas.
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Affiliation(s)
- Yuri Sasaki
- Department of International Health and Collaboration, National Institute of Public Health, Wako City 351-0197, Japan
| | - Yugo Shobugawa
- Graduate School of Medical and Dental Sciences, Niigata University, Niigata City 951-8510, Japan; (Y.S.); (Y.C.); (Y.S.)
| | - Ikuma Nozaki
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan;
| | - Daisuke Takagi
- Department of Health and Social Behavior, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan;
| | - Yuiko Nagamine
- Department of Family Medicine, Tokyo Medical and Dental University, Tokyo 113-8510, Japan;
| | - Masafumi Funato
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Yuki Chihara
- Graduate School of Medical and Dental Sciences, Niigata University, Niigata City 951-8510, Japan; (Y.S.); (Y.C.); (Y.S.)
| | - Yuki Shirakura
- Graduate School of Medical and Dental Sciences, Niigata University, Niigata City 951-8510, Japan; (Y.S.); (Y.C.); (Y.S.)
| | - Kay Thi Lwin
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon 245, Myanmar; (K.T.L.); (P.E.Z.); (T.Z.B.); (H.H.W.)
| | - Poe Ei Zin
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon 245, Myanmar; (K.T.L.); (P.E.Z.); (T.Z.B.); (H.H.W.)
| | - Thae Zarchi Bo
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon 245, Myanmar; (K.T.L.); (P.E.Z.); (T.Z.B.); (H.H.W.)
| | - Tomofumi Sone
- National Institute of Public Health, Wako City 351-0197, Japan;
| | - Hla Hla Win
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon 245, Myanmar; (K.T.L.); (P.E.Z.); (T.Z.B.); (H.H.W.)
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Kempel MK, Winding TN, Böttcher M, Andersen JH. Subjective social status and cardiometabolic risk markers in young adults. Psychoneuroendocrinology 2022; 137:105666. [PMID: 35038663 DOI: 10.1016/j.psyneuen.2022.105666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Low subjective social status (SSS), the perceived status in the social hierarchy, is associated with cardiometabolic risk in middle-aged and older adults. However, most studies are cross-sectional and very little is known about the association in adolescence and young adulthood. The aims of this study were; a) to prospectively investigate the association between SSS at ages 15 and 28 and cardiometabolic risk at age 28-30 and b) to examine if such an association was independent of smoking, physical activity and objective measures of social position. METHODS The study used questionnaire information at ages 15 and 28 from the West Jutland Cohort Study (N = 3681), health measurements from a sub-sample of the cohort (N = 264, age 28-30, 50% women) and information from population-based national registers. The independent variable was a measure of SSS evaluated by a 10-rung ladder scale and dichotomized at the 25th percentile of data from the cohort study population. The outcome measure was a composite score of cardiometabolic risk including measures of lipids, inflammation, blood pressure and glucose-metabolism. Co-variates included smoking, physical activity, childhood and adulthood socioeconomic position. Sex-stratified linear regression analyses were performed to evaluate the associations between SSS and cardiometabolic risk. RESULTS In both sexes, low SSS at age 28, but not at age 15, was significantly associated with increased cardiometabolic risk at age 28-30. Neither smoking, physical activity, childhood or adulthood objective socioeconomic position fully explained the associations. CONCLUSION In young adulthood, SSS was inversely related to cardiometabolic risk after accounting for smoking, physical activity and objective measures of socioeconomic position. These findings suggest that SSS could play a role in the social disparities in cardiometabolic risk in addition to traditional measures of socioeconomic position.
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Affiliation(s)
- Mia Klinkvort Kempel
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Occupational Medicine - University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Herning, Denmark.
| | - Trine Nøhr Winding
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Occupational Medicine - University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Herning, Denmark
| | - Morten Böttcher
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Cardiovascular Research Unit - University Research Clinic, Department of Cardiology, Goedstrup Hospital, Herning, Denmark
| | - Johan Hviid Andersen
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark; Department of Occupational Medicine - University Research Clinic, Danish Ramazzini Centre, Goedstrup Hospital, Herning, Denmark
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Wittström F, Skajaa N, Bonnesen K, Pedersen L, Ekholm O, Strate L, Erichsen R, Sørensen HT. Type 2 diabetes and risk of diverticular disease: a Danish cohort study. BMJ Open 2022; 12:e059852. [PMID: 35190447 PMCID: PMC8862453 DOI: 10.1136/bmjopen-2021-059852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To investigate the association between type 2 diabetes and risk of diverticular disease. Unlike previous studies, which have found conflicting results, we aimed to distinguish between diabetes types and adjust for modifiable risk factors. DESIGN Observational cohort study. SETTING Population-based Danish medical databases, covering the period 2005-2018. PARTICIPANTS Respondents of the 2010 or the 2013 Danish National Health Survey, of which there were 15 047 patients with type 2 diabetes and 210 606 patients without diabetes. PRIMARY AND SECONDARY OUTCOME MEASURES Hazard ratios (HRs) for incident hospital diagnosis of diverticular disease adjusted for survey year, sex, age, body mass index (BMI), physical activity intensity, smoking behaviour, diet and education based on Cox regression analysis. As latency may affect the association between type 2 diabetes and diverticular disease, patients with type 2 diabetes were stratified into those with <2.5, 2.5-4.9 and ≥5 years duration of diabetes prior to cohort entry. RESULTS For patients with and without diabetes the incidence rates of diverticular disease were 0.76 and 0.54 events per 1000 person years, corresponding to a crude HR of 1.08 (95% CI 1.00 to 1.16) and an adjusted HR of 0.88 (95% CI 0.80 to 0.96). The HR was lower among patients with ≥5 years duration of diabetes (adjusted HR: 0.76, 95% CI 0.67 to 0.87) than among those with 2.5-4.9 years or <2.5 years duration. CONCLUSION We found that patients with type 2 diabetes had a higher incidence rate of diverticular disease compared with patients without diabetes. However, after adjustment for modifiable risk factors, driven by BMI, type 2 diabetes appeared to be associated with a slightly lower risk of diverticular disease. Lack of adjustment for BMI may partially explain the conflicting findings of previous studies.
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Affiliation(s)
- Felix Wittström
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Pharmacology, Aalborg University Hospital, Aalborg, Denmark
| | - Nils Skajaa
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Bonnesen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lisa Strate
- Department of Medicine, University of Washington Medical School, Seattle, Washington, USA
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Varghese JS, Hall RW, Adair LS, Patel SA, Martorell R, Belleza DE, Kroker-Lobos MF, Lee NR, Nyati LH, Ramirez-Zea M, Richter LM, Stein AD. Subjective social status is associated with happiness but not weight status or psychological distress: An analysis of three prospective birth cohorts from low- and middle-income countries. WELLBEING, SPACE AND SOCIETY 2022; 3:None. [PMID: 36518911 PMCID: PMC9732742 DOI: 10.1016/j.wss.2022.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 09/27/2022] [Accepted: 11/08/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Subjective social status (SSS, perception of social position relative to a frame of reference) has been associated with physical, mental and socio-emotional wellbeing. However, these associations may be susceptible to unmeasured confounding by life course objective socio-economic position (SEP; such as wealth, education and employment) and life satisfaction. PURPOSE To estimate the association of position on ladders of perceived community respect and perceived economic status with weight, distress and wellbeing, independent of objective SEP in cohorts from three low and middle-income countries. METHODS We used data from birth cohorts in Guatemala (n = 1258), Philippines (n = 1323) and South Africa (n = 1393). We estimated the association of perceived community respect and perceived economic status with body mass index (kg/m2), the World Health Organization's Self-Reported Questionnaire-20 (SRQ-20) for psychological distress, and Lyubomirsky's Subjective Happiness Scale. We estimated these associations using robust linear regression models adjusting for indicators of life course objective SEP, early life characteristics, adult covariates, and life satisfaction. RESULTS Participants in South Africa (age 27-28y) rated themselves higher on average for both the respect (7 vs 5 in Guatemala and 6 in Philippines) and economic (5 vs 3 in Guatemala and 4 in Philippines) ladder measures. Position on neither community respect nor economic ladders were associated with BMI or psychological distress. Higher position on community respect (Guatemala: 0.03, 95%CI: 0.01, 0.04; Philippines: 0.03, 95% CI: 0.02, 0.05; South Africa: 0.07, 95%CI: 0.04, 0.09) and economic (Guatemala: 0.02, 95%CI: 0, 0.04; Philippines: 0.04, 95%CI: 0.02, 0.07; South Africa: 0.07, 95%CI: 0.04, 0.10) ladders were associated with greater happiness. CONCLUSIONS Subjective social status showed small but consistent associations with happiness in birth cohorts independent of life-course SEP.
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Affiliation(s)
- Jithin Sam Varghese
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rachel Waford Hall
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Shivani A Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Reynaldo Martorell
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Delia E. Belleza
- Department of Psychology, University of San Carlos, Cebu City, Philippines
| | - Maria F Kroker-Lobos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Nanette R. Lee
- USC-Office of Population Studies Foundation, Inc, University of San Carlos, Cebu City, Philippines
| | - Lukhanyo H. Nyati
- SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Manuel Ramirez-Zea
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Linda M Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Aryeh D. Stein
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Hu LX, Tang M, Hua W, Ren XQ, Jia YH, Chu JM, Zhang JT, Liu XN. Psychological Disturbances and Their Association with Sleep Disturbance in Patients Admitted for Arrhythmia Diseases. Neuropsychiatr Dis Treat 2022; 18:1739-1750. [PMID: 36000025 PMCID: PMC9393031 DOI: 10.2147/ndt.s370128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study aimed to assess the depression and anxiety status and their association with sleep disturbance among one single center Chinese inpatients with arrhythmia and help cardiologists better identify patients who need psychological care. METHODS A cross-sectional survey was conducted among 495 inpatients with arrhythmia treated in Fuwai Hospital from October to December 2019. The psychological status and sleep quality were assessed using the Zung Self-Rating Anxiety Scale (SAS), the Zung Self-Rating Depression Scale (SDS) and the Pittsburgh Sleep Quality Index (PSQI). Multivariate logistic regression was used to identify the potential risk factors for anxiety and depression. RESULTS The mean age of the participants was 52.8 ± 14.4 years, and 58.0% were male. Approximately 18.3% were in an anxious state, and 33.5% were in a depressive state. In multivariate logistic regression, age from 50 to 59 (p = 0.03), unemployment (p = 0.026) and sleep disturbance (p < 0.001) were the risk factors for anxiety status. Cardiac implanted electronic devices (CIEDs) (p = 0.004) and sleep disturbance (p < 0.001) were the risk factors for depression status. A total of 150 patients (30.3%) were categorized as having poor sleep quality (PSQI > 7). The adjusted odds ratio (OR) of having poor sleep quality was 4.30-fold higher in patients with both anxiety and depression (OR: 4.30; 95% confidence interval [CI]: 2.52-7.35); 2.67-fold higher in patients with depression (OR: 2.67; 95% CI: 1.78-4.00); and 3.94-fold higher in patients with anxiety (OR: 3.94; 95% CI: 2.41-6.44). CONCLUSIONS Psychological intervention is critical for Chinese inpatients with arrhythmia, especially for patients aged 50-59, unemployed, or those using CIEDs. Poor sleep quality could be an important risk factor linked to psychological disturbances.
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Affiliation(s)
- Li-Xing Hu
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Min Tang
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Wei Hua
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Xiao-Qing Ren
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Yu-He Jia
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Jian-Min Chu
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Jing-Tao Zhang
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
| | - Xiao-Ning Liu
- Center of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, 100037, People's Republic of China
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Chen MA, Brown RL, Chen JY, de Dios MA, Green CE, Heijnen CJ, Fagundes CP. Childhood maltreatment, subjective social status, and health disparities in bereavement. Psychoneuroendocrinology 2022; 135:105595. [PMID: 34837775 PMCID: PMC8702370 DOI: 10.1016/j.psyneuen.2021.105595] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/21/2021] [Accepted: 11/08/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Spousal bereavement can lead to adverse health outcomes; however, not all widow(er)s experience the same degree of health problems. Thus, it is important to understand the contribution of disparities (e.g., childhood maltreatment and subjective social status) that may underlie adverse health outcomes that arise following bereavement. METHODS We collected data from 130 spousally bereaved individuals at 3-time points (3 months post-loss, 4 months post-loss, and 6 months post-loss). Using mixed models, we assessed the interaction of childhood maltreatment, subjective social status, and time to predict changes in proinflammatory cytokine production, depressive symptoms, grief symptoms. RESULTS We found a significant interaction between childhood maltreatment, subjective social status, and time predicting proinflammatory cytokine production (beta > -0.01, p = 0.048), depressive symptoms (beta = 0.008, p = .010), and grief symptoms (beta = 0.001 p = .001). CONCLUSION This study highlights the role of disparities related to childhood maltreatment and subjective social status on adverse health outcomes following spousal bereavement.
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Affiliation(s)
- Michelle A. Chen
- Department of Psychological Sciences, Rice University, 6100 Main St, Houston, TX 77005, USA
| | - Ryan L. Brown
- Department of Psychological Sciences, Rice University, 6100 Main St, Houston, TX 77005, USA
| | - Jonathan Y. Chen
- McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX 77030, USA,School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX 77030, USA
| | - Marcel A. de Dios
- Department of Psychological, Health, and Learning Sciences, University of Houston, 4800 Calhoun Rd, Houston, TX 77004, USA
| | - Charles E. Green
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Cobi J. Heijnen
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX 77030
| | - Christopher P. Fagundes
- Department of Psychological Sciences, Rice University, 6100 Main St, Houston, TX 77005, USA,Department of Behavioral Sciences, The University of Texas MD Anderson Cancer Center, 1515 Holcome Blvd, Houston, TX 77030, USA,Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
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Social Deprivation and Peripheral Artery Disease. Can J Cardiol 2021; 38:612-622. [PMID: 34971734 DOI: 10.1016/j.cjca.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/08/2021] [Accepted: 12/22/2021] [Indexed: 12/24/2022] Open
Abstract
The link between peripheral artery disease and socioeconomic status is complex. The objective of this narrative review is to explore this relationship in detail, including how social factors impact the development, management, and outcomes of peripheral artery disease. Although the current literature on this topic is limited, some patterns do emerge. Populations of low socioeconomic status appear to be at increased risk for the development of peripheral artery disease, due to factors such as increased prevalence of cardiovascular risk factors (i.e. cigarette smoking) and decreased access to care. However, variables that are more difficult to quantify, such as chronic stress and health literacy, also likely play a significant role. Among those who are living with peripheral artery disease, socioeconomic status can also affect disease management. Secondary prevention strategies, such as medication use, smoking cessation, and exercise therapy, are underutilized in socially deprived populations. This underutilization of evidence-based management leads to adverse outcomes in these groups, including increased rates of amputation and decreased post-operative survival. The recognition of the importance of social factors in prognosis is an important first step towards addressing this health disparity. Moving forward, interventions that help to identify those who are at high risk and help to improve access to care in populations of low socioeconomic status, will be critical to improving outcomes.
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30
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Zhao L, Hessel P, Simon Thomas J, Beckfield J. Inequality in Place: Effects of Exposure to Neighborhood-Level Economic Inequality on Mortality. Demography 2021; 58:2041-2063. [PMID: 34477828 DOI: 10.1215/00703370-9463660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study contributes to the debate on whether income inequality is harmful for health by addressing several analytical weaknesses of previous studies. Using the Panel Study of Income Dynamics in combination with tract-level measures of income inequality in the United States, we estimate the effects of differential exposure to income inequality during three decades of the life course on mortality. Our study is among the first to consider the implications of income inequality within U.S. tracts for mortality using longitudinal and individual-level data. In addition, we improve upon prior work by accounting for the dynamic relationship between local areas and individuals' health, using marginal structural models to account for changes in exposure to local income inequality. In contrast to other studies that found no significant relation between income inequality and mortality, we find that recent exposure to higher local inequality predicts higher relative risk of mortality among individuals at ages 45 or older.
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Affiliation(s)
- Linda Zhao
- Cornell Population Center, Cornell University, Ithaca, NY, USA
| | - Philipp Hessel
- Alberto Lleras Camargo School of Government, University of the Andes, Bogotá, Colombia
| | | | - Jason Beckfield
- Department of Sociology, Harvard University, Cambridge, MA, USA
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Lillard AS, Meyer MJ, Vasc D, Fukuda E. An Association Between Montessori Education in Childhood and Adult Wellbeing. Front Psychol 2021; 12:721943. [PMID: 34899465 PMCID: PMC8656358 DOI: 10.3389/fpsyg.2021.721943] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/26/2021] [Indexed: 01/07/2023] Open
Abstract
Wellbeing, or how people think and feel about their lives, predicts important life outcomes from happiness to health to longevity. Montessori pedagogy has features that enhance wellbeing contemporaneously and predictively, including self-determination, meaningful activities, and social stability. Here, 1905 adults, ages 18-81 (M = 36), filled out a large set of wellbeing scales followed by demographic information including type of school attended each year from 2 to 17. About half the sample had only attended conventional schools and the rest had attended Montessori for between 2 and 16 years (M = 8 years). To reduce the variable set, we first developed a measurement model of wellbeing using the survey data with exploratory then confirmatory factor analyses, arriving at four factors: general wellbeing, engagement, social trust, and self-confidence. A structural equation model that accounted for age, gender, race, childhood SES, and years in private school revealed that attending Montessori for at least two childhood years was associated with significantly higher adult wellbeing on all four factors. A second analysis found that the difference in wellbeing between Montessori and conventional schools existed even among the subsample that had exclusively attended private schools. A third analysis found that the more years one attended Montessori, the higher one's wellbeing as an adult. Unmeasured selection effects could explain the results, in which case research should determine what third variable associated with Montessori schooling causes adult wellbeing. Several other limitations to the study are also discussed. Although some of these limitations need to be addressed, coupled with other research, including studies in which children were randomly assigned to Montessori schools, this study suggests that attending Montessori as a child might plausibly cause higher adult wellbeing.
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Affiliation(s)
- Angeline S. Lillard
- Department of Psychology, University of Virginia, Charlottesville, VA, United States
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Boos CJ, Schofield S, Cullinan P, Dyball D, Fear NT, Bull AMJ, Pernet D, Bennett AN. Association between combat-related traumatic injury and cardiovascular risk. Heart 2021; 108:367-374. [PMID: 34824088 PMCID: PMC8862100 DOI: 10.1136/heartjnl-2021-320296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The association between combat-related traumatic injury (CRTI) and cardiovascular risk is uncertain. This study aimed to investigate the association between CRTI and both metabolic syndrome (MetS) and arterial stiffness. Methods This was a prospective observational cohort study consisting of 579 male adult UK combat veterans (UK-Afghanistan War 2003–2014) with CRTI who were frequency-matched to 565 uninjured men by age, service, rank, regiment, deployment period and role-in-theatre. Measures included quantification of injury severity (New Injury Severity Score (NISS)), visceral fat area (dual-energy X-ray absorptiometry), arterial stiffness (heart rate-adjusted central augmentation index (cAIx) and pulse wave velocity (PWV)), fasting venous blood glucose, lipids and high-sensitivity C reactive protein (hs-CRP). Results Overall the participants were 34.1±5.4 years, with a mean (±SD) time from injury/deployment of 8.3±2.1 years. The prevalence of MetS (18.0% vs 11.8%; adjusted risk ratio 1.46, 95% CI 1.10 to 1.94, p<0.0001) and the mean cAIx (17.61%±8.79% vs 15.23%±8.19%, p<0.0001) were higher among the CRTI versus the uninjured group, respectively. Abdominal waist circumference, visceral fat area, triglycerides, estimated insulin resistance and hs-CRP levels were greater and physical activity and high-density lipoprotein-cholesterol lower with CRTI. There were no significant between-group differences in blood glucose, blood pressure or PWV. CRTI, injury severity (↑NISS), age, socioeconomic status (SEC) and physical activity were independently associated with both MetS and cAIx. Conclusions CRTI is associated with an increased prevalence of MetS and arterial stiffness, which are also influenced by age, injury severity, physical activity and SEC. The longitudinal impact of CRTI on clinical cardiovascular events needs further examination.
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Affiliation(s)
- Christopher J Boos
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK .,Academic Department of Military Mental Health, King's College London, London, UK.,Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK.,Cardiology, University Hospitals Dorset NHS Foundation Trust, Poole Hospital, Poole, UK
| | - Susie Schofield
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Paul Cullinan
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - Daniel Dyball
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK.,Academic Department of Military Mental Health, King's College London, London, UK
| | - Nicola T Fear
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK
| | - David Pernet
- Academic Department of Military Mental Health, King's College London, London, UK
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK.,National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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Olstad DL, Nejatinamini S, Kirkpatrick SI, Vanderlee L, Livingstone KM, Campbell DJT, Tang K, Minaker LM, Hammond D. Stress-Related Poor Diet Quality Does Not Explain Socioeconomic Inequities in Health: A Structural Equation Mediation Analysis of Gender-Specific Pathways. J Acad Nutr Diet 2021; 122:541-554.e1. [PMID: 34626824 DOI: 10.1016/j.jand.2021.09.018] [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: 03/16/2021] [Revised: 09/16/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Psychosocial stress and diet quality individually mediate associations between socioeconomic position (SEP) and health; however, it is not known whether they jointly mediate these associations. This is an important question because stress-related unhealthy eating is often invoked as an explanation for diet-related health inequities, particularly among women, seemingly with no empirical justification. OBJECTIVE This study examined whether psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women and men. DESIGN Multiple mediating pathways were modeled using data from the cross-sectional International Food Policy Study. PARTICIPANTS AND SETTING Data were collected from 5,645 adults (aged 18 years or older) in Canada during 2018 and 2019. MAIN OUTCOME MEASURES Participants reported SEP using indicators of materialist (educational attainment and perceived income adequacy) and psychosocial pathways (subjective social status), along with psychosocial stress, dietary intake (to assess overall diet quality via Healthy Eating Index-2015 scores), and self-rated health. STATISTICAL ANALYSES PERFORMED Structural equation modeling modeled pathways linking SEP (ie, educational attainment, perceived income adequacy, and subjective social status) with self-rated health mediated by psychosocial stress and diet quality, stratified by gender. RESULTS There was no evidence that psychosocial stress and diet quality jointly mediated associations between SEP and self-rated health in women or men. Diet quality mediated associations between educational attainment and self-rated health in women and men, with some evidence that it mediated associations between subjective social status and self-rated health in men (P = 0.051). Psychosocial stress mediated associations between perceived income adequacy and self-rated health in women and men, and between subjective social status and self-rated health in women. CONCLUSIONS Although often invoked as an explanation for diet-related health inequities, stress-related poor diet quality did not mediate associations between SEP and self-rated health in women or men. Psychosocial stress and diet quality individually mediated some of these associations, with some differences by gender.
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Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Sara Nejatinamini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Lana Vanderlee
- Université Laval École de Nutrition, Centre Nutrition, Santé et Société (Centre NUTRISS), Québec, Québec, Canada
| | - Katherine M Livingstone
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - David J T Campbell
- Department of Medicine, Department of Community Health Sciences, Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary Foothills Medical Centre, Calgary, Alberta, Canada
| | - Karen Tang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Leia M Minaker
- School of Planning, Faculty of Environment, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Cromhout PF, Thygesen LC, Moons P, Nashef S, Damgaard S, Berg SK. Social and emotional factors as predictors of poor outcomes following cardiac surgery. Interact Cardiovasc Thorac Surg 2021; 34:193-200. [PMID: 34606597 PMCID: PMC8766216 DOI: 10.1093/icvts/ivab261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/21/2021] [Accepted: 08/13/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Existing risk prediction models in cardiac surgery stratify individuals based on their predicted risk, including only medical and physiological factors. However, the complex nature of risk assessment and the lack of parameters representing non-medical aspects of patients’ lives point towards the need for a broader paradigm in cardiac surgery. Objectives were to evaluate the predictive value of emotional and social factors on 4 outcomes; death within 90 days, prolonged stay in intensive care (≥72 h), prolonged hospital admission (≥10 days) and readmission within 90 days following cardiac surgery, as a supplement to traditional risk assessment by European System for Cardiac Operative Risk Evaluation (EuroSCORE). METHODS The study included adults undergoing cardiac surgery in Denmark 2014–2017 including information on register-based socio-economic factors, and, in a nested subsample, self-reported symptoms of anxiety and depression. Logistic regression analyses were conducted, adjusted for EuroSCORE, of variables reflecting social and emotional factors. RESULTS Amongst 7874 included patients, lower educational level (odds ratio 1.33; 95% confidence interval 1.17–1.51) and living alone (1.25; 1.14–1.38) were associated with prolonged hospital admission after adjustment for EuroSCORE. Lower educational level was also associated with prolonged intensive care unit stay (1.27; 1.00–1.63). Having a high income was associated with decreased odds of prolonged hospital admission (0.78; 0.70–0.87). No associations or predictive value for symptoms of anxiety or depression were found on any outcomes. CONCLUSIONS Social disparity is predictive of poor outcomes following cardiac surgery. Symptoms of anxiety and depression are frequent especially amongst patients with a high-risk profile according to EuroSCORE. Subj collection 105, 123
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Affiliation(s)
| | - Lau Caspar Thygesen
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Samer Nashef
- Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Sune Damgaard
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
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Association between exposure to heavy occupational lifting and cardiac structure and function: a cross-sectional analysis from the Copenhagen City Heart Study. Int J Cardiovasc Imaging 2021; 38:521-532. [PMID: 34550509 DOI: 10.1007/s10554-021-02420-y] [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: 07/02/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
To investigate cross-sectional associations between heavy occupational lifting and cardiac structure and function. Participants from the 5th round of the Copenhagen City Heart Study, aged < 65 years old, answering a questionnaire regarding occupational physical activity, heavy occupational lifting, use of anti-hypertensive and heart medication, and data on blood pressure, cardiac structure and function, from an echocardiographic examination, were included. Adjusted linear regressions and logistic regressions were applied to estimate the cross-sectional association between heavy occupational lifting and cardiac structure and function across all included participants and in groups stratified by hypertension status, and the risk for having abnormal values of cardiac structure and function. 2511 participants were included. The cross-sectional standardized associations between heavy occupational lifting and measures of cardiac structure and function showed a trends for raised left ventricular mass index (LVMi) (β 0.14, 99% CI - 0.03 to 0.31). The standardized associations stratified by hypertensive status showed significant associations between exposure to heavy occupational lifting and LVMi (β 0.20, 99% CI - 0.002 to 0.40) and a trend of a raised end-diastolic interventricular septal thickness (IVSd) (β 0.15, 99% CI - 0.03 to 0.33) among normotensives. Exposure to heavy occupational lifting increased the odds for an abnormal IVSd (OR 1.42, 99% CI 1.07-1.89). This cross-sectional study shows heavy occupational lifting to associate with indices of abnormal cardiac structure and function among normotensives, indicating an increased risk for cardiovascular disease.
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36
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Godley J, Fundytus K, Stones C, Peller P, McLaren L. Survey Research on Health Inequalities: Exploring the Availability of Indicators of Multiple Forms of Capital in Canadian Datasets. Int J Public Health 2021; 66:584916. [PMID: 34616240 PMCID: PMC8489296 DOI: 10.3389/ijph.2021.584916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Much of the extensive quantitative research linking socio-economic position (SEP) and health utilizes three common indicators: income, occupation and education. Existing survey data may enable researchers to include indicators of additional forms of capital in their analyses, permitting more nuanced consideration of the relationship between SEP and health. Our objective was to identify the breadth of survey questions related to economic, cultural, and social capital available through Statistics Canada surveys, and the extent to which those surveys also include health measures. Methods: We compiled a list of all population-based Statistics Canada surveys, and developed a broad list of potential indicators of forms of capital. We systematically searched the surveys for those indicators and health measures, analyzing their co-occurrence. Results: Traditional SEP indicators were present in 73% of surveys containing health measures, while additional indicators of social and cultural capital were available in 57%. Conclusion: Existing national survey data represent an under-exploited opportunity for research examining the relationship between various forms of capital and health in Canada. Future empirical explorations of these data could enrich our theoretical understanding of health inequities.
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Affiliation(s)
- Jenny Godley
- Department of Sociology, University of Calgary, Calgary, AB, Canada
| | - Katrina Fundytus
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Cheyanne Stones
- Faculty of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Peter Peller
- Library and Cultural Resources, University of Calgary, Calgary, AB, Canada
| | - Lindsay McLaren
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
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Piedra LM, Andrade FCD, Hernandez R, Perreira KM, Gallo LC, González HM, Gonzalez S, Cai J, Chen J, Castañeda SF, Tabb KM, Talavera GA, Durazo-Arvizu RA, Daviglus ML. Association of Subjective Social Status With Life's Simple 7s Cardiovascular Health Index Among Hispanic/Latino People: Results From the HCHS/SOL. J Am Heart Assoc 2021; 10:e012704. [PMID: 34378404 PMCID: PMC8475025 DOI: 10.1161/jaha.119.012704] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Evidence suggests that subjective (perceived) social status (SSS) may predict health outcomes more strongly than objective social status, but little is known about the relationship between SSS and cardiovascular health (CVH). This study focuses on this relationship among diverse Hispanic/Latino adults because while poor CVH profiles are prevalent in this population, immigration complicates attempts to measure their social status. Methods and Results We analyzed baseline HCHS/SOL (Hispanic Community Health Study/Study of Latinos) data on 15 374 Hispanic/Latino adults aged 18 to 74 years in 2008 to 2011. SSS was assessed using the McArthur Scale, a 10‐rung “social ladder.” CVH was based on levels of 7 metrics defined by the American Heart Association. Linear and logistic regressions were used to examine cross‐sectional associations of SSS with CVH (overall and single metrics) after adjusting for objective social status, demographic, and health factors. Less than half of the population (46%) had Ideal scores in ≥4 metrics of CVH. In multivariable‐adjusted models, an increase in SSS was associated with a higher overall CVH score (β=0.04; 95% CI, 0.01–0.06) and greater likelihood of Ideal levels of body mass index, physical activity, and fasting blood glucose levels. Nativity and time in the United States modified the association between SSS and Ideal smoking. Conclusions Subjective measures of social status can enhance an understanding of CVH among Hispanic/Latino people. Future studies should explore the stability of SSS over time in comparison with objective social status and the mechanisms through which SSS may influence CVH.
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Affiliation(s)
- Lissette M Piedra
- School of Social Work University of Illinois at Urbana-Champaign Urbana IL
| | - Flavia C D Andrade
- School of Social Work University of Illinois at Urbana-Champaign Urbana IL
| | - Rosalba Hernandez
- School of Social Work University of Illinois at Urbana-Champaign Urbana IL
| | | | - Linda C Gallo
- Department of Psychology San Diego State University Chula Vista CA
| | - Hector M González
- Department of Neurosciences University of California, San Diego La Jolla CA
| | - Sara Gonzalez
- Department of Epidemiology and Population Health Albert Einstein College of Medicine Bronx NY
| | - Jianwen Cai
- Department of Biostatistics University of North Carolina at Chapel Hill NC
| | - Jinsong Chen
- Department of Medicine University of Illinois at Chicago IL
| | | | - K M Tabb
- School of Social Work University of Illinois at Urbana-Champaign Urbana IL
| | | | | | - Martha L Daviglus
- Department of Medicine University of Illinois at Chicago IL.,Feinberg School of Medicine Northwestern University Chicago IL
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Socioeconomic position over the life-course and subjective social status in relation to nutritional status and mental health among Guatemalan adults. SSM Popul Health 2021; 15:100880. [PMID: 34377763 PMCID: PMC8327130 DOI: 10.1016/j.ssmph.2021.100880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/20/2022] Open
Abstract
Objective We study how life course objective socioeconomic position (SEP) predicts subjective social status (SSS) and the extent to which SSS mediates the association of objective SEP with nutritional status and mental health outcomes. Methods We use data from participants of the INCAP Longitudinal Study 1969–2018 (n = 1258) from Guatemala. We use the MacArthur ladder for two measures of SSS - perceived community respect and perceived economic status. We estimate the association of SSS with health outcomes after adjusting for early life characteristics and life course objective SEP (wealth, schooling, employment) using linear regression. We use path analysis to study the extent of mediation by SSS on the health outcomes of body mass index (BMI; kg/m2), psychological distress (using the WHO Self-Reported Questionnaire; SRQ-20) and happiness, using the Subjective Happiness Scale (SHS). Results Median participant rating was 5 [IQR: 3–8] for the perceived community respect and 3 [IQR: 1–5] for the perceived economic status, with no differences by sex. Objective SEP in early life and adulthood were predictive of both measures of SSS in middle adulthood as well as health outcomes (BMI, SRQ-20 and SHS). Perceived community respect (z-scores; 1 z = 3.1 units) was positively associated with happiness (0.13, 95 % CI: 0.07, 0.19). Perceived economic status (z-scores; 1 z = 2.3 units) was inversely associated with psychological distress (−0.28, 95 % CI: −0.47, −0.09). Neither measure of SSS was associated with BMI. Neither perceived community respect nor perceived economic status attenuated associations of objective SEP with health outcomes on inclusion as a mediator. Conclusions Subjective social status was independently associated with happiness and psychological distress in middle adulthood after adjusting for objective SEP. Moreover, association of objective SEP with health was not mediated by SSS, suggesting potentially independent pathways. Subjective social status (SSS) is a self-appraisal of one's objective measures of socio-economic position (SEP; such as education and wealth) and social identity relative to their community. Perceived community respect and perceived economic status were positively associated with happiness and inversely associated with psychological distress respectively. Neither measure of SSS were associated with body mass index. The associations of objective SEP measures with health outcomes were not attenuated after adjusting for SSS, suggesting independent pathways.
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Key Words
- BMI, Body mass index
- FIML, Full Information Maximum Likelihood
- Happiness
- INCAP, Institute of Nutrition of Central America and Panama
- IQR, Interquartile Range
- LMIC, Low- and middle-income country
- MAR, Missing at Random
- MI, Multiple imputation
- MacArthur ladder
- Perceived social status
- Psychological distress
- Psychosocial framework
- Relative deprivation
- SEP, socio-economic position
- SRQ-20, World Health Organization Self-Reported Questionnaire-20
- SSS, Subjective social status
- Subjective status
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Chen C, Zhang Y, Zhao Q, Wang L, An Y, Fan X. The multiple mediating effects of social connectedness and self-care confidence on the relationship between subjective social status and emotional well-being in patients with heart failure: a cross-sectional study. Eur J Cardiovasc Nurs 2021; 21:227-234. [PMID: 34244707 DOI: 10.1093/eurjcn/zvab058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/05/2021] [Accepted: 06/16/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Previous studies have shown that subjective social status (SSS) was positively associated with well-being in various populations. However, little is known about the relationship considering the underlying mechanism in patients with heart failure (HF). AIMS The aim was to study the effects of social connectedness and self-care confidence on the relationship between SSS and well-being in patients with HF according to the Reserve Capacity Model. METHODS AND RESULTS We recruited 296 patients from a general hospital using convenience sampling. SSS, social connectedness, self-care confidence, and well-being were assessed using self-reported questionnaires. A multiple mediation model was examined using the PROCESS macro in SPSS.Higher levels of SSS (r = 0.18, P < 0.01), social connectedness (r = 0.21, P < 0.01), and self-care confidence (r = 0.20, P < 0.01) were positively correlated with better emotional well-being, but not with physical well-being. The multiple mediation analysis revealed that the relationship between SSS and emotional well-being was mediated by social connectedness (effect: 0.061, 95% CI [0.014, 0.148]) and self-care confidence (effect: 0.110, 95% CI [0.006, 0.249]) separately, and together in serial (effect: 0.008, 95% CI [0.001, 0.028]). CONCLUSIONS Social connectedness and self-care confidence are multiple mediators of the relationship between SSS and emotional well-being. Interventions targeting to strengthening social connectedness and self-care confidence may improve emotional well-being directly. In addition, emotional well-being may be improved by enhancing SSS indirectly in patients with HF.
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Affiliation(s)
- Cancan Chen
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, 44# Wenhua Xi Road, Jinan, Shandong 250012, China
| | - Yanting Zhang
- School of Nursing, Zhengzhou Railway Vocational and Technical College, 56# Pengcheng Avenue, Zhengzhou, Henan 450000, China
| | - Qiuge Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, 44# Wenhua Xi Road, Jinan, Shandong 250012, China
| | - Lyu Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, 44# Wenhua Xi Road, Jinan, Shandong 250012, China
| | - Yan An
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, 44# Wenhua Xi Road, Jinan, Shandong 250012, China
| | - Xiuzhen Fan
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, 44# Wenhua Xi Road, Jinan, Shandong 250012, China
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Rosário EVN, Severo M, Francisco D, Brito M, Costa D. Examining the relation between the subjective and objective social status with health reported needs and health-seeking behaviour in Dande, Angola. BMC Public Health 2021; 21:979. [PMID: 34034701 PMCID: PMC8152355 DOI: 10.1186/s12889-021-11003-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 05/06/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Assessing subjective social status (SSS) may be easily accommodated in the context of a Health and Demographic Surveillance System (HDSS). To our knowledge, no prior studies have examined the association of SSS and health in Angola. Subjective socioeconomic measures may provide a rapid assessment of a relevant social status construct, important for studying health inequalities. In this study, we addressed social determinants of health by examining the relationship between the subjective and objective social status, reported health and healthcare-seeking behaviour. METHODS This research results from a cross-sectional study performed during 2015 in the Dande HDSS, in Angola. We tested the application of the MacArthur scale as a measure of SSS in a developing setting, in a sample of 12,246 households. First, we investigated its relation to objective socioeconomic indicators, and then we explored how subjective and objective social status associate with health reported needs and health-seeking behaviour of the surveyed population. Chi-square, ANOVA tests, and Receiver Operating Characteristics (ROC) Curves analysis were computed for testing relationships between subjective status ladder quartiles, sociodemographic and household characteristics. Logistic regression was used to examine the influence of subjective perception of status in self-reported health and health-seeking behaviour. RESULTS Our findings suggest that the SSS follows a gradient distribution obtained with more objective socioeconomic indicators. Additionally, we found that subjective perception of status influence health needs reporting and health-seeking behaviour and its significant effect remained after controlling for the objective socioeconomic markers. Individuals standing in the second quartile of the social ladder have more odds of reporting illness and those in the highest quartiles of the ladder were twice more likely (OR = 2.23, 95% CI = 1.52-3.26) to seek help from formal health services than those at the bottom of the ladder. CONCLUSIONS The MacArthur Scale is a valuable tool to measure SSS in the Dande HDSS, relevant for studying socioeconomic disparities and health inequalities. It is also an easier alternative to traditional measures such as income, usually difficult to measure in developing settings. The social perception of status should be considered as a complement with objective indicators when exploring social determinants of health.
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Affiliation(s)
- Edite Vila Nova Rosário
- CISA - Centro de Investigação em Saúde de Angola (Health Research Centre of Angola), Hospital Geral do Caxito, Rua Direita, Caxito, Angola.
- Instituto de Saúde Pública da Universidade do Porto (ISPUP), Oporto, Portugal.
| | - Milton Severo
- Instituto de Saúde Pública da Universidade do Porto (ISPUP), Oporto, Portugal
| | - Diogo Francisco
- CISA - Centro de Investigação em Saúde de Angola (Health Research Centre of Angola), Hospital Geral do Caxito, Rua Direita, Caxito, Angola
| | - Miguel Brito
- CISA - Centro de Investigação em Saúde de Angola (Health Research Centre of Angola), Hospital Geral do Caxito, Rua Direita, Caxito, Angola
- Health and Technology Research Centre (H&TRC), Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Diogo Costa
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
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McClain AC, Gallo LC, Mattei J. Subjective Social Status and Cardiometabolic Risk Markers by Intersectionality of Race/Ethnicity and Sex Among U.S. Young Adults. Ann Behav Med 2021; 56:442-460. [PMID: 33942845 DOI: 10.1093/abm/kaab025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Subjective social status (SSS) has shown inverse relationships with cardiometabolic risk, but intersectionalities of race/ethnicity and sex may indicate more nuanced relationships. PURPOSE To investigate associations of SSS with cardiometabolic risk markers by race/ethnicity and sex. METHODS Data were from Wave IV (2008) of the National Longitudinal Study of Adolescent to Adult Health (n = 4,847; 24-32 years), which collected biological cardiometabolic risk markers. A 10-step ladder captured SSS; respondents indicated on which step they perceived they stood in relation to other people in the U.S. higher values indicated higher SSS (range: 1-10). We tested the relationship between SSS and individual markers using generalized least square means linear regression models, testing three-way interactions between SSS, race/ethnicity, and sex (p < .10) before stratification. RESULTS SSS-race/ethnicity-sex interactions were significantly associated with waist circumference (p ≤ .0001), body mass index (BMI; p ≤ .0001), systolic blood pressure (SBP; p ≤ .0001), diastolic blood pressure (DBP; p = .0004), and high-density lipoprotein cholesterol (HDL-C; p = .07). SSS was associated with waist circumference (β [SE]: -1.2 (0.4), p < .05) and BMI (-0.6 [0.2], p < .01) for non-Hispanic White females, compared with males; with HDL-C among non-Hispanic White (0.2 [0.1]; p < .05) and Hispanic (0.3 (0.1); p < .05) females, compared with males; with SBP for non-Hispanic Asian (1.7 [0.8]; p < .05) and Multiracial (1.8 [0.8]; p < .05), versus White, females; and with DBP for non-Hispanic Black (0.8 [0.3]; p < .01), versus White, males. CONCLUSIONS SSS was differentially related to cardiometabolic risk markers by race/ethnicity and sex, suggesting intersectional aspects. Clinical and research applications of SSS should consider race/ethnicity- and sex-specific pathways influencing cardiometabolic risk.
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Affiliation(s)
- Amanda C McClain
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, CA, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Josiemer Mattei
- Department of Nutrition, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
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Gąska I, Sygit K, Cipora E, Sygit M, Pacian A, Surmach M, Kaleta D, Rzeźnicki A. Assessment of the Health Behaviours and Value-Based Health Analysis of People Aged 50+ Who Were Hospitalized Due to Cardiovascular Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084221. [PMID: 33923460 PMCID: PMC8074081 DOI: 10.3390/ijerph18084221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/25/2022]
Abstract
Introduction: The basic determinant of healthy behaviour—among other human behaviours—is the fact that it consistently affects health. Nowadays, health behaviour studies are considered to be an important method of measuring the health of a population. Objective: To assess the health behaviours and value-based health analysis of people aged 50+ who were hospitalized due to cardiovascular disease, depending on the selected descriptive variables. Materials and methods: The study was conducted between April 2018 and December 2018 among 411 subjects aged 50+ who were hospitalized due to cardiovascular disease at the Independent Public Health Care Unit in Sanok (Podkarpackie voivodship in Poland). The method used in the study was a diagnostic survey. The study used the authors’ survey questionnaire and two standardized tests: Inventory of Health-Related Behaviour (IHB) and List of Health Criteria (LHC). A statistical analysis was carried out in the R program, version 3.5.1. The obtained results were subjected to thorough statistical analysis using the following tests: Student’s t, Mann–Whitney U, ANOVA, Kruskal–Wallis, Fisher’s Least Significant Difference (LSD), Pearson, and Spearman. Results: The strongest correlation between health status and health behaviours (according to the IHB questionnaire) was in the area of ‘health practices’, while the lowest correlation was found in the areas of ‘correct eating habits’ and ‘preventive behaviours’. Based on the LHC questionnaire, the most important health criteria according to the subjects were ‘not feeling any physical ailments’; ‘having all body parts functional’; ‘feeling well’; ‘eating properly’; and ‘infrequent need of going to the doctor’. A positive correlation was found in the group of respondents where the ‘preventive health behaviours’ were more intense; herein, the more important criterion for the respondents was ‘eating properly’. Conclusions: Respondents aged 50+ and hospitalized for cardiovascular diseases indicated (based on the IHB questionnaire) that health behaviours in the area of ‘health practices’ had the strongest correlation with their health, while the lowest correlation was found in the areas of ‘correct eating habits’ and ‘preventive behaviours’. According to the respondents, the most important criteria determining health (according to the LHC questionnaire) included ’not feeling any physical ailments’; ‘having all body parts functional’; ‘feeling well’; ‘eating properly’; and ‘infrequent need of going to the doctor’. Based on the information collected from the respondents, it was found that the most important criteria determining health depended on selected descriptive variables, such as age, gender, place of residence, education, and marital status.
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Affiliation(s)
- Izabela Gąska
- Medical Institute, Jan Godek State University in Sanok, 38-500 Sanok, Poland; (I.G.); (E.C.)
| | - Katarzyna Sygit
- Faculty of Health Sciences, Calisia University, 62-800 Kalisz, Poland;
- Correspondence:
| | - Elżbieta Cipora
- Medical Institute, Jan Godek State University in Sanok, 38-500 Sanok, Poland; (I.G.); (E.C.)
| | - Marian Sygit
- Faculty of Health Sciences, Calisia University, 62-800 Kalisz, Poland;
| | - Anna Pacian
- Department of Public Health, Faculty of Health Sciences, Medical University of Lublin, 20-093 Lublin, Poland;
| | - Maryna Surmach
- Head of the Department of Public Health and Health Services, Grodno State Medical University, 230009 Grodno, Belarus;
| | - Dorota Kaleta
- Department of Hygiene and Epidemiology, Faculty of Health Sciences, Medical University of Lodz, 90-647 Lodz, Poland;
| | - Adam Rzeźnicki
- Department of Social Medicine, Faculty of Health Sciences, Medical University of Lodz, 90-647 Lodz, Poland;
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Kim Y, Radoias V. Subjective socioeconomic status, health, and early-life conditions. J Health Psychol 2021; 26:595-604. [PMID: 30764667 DOI: 10.1177/1359105319828137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We study the role of subjective social status on health and its correlates, with an emphasis on the predictive power of early-life conditions on subjective social status. A well-established literature links early-life conditions to later-life objective measures of socioeconomic status, but little attention has been paid to their effects on subjective socioeconomic status. We find that socioeconomic factors during childhood are important predictors of subjective social status, even after controlling for contemporaneous socioeconomic conditions. This shows an additional psychological and behavioral channel through which early-life conditions influence later outcomes and which has not been yet studied in sufficient detail.
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Riley J, Antza C, Kempegowda P, Subramanian A, Chandan JS, Gokhale K, Thomas N, Sainsbury C, Tahrani AA, Nirantharakumar K. Social Deprivation and Incident Diabetes-Related Foot Disease in Patients With Type 2 Diabetes: A Population-Based Cohort Study. Diabetes Care 2021; 44:731-739. [PMID: 33483358 DOI: 10.2337/dc20-1027] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 12/19/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the relationship between social deprivation and incident diabetes-related foot disease (DFD) in newly diagnosed patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A population-based open retrospective cohort study using The Health Improvement Network (1 January 2005 to 31 December 2019) was conducted. Patients with type 2 diabetes free of DFD at baseline were stratified by Townsend deprivation index, and risk of developing DFD was calculated. DFD was defined as a composite of foot ulcer (FU), Charcot arthropathy, lower-limb amputation (LLA), peripheral neuropathy (PN), peripheral vascular disease (PVD), and gangrene. RESULTS A total of 176,359 patients were eligible (56% men; mean age 62.9 [SD 13.1] years). After excluding 26,094 patients with DFD before/within 15 months of type 2 diabetes diagnosis, DFD incidentally developed in 12.1% of the study population over 3.27 years (interquartile range 1.41-5.96). Patients in the most deprived Townsend quintile had increased risk of DFD compared with those in the least deprived (adjusted hazard ratio [aHR] 1.22; 95% CI 1.16-1.29) after adjusting for sex, age at type 2 diabetes diagnosis, ethnicity, smoking, BMI, HbA1c, cardiovascular disease, hypertension, retinopathy, estimated glomerular filtration rate, insulin, glucose/lipid-lowering medication, and baseline foot risk. Patients in the most deprived Townsend quintile had higher risk of PN (aHR 1.18; 95% CI 1.11-1.25), FU (aHR 1.44; 95% CI 1.17-1.77), PVD (aHR 1.40; 95% CI 1.28-1.53), LLA (aHR 1.75; 95% CI 1.08-2.83), and gangrene (aHR 8.49; 95% CI 1.01-71.58) compared with those in the least. CONCLUSIONS Social deprivation is an independent risk factor for the development of DFD, PN, FU, PVD, LLA, and gangrene in newly diagnosed patients with type 2 diabetes. Considering the high individual and economic burdens of DFD, strategies targeting patients in socially deprived areas are needed to reduce health inequalities.
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Affiliation(s)
- Jenny Riley
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | - Christina Antza
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, U.K.,Department of Diabetes and Endocrinology, University Hospitals NHS Foundation Trust, Birmingham, U.K
| | - Punith Kempegowda
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, U.K
| | | | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | - Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | | | - Abd A Tahrani
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, U.K. .,Department of Diabetes and Endocrinology, University Hospitals NHS Foundation Trust, Birmingham, U.K.,Centre of Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, U.K
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Barradas S, Lucumi D, Agudelo DM, Mentz G. Socioeconomic position and quality of life among Colombian hypertensive patients: The mediating effect of perceived stress. Health Psychol Open 2021; 8:2055102921996934. [PMID: 33747537 PMCID: PMC7905733 DOI: 10.1177/2055102921996934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
This study aimed to assess the relationships between socioeconomic position, perceived stress and Health Related Quality of Life (HRQoL) of patients with hypertension. Data were obtained using the baseline survey of 258 patients from the Social Determinants and Inequities in the Control of Blood Hypertension Program (ProDSICHA). HRQoL was measured with SF-8 Health Survey. Socioeconomic position was measured using education, and the MacArthur Scale. Stress was measured with Perceived Stress Scale. A higher educational level was associated with a higher perception of stress (Coeff = 0.78, p = 0.019). Also, a lower position in the community was associated with a higher perception of stress (Coeff = −0.56, p = 0.027). A higher level of perceived stress was associated with a higher level of mental health (Coeff = 0.64, p = 0.000). No statistical differences were found in the relations between socioeconomic position and physical HRQoL. These findings warrant further research to understand the role of socioeconomic position in physical HRQoL.
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Affiliation(s)
- Susana Barradas
- Universidad de los Andes, Colombia.,Universidad Externado de Colombia, Colombia
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Psychosocial Risk Factors in Cardiac Rehabilitation: Time to Screen Beyond Anxiety and Depression. Glob Heart 2021; 16:16. [PMID: 33833940 PMCID: PMC7894368 DOI: 10.5334/gh.896] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Although it is well acknowledged that psychosocial risk factors (PSRF) such as low socio-economic status, stress, social isolation, negative emotions and negative personality patterns may contribute to the development and adverse outcome of cardiovascular disease (CVD), screening for PSRF in CVD patients is usually limited to anxiety and depression, mainly for feasibility reasons. We therefore aimed to develop a user-friendly screening battery for routine assessment of PSRFs and to evaluate this instrument regarding feasibility of application, PSRF results and attendance of psychological counselling if recommended to cardiac rehabilitation (CR) patients. Methods This is a prospective single center cohort study including 609 consecutive CR patients. We first developed a screening instrument based on seven validated scales for the most relevant PSRFs with totally 90 questions presented in a uniform graphical design to facilitate completion called Psychocardiogram® (PCG) and applied the instrument in consecutive patients attending CR. Patients with positive screening results were invited to a psychological counseling session. Results Six hundred and nine consecutive patients, aged 34 to 86 years (mean 60.7 years), 85% men, entering the CR program at the Bern University Hospital with ischemic heart failure (CHF), coronary artery disease (CAD) or peripheral artery disease, were included in this study. Eighty-three point three percent of the patients completed the PCG within 40 minutes. Vital exhaustion and Type-D personality were the most prevalent PSRFs (56.9% and 51.1%, respectively), whereas low social support (14.4%) and elevated depressive symptoms (15.9%), were the least prevalent ones. After screening, 120 patients (52.86%) with at least one PSRF made use of psychological counseling. Conclusions We found the PCG to be a useful screening tool for PSRF in CR patients with the potential to get new insights into the prevalence of particular PSRF in specific populations and to better study their impact on occurrence and outcome of CVD.
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Connelly PJ, Azizi Z, Alipour P, Delles C, Pilote L, Raparelli V. The Importance of Gender to Understand Sex Differences in Cardiovascular Disease. Can J Cardiol 2021; 37:699-710. [PMID: 33592281 DOI: 10.1016/j.cjca.2021.02.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 01/11/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. There is robust evidence of heterogeneity in underlying mechanism, manifestation, prognosis, and response to treatment of CVD between male and female patients. Gender, which refers to the socially constructed roles, behaviours, expressions, and identities of individuals, is an important determinant of CV health, and its consideration might help in attaining a broader understanding of the observed sex differences in CVD. Established risk factors such as hypertension, dyslipidemia, diabetes mellitus, obesity, and smoking are well known to contribute to CVD. However, despite the differences in CVD risk between male and female, most studies looking into the magnitude of effect of each risk factor have traditionally focused on male subjects. While biological sex influences disease pathophysiology, the psycho-socio-cultural construct of gender can further interact with this effect. Behavioural, psychosocial, personal, cultural, and societal factors can create, repress, or strengthen underlying biological CV health differences. Although mechanisms of action are largely unclear, it is suggested that gender-related factors can further exacerbate the detrimental effect of established risk factors of CVD. In this narrative review, we explore the current literature investigating the role of gender in CV risk and its impact on established risk factors as a fundamental step toward precision medicine.
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Affiliation(s)
- Paul J Connelly
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Zahra Azizi
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montréal, Québec, Canada
| | - Pouria Alipour
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montréal, Québec, Canada
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom.
| | - Louise Pilote
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montréal, Québec, Canada; Divisions of Clinical Epidemiology and General Internal Medicine, McGill University Health Centre Research Institute, Montréal, Québec, Canada.
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy; University of Alberta, Faculty of Nursing, Edmonton, Alberta, Canada
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Tetzlaff J, Geyer S, Westhoff-Bleck M, Sperlich S, Epping J, Tetzlaff F. Social inequalities in mild and severe myocardial infarction: how large is the gap in health expectancies? BMC Public Health 2021; 21:259. [PMID: 33526035 PMCID: PMC7852180 DOI: 10.1186/s12889-021-10236-7] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/13/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (MI) remains a frequent health event and a major contributor to long-term impairments globally. So far, research on social inequalities in MI incidence and mortality with respect to MI severity is limited. Furthermore, evidence is lacking on disparities in the length of life affected by MI. This study investigates social inequalities in MI incidence and mortality as well as in life years free of MI and affected by the consequences of mild or severe MI. METHODS The study is based on data of a large German statutory health insurance provider covering the years 2008 to 2017 (N = 1,253,083). Income inequalities in MI incidence and mortality risks and in life years with mild or severe MI and without MI were analysed using multistate analyses. The assessment of MI severity is based on diagnosed heart failure causing physical limitations. RESULTS During the study period a total of 39,832 mild MI, 22,844 severe MI, 276,582 deaths without MI, 15,120 deaths after mild MI and 16,495 deaths after severe MI occurred. Clear inequalities were found in MI incidence and mortality, which were strongest among men and in severe MI incidence. Moreover, substantial inequalities were found in life years free of MI in both genders to the disadvantage of those with low incomes and increased life years after mild MI in men with higher incomes. Life years after severe MI were similar across income groups. CONCLUSIONS Social inequalities in MI incidence and mortality risks led to clear disparities in the length of life free of MI with men with low incomes being most disadvantaged. Our findings stress the importance of primary and secondary prevention focusing especially on socially disadvantaged groups.
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Affiliation(s)
- Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany.
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | | | | | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany
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Sasaki Y, Shobugawa Y, Nozaki I, Takagi D, Nagamine Y, Funato M, Chihara Y, Shirakura Y, Lwin KT, Zin PE, Bo TZ, Sone T, Win HH. Association between depressive symptoms and objective/subjective socioeconomic status among older adults of two regions in Myanmar. PLoS One 2021; 16:e0245489. [PMID: 33507963 PMCID: PMC7842968 DOI: 10.1371/journal.pone.0245489] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 01/03/2021] [Indexed: 12/20/2022] Open
Abstract
Low objective socioeconomic status (SES) has been correlated with poor physical and mental health among older adults. Some studies suggest that subjective SES is also important for ensuring sound physical and mental health among older adults. However, few studies have been conducted on the impact of both objective and subjective SES on mental health among older adults. This study examines whether objective or subjective SES is associated with depressive symptoms in older adults in Myanmar. This cross-sectional study, conducted between September and December, 2018, used a multistage sampling method to recruit participants from two regions of Myanmar, for face-to-face interviews. The Geriatric Depression Scale (GDS) was used to evaluate the depressive symptoms. Participants were classified as having no depressive symptom (GDS score <5) and having depressive symptoms (GDS score ≥5). Objective and subjective SES were assessed using the wealth index and asking participants a multiple-choice question about their current financial situation, respectively. The relationship between objective/subjective SES and depressive symptoms was examined using a multivariable logistic regression analysis. The mean age of the 1,186 participants aged 60 years and above was 69.7 (SD: 7.3), and 706 (59.5%) were female. Among them, 265 (22.3%) had depressive symptoms. After adjusting for objective SES and other covariates, only low subjective SES was positively associated with depressive symptoms (adjusted odds ratio, AOR: 4.18, 95% confidence interval, CI: 2.98-5.87). This association was stronger among participants in the rural areas (urban areas, AOR: 2.10, 95% CI: 1.08-4.05; rural areas, AOR: 5.65, 95% CI: 3.69-8.64). Subjective SES has a stronger association with depressive symptoms than objective SES, among older adults of the two regions in Myanmar, especially in the rural areas. Interventions for depression in older adults should consider regional differences in the context of subjective SES by reducing socioeconomic disparities among the communities.
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Affiliation(s)
- Yuri Sasaki
- National Institute of Public Health, Wako, Japan
- * E-mail:
| | - Yugo Shobugawa
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ikuma Nozaki
- National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | - Masafumi Funato
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Yuki Chihara
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuki Shirakura
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | | | - Poe Ei Zin
- University of Medicine 1, Yangon, Myanmar
| | | | | | - Hla Hla Win
- University of Medicine 1, Yangon, Myanmar
- University of Public Health, Yangon, Myanmar
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Woolliscroft JO. Making sense out of the world: Expanding our mental model of health and disease. FASEB Bioadv 2021; 3:5-10. [PMID: 33490880 PMCID: PMC7805542 DOI: 10.1096/fba.2020-00083] [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: 08/31/2020] [Revised: 09/28/2020] [Accepted: 10/16/2020] [Indexed: 11/11/2022] Open
Abstract
We make sense of the world through our mental representations or models. They allow us to identify and categorize objects and ideas and shape our views of the world determining what we consider relevant and valid. Mental models enable reasoning, including clinical reasoning in regard to diagnosis and therapy. Scientific advances in understanding of biologic processes in health and disease have begun to reveal their complexity. Systems biology has embraced this complexity and is recognized as complementary to the reductionist approach to science. The mental models educators impart in their students create the boundaries for what is deemed relevant scientifically and clinically. The successes emanating from the prevailing Western mental model of health and disease focusing on the individual and the reductionist approach to scientific inquiry is unquestioned. However, as our understanding of biologic processes has grown, the necessity of a new mental model that encompasses factors external to the individual is evident. The author proposes that a mental model, akin to an ecosystem, with the individual residing at the confluence of their genetic, behavioral, environmental, and microbiota factors be consciously developed in students. Embracing the complexity and interactions of biologic processes within and external to the individual is necessary to continue to advance science and medicine.
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Affiliation(s)
- James O. Woolliscroft
- Departments of Internal Medicine and Learning Health SciencesUniversity of MichiganAnn ArborMIUSA
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