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Vogel B, Jou S, Sartori S, Farhan S, Smith K, Snyder C, Spirito A, Nathani M, Byrne KK, Sharma R, Krishnan P, Dangas G, Kini A, Sharma S, Mehran R. Impact of sex on outcomes associated with polyvascular disease in patients after PCI. Am Heart J 2024:S0002-8703(24)00196-0. [PMID: 39121918 DOI: 10.1016/j.ahj.2024.08.002] [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: 12/08/2023] [Revised: 08/04/2024] [Accepted: 08/05/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Atherosclerosis in more than one vs. one arterial bed is associated with increased risk for major adverse cardiovascular events (MACE). This study aimed to determine whether the risk of post percutaneous coronary intervention (PCI) MACE associated with polyvascular disease (PVD) differs by sex. METHODS We analyzed 18,721 patients undergoing PCI at a tertiary-care center between 2012-2019. Polyvascular disease was defined as history of peripheral artery and/or cerebrovascular disease. The primary endpoint was MACE, a composite of all-cause death, myocardial infarction, or stroke at 1 year. Multivariate Cox regression was used to adjust for differences in baseline risk between patients with PVD vs. coronary artery disease (CAD) alone and interaction testing was used to assess risk modification by sex. RESULTS Women represented 29.2% (N=5,467) of the cohort and were more likely to have PVD than men (21.7% vs. 16.1%; p<0.001). Among both sexes, patients with PVD were older with higher prevalence of comorbidities and cardiovascular risk factors. Women with PVD had the highest MACE rate (10.0%), followed by men with PVD (7.2%), women with CAD alone (5.0%), and men with CAD alone (3.6%). Adjusted analyses revealed similar relative MACE risk associated with PVD vs. CAD alone in women and men (adjusted hazard ratio [aHR] 1.54, 95% confidence interval [CI] 1.20-1.99; p<0.001 and aHR 1.31, 95% CI 1.06-1.62; p=0.014, respectively; p-interaction=0.460). CONCLUSION Women and men derive similar excess risk of MACE from PVD after PCI. The heightened risk associated with PVD needs to be addressed with maximized use of secondary prevention in both sexes.
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Affiliation(s)
- Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephanie Jou
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Serdar Farhan
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kenneth Smith
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | | - Raman Sharma
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - George Dangas
- Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Samin Sharma
- Icahn School of Medicine at Mount Sinai, New York, NY
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY.
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Cheng K, Wang J, Zheng W, Wu S, Zheng J, Sang W, Ma J, Pang J, Pan C, Wang G, Wu Y, Chen Y, Xu F. Sex differences in the management of patients with suspected acute coronary syndrome in China. Intern Emerg Med 2024; 19:1071-1079. [PMID: 38102447 DOI: 10.1007/s11739-023-03494-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 11/18/2023] [Indexed: 12/17/2023]
Abstract
Few studies have assessed sex differences in the management of suspected acute coronary syndrome (ACS). We aimed to compare the evaluation, treatment, and outcomes between males and females with suspected ACS in the emergency department. Data were obtained from a prospective registry of acute chest pain involving 21 emergency departments in Shandong Province, China. The primary endpoint was 30-day major adverse cardiac events (MACEs). Overlap propensity score weighting was used to address potential confounding. A total of 8046 patients were analysed (42.8% female). Overlap-weighted analysis showed no significant association of female sex with 30-day MACEs (odds ratio, 0.91; 95% CI 0.75 to 1.11; P = 0.363). Secondary analyses found that women were less likely to be identified as high risk at first presentation (odds ratio, 0.86; 95% CI 0.78 to 0.94; P < 0.001). In the emergency department, women were less likely to undergo antiplatelet therapy (odds ratio, 0.87; 95% CI 0.79 to 0.96; P = 0.004) or coronary angiography (odds ratio, 0.78; 95% CI, 0.69 to 0.88; P < 0.001). Women had a longer length of stay in the emergency department and were less likely to be admitted to a ward at disposition. These sex differences existed only in the non-ST-elevation subgroup and were independent of risk stratification. Women with non-ST-elevation chest pain in China received suboptimal treatment in the emergency department. However, their clinical outcomes were not significantly different from those of men. Further studies are needed to determine the causes and impacts of these sex differences.
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Affiliation(s)
- Kai Cheng
- Department of Emergency Medicine, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China
- Shandong Provincial Clinical Research Centre for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Centre, Qilu Hospital of Shandong University, Jinan, China
- Shandong Key Laboratory: Magnetic Field-Free Medicine and Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan, China
| | - Jiali Wang
- Department of Emergency Medicine, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China
- Shandong Provincial Clinical Research Centre for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Centre, Qilu Hospital of Shandong University, Jinan, China
- Shandong Key Laboratory: Magnetic Field-Free Medicine and Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan, China
| | - Wen Zheng
- Department of Emergency Medicine, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China
- Shandong Provincial Clinical Research Centre for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Centre, Qilu Hospital of Shandong University, Jinan, China
- Shandong Key Laboratory: Magnetic Field-Free Medicine and Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan, China
| | - Shuo Wu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China
- Shandong Provincial Clinical Research Centre for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Centre, Qilu Hospital of Shandong University, Jinan, China
- Shandong Key Laboratory: Magnetic Field-Free Medicine and Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan, China
| | - Jiaqi Zheng
- Department of Emergency Medicine, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China
- Shandong Provincial Clinical Research Centre for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Centre, Qilu Hospital of Shandong University, Jinan, China
- Shandong Key Laboratory: Magnetic Field-Free Medicine and Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan, China
| | - Wentao Sang
- Department of Emergency Medicine, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China
- Shandong Provincial Clinical Research Centre for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Centre, Qilu Hospital of Shandong University, Jinan, China
- Shandong Key Laboratory: Magnetic Field-Free Medicine and Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan, China
| | - Jingjing Ma
- Department of Emergency Medicine, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China
- Shandong Provincial Clinical Research Centre for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Centre, Qilu Hospital of Shandong University, Jinan, China
- Shandong Key Laboratory: Magnetic Field-Free Medicine and Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan, China
| | - Jiaojiao Pang
- Department of Emergency Medicine, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China
- Shandong Provincial Clinical Research Centre for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Centre, Qilu Hospital of Shandong University, Jinan, China
- Shandong Key Laboratory: Magnetic Field-Free Medicine and Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan, China
| | - Chang Pan
- Department of Emergency Medicine, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China
- Shandong Provincial Clinical Research Centre for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Centre, Qilu Hospital of Shandong University, Jinan, China
- Shandong Key Laboratory: Magnetic Field-Free Medicine and Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan, China
| | - Guangmei Wang
- Department of Emergency Medicine, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China
- Shandong Provincial Clinical Research Centre for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Centre, Qilu Hospital of Shandong University, Jinan, China
- Shandong Key Laboratory: Magnetic Field-Free Medicine and Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan, China
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China.
| | - Yuguo Chen
- Department of Emergency Medicine, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China.
- Shandong Provincial Clinical Research Centre for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Centre, Qilu Hospital of Shandong University, Jinan, China.
- Shandong Key Laboratory: Magnetic Field-Free Medicine and Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan, China.
- NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan, China.
| | - Feng Xu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan, 250012, China.
- Shandong Provincial Clinical Research Centre for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Centre, Qilu Hospital of Shandong University, Jinan, China.
- Shandong Key Laboratory: Magnetic Field-Free Medicine and Functional Imaging (MF), Qilu Hospital of Shandong University, Jinan, China.
- NMPA Key Laboratory for Clinical Research and Evaluation of Innovative Drug, Qilu Hospital of Shandong University, Jinan, China.
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Alter DA, Austin PC, Rosenfeld A. The Dynamic Nature of the Socioeconomic Determinants of Cardiovascular Health: A Narrative Review. Can J Cardiol 2024; 40:989-999. [PMID: 38309464 DOI: 10.1016/j.cjca.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/08/2024] [Accepted: 01/14/2024] [Indexed: 02/05/2024] Open
Abstract
Despite decades of social epidemiologic research, health inequities remain pervasive and ubiquitous in Canada and elsewhere. One reason may be our use of socioeconomic measurement, which has often relied on single point-in-time exposures. To explore the extent to which researchers have incorporated dynamic socioeconomic measurement into cardiovascular health outcome evaluations, we performed a narrative review. We estimated the prevalence of socioeconomic longitudinal cardiovascular research studies that identified socioeconomic exposures at 2 or more points in time between the years of 2019 and 2023. We defined cardiovascular outcome studies as those that examined coronary artery disease, myocardial infarction, acute coronary syndrome, stroke, heart failure, cardiac arrhythmias, cardiac death, cardiometabolic factors, transient ischemic attacks, peripheral artery disease, or hypertension. Socioeconomic exposures included individual income, neighbourhood income, intergenerational social mobility, education, occupation, insurance status, and economic security. Seven percent of socioeconomic cardiovascular outcome studies have measured socioeconomic status at 2 or more points in time throughout the follow-up period, hypothesized mechanisms by which dynamic socioeconomic measures affected outcome focused on social mobility, accumulation, and critical period theories. Insights, implications, and future directions are discussed, in which we highlight ways in which postal code data can be better used methodologically as a dynamic socioeconomic measure. Future research must incorporate dynamic socioeconomic measurement to better inform root causes, interventions, and health-system designs if health equity is to be improved.
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Affiliation(s)
- David A Alter
- ICES, Sunnybrook Health Sciences, Toronto, Ontario, Canada; Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Peter C Austin
- ICES, Sunnybrook Health Sciences, Toronto, Ontario, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Rosenfeld
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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van der Veer A, Madern T, van Lenthe FJ. Tunneling, cognitive load and time orientation and their relations with dietary behavior of people experiencing financial scarcity - an AI-assisted scoping review elaborating on scarcity theory. Int J Behav Nutr Phys Act 2024; 21:26. [PMID: 38439067 PMCID: PMC10910771 DOI: 10.1186/s12966-024-01576-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 02/14/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND The concept of a financial scarcity mindset has raised much attention as an explanation for poor decision-making and dysfunctional behavior. It has been suggested that financial scarcity could also impair dietary behavior, through a decline in self-control. Underlying cognitive mechanisms of tunneling (directing attention to financial issues and neglecting other demands), cognitive load (a tax on mental bandwidth interfering with executive functioning) and time orientation (a shift towards a present time horizon, versus a future time horizon) may explain the association between financial scarcity and self-control related dietary behavior. The current scoping review gathers recent evidence on how these mechanisms affect dietary behavior of people experiencing financial scarcity. It builds on a theoretical framework based on insights from behavioral economics and health psychology. METHODS A literature search was executed in six online databases, which resulted in 9.975 papers. Search terms were tunneling, cognitive load and time orientation, financial scarcity, and dietary behavior. Screening was performed with ASReview, an AI-ranking tool. In total, 14 papers were included in the scoping review. We used PRISMA-ScR guidelines for reporting. RESULTS Limited evidence indicates that a scarcity mindset could increase tunneling, through attentional narrowing on costs of food, which then directly impacts dietary behavior. A scarcity mindset involves experiencing financial stress, which can be understood as cognitive load. Cognitive load decreases attentional capacity, which could impair self-control in dietary choices. Financial scarcity is related to a present time orientation, which affects dietary choices by shifting priorities and decreasing motivation for healthy dietary behavior. CONCLUSIONS A scarcity mindset affects dietary behavior in different ways. Tunneling and a shift in time orientation are indicative of an attentional redirection, which can be seen as more adaptive to the situation. These may be processes indirectly affecting self-control capacity. Cognitive load could decrease self-control capacity needed for healthy dietary behavior because it consumes mental bandwidth. How a changing time orientation when experiencing financial scarcity relates to motivation for self-control in dietary behavior is a promising theme for further inquiry.
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Affiliation(s)
- Annemarieke van der Veer
- Research Group of Debt and Debt Collection, University of Applied Sciences Utrecht, Utrecht, PO Box 85397, 3508 AJ, The Netherlands.
| | - Tamara Madern
- Research Group of Debt and Debt Collection, University of Applied Sciences Utrecht, Utrecht, PO Box 85397, 3508 AJ, The Netherlands
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, PO Box 2040, Rotterdam, 3000 CA, The Netherlands
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5
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Choi HJ, LeBlanc M, Moger TA, Valberg M, Page CM, Aamodt G, Næss Ø. Geographical variation in cardiovascular disease mortality in Norway: The role of life course socioeconomic position and parental health. Health Place 2023; 83:103095. [PMID: 37659155 DOI: 10.1016/j.healthplace.2023.103095] [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: 11/01/2022] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 09/04/2023]
Abstract
Despite substantial geographical variation in cardiovascular (CVD) mortality within countries, little is known about whether this variation can be explained by individuals' life course socioeconomic position (SEP) or differences in family history of premature CVD deaths. Cox proportional hazards models were used to investigate the association between the county of residence at ages 50-59 and CVD death in Norwegians born between 1940 and 1959 and survived to at least age 60, using national data. Individual life course SEP and family history of premature CVD death reduced the geographical variation in CVD mortality across Norwegian counties, but some significant differences remained. Furthermore, CVD risk varied by residents' migration histories between two counties with distinct CVD and socioeconomic profiles.
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Affiliation(s)
- Hye Jung Choi
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Marissa LeBlanc
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway; Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Tron Anders Moger
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Morten Valberg
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway; Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Christian M Page
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Mathematics, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Geir Aamodt
- Department of Public Health Science, LANDSAM, Norwegian University of Life Science, Ås, Norway
| | - Øyvind Næss
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway; Norwegian Institute of Public Health, Oslo, Norway
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6
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Barakat C, Konstantinidis T. A Review of the Relationship between Socioeconomic Status Change and Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6249. [PMID: 37444097 PMCID: PMC10341459 DOI: 10.3390/ijerph20136249] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES This review aimed to identify and synthesize the existing literature on the effects of socioeconomic status (SES) changes on health. METHODS A review was conducted using Medline, Cochrane library, and CINAHL (Cumulative Index to Nursing and Allied Health Literature). All longitudinal or cross-sectional studies that examined links between changes to SES across different time periods and measured health outcomes were included. Screening was conducted using select inclusion and exclusion criteria in order of title, abstract, and full text. Two independent reviewers assessed the quality of the full text articles using the Downs and Black checklist. RESULTS Our literature search led to 2719 peer reviewed articles, 2639 of which were title screened after duplicates were removed. A total of 117 abstracts and 12 full text articles were screened. Overall, findings from 11 articles form the basis of this review. Eight different types of measures of changes to SES were identified. These include education, occupation, economic security, income sufficiency, home ownership, car ownership, health insurance, and marital status. Assessed outcomes included measures related to physical health, cardiovascular disease, mental health, and oral health. A large proportion of studies found that an SES change impacts health. Evidence suggests that those with consistently high SES have the best health outcomes, followed by those who report their SES change from low to high (upward social mobility). Evidence on the relative health effects for those who report their SES change from high to low (downward social mobility) compared to those who report consistently low SES is inconsistent. CONCLUSION Current evidence suggests that an SES change has an impact on an individual's health. More research on the effects of SES changes on health outcomes in adulthood is needed and can inform various areas of health research including health resiliency and development. Future studies should focus on individual SES indicators and their effects on health outcomes at multiple points throughout life.
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Affiliation(s)
- Caroline Barakat
- Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe St. N, Oshawa, ON L1G 0C5, Canada
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7
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Bennett M, Pistillo A, Recalde M, Reyes C, Freisling H, Duarte-Salles T. Time trends in the incidence of cardiovascular disease, hypertension and diabetes by sex and socioeconomic status in Catalonia, Spain: a population-based cohort study. BMJ Open 2023; 13:e066404. [PMID: 37225269 PMCID: PMC10230898 DOI: 10.1136/bmjopen-2022-066404] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 04/23/2023] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVE We aimed to estimate how longitudinal trends in cardiovascular disease, hypertension and type 2 diabetes mellitus incidence in Catalonia, Spain from 2009 to 2018 may differ by age, sex and socioeconomic deprivation. DESIGN Cohort study using prospectively collected data. SETTING Electronic health records from primary healthcare centres in Catalonia, Spain. PARTICIPANTS 3 247 244 adults (≥40 years). OUTCOME MEASURES We calculated the annual incidence (per 1000 persons-year) and incidence rate ratios (IRR) between three time periods of cardiovascular disease, hypertension and type 2 diabetes mellitus to measure trends and changes in incidence during the study period. RESULTS In 2016-2018 compared with 2009-2012, cardiovascular disease incidence increased in the 40-54 (eg, IRR=1.61, 95% CI: 1.52 to 1.69 in women) and 55-69 age groups. There was no change in cardiovascular disease incidence in women aged 70+ years, and a slight decrease in men aged 70+ years (0.93, 0.90 to 0.95). Hypertension incidence decreased in all age groups for both sexes. Type 2 diabetes mellitus incidence decreased in all age groups for both sexes (eg, 0.72, 0.70 to 0.73 in women aged 55-69 years), except for the 40-54 year age group (eg, 1.09, 1.06 to 1.13 in women). Higher incidence levels were found in the most deprived areas, especially in the 40-54 and 55-69 groups. CONCLUSIONS Overall cardiovascular disease incidence has increased while hypertension and type 2 diabetes mellitus incidence have decreased in the last years in Catalonia, Spain, with differences in trends by age group and socioeconomic deprivation.
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Affiliation(s)
- Matthew Bennett
- IDIAP Jordi Gol, Barcelona, Catalunya, Spain
- Departament d'Antropologia, Filosofia i Treball Social, Universitat Rovira i Virgili, Tarragona, Catalunya, Spain
| | | | - Martina Recalde
- International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
| | | | - Heinz Freisling
- International Agency for Research on Cancer, Lyon, Rhône-Alpes, France
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8
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White PA, Faresjö T, Jones MP, Ludvigsson J. Low maternal education increases the risk of Type 1 Diabetes, but not other autoimmune diseases: a mediating role of childhood BMI and exposure to serious life events. Sci Rep 2023; 13:6166. [PMID: 37061552 PMCID: PMC10105777 DOI: 10.1038/s41598-023-32869-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/04/2023] [Indexed: 04/17/2023] Open
Abstract
The objective of this paper was to investigate if socioeconomic status (SES), measured by maternal education and household income, influenced the risk of developing autoimmune disease (Type 1 Diabetes, Celiac disease, Juvenile Idiopathic Arthritis, Crohn's disease, Ulcerative colitis, and autoimmune thyroid disease), or age at diagnosis, and to analyse pathways between SES and autoimmune disease. We used data from the All Babies in Southeast Sweden (ABIS) study, a population-based prospective birth cohort, which included children born 1997-1999. Diagnoses of autoimmune disease was collected from the Swedish National Patient Register Dec 2020. In 16,365 individuals, low maternal education, but not household income, was associated with increased risk of Type 1 Diabetes; middle education RR 1.54, 95% CI 1.06, 2.23; P 0.02, low education RR 1.81, 95% CI 1.04, 3.18; P 0.04. Maternal education and household income was not associated with any other autoimmune disease and did not influence the age at diagnosis. Part of the increased risk of Type 1 Diabetes by lower maternal education was mediated by the indirect pathway of higher BMI and higher risk of Serious Life Events (SLE) at 5 years of age. The risk of developing Type 1 Diabetes associated to low maternal education might be reduced by decreasing BMI and SLE during childhood.
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Affiliation(s)
- Pär Andersson White
- Department of Health, Medicine and Care, General Practice, Linköping University, Linköping, 581 83, Sweden.
- Crown Princess Victoria Children's Hospital, Linköping University, Linköping, 581 85, Sweden.
| | - Tomas Faresjö
- Department of Health, Medicine and Care, General Practice, Linköping University, Linköping, 581 83, Sweden
| | - Michael P Jones
- School of Psychological Sciences, Macquarie University, North Ryde, NSW, 2109, Australia
| | - Johnny Ludvigsson
- Crown Princess Victoria Children's Hospital, Linköping University, Linköping, 581 85, Sweden
- Department of Biomedical and Clinical Sciences, Division of Pediatrics, Linköping University, Linköping, 581 83, Sweden
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9
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Kozela M, Polak M, Stepaniak U, Bobak M, Pająk A. Changes in Socioeconomic Status as Predictors of Cardiovascular Disease Incidence and Mortality: A 10-Year Follow-Up of a Polish-Population-Based HAPIEE Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15411. [PMID: 36430130 PMCID: PMC9693797 DOI: 10.3390/ijerph192215411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
Although the inverse association between socioeconomic status (SES) and cardiovascular disease (CVD) is well established, research on the effect of changes in the SES throughout life on CVD risk in populations with different social backgrounds remains scarce. This study aimed to assess the relationship between childhood SES, adulthood SES, and changes in SES over time, and CVD incidence and mortality in a Polish urban population. In addition, the predictive performance of the SES index was compared with education alone. A cohort study with a 10-year follow-up was conducted, in which a random sample of 10,728 residents in Kraków aged 45-69 years were examined. The SES was assessed at baseline using data on education, parents' education, housing standard at the age of 10 years, professional activity, household amenities, and difficulties in paying bills and buying food. SES categories (low, middle, and high) were extracted using cluster analyses. Information on new CVD cases was obtained from questionnaires in subsequent phases of the study and confirmed by reviewing clinical records. Data on deaths and causes were obtained from the residents' registry, Central Statistical Office, and the participants' families. The effect of the SES index on the risk of CVD was assessed using Cox proportional hazard models. In male and female participants, the CVD incidence and mortality were observed to be 27,703 and 32,956 person-years (384 and 175 new CVD cases) and 36,219 and 40,048 person-years (159 and 92 CVD deaths), respectively. Childhood SES was not associated with CVD incidence and mortality. A protective effect of high adulthood SES against CVD mortality was observed in men and women (HR = 0.59, 95% CI = 0.31-0.97; HR = 0.33, 95% CI = 0.14-0.75, respectively). In women, downward social mobility was related to 2.24 and 3.75 times higher CVD incidence and mortality, respectively. In men, a protective effect against mortality was observed in upward mobility (HR = 0.50, 95% CI = 0.29-0.84). Model discrimination was similar for the SES index and education alone for the association with CVD incidence. In women, the SES index was a slightly better predictor of CVD mortality than education alone (C-index = 0.759, SE = 0.0282 vs. C-index = 0.783, SE = 0.0272; p = 0.041). In conclusion, high adulthood SES, but not childhood SES, may be considered to be a protective factor against CVD in urban populations in high-CVD-risk regions. No effects of critical periods in early life were observed on CVD risk. In later life, social mobility was found to affect CVD mortality in both men and women. In men, a protective effect of upward mobility was confirmed, whereas in women, an increased CVD risk was related to downward mobility. It can be concluded that CVD prevention may be beneficial if socioeconomic potentials are strengthened in later life.
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Affiliation(s)
- Magdalena Kozela
- Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Maciej Polak
- Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Urszula Stepaniak
- Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, 31-008 Krakow, Poland
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Andrzej Pająk
- Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, 31-008 Krakow, Poland
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10
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Beukers NGFM, Heijden GJMG, Su N, Galiën O, Gerdes VEA, Loos BG. An examination of the risk of periodontitis for nonfatal cardiovascular diseases on the basis of a large insurance claims database. Community Dent Oral Epidemiol 2022; 51:408-417. [DOI: 10.1111/cdoe.12752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Nicky G. F. M. Beukers
- Department of Periodontology, Academic Centre for Dentistry Amsterdam University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Geert J. M. G. Heijden
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Naichuan Su
- Department of Oral Public Health, Academic Centre for Dentistry Amsterdam University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Onno Galiën
- Knowledge Center Achmea Health Insurance Company Leusden The Netherlands
| | - Victor E. A. Gerdes
- Department of Vascular Medicine, Amsterdam University Medical Center University of Amsterdam Amsterdam The Netherlands
- Department of Internal Medicine Spaarne Gasthuis Hoofddorp The Netherlands
| | - Bruno G. Loos
- Department of Periodontology, Academic Centre for Dentistry Amsterdam University of Amsterdam and Vrije Universiteit Amsterdam Amsterdam The Netherlands
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11
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Papamichael MM, Karatzi K, Mavrogianni C, Cardon G, De Vylder F, Iotova V, Usheva N, Tankova T, González-Gil EM, Kivelä J, Wikström K, Moreno L, Liatis S, Makrilakis K, Manios Y. Socio-economic vulnerabilities and food intake in European children: The Feel4Diabetes Study. Nutrition 2022; 103-104:111744. [DOI: 10.1016/j.nut.2022.111744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 11/27/2022]
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Abstract
In a context where epidemiologic research has been heavily influenced by a biomedical and individualistic approach, the naming of “social epidemiology” allowed explicit emphasis on the social production of disease as a powerful explanatory paradigm and as critically important for interventions to improve population health. This review briefly highlights key substantive areas of focus in social epidemiology over the past 30 years, reflects on major advances and insights, and identifies challenges and possible future directions. Future opportunities for social epidemiology include grounding research in theoretically based and systemic conceptual models of the fundamental social drivers of health; implementing a scientifically rigorous yet realistic approach to drawing conclusions about social causes; using complementary methods to generate valid explanations and identify effective actions; leveraging the power of harmonization, replication, and big data; extending interdisciplinarity and diversity; advancing emerging critical approaches to understanding the health impacts of systemic racism and its policy implications; going global; and embracing a broad approach to generating socially useful research. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Ana V. Diez Roux
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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13
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Multiple Socioeconomic Circumstances and Initiation of Cardiovascular Medication among Ageing Employees. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910148. [PMID: 34639449 PMCID: PMC8507630 DOI: 10.3390/ijerph181910148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/24/2021] [Accepted: 09/22/2021] [Indexed: 12/31/2022]
Abstract
There are persisting socioeconomic differences in cardiovascular diseases, but studies on socioeconomic differences in the initiation of cardiovascular medication are scarce. This study examined the associations between multiple socioeconomic circumstances and cardiovascular medication. The Helsinki Health Study baseline survey (2000-2002) of 40-60-year-old employees was linked with cardiovascular medication data from national registers. The analyses included 5805 employees concerning lipid medication and 4872 employees concerning hypertension medication. Medication purchases were followed for 10 years. The analyses were made using logistic regression, and the odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for childhood, conventional and material socioeconomic circumstances. Low parental education showed an association with lipid medication among women only (OR 1.34, 95% CI 1.11-1.61), whereas childhood economic difficulties showed more widespread associations. Low education and occupational class were associated with an increased risk of both hypertension (education: OR 1.58, 1.32-1.89; occupational class: 1.31, 1.08-1.59) and lipid medication (education: 1.34, 1.12-1.61; occupational class: 1.38, 1.13-1.67). Rented housing (1.35, 1.18-1.54 for hypertension medication; 1.21, 1.05-1.38 for lipid medication) and current economic difficulties (1.59, 1.28-1.98 for hypertension medication; 1.35, 1.07-1.71 for lipid medication) increased the risk. Several measures of socioeconomic circumstances acting at different stages of the life course were associated with cardiovascular medication, with individuals in disadvantageous socioeconomic circumstances having elevated risks.
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14
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Vogel B, Acevedo M, Appelman Y, Bairey Merz CN, Chieffo A, Figtree GA, Guerrero M, Kunadian V, Lam CSP, Maas AHEM, Mihailidou AS, Olszanecka A, Poole JE, Saldarriaga C, Saw J, Zühlke L, Mehran R. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021; 397:2385-2438. [PMID: 34010613 DOI: 10.1016/s0140-6736(21)00684-x] [Citation(s) in RCA: 507] [Impact Index Per Article: 169.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.
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Affiliation(s)
- Birgit Vogel
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Monica Acevedo
- Divisón de Enfermedades Cardiovasculares, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Yolande Appelman
- Amsterdam UMC, VU University Medical Center, Amsterdam, Netherlands
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gemma A Figtree
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mayra Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundations Trust, Newcastle Upon Tyne, UK
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; Cardiovascular Sciences Academic Clinical Programme, Duke-National University of Singapore, Singapore
| | - Angela H E M Maas
- Department of Women's Cardiac Health, Radboud University Medical Center, Nijmegen, Netherlands
| | - Anastasia S Mihailidou
- Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia; Cardiovascular and Hormonal Research Laboratory, Kolling Institute, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Agnieszka Olszanecka
- 1st Department of Cardiology, Interventional Electrocardiology and Hypertension, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jeanne E Poole
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Clara Saldarriaga
- Department of Cardiology and Heart Failure Clinic, Clinica CardioVID, University of Antioquia, Medellín, Colombia
| | - Jacqueline Saw
- Division of Cardiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Liesl Zühlke
- Departments of Paediatrics and Medicine, Divisions of Paediatric and Adult Cardiology, Red Cross Children's and Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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15
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16
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Beukers NGFM, Su N, Loos BG, van der Heijden GJMG. Lower Number of Teeth Is Related to Higher Risks for ACVD and Death-Systematic Review and Meta-Analyses of Survival Data. Front Cardiovasc Med 2021; 8:621626. [PMID: 34026863 PMCID: PMC8138430 DOI: 10.3389/fcvm.2021.621626] [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] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/22/2021] [Indexed: 12/17/2022] Open
Abstract
Tooth loss reflects the endpoint of two major dental diseases: dental caries and periodontitis. These comprise 2% of the global burden of human diseases. A lower number of teeth has been associated with various systemic diseases, in particular, atherosclerotic cardiovascular diseases (ACVD). The aim was to summarize the evidence of tooth loss related to the risk for ACVD or death. Cohort studies with prospective follow-up data were retrieved from Medline-PubMed and EMBASE. Following the PRISMA guidelines, two reviewers independently selected articles, assessed the risk of bias, and extracted data on the number of teeth (tooth loss; exposure) and ACVD-related events and all-cause mortality (ACM) (outcome). A total of 75 articles were included of which 44 were qualified for meta-analysis. A lower number of teeth was related to a higher outcome risk; the pooled risk ratio (RR) for the cumulative incidence of ACVD ranged from 1.69 to 2.93, and for the cumulative incidence of ACM, the RR ranged from 1.76 to 2.27. The pooled multiple adjusted hazard ratio (HR) for the incidence density of ACVD ranged from 1.02 to 1.21, and for the incidence density of ACM, the HR ranged from 1.02 to 1.30. This systematic review and meta-analyses of survival data show that a lower number of teeth is a risk factor for both ACVD and death. Health care professionals should use this information to inform their patients and increase awareness on the importance of good dental health and increase efforts to prevent tooth loss.
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Affiliation(s)
- Nicky G F M Beukers
- Academic Centre for Dentistry Amsterdam, Department of Periodontology, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Naichuan Su
- Academic Centre for Dentistry Amsterdam, Department of Social Dentistry, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Bruno G Loos
- Academic Centre for Dentistry Amsterdam, Department of Periodontology, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Geert J M G van der Heijden
- Academic Centre for Dentistry Amsterdam, Department of Social Dentistry, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health Research Institute, University of Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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17
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Pool LR, Aguayo L, Brzezinski M, Perak AM, Davis MM, Greenland P, Hou L, Marino BS, Van Horn L, Wakschlag L, Labarthe D, Lloyd-Jones D, Allen NB. Childhood Risk Factors and Adulthood Cardiovascular Disease: A Systematic Review. J Pediatr 2021; 232:118-126.e23. [PMID: 33516680 DOI: 10.1016/j.jpeds.2021.01.053] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To conduct a comprehensive review of the literature on childhood risk factors and their associations with adulthood subclinical and clinical cardiovascular disease (CVD). STUDY DESIGN A systematic search was performed using the MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science databases to identify English-language articles published through June 2018. Articles were included if they were longitudinal studies in community-based populations, the primary exposure occurred during childhood, and the primary outcome was either a measure of subclinical CVD or a clinical CVD event occurring in adulthood. Two independent reviewers screened determined whether eligibility criteria were met. RESULTS There were 210 articles that met the predefined criteria. The greatest number of publications examined associations of clinical risk factors, including childhood adiposity, blood pressure, and cholesterol, with the development of adult CVD. Few studies examined childhood lifestyle factors including diet quality, physical activity, and tobacco exposure. Domains of risk beyond "traditional" cardiovascular risk factors, such as childhood psychosocial adversity, seemed to have strong published associations with the development of CVD. CONCLUSIONS Although the evidence was fairly consistent in direction and magnitude for exposures such as childhood adiposity, hypertension, and hyperlipidemia, significant gaps remain in the understanding of how childhood health and behaviors translate to the risk of adulthood CVD, particularly in lesser studied exposures like glycemic indicators, physical activity, diet quality, very early life course exposure, and population subgroups.
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Affiliation(s)
- Lindsay R Pool
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Liliana Aguayo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Michal Brzezinski
- Department of Public Health and Social Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Amanda M Perak
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Matthew M Davis
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lifang Hou
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bradley S Marino
- Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Division of Cardiology, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Innovations in Developmental Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Linda Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lauren Wakschlag
- Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Darwin Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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18
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Zhang J, Lu N. The association between childhood conditions and heart disease among middle-aged and older population in China: a life course perspective. BMC Geriatr 2021; 21:184. [PMID: 33731011 PMCID: PMC7968160 DOI: 10.1186/s12877-021-02134-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 03/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background Heart disease is a severe health problem among adult populations in China. The prevalence rates of heart disease increase with age. The pathogenic causes of heart disease are often related to conditions in early life. Using a nationally representative sample of adults aged 45 or older in China, we examined the association between childhood conditions and heart disease in later life from a life course perspective. Methods The data used in this study were derived from the life history module and 2015 wave of China Health and Retirement Longitudinal Study (CHARLS). Missingness were handled by multiple imputation, generating 20 complete datasets with a final sample of 19,800. Doctor-diagnosed heart disease was the main dependent variable. Respondents’ conditions in childhood, adulthood, and older age were the independent variables (e.g., socioeconomic status, health, and health resources). Random-effects logistic regression models were conducted to test the hypotheses. Results A total of 16.6% respondents reported being diagnosed with heart disease by doctors. Regarding childhood socioeconomic status, 8.2% of the respondents considered that they were (a lot) better off than their neighbors, and 31.1% considered that their health status in childhood was better than their peers. More than 90% of respondents did not have severe illnesses during their childhood, and around 80.3% had access to health resources nearby in childhood. Lower socioeconomic status and poorer health conditions in childhood were associated with a greater likelihood of reporting doctor-diagnosed heart diseases, even after controlling for conditions in adulthood and older age (socioeconomic status: odds ratio (OR) = 0.947; self-rated health: OR = 0.917; severe illnesses: OR = 1.196). Conclusions Along with chronic diseases (e.g., hypertension, diabetes, and dyslipidemia), unhealthy behaviors, overweight and obesity, poor childhood conditions should be considered as screening criteria to identify populations at risk of heart disease. Relevant preventive strategies and interventions should be developed from a life course perspective and conducted in communities by providing health education program among older population with low socioeconomic status, and encouraging early detection and treatment.
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Affiliation(s)
- Jingyue Zhang
- Institute of Gender and Culture, Changchun Normal University, Changji North Road 677, Changchun, 130052, Jilin Province, China.,Department of Sociology, School of Philosophy and Sociology, Jilin University, Qianjin Street 2699, Changchun, 130012, Jilin Province, China
| | - Nan Lu
- Department of Social Work and Social Policy, School of Sociology and Population Studies, Renmin University of China, No. 59 Zhongguancun Street, Haidian District, Beijing, 100872, China.
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Brain tissue properties link cardio-vascular risk factors, mood and cognitive performance in the CoLaus|PsyCoLaus epidemiological cohort. Neurobiol Aging 2021; 102:50-63. [PMID: 33765431 DOI: 10.1016/j.neurobiolaging.2021.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/31/2021] [Accepted: 02/04/2021] [Indexed: 01/15/2023]
Abstract
Given the controversy about the impact of modifiable risk factors on mood and cognition in ageing, we sought to investigate the associations between cardio-vascular risk, mental health, cognitive performance and brain anatomy in mid- to old age. We analyzed a set of risk factors together with multi-parameter magnetic resonance imaging (MRI) in the CoLaus|PsyCoLaus cohort (n > 1200). Cardio-vascular risk was associated with differences in brain tissue properties - myelin, free tissue water, iron content - and regional brain volumes that we interpret in the context of micro-vascular hypoxic lesions and neurodegeneration. The interaction between clinical subtypes of major depressive disorder and cardio-vascular risk factors showed differential associations with brain structure depending on individuals' lifetime trajectory. There was a negative correlation between melancholic depression, anxiety and MRI markers of myelin and iron content in the hippocampus and anterior cingulate. Verbal memory and verbal fluency performance were positively correlated with left amygdala volumes. The concomitant analysis of brain morphometry and tissue properties allowed for a neuro-biological interpretation of the link between modifiable risk factors and brain health.
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20
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How Educational Inequalities in Cardiovascular Mortality Evolve While Healthcare Insurance Coverage Grows: Colombia, 1998 to 2015. Value Health Reg Issues 2020; 23:112-121. [DOI: 10.1016/j.vhri.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/09/2020] [Accepted: 08/19/2020] [Indexed: 12/19/2022]
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21
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Khalatbari-Soltani S, Stanaway F, Cvejic E, Blyth FM, Naganathan V, Handelsman DJ, Le Couteur DG, Seibel MJ, Waite LM, Cumming RG. Contribution of psychosocial factors to socioeconomic inequalities in mortality among older Australian men: a population-based cohort study. Int J Equity Health 2020; 19:177. [PMID: 33028353 PMCID: PMC7539396 DOI: 10.1186/s12939-020-01277-2] [Citation(s) in RCA: 6] [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] [Received: 06/09/2020] [Accepted: 09/10/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Among older people, the extent to which psychosocial factors explain socioeconomic inequalities in mortality is debated. We aimed to investigate the potential mediating effect of psychosocial factors on socioeconomic inequalities in mortality. METHODS We used data from a prospective population-based cohort (the Concord Health and Ageing in Men Project; baseline recruitment in 2005-2007), in Sydney, Australia. The main outcomes were all-cause and cause-specific mortality. Socioeconomic status (SES; educational attainment, occupational position, source of income, housing tenure, and a cumulative SES score) was assessed at baseline. Measures of structural and functional social support, as well as depressive and anxiety symptoms were assessed three times during follow-ups. Associations were quantified using Cox regression. Mediation was calculated using "change-in-estimate method". RESULTS 1522 men (mean age at baseline: 77·4 ± 5·5 years) were included in the analyses with a mean (SD) follow-up time of 9·0 (3·6) years for all-cause and 8·0 (2·8) years for cause-specific mortality. At baseline, psychosocial measures displayed marked social patterning. Being unmarried, living alone, low social interactions, and elevated depressive symptoms were associated with higher risk of all-cause and cardiovascular disease (CVD) mortality. Psychosocial factors explained 35% of SES inequalities in all-cause mortality, 29% in CVD mortality, 12% in cancer mortality, and 39% in non-CVD, non-cancer mortality. CONCLUSION Psychosocial factors may account for up to one-third of SES inequalities in deaths from all and specific causes (except cancer mortality). Our findings suggest that interventional studies targeting social relationships and/or psychological distress in older men aiming to reduce socioeconomic inequalities in mortality are warranted.
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Affiliation(s)
- Saman Khalatbari-Soltani
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia.
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, Australia.
| | - Fiona Stanaway
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Erin Cvejic
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Fiona M Blyth
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Ageing and Alzheimer's Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - David J Handelsman
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Ageing and Alzheimer's Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, Australia
| | - Markus J Seibel
- ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, Australia
| | - Louise M Waite
- Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Ageing and Alzheimer's Institute, Concord Repatriation and General Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Robert G Cumming
- The University of Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia.
- ARC Centre of Excellence in Population Ageing Research (CEPAR), University of Sydney, Sydney, Australia.
- Centre for Education and Research on Ageing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
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Vineis P, Avendano-Pabon M, Barros H, Bartley M, Carmeli C, Carra L, Chadeau-Hyam M, Costa G, Delpierre C, D'Errico A, Fraga S, Giles G, Goldberg M, Kelly-Irving M, Kivimaki M, Lepage B, Lang T, Layte R, MacGuire F, Mackenbach JP, Marmot M, McCrory C, Milne RL, Muennig P, Nusselder W, Petrovic D, Polidoro S, Ricceri F, Robinson O, Stringhini S, Zins M. Special Report: The Biology of Inequalities in Health: The Lifepath Consortium. Front Public Health 2020; 8:118. [PMID: 32478023 PMCID: PMC7235337 DOI: 10.3389/fpubh.2020.00118] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 03/24/2020] [Indexed: 12/16/2022] Open
Abstract
Funded by the European Commission Horizon 2020 programme, the Lifepath research consortium aimed to investigate the effects of socioeconomic inequalities on the biology of healthy aging. The main research questions included the impact of inequalities on health, the role of behavioral and other risk factors, the underlying biological mechanisms, the efficacy of selected policies, and the general implications of our findings for theories and policies. The project adopted a life-course and comparative approach, considering lifetime effects from childhood and adulthood, and pooled data on up to 1.7 million participants of longitudinal cohort studies from Europe, USA, and Australia. These data showed that socioeconomic circumstances predicted mortality and functional decline as strongly as established risk factors currently targeted by global prevention programmes. Analyses also looked at socioeconomically patterned biological markers, allostatic load, and DNA methylation using richly phenotyped cohorts, unraveling their association with aging processes across the life-course. Lifepath studies suggest that socioeconomic circumstances are embedded in our biology from the outset-i.e., disadvantage influences biological systems from molecules to organs. Our findings have important implications for policy, suggesting that (a) intervening on unfavorable socioeconomic conditions is complementary and as important as targeting well-known risk factors, such as tobacco and alcohol consumption, low fruit and vegetable intake, obesity and a sedentary lifestyle, and that (b) effects of preventive interventions in early life integrate interventions in adulthood. The report has an executive summary that refers to the different sections of the main paper.
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Affiliation(s)
- Paolo Vineis
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Mauricio Avendano-Pabon
- Department of Social Sciences, Health and Medicine, King's College London, London, United Kingdom
| | - Henrique Barros
- EPIUnit – Institute of Public Health University of Porto, Porto, Portugal
| | - Mel Bartley
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Cristian Carmeli
- Center for Primary Care and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
| | | | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Giuseppe Costa
- Department of Clinical Science & Biology, Turin University Medical School, Turin, Italy
| | - Cyrille Delpierre
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | | | - Silvia Fraga
- EPIUnit – Institute of Public Health University of Porto, Porto, Portugal
| | - Graham Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Marcel Goldberg
- UMS 011 Inserm - UVSQ ≪ Cohortes épidémiologiques en population ≫, Villejuif, France
| | | | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Benoit Lepage
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | - Thierry Lang
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | - Richard Layte
- Department of Sociology, School of Social Sciences and Philosophy, Trinity College Dublin, Dublin, Ireland
| | - Frances MacGuire
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Johan P. Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Michael Marmot
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Cathal McCrory
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Roger L. Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Peter Muennig
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Wilma Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dusan Petrovic
- Center for Primary Care and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
| | - Silvia Polidoro
- Molecular Epidemiology and Exposomics Unit, Italian Institute for Genomic Medicine, Turin, Italy
| | - Fulvio Ricceri
- Department of Clinical Science & Biology, Turin University Medical School, Turin, Italy
- Department of Epidemiology, ASL TO3, Turin, Italy
| | - Oliver Robinson
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Zins
- UMS 011 Inserm - UVSQ ≪ Cohortes épidémiologiques en population ≫, Villejuif, France
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23
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Vineis P, Avendano-Pabon M, Barros H, Bartley M, Carmeli C, Carra L, Chadeau-Hyam M, Costa G, Delpierre C, D'Errico A, Fraga S, Giles G, Goldberg M, Kelly-Irving M, Kivimaki M, Lepage B, Lang T, Layte R, MacGuire F, Mackenbach JP, Marmot M, McCrory C, Milne RL, Muennig P, Nusselder W, Petrovic D, Polidoro S, Ricceri F, Robinson O, Stringhini S, Zins M. Special Report: The Biology of Inequalities in Health: The Lifepath Consortium. Front Public Health 2020. [PMID: 32478023 DOI: 10.3389/fpubh.2020.00118/full] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
Funded by the European Commission Horizon 2020 programme, the Lifepath research consortium aimed to investigate the effects of socioeconomic inequalities on the biology of healthy aging. The main research questions included the impact of inequalities on health, the role of behavioral and other risk factors, the underlying biological mechanisms, the efficacy of selected policies, and the general implications of our findings for theories and policies. The project adopted a life-course and comparative approach, considering lifetime effects from childhood and adulthood, and pooled data on up to 1.7 million participants of longitudinal cohort studies from Europe, USA, and Australia. These data showed that socioeconomic circumstances predicted mortality and functional decline as strongly as established risk factors currently targeted by global prevention programmes. Analyses also looked at socioeconomically patterned biological markers, allostatic load, and DNA methylation using richly phenotyped cohorts, unraveling their association with aging processes across the life-course. Lifepath studies suggest that socioeconomic circumstances are embedded in our biology from the outset-i.e., disadvantage influences biological systems from molecules to organs. Our findings have important implications for policy, suggesting that (a) intervening on unfavorable socioeconomic conditions is complementary and as important as targeting well-known risk factors, such as tobacco and alcohol consumption, low fruit and vegetable intake, obesity and a sedentary lifestyle, and that (b) effects of preventive interventions in early life integrate interventions in adulthood. The report has an executive summary that refers to the different sections of the main paper.
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Affiliation(s)
- Paolo Vineis
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Mauricio Avendano-Pabon
- Department of Social Sciences, Health and Medicine, King's College London, London, United Kingdom
| | - Henrique Barros
- EPIUnit - Institute of Public Health University of Porto, Porto, Portugal
| | - Mel Bartley
- Department of Epidemiology & Public Health, University College London, London, United Kingdom
| | - Cristian Carmeli
- Center for Primary Care and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
| | | | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Giuseppe Costa
- Department of Clinical Science & Biology, Turin University Medical School, Turin, Italy
| | - Cyrille Delpierre
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | | | - Silvia Fraga
- EPIUnit - Institute of Public Health University of Porto, Porto, Portugal
| | - Graham Giles
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Marcel Goldberg
- UMS 011 Inserm - UVSQ ≪ Cohortes épidémiologiques en population ≫, Villejuif, France
| | | | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Benoit Lepage
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | - Thierry Lang
- UMR LEASP, Université de Toulouse III, UPS, Inserm, Toulouse, France
| | - Richard Layte
- Department of Sociology, School of Social Sciences and Philosophy, Trinity College Dublin, Dublin, Ireland
| | - Frances MacGuire
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Johan P Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Michael Marmot
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Cathal McCrory
- Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
| | - Roger L Milne
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Peter Muennig
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Wilma Nusselder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Dusan Petrovic
- Center for Primary Care and Public Health (UNISANTE), University of Lausanne, Lausanne, Switzerland
| | - Silvia Polidoro
- Molecular Epidemiology and Exposomics Unit, Italian Institute for Genomic Medicine, Turin, Italy
| | - Fulvio Ricceri
- Department of Clinical Science & Biology, Turin University Medical School, Turin, Italy
- Department of Epidemiology, ASL TO3, Turin, Italy
| | - Oliver Robinson
- Department of Epidemiology and Biostatistics, Imperial College London, London, United Kingdom
| | - Silvia Stringhini
- Unit of Population Epidemiology, Division of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Marie Zins
- UMS 011 Inserm - UVSQ ≪ Cohortes épidémiologiques en population ≫, Villejuif, France
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How does bridging social capital relate to health-behavior, overweight and obesity among low and high educated groups? A cross-sectional analysis of GLOBE-2014. BMC Public Health 2019; 19:1635. [PMID: 31801497 PMCID: PMC6894329 DOI: 10.1186/s12889-019-8007-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 11/27/2019] [Indexed: 11/19/2022] Open
Abstract
Background Social capital is an important determinant of health, but how specific sub-dimensions of social capital affect health and health-related behaviors is still unknown. To better understand its role for health inequalities, it is important to distinguish between bonding social capital (connections between homogenous network members; e.g. similar educational level) and bridging social capital (connections between heterogeneous network members). In this study, we test the hypotheses that, 1) among low educational groups, bridging social capital is positively associated with health-behavior, and negatively associated with overweight and obesity, and 2) among high educational groups, bridging social capital is negatively associated with health-behavior, and positively with overweight and obesity. Methods Cross-sectional data on educational level, health-behavior, overweight and obesity from participants (25–75 years; Eindhoven, the Netherlands) of the 2014-survey of the GLOBE study were used (N = 2702). Social capital (“How many of your close friends have the same educational level as you have?”) was dichotomized as: bridging (‘about half’, ‘some’, or ‘none of my friends’), or bonding (‘all’ or ‘most of my friends’). Logistic regression models were used to study whether bridging social capital was related to health-related behaviors (e.g. smoking, food intake, physical activity), overweight and obesity, and whether these associations differed between low and high educational groups. Results Among low educated, having bridging social capital (i.e. friends with a higher educational level) reduced the likelihood to report overweight (OR 0.73, 95% CI 0.52–1.03) and obesity (OR 0.58, 95% CI 0.38–0.88), compared to low educated with bonding social capital. In contrast, among high educated, having bridging social capital (i.e. friends with a lower educational level) increased the likelihood to report daily smoking (OR 2.11, 95% CI 1.37–3.27), no leisure time cycling (OR 1.55, 95% CI 1.17–2.04), not meeting recommendations for vegetable intake (OR 2.09, 95% CI 1.50–2.91), and high meat intake (OR 1.39, 95% CI 1.05–1.83), compared to high educated with bonding social capital. Conclusions Bridging social capital had differential relations with health-behavior among low and high educational groups. Policies aimed at reducing segregation between educational groups may reduce inequalities in overweight, obesity and unhealthy behaviors.
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26
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Reiss D, Nielsen L, Godfrey K, McEwen B, Power C, Seeman T, Suomi S. Midlife reversibility of early-established biobehavioral risk factors: A research agenda. Dev Psychol 2019; 55:2203-2218. [PMID: 31368762 DOI: 10.1037/dev0000780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epidemiological evidence links exposure to early life adversities-such as childhood maltreatment-with impaired health and well-being in adulthood. Since these effects are usually unrecognized or untreated in childhood, preventive and remediating interventions in adults are needed. Our focus on adulthood prompted three major questions. First, does our increased understanding of mechanisms accounting for the long-term effects of early life adversities help delineate underlying dimensions that underscore key similarities and differences among these adversities? Second, can adults accurately report on adversities they experienced in childhood? Third, can we identify malleable risk processes in adulthood that might be targets for preventive intervention? Supported by the National Institute on Aging, the U.K. Economic and Social and the Biotechnology and Biological Sciences Research Councils, a network of researchers in human and animal development addressed these questions through meetings and literature review. A small number of dimensions may adequately distinguish among a range of co-occurring childhood adversities. Widely used adult ascertainments of childhood adversity are poorly related to prospective ascertainment. Strategies for preventive interventions should be aimed both at adults who were actually exposed to adversity as well as those who recall adversity, but the targeted risk processes may be different. Now is an opportune time to support research on adult interventions based on unfolding research on critical periods of sensitivity to adversity in fetal and child development, on improved understanding of risk mechanisms that may persist across the life span, and on new insights on enhancing neuroplasticity in adults. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Lisbeth Nielsen
- Division of Social and Behavioral Research, National Institute on Aging
| | - Keith Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - Bruce McEwen
- Laboratory of Neuroendocrinology, The Rockefeller University
| | - Christine Power
- Great Ormond Street Institute of Child Health, University College London
| | - Teresa Seeman
- Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles
| | - Stephen Suomi
- Laboratory of Comparative Ethology, Eunice Kennedy Shriver National Institute of Child Health and Human Development
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27
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Albus C, Waller C, Fritzsche K, Gunold H, Haass M, Hamann B, Kindermann I, Köllner V, Leithäuser B, Marx N, Meesmann M, Michal M, Ronel J, Scherer M, Schrader V, Schwaab B, Weber CS, Herrmann-Lingen C. Significance of psychosocial factors in cardiology: update 2018. Clin Res Cardiol 2019; 108:1175-1196. [DOI: 10.1007/s00392-019-01488-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/29/2019] [Indexed: 12/13/2022]
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28
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Mackenbach JD, de Groot R, Lakerveld J, De Cocker K, Cardon G, De Bourdeaudhuij I, Compernolle S. What factors explain socioeconomic inequalities in adults' television-related sitting time? Eur J Public Health 2019; 29:248-254. [PMID: 30169565 DOI: 10.1093/eurpub/cky170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are considerable socioeconomic inequalities in television-related sitting time, but there is little evidence for the explanatory mechanisms. We used a cohort of Belgian adults (25-60 years) and older adults (≥65 years) to examine the social cognitive, home environmental and health-related factors contributing to socioeconomic differences in television-related sitting. METHODS We included 301 adults and 258 older adults (total n = 559). Linear regression analyses were used to examine the associations of education and occupational status with television-related sitting time, adjusted for age and gender. We assessed the explanatory power of social cognitive, home environmental and health-related factors using the traditional 'change-in-estimation method'. RESULTS Those with low and medium education, respectively, engaged in 54 and 28 minutes per day more television-related sitting time than those with high education. We found no association between occupational status and television-related sitting time. Social cognitive factors explained 54% of the difference in television-related sitting time between those with low and high education, while home environmental factors only explained 6%, and health-related variables explained 10% of these differences. CONCLUSION We found no occupational inequalities in television-related sitting time. Social cognitive variables such as attitude and modelling of the partner explained a large part of the educational inequalities in television-related sitting time. If confirmed by future studies, a focus on social cognition may help reduce sedentary behaviours in low-educated adults and diminish inequalities in sedentary behaviours.
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Affiliation(s)
- Joreintje D Mackenbach
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Rosa de Groot
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Department of Donorstudies, Sanquin Research, Amsterdam, The Netherlands
| | - Jeroen Lakerveld
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Katrien De Cocker
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.,Physically Active Lifestyles Research Group (USQ PALs), Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Australia
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
| | | | - Sofie Compernolle
- Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
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29
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Bonaccio M, Di Castelnuovo A, Costanzo S, De Curtis A, Persichillo M, Cerletti C, Donati MB, de Gaetano G, Iacoviello L. Socioeconomic trajectories across the life course and risk of total and cause-specific mortality: prospective findings from the Moli-sani Study. J Epidemiol Community Health 2019; 73:516-528. [DOI: 10.1136/jech-2018-211582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/25/2019] [Accepted: 02/12/2019] [Indexed: 11/04/2022]
Abstract
BackgroundA life course approach has been suggested as the most appropriate to establish the total impact of socioeconomic status (SES) on adult health outcomes; however, such an approach has been poorly used within Mediterranean populations. We aimed to examine the SES trajectories from childhood to adulthood associated with mortality risk in a large general population-based cohort and to test potential pathways (eg, inflammation) underlying such associations.MethodsLongitudinal analyses on 22 194 subjects recruited in the Moli-sani Study, Italy (2005–2010). Low and high SES in childhood, educational attainment (low/high) and SES during adulthood (measured by a score including material resources and dichotomised as low/high) were used to define overall trajectories.ResultsOver 8.3 years of follow-up, 1155 deaths occurred. In the group with poor childhood SES, an upward trajectory in both educational and material circumstances was associated with lower risk of all-cause death (HR=0.64; 95% CI 0.47 to 0.87), as opposed to subjects who remained stably low (low education and adulthood SES). Subjects with high childhood SES, but not educational achievement, were at increased risk of total and cardiovascular disease (CVD) death, although reporting higher material SES in adult life, as compared with the stably high SES group (HR=1.44; 1.02 to 2.02 and HR=1.90; 1.10 to 3.28, respectively). Inflammatory markers marginally accounted for such associations.ConclusionFor individuals with low SES in early life, an educational and material upward trajectory over the life course was associated with lower mortality risk. In the high SES childhood group, lack of a higher educational attainment appeared to be unfavourably associated with survival.
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30
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Stringhini S, Zaninotto P, Kumari M, Kivimäki M, Lassale C, Batty GD. Socio-economic trajectories and cardiovascular disease mortality in older people: the English Longitudinal Study of Ageing. Int J Epidemiol 2019; 47:36-46. [PMID: 29040623 PMCID: PMC5837467 DOI: 10.1093/ije/dyx106] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2017] [Indexed: 11/14/2022] Open
Abstract
Background Socio-economic status from early life has been linked to cardiovascular disease risk, but the impact of life-course socio-economic trajectories, as well as the mechanisms underlying social inequalities in cardiovascular disease risk, is uncertain. Objectives We assessed the role of behavioural, psychosocial and physiological (including inflammatory) factors in the association between life-course socio-economic status and cardiovascular disease mortality in older adults. Methods Participants were 7846 individuals (44% women) from the English Longitudinal Study of Ageing, a representative study of individuals aged ≥ 50 years, established in 2002-03. Comprising four indicators of socio-economic status (father's social class, own education, occupational position and wealth), we computed an index of socio-economic trajectory and a lifetime cumulative socio-economic score. Behavioural (smoking, physical activity, alcohol consumption, body mass index) and psychosocial (social relations, loneliness) factors, physiological (blood pressure, total cholesterol, triglycerides) and inflammatory markers (C-reactive protein, fibrinogen), measured repeatedly over time, were potential explanatory variables. Cardiovascular disease mortality was ascertained by linkage of study members to a national mortality register. Mediation was calculated using the traditional 'change-in-estimate method' and alternative approaches such as counterfactual mediation modelling could not be applied in this context. Results During the 8.4-year follow-up, 1301 study members died (438 from cardiovascular disease). A stable low-social-class trajectory was associated with around double the risk of cardiovascular disease mortality (hazard ratio; 95% confidence interval: 1.94, 1.37; 2.75) compared with a stable high social class across the life course. Individuals in the lowest relative to the highest life-course cumulative socio-economic status group were also more than twice as likely to die of cardiovascular disease (2.57, 1.81; 3.65). Behavioural factors and inflammatory markers contributed most to explaining this gradient, whereas the role of psychosocial and other physiological risk factors was modest. Conclusions In a population-based cohort of older individuals living in England, we provide evidence that disadvantage across the life course is linked to cardiovascular mortality. That behavioural factors and inflammatory markers partially explain this gradient may provide insights into the potential for intervention.
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Affiliation(s)
- Silvia Stringhini
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Paola Zaninotto
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Meena Kumari
- Institute for Social and Economic Research, University of Essex, Essex, UK
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Camille Lassale
- Department of Epidemiology and Public Health, University College London, London, UK
| | - G David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
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31
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Kollia N, Panagiotakos DB, Chrysohoou C, Georgousopoulou E, Tousoulis D, Stefanadis C, Papageorgiou C, Pitsavos C. Determinants of healthy ageing and its relation to 10-year cardiovascular disease incidence: the ATTICA study. Cent Eur J Public Health 2018; 26:3-9. [PMID: 29684290 DOI: 10.21101/cejph.a5165] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 02/23/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of the study was to understand determinants of ageing in relation to future cardiovascular disease (CVD) events at population level, and to explore determinants of healthy ageing and its relation to 10-year CVD incidence among apparently healthy individuals. METHODS In the context of the ATTICA study 453 apparently healthy men (45±13 years) and 400 women (44±18 years) with complete psychological evaluation were studied and followed during 2002-2012. Healthy Ageing Index (HAI) (range 0-7) was calculated based on socio-economical, bio-clinical, psychological, and lifestyle characteristics (i.e. dietary habits and physical activity) of the participants during the baseline examination. CVD incidence during the follow-up period was defined according to ICD-10 criteria. RESULTS Healthy Ageing Index was inversely associated with higher 10-year CVD risk (OR per 1/7 (95% CI): 0.47 (0.28, 0.80). Age and sex-adjusted determinants of healthy ageing were abnormal waist to hip ratio (p<0.001), increased coffee consumption (p=0.04), reduced basic metabolic rhythm (p<0.001), increased triglycerides (p=0.003), and C-reactive protein levels (p=0.02), as aggravating factors, while moderate alcohol consumption (p=0.002) was identified as a positive influential parameter. CONCLUSIONS Understanding healthy ageing, as a dominant factor of CVD development, provides a new direction for better prevention efforts focused on healthy ageing at both population and individual level.
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Affiliation(s)
- Natasa Kollia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Christina Chrysohoou
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | - Ekavi Georgousopoulou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
| | | | | | - Christos Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, Athens, Greece
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van Hedel K, van Lenthe FJ, Oude Groeniger J, Mackenbach JP. What's the difference? A gender perspective on understanding educational inequalities in all-cause and cause-specific mortality. BMC Public Health 2018; 18:1105. [PMID: 30200912 PMCID: PMC6131918 DOI: 10.1186/s12889-018-5940-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Material and behavioural factors play an important role in explaining educational inequalities in mortality, but gender differences in these contributions have received little attention thus far. We examined the contribution of a range of possible mediators to relative educational inequalities in mortality for men and women separately. Methods Baseline data (1991) of men and women aged 25 to 74 years participating in the prospective Dutch GLOBE study were linked to almost 23 years of mortality follow-up from Dutch registry data (6099 men and 6935 women). Cox proportional hazard models were used to calculate hazard ratios with 95% confidence intervals, and to investigate the contribution of material (financial difficulties, housing tenure, health insurance), employment-related (type of employment, occupational class of the breadwinner), behavioural (alcohol consumption, smoking, leisure and sports physical activity, body mass index) and family-related factors (marital status, living arrangement, number of children) to educational inequalities in all-cause and cause-specific mortality, i.e. mortality from cancer, cardiovascular disease, other diseases and external causes. Results Educational gradients in mortality were found for both men and women. All factors together explained 62% of educational inequalities in mortality for lowest educated men, and 71% for lowest educated women. Yet, type of employment contributed substantially more to the explanation of educational inequalities in all-cause mortality for men (29%) than for women (− 7%), whereas the breadwinner’s occupational class contributed more for women (41%) than for men (7%). Material factors and employment-related factors contributed more to inequalities in mortality from cardiovascular disease for men than for women, but they explained more of the inequalities in cancer mortality for women than for men. Conclusions Gender differences in the contribution of employment-related factors to the explanation of educational inequalities in all-cause mortality were found, but not of material, behavioural or family-related factors. A full understanding of educational inequalities in mortality benefits from a gender perspective, particularly when considering employment-related factors. Electronic supplementary material The online version of this article (10.1186/s12889-018-5940-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen van Hedel
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.,Max Planck Institute for Demographic Research, Rostock, Germany
| | - Frank J van Lenthe
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Joost Oude Groeniger
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus MC, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands
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Calocer F, Dejardin O, Droulon K, Launoy G, Defer G. Socio-economic status influences access to second-line disease modifying treatment in Relapsing Remitting Multiple Sclerosis patients. PLoS One 2018; 13:e0191646. [PMID: 29390025 PMCID: PMC5794112 DOI: 10.1371/journal.pone.0191646] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 01/09/2018] [Indexed: 11/21/2022] Open
Abstract
Objective In MS, Socio-Economic status (SES) may influence healthcare and access to disease-modifying treatments (DMTs). Optimising delays to switch patients to a second-line DMT may hamper disease progression most effectively and achieve long term disease control. The objective of this study is to identify the influence of SES on the delay between first and second line DMT in RRMS patients, in Western-Normandy, France. Methods The association between SES and the delay to access a second-line DMT were studied using data from the MS registry of Western-Normandy including 733 patients with a diagnosis of RRMS during the period in question [1982–2011]. We used the European Deprivation Index (EDI), a score with a rank level inversely related to SES. We performed multivariate adjusted Cox models for studying EDI effect on the delay between first and second line DMT. Results No significant influence of SES was observed on delay to access a second-line DMT if first-line DMT exposure time was less than 5 years. After 5 years from initiation of first-line treatment the risk of accessing a second-line DMT is 3 times higher for patients with lower deprivation indices (1st quintile of EDI) ([HR] 3.14 95%CI [1.72–5.72], p-value<0.001) compared to patients with higher values (EDI quintiles 2 to 5). Interpretation In RRMS, a high SES may facilitate access to a second-line DMT a few years after first-line DMT exposure. Greater consideration should also be given to the SES of MS patients as a risk factor in therapeutic healthcare issues throughout medical follow-up.
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Affiliation(s)
- Floriane Calocer
- CHU de Caen, Department of Neurology, Caen, FR
- Normandie Université, UNICAEN, INSERM 1237, Physiopathology and Imaging of Neurological Disorders, Caen, FR
- * E-mail:
| | - Olivier Dejardin
- CHU de Caen, Pôle de Recherche, Caen, FR
- Normandie Université, UNICAEN, INSERM 1086, ANTICIPE « Cancers et Préventions » Caen, FR
| | | | - Guy Launoy
- CHU de Caen, Pôle de Recherche, Caen, FR
- Normandie Université, UNICAEN, INSERM 1086, ANTICIPE « Cancers et Préventions » Caen, FR
| | - Gilles Defer
- CHU de Caen, Department of Neurology, Caen, FR
- Normandie Université, UNICAEN, INSERM 1237, Physiopathology and Imaging of Neurological Disorders, Caen, FR
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Repeatedly measured material and behavioral factors changed the explanation of socioeconomic inequalities in all-cause mortality. J Clin Epidemiol 2017; 91:137-145. [DOI: 10.1016/j.jclinepi.2017.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 06/09/2017] [Accepted: 08/18/2017] [Indexed: 11/19/2022]
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Abstract
PURPOSE OF REVIEW The aim of this paper is to summarize the recent and relevant evidence linking socioeconomic status (SES) to cardiovascular disease (CVD) and cardiovascular risk factors (CVRFs). RECENT FINDINGS In high-income countries (HICs), the evidence continues to expand, with meta-analyses of large longitudinal cohort studies consistently confirming the inverse association between SES and several CVD and CVRFs. The evidence remains limited in low-income and middle-income countries (LMICs), where most of the evidence originates from cross-sectional studies of varying quality and external validity; the available evidence indicates that the association between SES and CVD and CVRFs depends on the socioeconomic development context and the stage in the demographic, epidemiological, and nutrition transition of the population. The recent evidence confirms that SES is strongly inversely associated with CVD and CVRFs in HICs. However, there remains a need for more research to better understand the way socioeconomic circumstances become embodied in early life and throughout the life course to affect cardiovascular risk in adult and later life. In LMICs, the evidence remains scarce; thus, there is an urgent need for large longitudinal studies to disaggregate CVD and CVRFs by socioeconomic indicators, particularly as these countries already suffer the greatest burden of CVD.
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Affiliation(s)
- Carlos de Mestral
- Division of Chronic Diseases, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Biopôle 2 - Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Silvia Stringhini
- Division of Chronic Diseases, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Biopôle 2 - Route de la Corniche 10, 1010, Lausanne, Switzerland.
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Dégano IR, Marrugat J, Grau M, Salvador-González B, Ramos R, Zamora A, Martí R, Elosua R. The association between education and cardiovascular disease incidence is mediated by hypertension, diabetes, and body mass index. Sci Rep 2017; 7:12370. [PMID: 28959022 PMCID: PMC5620039 DOI: 10.1038/s41598-017-10775-3] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/14/2017] [Indexed: 11/19/2022] Open
Abstract
Education and cardiovascular disease (CVD) are inversely associated but the mediating factors have not been totally elucidated. Our aim was to analyze the mediating role of modifiable risk factors. Cohort study using the REGICOR population cohorts. Participants without previous CVD were included (n = 9226). Marginal structural models were used to analyze the association between education and CVD incidence at 6 years of follow-up. Mediation by modifiable risk factors (diabetes, dyslipidemia, hypertension, smoking, body mass index, and physical activity) was assessed using the counterfactual framework. Participants with a university degree had a CVD incidence hazard ratio (HR) of 0.51 (95% confidence interval (CI) = 0.30, 0.85), compared to those with primary or lower education. Only hypertension, BMI, and diabetes mediated the association between education and CVD incidence, accounting for 26% of the association (13.9, 6.9, and 5.2%, respectively). Sensitivity analyses showed that hypertension was the strongest mediator (average causal mediation effect [95% CI] = increase of 2170 days free of CVD events [711, 4520]). The association between education and CVD incidence is partially mediated by hypertension, BMI, and diabetes. Interventions to decrease the prevalence of these risk factors could contribute to diminish the CVD inequalities associated with educational level.
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Affiliation(s)
- Irene R Dégano
- CIBER of Cardiovascular Diseases (CIBERCV), ISCIII, Madrid, Spain. .,REGICOR Study Group. Cardiovascular Epidemiology and Genetics Group. Epidemiology and Public Health Program. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - Jaume Marrugat
- CIBER of Cardiovascular Diseases (CIBERCV), ISCIII, Madrid, Spain.,REGICOR Study Group. Cardiovascular Epidemiology and Genetics Group. Epidemiology and Public Health Program. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Maria Grau
- REGICOR Study Group. Cardiovascular Epidemiology and Genetics Group. Epidemiology and Public Health Program. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,School of Pharmacy, University of Barcelona, Barcelona, Spain
| | - Betlem Salvador-González
- REGICOR Study Group. Cardiovascular Epidemiology and Genetics Group. Epidemiology and Public Health Program. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,ABS Florida Sud and Cardiovascular Research Group in Primary Care (MACAP Costa Ponent), Primary Care Research Institute Jordi Gol, Catalan Institute of Health, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Rafel Ramos
- Vascular Health Research Group (ISV-Girona). Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Institut Català de la Salut, Àmbit d'atenció Primaria, Girona, Spain
| | - Alberto Zamora
- Translab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Lipid and Atherosclerosis Unit and Department of Internal Medicine, Hospital de Blanes, Girona, Spain
| | - Ruth Martí
- Vascular Health Research Group (ISV-Girona). Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.,Institut d'Investigació Biomèdica de Girona (IDIBGI), Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Roberto Elosua
- CIBER of Cardiovascular Diseases (CIBERCV), ISCIII, Madrid, Spain. .,REGICOR Study Group. Cardiovascular Epidemiology and Genetics Group. Epidemiology and Public Health Program. IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
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Berkman AM, Brewster AM, Jones LW, Yu J, Lee JJ, Peng SA, Crocker A, Ater JL, Gilchrist SC. Racial Differences in 20-Year Cardiovascular Mortality Risk Among Childhood and Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2017; 6:414-421. [PMID: 28530506 DOI: 10.1089/jayao.2017.0024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Whether cardiovascular disease (CVD) risk differs according to race and cancer type among survivors of childhood or young adulthood cancers is unknown. METHODS Data from the years 1973-2011 were analyzed using the Surveillance, Epidemiology, and End Results (SEER) registries. Cases were categorized by ICD-0-3/WHO 2008 Adolescent and Young Adult classification. CVD death was determined by ICD-10 codes for diseases of the heart, atherosclerosis, cerebrovascular diseases, or other diseases of the arteries. Cox proportional hazards models were fitted to evaluate the hazard ratio (HR) and 95% confidence intervals (CIs) for the effects of race on time-to-event outcomes. RESULTS A total of 164,316 cases of childhood and young adult primary cancers were identified. There were 43,335 total and 1466 CVD deaths among Black and White survivors. Black survivors had higher risks of all-cause mortality (HR: 1.75, 95% CI: 1.70-1.7) and CVD mortality (HR: 2.13, 95% CI: 1.85-2.46) compared to White survivors. The increased risk of CVD for Black survivors compared to White survivors persisted at 5-years (HR: 2.38, 95% CI: 1.83-3.10), 10-years (HR: 2.59, 95% CI: 2.09-3.21), and 20-years (HR: 2.31, 95% CI: 1.95-2.74) postdiagnosis, and varied by cancer type, with the highest HRs for melanoma (HR: 8.16, 95% CI: 1.99-33.45) and thyroid cancer (HR: 3.43, 95% CI: 1.75-6.73). CONCLUSIONS Black survivors of childhood or young adulthood cancers have a higher risk of CVD mortality compared to Whites that varies by cancer type. Knowledge of at-risk populations is important to guide surveillance recommendations and behavioral interventions. Further study is needed to understand the etiology of racial differences in CVD mortality in this population.
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Affiliation(s)
- Amy M Berkman
- 1 Larner College of Medicine, University of Vermont , Burlington, Vermont
| | - Abenaa M Brewster
- 2 Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Lee W Jones
- 3 Department of Medicine, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Jun Yu
- 4 Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - J Jack Lee
- 4 Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - S Andrew Peng
- 4 Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Abigail Crocker
- 5 Department of Mathematics and Statistics, University of Vermont , Burlington, Vermont
| | - Joann L Ater
- 6 Division of Pediatrics, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
| | - Susan C Gilchrist
- 2 Department of Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center , Houston, Texas
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Moor I, Spallek J, Richter M. Explaining socioeconomic inequalities in self-rated health: a systematic review of the relative contribution of material, psychosocial and behavioural factors. J Epidemiol Community Health 2016; 71:565-575. [PMID: 27682963 DOI: 10.1136/jech-2016-207589] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 09/05/2016] [Accepted: 09/11/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Material, psychosocial and behavioural factors are important explanatory pathways for socioeconomic inequalities in health. The aim of this systematic review was to summarise the available evidence on empirical studies and to analyse the relative contribution of these factors for explaining inequalities in self-rated health. METHODS The study was performed in compliance with PRISMA guidelines. The literature search was conducted in the electronic databases PubMed and Web of Science (1996-2016) as well as by screening of reference lists of obtained articles. Two reviewers performed the search and critical appraisal of the studies. All studies that focus on explaining socioeconomic inequalities in self-rated health, including at least 2 of the 3 main pathways and analysing the relative contribution of these approaches in separate and joint models, were included. RESULTS Eleven publications were included. Separate analyses showed that material, psychosocial and behavioural factors contribute to the explanation of socioeconomic inequalities in self-rated health. However, the combined analyses revealed that material factors contributed most to differences in self-rated health because of their higher independent (direct) effect and additional shared (indirect) effect (through psychosocial and behavioural factors). These results were largely independent of age, gender and indicator of socioeconomic status. CONCLUSIONS The evidence presented might be used for policymakers to identify and to justify prioritisation in terms of prevention and health promotion. The findings show that multiple factors are important for tackling social inequalities in health. Strategies for reducing these inequalities should focus on material/structural living conditions as they shape conditions of psychosocial resources and health behaviour.
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Affiliation(s)
- Irene Moor
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
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Kjøllesdal MKR, Ariansen I, Mortensen LH, Davey Smith G, Næss Ø. Educational differences in cardiovascular mortality: The role of shared family factors and cardiovascular risk factors. Scand J Public Health 2016; 44:744-750. [PMID: 27655782 DOI: 10.1177/1403494816669427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To explore the confounding effects of early family factors shared by siblings and cardiovascular risk factors in midlife on the educational differences in mortality from cardiovascular disease (CVD). METHODS Data from national and regional health surveys in Norway (1974-2003) were linked with data from the Norwegian Family Based Life Course Study, the National Educational Registry and the Cause of Death Registry. The study population consisted of participants with at least one full sibling among the health survey participants ( n=271,310). Data were available on CVD risk factors, including weight, height, blood pressure, total cholesterol and smoking. RESULTS The hazards ratio (HR) of CVD mortality was 3.44 (95% confidence interval (CI) 2.98-3.96) in the lowest educational group relative to the highest. The HRs were little altered in the within-sibship analyses. Adjusted for risk factors, the HR for CVD mortality in the cohort analyses was 2.05 (CI 1.77-2.37) in the lowest educational group relative to the highest. The respective HR in the within-sibship analyses was 2.46 (CI 1.48-2.24). CONCLUSIONS Using a sibling design, we did not find that the association between education and CVD mortality was confounded by early life factors shared by siblings, but it was explained to a large extent by CVD risk factors. These results suggest that reducing levels of CVD risk factors could have the greatest effect on mortality in less well-educated people.
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Affiliation(s)
| | - I Ariansen
- 2 Norwegian Institute of Public Health, Norway
| | | | - G Davey Smith
- 4 MRC Integrative Epidemiology Unit, University of Bristol, UK
| | - Ø Næss
- 1 Institute of Health and Society, University of Oslo, Norway.,2 Norwegian Institute of Public Health, Norway
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Socioeconomic Differences in Cause-Specific Disability Retirement in Finland, 1988 to 2009. J Occup Environ Med 2016; 58:840-5. [DOI: 10.1097/jom.0000000000000808] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gender differences in the relationships between psychosocial factors and hypertension. Maturitas 2016; 93:58-64. [PMID: 27338977 DOI: 10.1016/j.maturitas.2016.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/25/2016] [Accepted: 06/01/2016] [Indexed: 12/19/2022]
Abstract
Gender differences in the epidemiology, pathophysiology, clinical manifestations and outcomes of cardiovascular disease are well established but there is still a lack of awareness of this both in the general population and among healthcare providers. In addition to the traditionally recognized cardiovascular risk factors, more recently psychosocial risk factors such as stress, mood disorders, low socioeconomic status and sleep disorders have been linked to cardiovascular diseases and hypertension. Psychosocial factors may have different cardiovascular consequences in men and women; thus further efforts are required to explore pathophysiological mechanisms, to obtain gender-specific data from clinical trials and to translate this knowledge into everyday clinical practice.
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Chahkandi T, Taheri F, Kazemi T, Bijari B. The Prevalence of Diabetes and Prediabetes Among Elementary School Children in Birjand. IRANIAN JOURNAL OF PEDIATRICS 2015. [PMID: 26199685 PMCID: PMC4505967 DOI: 10.5812/ijp.183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Diabetes is associated with increased cardiovascular disease, mortality and morbidity. Objectives: The present study aimed at assessing fasting blood sugar (FBS) in elementary school students in Birjand, 2012. Materials and Methods: This cross-sectional and descriptive study was done on 1530 elementary school students who had been selected through multiple cluster sampling. FBS of these students was tested applying the enzymatic process. The obtained data was analyzed by means of SPSS software (v15) and statistical tests t and X2. Results: In this study, 833 girls and 697 boys were evaluated. Mean FBS of the whole study population was 86.9 ± 8.8 mg/dL; FBS was higher in boys compared to girls. FBS of 1453 (95%) children was < 100 mg/dL, the mean being 85.8 ± 6.8 mg/dL. FBS of 698 (45.6%) students of the above population was 86-99 mg/dl. It was 100-125 mg/dL in 72 (4.7%) individuals. Five (0.3%) students had FBS >126 mg/dL. Mean FBS increased in proportion to age, which was statistically significant. Conclusions: Although the prevalence of diabetes is not considerable; however, based on the relatively high portion of those children with high degree of blood glucose in the range in which the risk of diabetes and prediabetes in the following years rises dramatically, the need for further care of health authorities, an extensive screening activity, and undertaking intervening measures to prevent the epidemic of diabetes and consequently cardiovascular disease is emphasized.
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Affiliation(s)
- Tayyebeh Chahkandi
- Department of Pediatrics, Birjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, IR Iran
| | - Fatemeh Taheri
- Department of Pediatrics, Birjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, IR Iran
- Corresponding author: Fatemeh Taheri, Birjand Atherosclerosis and Coronary Artery Research Center, Pasdaran Avenue, Birjand University of Medical Sciences, Birjand, IR Iran, E-mail:
| | - Toba Kazemi
- Department of Pediatrics, Birjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, IR Iran
| | - Bita Bijari
- Department of Pediatrics, Birjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, IR Iran
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Lim D, Kong KA, Lee HA, Lee WK, Park SH, Baik SJ, Park H, Jung-Choi K. The population attributable fraction of low education for mortality in South Korea with improvement in educational attainment and no improvement in mortality inequalities. BMC Public Health 2015; 15:313. [PMID: 25880221 PMCID: PMC4425894 DOI: 10.1186/s12889-015-1665-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Accepted: 03/19/2015] [Indexed: 11/13/2022] Open
Abstract
Background The educational attainment of Koreans has greatly increased, which was expected to reduce the magnitude of the population attributable fraction (PAF) of mortality associated with low education levels. However, increase in the relative risk (RR) of mortality among those with lower educational levels actually increased the PAF. The purpose of this study was to examine the change in the PAF of lower educational levels for mortality in Korea, where educational attainment has improved and is associated with the exacerbation of inequalities in mortality levels. Methods National census data were used to derive educational levels. The mortality-associated RR of lower educational levels was calculated by reference to national census and death certificate data from 1995, 2000, 2005, and 2010. PAFs were calculated for all-cause mortality, malignant neoplasms, cerebrovascular disease, heart disease, and suicide by gender and age group (30–44 and 45–59 years). Results The PAF of low educational level in terms of total mortality has decreased since 1995 in both genders. This trend was more prominent among those aged 30–44 years. However, the PAFs of suicide in younger females (30–44 years) and of cerebrovascular disease in older males (45–59 years) have increased. The RRs of all-cause mortality and those of the four leading causes of death in those with the lowest educational levels have increased, especially in females aged 30–44 years. Conclusions The consistent and sharp increase in the attainment of education has contributed to the reduction in the PAFs of lower education for mortality, despite the fact that mortality inequalities have not improved. Efforts to reduce health inequalities must promote healthy public policy and address public health policies. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1665-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dohee Lim
- Department of Preventive Medicine, Ewha Womans University School of Medicine, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
| | - Kyoung Ae Kong
- Clinical Trial Center, Ewha Womans University Medical Center, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
| | - Hye Ah Lee
- Department of Preventive Medicine, Ewha Womans University School of Medicine, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
| | - Won Kyung Lee
- Department of Social and Preventive Medicine, Inha University School of Medicine, Incheon, South Korea.
| | - Su Hyun Park
- Department of Preventive Medicine, Ewha Womans University School of Medicine, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
| | - Sun Jung Baik
- Department of Preventive Medicine, Ewha Womans University School of Medicine, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
| | - Hyesook Park
- Department of Preventive Medicine, Ewha Womans University School of Medicine, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
| | - Kyunghee Jung-Choi
- Department of Preventive Medicine, Ewha Womans University School of Medicine, 911-1, Mok-6dong, Yang Cheon-gu, Seoul, 158-710, South Korea.
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Polvinen A, Laaksonen M, Gould R, Lahelma E, Leinonen T, Martikainen P. Socioeconomic inequalities in cause-specific mortality after disability retirement due to different diseases. Scand J Public Health 2014; 43:159-68. [DOI: 10.1177/1403494814562597] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims: Socioeconomic inequalities in both disability retirement and mortality are large. The aim of this study was to examine socioeconomic differences in cause-specific mortality after disability retirement due to different diseases. Methods: We used administrative register data from various sources linked together by Statistics Finland and included an 11% sample of the Finnish population between the years 1987 and 2007. The data also include an 80% oversample of the deceased during the follow-up. The study included men and women aged 30-64 years at baseline and those who turned 30 during the follow-up. We used Cox regression analysis to examine socioeconomic differences in mortality after disability retirement. Results: Socioeconomic differences in mortality after disability retirement were smaller than in the population in general. However, manual workers had a higher risk of mortality than upper non-manual employees after disability retirement due to mental disorders and cardiovascular diseases, and among men also diseases of the nervous system. After all-cause disability retirement, manual workers ran a higher risk of cardiovascular and alcohol-related death. However, among men who retired due to mental disorders or cardiovascular diseases, differences in social class were found for all causes of death examined. For women, an opposite socioeconomic gradient in mortality after disability retirement from neoplasms was found. Conclusions: The disability retirement process leads to smaller socioeconomic differences in mortality compared with those generally found in the population. This suggests that the disability retirement system is likely to accurately identify chronic health problems with regard to socioeconomic status.
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Affiliation(s)
| | | | - R. Gould
- Finnish Centre for Pensions, Finland
| | - E. Lahelma
- Hjelt Institute, Department of Public Health, University of Helsinki, Finland
| | - T. Leinonen
- Population Research Unit, Department of Social Research, University of Helsinki, Finland
| | - P. Martikainen
- Population Research Unit, Department of Social Research, University of Helsinki, Finland
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Sheikh MA, Abelsen B, Olsen JA. Role of respondents' education as a mediator and moderator in the association between childhood socio-economic status and later health and wellbeing. BMC Public Health 2014; 14:1172. [PMID: 25404212 PMCID: PMC4289264 DOI: 10.1186/1471-2458-14-1172] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 10/22/2014] [Indexed: 11/22/2022] Open
Abstract
Background Most research assessing the effect of childhood socioeconomic status (CSES) on health in adulthood has focused on cause-specific mortality. Low CSES is associated with mortality from coronary heart disease, lung cancer, and respiratory diseases in adulthood. But little evidence is available on the unique effect of different indicators of CSES on subjective measures of health and wellbeing in adulthood. Methods Cross-sectional data from the last wave of The Tromsø Study (n = 12,984) was used to assess the unique effect of three indicators of CSES (childhood financial conditions, mothers’ education and fathers’ education) on a range of subjective health measures: EQ-5D health dimensions, self-rated health, age-comparative self-rated health, as well as subjective wellbeing. Data was analyzed with the Paramed command in Stata. Log-linear regression was used for the subjective measures of health and wellbeing to estimate the natural direct effects (NDE’s), natural indirect effects (NIE’s), controlled direct effects (CDE’s) and marginal total effects (MTE’s) as risk ratios (RRs). Results Low childhood financial conditions were associated with lower health and wellbeing in adulthood, independently of respondents’ education. Among men, Low childhood financial conditions increased the risk (NDE) of being unhealthy on the composite EQ-5D by 22% (RR 1.22, 95% 1.14-1.31) and on subjective wellbeing by 24% (RR 1.24, 95% 1.18-1.30), while for women the risk increased by 16% (RR 1.16, 95% 1.10-1.23) and 26% (RR 1.26, 95% 1.19-1.33), respectively. Among men, the NDE of low mothers’ education on age-comparative self-rated health increased by 9% (RR 1.09, 95% 1.01-1.16), while the NIE increased the risk by 3% (RR 1.03, 95% 1.01-1.04). The NDE of low mothers’ education increased the risk on anxiety/depression among women by 38% (RR 1.38, 95% 1.13-1.69), whereas the NIE increased the risk by 5% (RR 1.05, 95% 1.02-1.08). Conclusions Childhood financial conditions have a unique direct effect on a wide range of health and wellbeing measures. These findings apply to both men and women. Generally, parental education has an indirect effect on later health, but mothers’ education may also have a long-term direct effect on later health.
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Votruba SB, Thearle MS, Piaggi P, Knowler WC, Hanson RL, Krakoff J. Weight maintenance from young adult weight predicts better health outcomes. Obesity (Silver Spring) 2014; 22:2361-9. [PMID: 25131650 PMCID: PMC4224987 DOI: 10.1002/oby.20854] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/16/2014] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Defining groups of individuals within a larger population with similar patterns of weight change over time may provide insight into influences of weight stability or gain. METHODS Latent class growth modeling was used to define subgroups of weight change in adult members of the Gila River Indian Community participating in at least four non-diabetic health exams including OGTTs (N = 1,157, 762F/395M; 78.4 ± 19.0 kg). In a separate study, 152 individuals had 24-h EE measured in a respiratory chamber. RESULTS Eight groups with baseline weights of 54.6 ± 7.3 (n = 124), 64.2 ± 7.7 (n = 267), 73.6 ± 7.8 (n = 298), 86.1 ± 10.2 (n = 194), 95.5 ± 6.7 (n = 90), 97.9 ± 10.4 (n = 92), 110.9 ± 11.9 (n = 61), and 122.1 ± 13.6 (n = 31) kg (P < 0.001) were delineated. Group 5, (initial weight = 95.5 ± 6.7 kg) maintained a comparatively stable weight over time (+3.3 ± 10.3 kg, +3.8 ± 11.2% of initial weight; median follow-up time: 13.1 years). All other groups gained weight over time (+29.9 ± 21.1% of initial weight; median follow-up time: 16.3 years). Higher starting weight defined weight gain in most groups, but higher 2 h glucose predicted membership in the lower weight trajectories. The weight stable group had higher rates of impaired glucose regulation at baseline and higher 24-h EE. CONCLUSIONS Weight in young adulthood defined weight gain trajectory underscoring the importance of intervening early to prevent weight gain.
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Affiliation(s)
- Susanne B Votruba
- Obesity and Diabetes Clinical Research Section, NIDDK/NIH/DHHS, Phoenix, AZ
- Corresponding Author: Susanne B Votruba Obesity & Diabetes Clinical Research Section NIDDK/NIH/DHHS 4212 N 16 St Phoenix, AZ 85016 Tel. 602-200-5336 Fax 602-200-5335
| | - Marie S Thearle
- Obesity and Diabetes Clinical Research Section, NIDDK/NIH/DHHS, Phoenix, AZ
| | - Paolo Piaggi
- Diabetes Molecular Genetics Section, NIDDK/NIH/DHHS, Phoenix, AZ
| | - William C Knowler
- Diabetes Epidemiology & Clinical Research Section, NIDDK/NIH/DHHS, Phoenix, AZ
| | - Robert L Hanson
- Diabetes Epidemiology & Clinical Research Section, NIDDK/NIH/DHHS, Phoenix, AZ
| | - Jonathan Krakoff
- Obesity and Diabetes Clinical Research Section, NIDDK/NIH/DHHS, Phoenix, AZ
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Etman A, Kamphuis CBM, van der Cammen TJM, Burdorf A, van Lenthe FJ. Do lifestyle, health and social participation mediate educational inequalities in frailty worsening? Eur J Public Health 2014; 25:345-50. [PMID: 25061232 DOI: 10.1093/eurpub/cku093] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Lower educated older persons are at increased risk of becoming frail as compared with higher educated older persons. To reduce educational inequalities in the development of frailty, we investigated whether lifestyle, health and social participation mediate this relationship. METHODS Longitudinal data of 14 082 European community-dwelling persons aged 55 years and older participating in the Survey on Health, Ageing, and Retirement in Europe (SHARE) in 2004 and 2006, were used. Associations of lifestyle (smoking behaviour and alcohol consumption), health (depression, memory function, chronic diseases) and social participation, with educational level and frailty worsening were investigated using regression models. In multinomial logistic regression analysis, mediators were added to models in which educational level was associated with worsening in frailty over 2 years follow-up. RESULTS In all countries, frailty worsening was more prevalent among lower as compared with higher educated persons, although odds ratios were only statistically significant in five of the 11 countries included [ORs varying from 1.40 (95% CI: 1.06-1.84) to 1.61 (95% CI: 1.21-2.14)]. Except for smoking behaviour and memory function, the factors under study all showed associations with educational level and frailty worsening that met the conditions for mediation. After inclusion of the four relevant mediators, attenuation of odds ratios varied between 4.9 and 31.5%. CONCLUSION While lifestyle, health and social participation were associated with frailty worsening over 2 years among European community-dwelling older persons, only small to moderate parts of educational inequalities in frailty worsening were explained by these factors.
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Affiliation(s)
- Astrid Etman
- 1 Department of Public Health, Erasmus University MC, Rotterdam, The Netherlands
| | - Carlijn B M Kamphuis
- 1 Department of Public Health, Erasmus University MC, Rotterdam, The Netherlands
| | - Tischa J M van der Cammen
- 2 Department of Internal Medicine, Section of Geriatric Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands 3 Department of Medicine, Brighton and Sussex Medical School, Brighton, UK 4 Faculty of Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Alex Burdorf
- 1 Department of Public Health, Erasmus University MC, Rotterdam, The Netherlands
| | - Frank J van Lenthe
- 1 Department of Public Health, Erasmus University MC, Rotterdam, The Netherlands
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Hoebel J, Richter M, Lampert T. Social status and participation in health checks in men and women in Germany: results from the German Health Update (GEDA), 2009 and 2010. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:679-85. [PMID: 24194789 DOI: 10.3238/arztebl.2013.0679] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 05/07/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Representative data for Germany were used to determine whether a person's social-status characteristics affect the likelihood of having a check-up for the early detection of disease. METHODS The analyses reported here were performed on data obtained in the Robert Koch Institute's German Health Update (GEDA) in 2009 and 2010. The survey responses of 26 555 people about whether they had had a check-up were evaluated. For inclusion, participants were required to be over age 35 and covered by statutory health insurance. To study the potential links between social status and check-up participation rates, a multidimensional social-status index was used in addition to three individual components of social status (highest educational level attained, occupational status, income). RESULTS 50.8% of the men and 49.8% of the women surveyed had had a check-up in the two years before the survey. Low social status was associated with a lower rate of check-ups for both sexes (for men, odds ratio [OR] 0.59, 95% confidence interval [CI] 0.50-0.70, p<0.001; for women, OR 0.63, 95% CI 0.55-0.72, p<0.001). For both men and women, occupational status and income each had independent effects on check-up participation, while educational level was not found to have any independent effect. CONCLUSION These findings indicate that socially disadvantaged persons are less likely to have check-ups than others. Efforts to increase check-up rates should take account of the demonstrated effects of income level and occupational status.
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Affiliation(s)
- Jens Hoebel
- Department of Epidemiology and Health Reporting, Robert Koch Institute Berlin
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Méjean C, Droomers M, van der Schouw YT, Sluijs I, Czernichow S, Grobbee DE, Bueno-de-Mesquita HB, Beulens JWJ. The contribution of diet and lifestyle to socioeconomic inequalities in cardiovascular morbidity and mortality. Int J Cardiol 2013; 168:5190-5. [PMID: 23998549 DOI: 10.1016/j.ijcard.2013.07.188] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 07/20/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND The role of differences in diet on the relationship between socioeconomic factors and cardiovascular diseases remains unclear. We studied the contribution of diet and other lifestyle factors to the explanation of socioeconomic inequalities in cardiovascular diseases. METHODS We prospectively examined the incidence of coronary heart disease (CHD) and stroke events amongst 33,106 adults of the EPIC-NL cohort. Education and employment status indicated socioeconomic status. We used Cox proportional models to estimate hazard ratios ((HR (95% confidence intervals)) for the association of socioeconomic factors with CHD and stroke and the contribution of diet and lifestyle. RESULTS During 12 years of follow-up, 1617 cases of CHD and 531 cases of stroke occurred. The risks of CHD and stroke were higher in lowest (HR=1.98 (1.67;2.35); HR=1.55 (1.15;2.10)) and lower (HR=1.50 (1.29;1.75); HR=1.42 (1.08;1.86)) educated groups than in the highest. Unemployed and retired subjects more often suffered from CHD (HR=1.37 (1.19;1.58); HR=1.20 (1.05;1.37), respectively), but not from stroke, than the employed. Diet and lifestyle, mainly smoking and alcohol, explained more than 70% of the educational differences in CHD and stroke and 65% of employment status variation in CHD. Diet explained more than other lifestyle factors of educational and employment status differences in CHD and stroke (36% to 67% vs. 9% to 27%). CONCLUSION The socioeconomic distribution of diet, smoking and alcohol consumption largely explained the inequalities in CHD and stroke in the Netherlands. These findings need to be considered when developing policies to reduce socioeconomic inequalities in cardiovascular diseases.
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Affiliation(s)
- Caroline Méjean
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; Université Paris 13, Sorbonne Paris Cité, UREN, Inserm (U557), Inra (U1125), Cnam, F-93017 Bobigny Cedex, France.
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