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Zhang S, Jiang Z, Zhang H, Liu Y, Qi J, Yan Y, Wang T, Zeng P. Association of cigarette smoking, smoking cessation with the risk of cardiometabolic multimorbidity in the UK Biobank. BMC Public Health 2024; 24:1910. [PMID: 39014423 PMCID: PMC11253396 DOI: 10.1186/s12889-024-19457-y] [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: 10/19/2023] [Accepted: 07/11/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND To investigate the association between cigarette smoking, smoking cessation and the trajectory of cardiometabolic multimorbidity (CMM), and further to examine the association of age at smoking initiation and smoking cessation with CMM. METHODS This study included 298,984 UK Biobank participants without cardiometabolic diseases (CMDs) (including type 2 diabetes, coronary heart diseases, stroke, and hypertension) at baseline. Smoking status was categorized into former, current, and never smokers, with age at smoking initiation and smoking cessation as a proxy for current and former smokers. The multi-state model was performed to evaluate the association between cigarette smoking, smoking cessation and CMM. RESULTS During a median follow-up of 13.2 years, 59,193 participants developed first cardiometabolic disease (FCMD), 14,090 further developed CMM, and 16,487 died. Compared to former smokers, current smokers had higher risk at all transitions, with hazard ratio (95% confidence interval) = 1.59 (1.55 ∼ 1.63) vs. 1.18 (1.16 ∼ 1.21) (P = 1.48 × 10- 118) from health to FCMD, 1.40 (1.33 ∼ 1.47) vs. 1.09 (1.05 ∼ 1.14) (P = 1.50 × 10- 18) from FCMD to CMM, and 2.87 (2.72 ∼ 3.03) vs. 1.38 (1.32 ∼ 1.45) (P < 0.001) from health, 2.16 (1.98 ∼ 2.35) vs. 1.25 (1.16 ∼ 1.34) (P = 1.18 × 10- 46) from FCMD, 2.02 (1.79 ∼ 2.28) vs. 1.22 (1.09 ∼ 1.35) (P = 3.93 × 10- 17) from CMM to death; whereas quitting smoking reduced the risk attributed to cigarette smoking by approximately 76.5% across all transitions. Reduced risks of smoking cessation were also identified when age at quitting smoking was used as a proxy for former smokers. CONCLUSIONS Cigarette smoking was associated with a higher risk of CMM across all transitions; however, smoking cessation, especially before the age of 35, was associated with a significant decrease in CMM risk attributed to cigarette smoking.
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Affiliation(s)
- Shuo Zhang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Zhou Jiang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Hao Zhang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Yuxin Liu
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Jike Qi
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Yu Yan
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Ting Wang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Ping Zeng
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China.
- Jiangsu Engineering Research Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China.
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Feng X, Sarma H, Seubsman SA, Sleigh A, Kelly M. Impact of age and gender differences in the prevalence and patterns of multimorbidity in the Thai Cohort Study. Int Health 2024; 16:454-462. [PMID: 38520373 PMCID: PMC11218883 DOI: 10.1093/inthealth/ihae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/30/2023] [Accepted: 03/19/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND The study aims to identify the common patterns of multimorbidity and their distribution by age and gender. METHOD This cross-sectional study collected self-reported data from 42 785 Thai Cohort Study members through mailed questionnaires. Employing prevalence-based analysis, it identified common multimorbidity (coexistence of two or more chronic conditions) patterns, analysing the three most common patterns stratified by age and sex. P for trend (p-trend) was used to test the linear trend for associations between age and prevalence of these chronic conditions in the multimorbidity patterns. RESULTS Chronic conditions with the highest prevalence were related to metabolic syndromes: obesity (28.5%), hyperlipidaemia (13.2%) and hypertension (7.2%). A positive linear age-multimorbidity association was observed (p-trend = 0.0111). The 60+ participants averaged 1.20 diseases, with 33.7% multimorbidity prevalence. Hyperlipidaemia + obesity was most prevalent in the under-40 multimorbid group (38.7%). Men exhibited a higher prevalence of multimorbidity and associated patterns involving hypertension, hyperlipidaemia and obesity than women. CONCLUSION Metabolic syndrome components were the prominent factors driving multimorbidity. Significant age and gender differences were also revealed in multimorbidity prevalence. People aged 60+ faced high risk of multimorbidity, while younger individuals tended towards the multimorbidity pattern of obesity and hyperlipidaemia. Men were more susceptible to multimorbidity patterns associated with metabolic syndromes. Future studies for metabolic-related multimorbidity should consider these differences, addressing age and gender issues.
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Affiliation(s)
- Xiyu Feng
- Department of Applied Epidemiology, National Centre of Epidemiology and Population Health, the Australian National University, Canberra 2601, Australia
| | - Haribondhu Sarma
- Department of Applied Epidemiology, National Centre of Epidemiology and Population Health, the Australian National University, Canberra 2601, Australia
| | - Sam-ang Seubsman
- School of Human Ecology, Sukhothai Thammathirat Open University, Nonthaburi, 11120, Thailand
| | - Adrian Sleigh
- Department of Applied Epidemiology, National Centre of Epidemiology and Population Health, the Australian National University, Canberra 2601, Australia
| | - Matthew Kelly
- Department of Applied Epidemiology, National Centre of Epidemiology and Population Health, the Australian National University, Canberra 2601, Australia
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Stockmarr A, Frølich A. Clusters from chronic conditions in the Danish adult population. PLoS One 2024; 19:e0302535. [PMID: 38687772 PMCID: PMC11060538 DOI: 10.1371/journal.pone.0302535] [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: 10/20/2023] [Accepted: 04/09/2024] [Indexed: 05/02/2024] Open
Abstract
Multimorbidity, the presence of 2 or more chronic conditions in a person at the same time, is an increasing public health concern, which affects individuals through reduced health related quality of life, and society through increased need for healthcare services. Yet the structure of chronic conditions in individuals with multimorbidity, viewed as a population, is largely unmapped. We use algorithmic diagnoses and the K-means algorithm to cluster the entire 2015 Danish multimorbidity population into 5 clusters. The study introduces the concept of rim data as an additional tool for determining the number of clusters. We label the 5 clusters the Allergies, Chronic Heart Conditions, Diabetes, Hypercholesterolemia, and Musculoskeletal and Psychiatric Conditions clusters, and demonstrate that for 99.32% of the population, the cluster allocation can be determined from the diagnoses of 4-5 conditions. Clusters are characterized through most prevalent conditions, absent conditions, over- or under-represented conditions, and co-occurrence of conditions. Clusters are further characterized through socioeconomic variables and healthcare service utilizations. Additionally, geographical variations throughout Denmark are studied at the regional and municipality level. We find that subdivision into municipality levels suggests that the Allergies cluster frequency is positively associated with socioeconomic status, while the subdivision suggests that frequencies for clusters Diabetes and Hypercholesterolemia are negatively correlated with socioeconomic status. We detect no indication of association to socioeconomic status for the Chronic Heart Conditions cluster and the Musculoskeletal and Psychiatric Conditions cluster. Additional spatial variation is revealed, some of which may be related to urban/rural populations. Our work constitutes a step in the process of characterizing multimorbidity populations, leading to increased comprehension of the nature of multimorbidity, and towards potential applications to individual-based care, prevention, the development of clinical guidelines, and population management.
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Affiliation(s)
- Anders Stockmarr
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Saoud F, AlHenaidi M, AlOtaibi H, AlEnezi A, Mohammed M, AlOtaibi F, AlShammari D, AlKharqawi S, AlMayas H, AlMathkour H, Akhtar S. Prevalence of and factors associated with multimorbidity among adults in Kuwait. BMC Public Health 2024; 24:768. [PMID: 38475726 DOI: 10.1186/s12889-024-18298-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND This cross-sectional study aimed to assess the prevalence of morbidity i.e., one morbidity and multimorbidity (≥ 2 morbid conditions) among adults in Kuwait and to examine the sociodemographic and lifestyle factors associated with morbidity as a multinomial outcome in the study population. METHODS The data were collected from January 26, 2021, to February 3, 2021, using an electronic questionnaire, which was distributed on social media platforms. The consent form was attached with the questionnaire and the participants were requested to sign the consent form before completing the questionnaire. The prevalences (%) of each morbidity and multimorbidity were computed. Multivariable polychotomous logistic regression analysis was used to evaluate the association between the demographic and lifestyle factors with morbidity as a multinomial outcome. RESULTS Of 3572 respondents included, 89% were Kuwaiti, 78.3% females and 66% were 21- 40 years old. The prevalence of multimorbidity and one morbidity respectively was 27.4% and 29.7%. The prevalence of multimorbidity with two, three, four or five ill-health conditions were 14.3%, 7.4%, 3.5%, and 1.2%, respectively. A higher prevalence of multimorbidity was among respondents over 60 years of age (71%) and Kuwaiti nationals (28.9%). The final multivariable polychotomous logistic regression model revealed that age, sex, nativity, sedentary lifestyle, smoking, and alcohol drinking were significantly (p < 0.05) associated with multimorbidity. However, age and alcohol drinking were significant (p < 0.05) predictors of one morbidity. CONCLUSION This study provides evidence that multimorbidity is more prevalent among the elderly, females, and Kuwaiti nationals. Sedentary behaviour, smoking and alcohol consumption were significantly and independently associated with multimorbidity. These findings highlight the burden of multimorbidity and should be considered in the development of future prevention programs.
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Affiliation(s)
- Fajer Saoud
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Maryam AlHenaidi
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Hajer AlOtaibi
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Asayel AlEnezi
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Mariam Mohammed
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Fatemah AlOtaibi
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Danah AlShammari
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Sebakah AlKharqawi
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Hadil AlMayas
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Hatoun AlMathkour
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait
| | - Saeed Akhtar
- Department of Community Medicine and Behavioural Sciences, College of Medicine, Kuwait University, PO Box 24923, 13110, Safat, Kuwait.
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Das P, Saha S, Das T, Das P, Roy TB. Assessing the modifiable and non-modifiable risk factors associated with multimorbidity in reproductive aged women in India. BMC Public Health 2024; 24:676. [PMID: 38439011 PMCID: PMC10910662 DOI: 10.1186/s12889-024-18186-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/22/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Reproductive span is the foundation of every woman's health in later life. India is currently facing a growing burden of multiple morbidities among the women in their reproductive age group which may further increase over the coming decades. The purpose of the present study aimed to identify different modifiable and non-modifiable risk factors affecting multimorbidity among the women in reproductive age group in Indian context. METHODS Secondary data were obtained from the Demography and Health Survey (DHS), conducted in India during 2019-2021. A total of 671,967 women aged 15-49 years were selected for this present study. Descriptive, association studies and multinominal logistic regression analyses were performed to accomplish the objectives. RESULTS Currently, 6.3% of total study participant's reproductive age group women suffered from multimorbidity in India. Never consuming protein, fruits, vegetables and milk increase the chances of developing multimorbidity. Consumption of fried foods, aerated drinks and addiction towards tobacco and alcohol also has a greater influence on the prevalence of multimorbidity. The prevalence of multimorbidity is sharply increased with increasing age and Body Mass Index (BMI). Regionally, the prevalence of multimorbidity was found more among the women hailed from eastern and north-eastern India. CONCLUSION To reduce the risk of developing multimorbidity, targeted interventions are needed in the form of educating every woman concerning the importance of having minimum health-related knowledge, maintaining healthy lifestyle, weight management and having proper and balanced diet.
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Affiliation(s)
- Priya Das
- Department of Geography, University of Gour Banga, 732101, Malda, West Bengal, India
| | - Subhadeep Saha
- Department of Geography, Raiganj University, 733134, Uttar Dinajpur, West Bengal, India
| | - Tanu Das
- Department of Geography, Raiganj University, 733134, Uttar Dinajpur, West Bengal, India
| | - Partha Das
- Department of Geography, Raiganj University, 733134, Uttar Dinajpur, West Bengal, India
| | - Tamal Basu Roy
- Department of Geography, Raiganj University, 733134, Uttar Dinajpur, West Bengal, India.
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Jäger M, Zangger G, Bricca A, Dideriksen M, Smith SM, Midtgaard J, Taylor RS, Skou ST. Mapping interventional components and behavior change techniques used to promote self-management in people with multimorbidity: a scoping review. Health Psychol Rev 2024; 18:165-188. [PMID: 36811829 PMCID: PMC7615688 DOI: 10.1080/17437199.2023.2182813] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
Ageing populations and improved survival, have contributed to a rise in the number of people living with multimorbidity, raising issues related to polypharmacy, treatment burden, competing priorities and poor coordination of care. Self-management programs are increasingly included as an essential component of interventions to improve outcomes in this population. However, an overview of how interventions supporting self-management in patients with multimorbidity is missing. This scoping review focused on mapping the literature on patient-centered interventions for people living with multimorbidity. We searched several databases, clinical registries, and grey literature for RCTs published between 1990-2019 describing interventions that supported self-management in people with multimorbidity. We included 72 studies that were found to be very heterogeneous when it comes to the population, delivery modes and modalities, intervention elements and facilitators. The results pointed to an extensive use of cognitive behavioral therapy as a basis for interventions, as well as behavior change theories and disease management frameworks. The most coded behavior change techniques stemmed from the categories Social Support, Feedback and monitoring and Goals and Planning. To allow for implementation of effective interventions in clinical practice, improved reporting of intervention mechanisms in RCTs is warranted.
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Affiliation(s)
- Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Danish Centre for Motivation and Behaviour Science, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Graziella Zangger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Mette Dideriksen
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Susan M. Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Rod S. Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, Scotland
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
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Freund M, Clapham M, Ooi JY, Adamson D, Boyes A, Sanson-Fisher R. The health and wellbeing of Australian social housing tenants compared to people living in other types of housing. BMC Public Health 2023; 23:2334. [PMID: 38001441 PMCID: PMC10675914 DOI: 10.1186/s12889-023-17267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 11/20/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Although social housing provides access to safe and affordable housing, recent studies have found that social housing tenants consistently have lower levels of health and well-being compared to other people. Given this, there is a need to examine multimorbidity for social housing tenants. METHODS Secondary data analysis of the 2017-18 Australian National Health Survey (n = 14,327) compared the health of adults residing in social housing compared to people in other housing types (private rentals, homeowners, and homeowners/mortgagees). RESULTS Most health factors examined were more prevalent in social housing tenants compared to those living in other housing types. Individual health problems identified as more highly prevalent in social housing tenants compared to all other housing types included mental health issues (43%), arthritis (36%), back problems (32%), hypertension (25%), asthma (22%) and COPD (11%). 24% of social housing tenants reported five or more health factors compared to 3-6% of people in other housing types. CONCLUSIONS Although these findings are not unexpected, they provide more detailed evidence that social housing providers and policy makers should consider when planning future initiatives.
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Affiliation(s)
- Megan Freund
- Health Behaviour Research Collaborative, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales (NSW), 2308, Australia.
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
| | - Matthew Clapham
- Clinical Research Design and Statistics Support Unit, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Jia Ying Ooi
- Health Behaviour Research Collaborative, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales (NSW), 2308, Australia
| | - David Adamson
- Home in Place Co Ltd., Newcastle West, NSW, Australia
- University of South Wales, Cardiff, South Wales, UK
| | - Allison Boyes
- Health Behaviour Research Collaborative, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales (NSW), 2308, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Robert Sanson-Fisher
- Health Behaviour Research Collaborative, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales (NSW), 2308, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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Zheng X, Xue B, Xiao S, Li X, Chen Y, Shi L, Liang X, Tian F, Zhang C. Development and validation of a multimorbidity risk prediction nomogram among Chinese middle-aged and older adults: a retrospective cohort study. BMJ Open 2023; 13:e077573. [PMID: 37940154 PMCID: PMC10632863 DOI: 10.1136/bmjopen-2023-077573] [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: 07/13/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023] Open
Abstract
OBJECTIVES The aim of this study is to establish a self-simple-to-use nomogram to predict the risk of multimorbidity among middle-aged and older adults. DESIGN A retrospective cohort study. PARTICIPANTS We used data from the Chinese Longitudinal Healthy Longevity Survey, including 7735 samples. MAIN OUTCOME MEASURES Samples' demographic characteristics, modifiable lifestyles and depression were collected. Cox proportional hazard models and nomogram model were used to estimate the risk factors of multimorbidity. RESULTS A total of 3576 (46.2%) participants have multimorbidity. The result showed that age, female (HR 0.80, 95% CI 0.72 to 0.89), chronic disease (HR 2.59, 95% CI 2.38 to 2.82), sleep time (HR 0.78, 95% CI 0.72 to 0.85), regular physical activity (HR 0.88, 95% CI 0.81 to 0.95), drinking (HR 1.27 95% CI 1.16 to 1.39), smoking (HR 1.40, 95% CI 1.26 to 1.53), body mass index (HR 1.04, 95% CI 1.03 to 1.05) and depression (HR 1.02, 95% CI 1.01 to 1.03) were associated with multimorbidity. The C-index of nomogram models for derivation and validation sets were 0.70 (95% CI 0.69 to 0.71, p=0.006) and 0.71 (95% CI 0.70 to 0.73, p=0.008), respectively. CONCLUSIONS We have crafted a user-friendly nomogram model for predicting multimorbidity risk among middle-aged and older adults. This model integrates readily available and routinely assessed risk factors, enabling the early identification of high-risk individuals and offering tailored preventive and intervention strategies.
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Affiliation(s)
- Xiao Zheng
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, China
- School of Health Management, Southern Medical University, Guangzhou, China
| | - Benli Xue
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Shujuan Xiao
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Xinru Li
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Yimin Chen
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Lei Shi
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Xiaoyan Liang
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Feng Tian
- Department of Health Management, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde, Foshan), Foshan, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
| | - Chichen Zhang
- School of Health Management, Southern Medical University, Guangzhou, China
- Key Laboratory of Philosophy and Social Sciences of Guangdong Higher Education Institutions for Collaborative Innovation of Health Management Policy and Precision Health Service, Guangzhou, China
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Ni Y, Zhou Y, Kivimäki M, Cai Y, Carrillo-Larco RM, Xu X, Dai X, Xu X. Socioeconomic inequalities in physical, psychological, and cognitive multimorbidity in middle-aged and older adults in 33 countries: a cross-sectional study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e618-e628. [PMID: 37924843 DOI: 10.1016/s2666-7568(23)00195-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Many physical, psychological, and cognitive disorders are highly clustered among populations with low socioeconomic status. However, the extent to which socioeconomic status is associated with different combinations of these disorders is unclear, particularly outside high-income countries. We aimed to evaluate these associations in 33 countries including high-income countries, upper-middle-income countries, and one lower-middle-income country. METHODS This cross-sectional multi-region study pooled individual-level data from seven studies on ageing between 2017 and 2020. Education and total household wealth were used to measure socioeconomic status. Physical disorder was defined as having one or more of the self-reported chronic conditions. Psychological and cognitive disorders were measured by study-specific instruments. The outcome included eight categories: no disorders, physical disorder, psychological disorder, cognitive disorder, and their four combinations. Multivariable-adjusted logistic regression models were used to estimate odds ratios (ORs) and 95% CIs for the associations of socioeconomic status with these outcomes separately for high-income countries, upper-middle-income countries, and the lower-middle-income country. FINDINGS Among 167 376 individuals aged 45 years and older, the prevalence of multimorbidity was 24·5% in high-income countries, 33·9% in upper-middle-income countries, and 8·1% in the lower-middle-income country (India). Lower levels of education, household wealth, and a combined socioeconomic status score were strongly associated with physical, psychological, and cognitive multimorbidity in high-income countries and upper-middle-income countries, with ORs (low vs high socioeconomic status) for physical-psychological-cognitive multimorbidity of 12·36 (95% CI 10·29-14·85; p<0·0001) in high-income countries and of 23·84 (18·85-30·14; p<0·0001) in upper-middle-income countries. The associations in the lower-middle-income country were mixed. Participants with both a low level of education and low household wealth had the highest odds of multimorbidity (eg, OR for physical-psychological-cognitive multimorbidity 21·21 [15·95-28·19; p<0·0001] in high-income countries, 37·07 [25·66-53·56; p<0·0001] in upper-middle-income countries, and 54·96 [7·66-394·38; p<0·0001] in the lower-middle-income country). INTERPRETATION In study populations from high-income countries, upper-middle-income countries, and the lower-middle-income country, the odds of multimorbidity, which included physical, psychological, and cognitive disorders, were more than ten times greater in individuals with low socioeconomic status. Equity-oriented policies and programmes that reduce social inequalities in multimorbidity are urgently needed to achieve Sustainable Development Goals. FUNDING Zhejiang University, Fundamental Research Funds for the Central Universities, The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Wellcome Trust, Medical Research Council, National Institute on Aging, and Academy of Finland. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Yujie Ni
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, China
| | - Yaguan Zhou
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, China
| | - Mika Kivimäki
- UCL Brain Sciences, University College London, London, UK
| | - Ying Cai
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Rodrigo M Carrillo-Larco
- Emory Global Diabetes Research Center, Emory University, Atlanta, GA, USA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Xin Xu
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, China
| | - Xiaochen Dai
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Xiaolin Xu
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, China; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
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10
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Bobinet K, Greer SM. The Iterative Mindset Method: a neuroscientific theoretical approach for sustainable behavior change and weight-loss in digital medicine. NPJ Digit Med 2023; 6:179. [PMID: 37752181 PMCID: PMC10522664 DOI: 10.1038/s41746-023-00910-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
With the growing prevalence of chronic conditions driving 85% of all healthcare costs, digital health offers a promising opportunity to reverse disease and improve health at-scale. The healthcare industry's predominant approach to behavior change is performance-based with a focus on goals and tracking. This has not reversed the epidemic of chronic diseases and also can harm chronically ill and vulnerable patients via perceived failure-induced loss of motivation. Still nascent, the digital health industry is uniquely positioned to adopt and scale new and better behavior change approaches. In this paper, we present the theoretical foundation and initial findings of a neuroscience-based behavior change approach-what we call the Iterative Mindset MethodTM. We discuss its promise, as a potentially more effective, neuroscience-based approach to changing health behaviors long-term, particularly in vulnerable populations. We conclude with avenues for future research.
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Affiliation(s)
- Kyra Bobinet
- Fresh Tri, Inc., 13001 East Zayante Road, Felton, CA, 95018, USA.
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11
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Rios S, García-Gavilán JF, Babio N, Paz-Graniel I, Ruiz-Canela M, Liang L, Clish CB, Toledo E, Corella D, Estruch R, Ros E, Fitó M, Arós F, Fiol M, Guasch-Ferré M, Santos-Lozano JM, Li J, Razquin C, Martínez-González MÁ, Hu FB, Salas-Salvadó J. Plasma metabolite profiles associated with the World Cancer Research Fund/American Institute for Cancer Research lifestyle score and future risk of cardiovascular disease and type 2 diabetes. Cardiovasc Diabetol 2023; 22:252. [PMID: 37716984 PMCID: PMC10505328 DOI: 10.1186/s12933-023-01912-6] [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: 04/24/2023] [Accepted: 07/01/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND A healthy lifestyle (HL) has been inversely related to type 2 diabetes (T2D) and cardiovascular disease (CVD). However, few studies have identified a metabolite profile associated with HL. The present study aims to identify a metabolite profile of a HL score and assess its association with the incidence of T2D and CVD in individuals at high cardiovascular risk. METHODS In a subset of 1833 participants (age 55-80y) of the PREDIMED study, we estimated adherence to a HL using a composite score based on the 2018 Word Cancer Research Fund/American Institute for Cancer Research recommendations. Plasma metabolites were analyzed using LC-MS/MS methods at baseline (discovery sample) and 1-year of follow-up (validation sample). Cross-sectional associations between 385 known metabolites and the HL score were assessed using elastic net regression. A 10-cross-validation procedure was used, and correlation coefficients or AUC were assessed between the identified metabolite profiles and the self-reported HL score. We estimated the associations between the identified metabolite profiles and T2D and CVD using multivariable Cox regression models. RESULTS The metabolite profiles that identified HL as a dichotomous or continuous variable included 24 and 58 metabolites, respectively. These are amino acids or derivatives, lipids, and energy intermediates or xenobiotic compounds. After adjustment for potential confounders, baseline metabolite profiles were associated with a lower risk of T2D (hazard ratio [HR] and 95% confidence interval (CI): 0.54, 0.38-0.77 for dichotomous HL, and 0.22, 0.11-0.43 for continuous HL). Similar results were observed with CVD (HR, 95% CI: 0.59, 0.42-0.83 for dichotomous HF and HR, 95%CI: 0.58, 0.31-1.07 for continuous HL). The reduction in the risk of T2D and CVD was maintained or attenuated, respectively, for the 1-year metabolomic profile. CONCLUSIONS In an elderly population at high risk of CVD, a set of metabolites was selected as potential metabolites associated with the HL pattern predicting the risk of T2D and, to a lesser extent, CVD. These results support previous findings that some of these metabolites are inversely associated with the risk of T2D and CVD. TRIAL REGISTRATION The PREDIMED trial was registered at ISRCTN ( http://www.isrctn.com/ , ISRCTN35739639).
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Affiliation(s)
- Santiago Rios
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentaciò, Nutrició Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Jesús F García-Gavilán
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentaciò, Nutrició Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain.
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain.
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.
| | - Nancy Babio
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentaciò, Nutrició Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Indira Paz-Graniel
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentaciò, Nutrició Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Miguel Ruiz-Canela
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA, Pamplona, Spain
| | - Liming Liang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Clary B Clish
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Estefania Toledo
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA, Pamplona, Spain
| | - Dolores Corella
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine, University of Valencia, Valencia, Spain
| | - Ramón Estruch
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Internal Medicine, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Emilio Ros
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Endocrinology and Nutrition, Lipid Clinic, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain
| | - Montserrat Fitó
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Unit of Cardiovascular Risk and Nutrition, Institut Hospital del Mar de Investigaciones Médicas Municipal d'Investigació Médica (IMIM), Barcelona, Spain
| | - Fernando Arós
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Cardiology, Hospital Universitario de Álava, Vitoria, Spain
| | - Miquel Fiol
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Son Espases, Palma de Mallorca, Spain
| | - Marta Guasch-Ferré
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Public Health and Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - José M Santos-Lozano
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Research Unit, Department of Family Medicine, Distrito Sanitario Atención Primaria Sevilla, Sevilla, Spain
| | - Jun Li
- Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA, Pamplona, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Hospital Son Espases, Palma de Mallorca, Spain
| | - Cristina Razquin
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA, Pamplona, Spain
| | - Miguel Ángel Martínez-González
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Navarra, IdiSNA, Pamplona, Spain
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Frank B Hu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jordi Salas-Salvadó
- Universitat Rovira i Virgili, Departament de Bioquímica i Biotecnologia, Alimentaciò, Nutrició Desenvolupament i Salut Mental ANUT-DSM, Reus, Spain.
- CIBER de Fisiopatología de la Obesidad y Nutrición, Instituto de Salud Carlos III, Madrid, Spain.
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.
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Ahmed W, Muhammad T, Muneera K. Prevalence of early and late onset of chronic diseases and multimorbidity and its association with physical, mental and functional health among older Indian adults. BMC Geriatr 2023; 23:563. [PMID: 37710170 PMCID: PMC10502995 DOI: 10.1186/s12877-023-04264-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Identifying people with early and late onset of chronic conditions might help target the subpopulations that are more vulnerable to negative mental, physical and functional health outcomes. The current study aimed to examine the association of early and late onset of chronic single and multiple morbidities with self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults. METHODS Cross-sectional study was conducted using data from the Longitudinal Ageing Study in India (LASI) Wave 1 (2017-2018). The total sample size for the present study was 31,386 older adults age 60 years or older. Multivariable binary logistic regression analysis was used to establish the association between the outcomes (poor perceived physical/mental health, functional difficulty and physical inactivity) and explanatory variables (early [ = < 50 years of age] and late [> 50 years]) onset of chronic illnesses such as hypertension, diabetes, heart attack, heart disease, stroke, cancer, lung disease, arthritis, osteoporosis and psychiatric disease). RESULTS Overall, 24.21% of the sample population had poor self-perceived physical health, whereas 8.67% of participants had poor self-perceived mental health. The prevalence of difficulty in ADL, difficulty in IADL, and physical inactivity was 23.77%, 48.36%, and 68.9%, respectively. Odds of poor perceived mental health were higher for the respondents with early as well as late onset of hypertension, stroke, and arthritis; while individuals with late onset of diabetes, and heart disease had higher odds of poor perceived mental health than those without chronic disease. Individuals with early onset of single morbidity were more likely to report ADL difficulty (adjusted odds ratio [AOR]: 1.33, confidence interval [CI]: 1.06-1.67); while those with late onset of single (AOR: 1.34, CI: 1.17-1.53) and multimorbidity (AOR: 1.91, CI: 1.63-2.24) were more likely to report ADL difficulty compared with individuals without morbidity. Individuals with early as well as late-onset of multimorbidity had more than two times higher odds of reporting poor physical health, poor mental health and IADL difficulty compared with individuals without chronic disease. CONCLUSIONS The present study revealed that early and/or late onset of chronic single and/or multiple morbidities significantly predicted poor self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults. The findings further suggest that late onset of chronic diseases such as cancer and stroke and multi-morbidity had stronger associations with physical inactivity that may help identify high risk groups for screening and support.
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Affiliation(s)
- Waquar Ahmed
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - T Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, India.
| | - K Muneera
- National Institute of Technology, Calicut, Kerala, 673601, India
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Carlson DM, Yarns BC. Managing medical and psychiatric multimorbidity in older patients. Ther Adv Psychopharmacol 2023; 13:20451253231195274. [PMID: 37663084 PMCID: PMC10469275 DOI: 10.1177/20451253231195274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/14/2023] [Indexed: 09/05/2023] Open
Abstract
Aging increases susceptibility both to psychiatric and medical disorders through a variety of processes ranging from biochemical to pharmacologic to societal. Interactions between aging-related brain changes, emotional and psychological symptoms, and social factors contribute to multimorbidity - the presence of two or more chronic conditions in an individual - which requires a more patient-centered, holistic approach than used in traditional single-disease treatment guidelines. Optimal treatment of older adults with psychiatric and medical multimorbidity necessitates an appreciation and understanding of the links between biological, psychological, and social factors - including trauma and racism - that underlie physical and psychiatric multimorbidity in older adults, all of which are the topic of this review.
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Affiliation(s)
- David M. Carlson
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Brandon C. Yarns
- Department of Psychiatry/Mental Health, VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Bldg. 401, Rm. A236, Mail Code 116AE, Los Angeles, CA 90073, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
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14
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Zhang H, Chen Y, Ni R, Cao Y, Fang W, Hu W, Pan G. Traffic-related air pollution, adherence to healthy lifestyles, and risk of cognitive impairment: A nationwide population-based study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2023; 262:115349. [PMID: 37567107 DOI: 10.1016/j.ecoenv.2023.115349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/13/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Traffic-related air pollution (TRAP) is a risk factor for cognitive function, whereas healthy lifestyles are associated with better cognition. We aimed to examine their joint effects on cognition among the Chinese elderly. METHODS The data from the Chinese Longitudinal Healthy Longevity Survey was used. Participants' cognitive performance was assessed by the Chinese version of the mini-mental state examination. Residential proximity to major roadways was obtained through self-report and categorized into five categories: > 300 m, 201-300 m, 101-200 m, 50-100 m, and < 50 m, serving as a surrogate for TRAP. Six lifestyle behaviors (smoking, drinking, exercise, body mass index, sleep duration, and dietary diversity) were taken into account to calculate healthy lifestyle scores. The scores ranged from zero to six and were then divided into three groups: healthy (5-6), intermediate (2-4), and unhealthy (0-1). Logistic regression models were applied to investigate the joint effects of TRAP and healthy lifestyle scores on cognition. RESULTS Compared to participants living < 50 m from major roadways and adopting an unhealthy lifestyle, those living > 300 m from major roadways and adopting a healthy lifestyle had a significantly decreased risk of cognitive impairment. Stratified analysis indicated that the associations between TRAP and cognitive impairment were more pronounced among participants adopting an unhealthy lifestyle compared to the participants adopting a healthy lifestyle. CONCLUSIONS TRAP may impair cognitive function, and its detrimental impacts may be lessened by healthy lifestyles.
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Affiliation(s)
- Hengchuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Yingying Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Ruyu Ni
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Yawen Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Wenbin Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Wan Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China
| | - Guixia Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui 230032, China; Key Laboratory of Population Health Across Life Cycle (Anhui Medical University), Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei, Anhui, China; Medical Data Processing Center of School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei 230032, Anhui, China.
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15
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Niebuur J, Vonk JM, Du Y, de Bock GH, Lunter G, Krabbe PFM, Alizadeh BZ, Snieder H, Smidt N, Boezen M, Corpeleijn E. Lifestyle factors related to prevalent chronic disease multimorbidity: A population-based cross-sectional study. PLoS One 2023; 18:e0287263. [PMID: 37486939 PMCID: PMC10365307 DOI: 10.1371/journal.pone.0287263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 06/02/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Multimorbidity is associated with poor quality of life, polypharmacy, health care costs and mortality, with those affected potentially benefitting from a healthy lifestyle. We assessed a comprehensive set of lifestyle factors in relation to multimorbidity with major chronic diseases. METHODS This cross-sectional study utilised baseline data for adults from the prospective Lifelines Cohort in the north of the Netherlands (N = 79,345). We defined multimorbidity as the co-existence of two or more chronic diseases (i.e. cardiovascular disease, cancer, respiratory disease, type 2 diabetes) and evaluated factors in six lifestyle domains (nutrition, physical (in)activity, substance abuse, sleep, stress, relationships) among groups by the number of chronic diseases (≥2, 1, 0). Multinomial logistic regression models were created, adjusted for appropriate confounders, and odds ratios (OR) with 95% confidence intervals (95%CI) were reported. RESULTS 3,712 participants had multimorbidity (4.7%, age 53.5 ± 12.5 years), and this group tended to have less healthy lifestyles. Compared to those without chronic diseases, those with multimorbidity reported physical inactivity more often (OR, 1.15; 95%CI, 1.06-1.25; not significant for one condition), chronic stress (OR, 2.14; 95%CI, 1.92-2.38) and inadequate sleep (OR, 1.70; 95%CI, 1.41-2.06); as expected, they more often watched television (OR, 1.70; 95%CI, 1.42-2.04) and currently smoked (OR, 1.91; 95%CI, 1.73-2.11), but they also had lower alcohol intakes (OR, 0.66; 95%CI, 0.59-0.74). CONCLUSIONS Chronic stress and poor sleep, in addition to physical inactivity and smoking, are lifestyle factors of great concern in patients with multimorbidity.
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Affiliation(s)
- Jacobien Niebuur
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Judith M. Vonk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yihui Du
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H. de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerton Lunter
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul F. M. Krabbe
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Behrooz Z. Alizadeh
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harold Snieder
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nynke Smidt
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marike Boezen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Kamps A, Runhaar J, de Ridder MAJ, de Wilde M, van der Lei J, Zhang W, Prieto-Alhambra D, Englund M, de Schepper EIT, Bierma-Zeinstra SMA. Comorbidity in incident osteoarthritis cases and matched controls using electronic health record data. Arthritis Res Ther 2023; 25:114. [PMID: 37403135 PMCID: PMC10318652 DOI: 10.1186/s13075-023-03086-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/04/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Comorbidities are common in patients with osteoarthritis (OA). This study aimed to determine the association of a wide range of previously diagnosed comorbidities in adults with newly diagnosed OA compared with matched controls without OA. METHODS A case-control study was conducted. The data were derived from an electronic health record database that contains the medical records of patients from general practices throughout the Netherlands. Incident OA cases were defined as patients with one or more diagnostic codes recorded in their medical records that correspond to knee, hip, or other/peripheral OA. Additionally, the first OA code had to be recorded between January 1, 2006, and December 31, 2019. The date of cases' first OA diagnosis was defined as the index date. Cases were matched (by age, sex, and general practice) to up to 4 controls without a recorded OA diagnosis. Odds ratios were derived for each 58 comorbidities separately by dividing the comorbidity prevalence of cases by that of their matched controls at the index date. RESULTS 80,099 incident OA patients were identified of whom 79,937 (99.8%) were successfully matched with 318,206 controls. OA cases had higher odds for 42 of the 58 studied comorbidities compared with matched controls. Musculoskeletal diseases and obesity showed large associations with incident OA. CONCLUSIONS Most of the comorbidities under study had higher odds in patients with incident OA at the index date. While previously known associations were confirmed in this study, some associations were not described earlier.
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Affiliation(s)
- Anne Kamps
- Department of General Practice, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - Jos Runhaar
- Department of General Practice, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Maria A J de Ridder
- Department of Medical Informatics, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Marcel de Wilde
- Department of Medical Informatics, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Weiya Zhang
- School of Medicine, Faculty of Medicine & Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
| | - Daniel Prieto-Alhambra
- Department of Medical Informatics, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Windmill Road, Headington, OX3 7HE, Oxford, UK
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden
| | - Evelien I T de Schepper
- Department of General Practice, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
- Department of Orthopaedics and Sports Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
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Jiao D, Li X, Zhu Z, Zhang J, Liu Y, Cui M, Matsumoto M, Banu AA, Sawada Y, Watanabe T, Tanaka E, Anme T. Latent Subtype of Cognitive Frailty among Multimorbidity Older Adults and Their Association with Social Relationships. Healthcare (Basel) 2023; 11:1933. [PMID: 37444767 DOI: 10.3390/healthcare11131933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/18/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
This study aimed to explore all the relevant subtypes of cognitive frailty among Japanese community-dwelling older adults with multimorbidity. Moreover, it examined the associations between these potential subtypes of cognitive frailty and social relationships. This study targeted relevant cross-sectional data regarding community-based older adults with multimorbidity. It employed a person-centered method to perform a latent class analysis and explore the subtypes of cognitive frailty among older adults. Moreover, a multinominal logistic regression analysis was employed to examine the association between potential subtypes of cognitive frailty and social relationships. Data for 396 participants (mean age, 75.8 [SD, 7.3] years; 51.3% females) were analyzed. Three cognitive frailty subtypes were subsequently revealed: the robust group (42.0%), the group with partial cognitive frailty (38.6%), and the group with cognitive frailty (19.4%). People with high levels of social relationships were more likely to be in the robust and the partial cognitive frailty groups. This study identified different subtypes of cognitive frailty among multimorbid older adults and highlighted the significance of social relationships. These findings could serve as a reference for conceptualizing cognitive frailty through the person-centered method. Promoting a high level of social relationships could be useful to prevent the cognitive frailty among older adults with multimorbidity.
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Affiliation(s)
- Dandan Jiao
- Department of Nursing, The First Affiliated Hospital, and College of Clinical Medicine, Henan University of Science and Technology, Luoyang 471003, China
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Xiang Li
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Zhu Zhu
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Jinrui Zhang
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Yang Liu
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Mingyu Cui
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Munenori Matsumoto
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Alpona Afsari Banu
- School of Comprehensive Human Science, University of Tsukuba, Tsukuba 305-8577, Japan
| | - Yuko Sawada
- Department of Physical Therapy, Morinomiya University of Medical Sciences, Osaka 559-0034, Japan
| | - Taeko Watanabe
- Faculty of Nursing, Shukutoku University, Chiba 260-8701, Japan
| | - Emiko Tanaka
- Faculty of Nursing, Musashino University, Tokyo 135-8181, Japan
| | - Tokie Anme
- Faculty of Medicine, University of Tsukuba, Tsukuba 305-8575, Japan
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Yang Q, Zhang Q, Ngai FW, Wang S, Zhang D, Gao Y, Hao C, Wang HH, Nogueira OCBL, Liu M, Molasiotis A, Loke A, Xie Y. The Multimorbidity and Lifestyle Correlates in Chinese Population Residing in Macau: Findings from a Community-Based Needs Assessment Study. Healthcare (Basel) 2023; 11:1906. [PMID: 37444739 DOI: 10.3390/healthcare11131906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/19/2023] [Accepted: 06/29/2023] [Indexed: 07/15/2023] Open
Abstract
Multimorbidity has become one of the most pressing public health concerns worldwide. The objectives of this study were to understand the prevalence of multimorbidity and its relationship with lifestyle factors among Chinese adults in Macau, and to investigate the combined contribution of common lifestyle factors in predicting multimorbidity. Data were collected through face-to-face interviews using a self-reported questionnaire on common chronic diseases, lifestyle factors and sociodemographics. BMI, physical activity, drinking status, smoking status and sleep quality were assessed, and a composite lifestyle score (0 to 9 points) was calculated, and the higher the score, the healthier the lifestyle. A total of 1443 participants were included in the analysis, of whom 55.2% were female, 51.8% were middle aged or elderly and 30.5% completed tertiary education or higher. The prevalence of multimorbidity was 10.3%. The combination of hypertension and hyperlipidaemia was the most common (22.2%) multimorbidity among the participants with multimorbidity. After the adjustment of the covariates, it was found that the participants who were overweight (OR: 1.95, 95% CI: 1.18-3.20, p = 0.009) or obese (OR: 3.76, 95% CI: 2.38-5.96, p < 0.001), former drinkers (OR: 2.43, 95% CI: 1.26-4.69, p = 0.008), and those who reported poor sleep quality (OR: 2.25, 95% CI: 1.49-3.40, p < 0.001) had a high risk of developing multimorbidity. A one-unit increase in the lifestyle score was associated with a 0.33-times reduction in the risk of developing multimorbidity (OR: 0.67; 95% CI: 0.59-0.77, p < 0.001). A combination of lifestyle factors can influence a variety of multimorbidity among the Chinese adults in Macau. Thus, comprehensively assessing the combined contribution of several lifestyle factors in predicting multimorbidity is important.
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Affiliation(s)
- Qingling Yang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Quanzhi Zhang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
- School of Nursing, Harbin Medical University, Harbin 150088, China
| | - Fei Wan Ngai
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Shaoling Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Dexing Zhang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yang Gao
- Department of Sport, Physical Education, and Health, Hong Kong Baptist University, Hong Kong SAR, China
| | - Chun Hao
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Harry Haoxiang Wang
- School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh EH8 9AG, UK
| | | | - Ming Liu
- School of Health Sciences and Sports, Macao Polytechnic Institute, Macao 999078, China
| | - Alex Molasiotis
- Health and Social Care Research Centre, University of Derby, Derby DE22 1GB, UK
| | - Alice Loke
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yaojie Xie
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Sharma SK, Nambiar D, Ghosh A. Sex differences in non-communicable disease multimorbidity among adults aged 45 years or older in India. BMJ Open 2023; 13:e067994. [PMID: 36972971 PMCID: PMC10069553 DOI: 10.1136/bmjopen-2022-067994] [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] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE Older male and female adults differ in key characteristics such as disease-specific life expectancy, health behaviours and clinical presentations and non-communicable disease multimorbidity (NCD-MM). Therefore, examining the sex differences in NCD-MM among older adults is vital, as this issue is understudied in low-income and middle-income country (LMIC) contexts such as India, and has been growing in the past few decades. DESIGN Large scale nationally representative cross-sectional study. SETTINGS AND PARTICIPANTS Longitudinal Ageing Study in India (LASI 2017-2018) had data on 27 343 men and 31 730 women aged 45+, drawn from a sample of 59 073 individuals across India. PRIMARY AND SECONDARY OUTCOMES MEASURES We operationalised NCD-MM based on prevalence of the presence of two or more long-term chronic NCD morbidities. Descriptive statistics and bivariate analysis along with multivariate statistics were used. RESULTS Women aged 75+ had a higher prevalence of multimorbidity as compared with men (52.1% vs 45.17%). NCD-MM was more common among widows (48.5%) than widowers (44.8%). The female-to-male ratios of ORs (RORs) for NCD-MM associated with overweight/obesity and prior history of chewing tobacco were 1.10 (95% CI: 1.01 to 1.20) and 1.42 (95% CI: 1.12 to 1.80), respectively. The female-to-male RORs show that the odds of NCD-MM were greater in formerly working women (1.24 (95% CI: 1.06 to 1.44)) relative to formerly working men. The effect of increasing NCD-MM on limitations in activities of daily living and instrumental ADL was greater in men than women but reversed for the hospitalisation. CONCLUSIONS We found significant sex differences in NCD-MM prevalence among older Indian adults, with various associated risk factors. The patterns underlying these differences warrant greater study, given existing evidence on differential longevity, health burdens and health-seeking patterns all of which operate in a larger structural context of patriarchy. Health systems in turn must respond to NCD-MM mindful of these patterns and aim to redress some of the larger inequities they reflect.
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Affiliation(s)
| | - Devaki Nambiar
- The George Institute for Global Health India, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Arpita Ghosh
- The George Institute for Global Health India, New Delhi, India
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Gaitatzis A, Majeed A. Multimorbidity in People with Epilepsy. Seizure 2023; 107:136-145. [PMID: 37023627 DOI: 10.1016/j.seizure.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
Multimorbidity is an emerging priority in healthcare due to associations with the ageing population, frailty, polypharmacy, health and social care demands. It affects 60-70% of adults and 80% of children with epilepsy. Neurodevelopmental conditions are commonly seen in children with epilepsy, while cancer, cardiovascular and neurodegenerative conditions often afflict older people with epilepsy. Mental health problems are common across the lifespan. Genetic, environmental, social and lifestyle factors contribute to multimorbidity and its consequences. Multimorbid people with epilepsy (PWE) are at higher risk of depression and suicide, premature death, suffer lower health-related quality of life, and require more hospital admissions and health care costs. The best management of multimorbid PWE requires a paradigm shift from the traditional single disease-single comorbidity approach and a refocus on a person-centred approach. Improvements in health care must be informed by assessing the burden of multimorbidity associated with epilepsy, delineating disease clusters, and measuring the effects on health outcomes.
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21
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Gomez KU, McBride O, Roberts E, Angus C, Keyes K, Drummond C, Buchan I, Fleming K, Gilmore I, Donoghue K, Bonnet L, Goodwin L. The clustering of physical health conditions and associations with co-occurring mental health problems and problematic alcohol use: a cross-sectional study. BMC Psychiatry 2023; 23:89. [PMID: 36747152 PMCID: PMC9901006 DOI: 10.1186/s12888-023-04577-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/27/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND There is strong evidence for the co-occurrence of mental health conditions and alcohol problems, yet physical health outcomes among this group are not well characterised. This study aimed to identify clusters of physical health conditions and their associations with mental health and problematic alcohol use in England's general population. METHODS Cross-sectional analysis of the 2014 Adult Psychiatric Morbidity Survey (N = 7546) was conducted. The survey used standardised measures of problematic alcohol use and mental health conditions, including the Alcohol Use Disorders Identification Test (AUDIT) and the Clinical Interview Schedule-Revised. Participants self-reported any lifetime physical health conditions. Latent class analysis considered 12 common physical illnesses to identify clusters of multimorbidity. Multinomial logistic regression (adjusting for age, gender, ethnicity, education, and occupational grade) was used to explore associations between mental health, hazardous drinking (AUDIT 8 +), and co-occurring physical illnesses. RESULTS Five clusters were identified with statistically distinct and clinically meaningful disease patterns: 'Physically Healthy' (76.62%), 'Emerging Multimorbidity' (3.12%), 'Hypertension & Arthritis' (14.28%), 'Digestive & Bowel Problems'' (3.17%), and 'Complex Multimorbidity' (2.8%). Having a mental health problem was associated with increased odds of 'Digestive & Bowel Problems' (adjusted multinomial odds ratio (AMOR) = 1.58; 95% CI [1.15-2.17]) and 'Complex Multimorbidity' (AMOR = 2.02; 95% CI [1.49-2.74]). Individuals with co-occurring mental health conditions and problematic alcohol use also had higher odds of 'Digestive & Bowel Problems' (AMOR = 2.64; 95% CI [1.68-4.15]) and 'Complex Multimorbidity' (AMOR = 2.62; 95% CI [1.61-4.23]). CONCLUSIONS Individuals with a mental health condition concurrent with problematic alcohol use experience a greater burden of physical illnesses, highlighting the need for timely treatment which is likely to include better integration of alcohol and mental health services.
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Affiliation(s)
- Katalin Ujhelyi Gomez
- Department of Primary Care and Mental Health, University of Liverpool, Waterhouse Block B 1St Floor, 1-5 Brownlow St, Liverpool, L69 3G, UK.
| | - Orla McBride
- School of Psychology, Ulster University, Belfast, UK
| | - Emmert Roberts
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and the Maudsley NHS Foundation Trust, London, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Katherine Keyes
- Department of Epidemiology, Columbia University, New York, USA
| | - Colin Drummond
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London and South London and the Maudsley NHS Foundation Trust, London, UK
| | - Iain Buchan
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
| | - Kate Fleming
- National Disease Registration Service, NHS Digital, Leeds, UK
| | - Ian Gilmore
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, UK
| | - Kim Donoghue
- Clinical, Education & Health Psychology, University College London, London, UK
| | - Laura Bonnet
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Laura Goodwin
- Division of Health Research, Lancaster University, Lancaster, UK
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Zheng Y, Zhou Z, Wu T, Zhong K, Hu H, Zhang H, Sun R, Liu W. Association between composite lifestyle factors and cardiometabolic multimorbidity in Chongqing, China: A cross-sectional exploratory study in people over 45 years and older. Front Public Health 2023; 11:1118628. [PMID: 36817881 PMCID: PMC9929179 DOI: 10.3389/fpubh.2023.1118628] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/10/2023] [Indexed: 02/04/2023] Open
Abstract
Introduction Modifiable lifestyle factors are considered key to the control of cardiometabolic diseases. This study aimed to explore the association between multiple lifestyle factors and cardiometabolic multimorbidity. Methods A total of 14,968 participants were included in this cross-sectional exploratory study (mean age 54.33 years, range 45-91; 49.6% male). Pearson's Chi-square test, logistic regression, and latent class analysis were employed. Results We found that men with 4-5 high-risk lifestyle factors had a 2.54-fold higher risk (95% CI: 1.60-4.04) of developing multimorbidity compared to males with zero high-risk lifestyle factors. In an analysis of dietary behavior, we found that in women compared to men, over-eating (OR = 1.94, P < 0.001) and intra-meal water drinking (OR = 2.15, P < 0.001) were more likely to contribute to the development of cardiometabolic multimorbidity. In an analysis of taste preferences, men may be more sensitive to the effect of taste preferences and cardiometabolic multimorbidity risk, particularly for smoky (OR = 1.71, P < 0.001), hot (OR = 1.62, P < 0.001), and spicy (OR = 1.38, P < 0.001) tastes. Furthermore, "smoking and physical activity" and "physical activity and alcohol consumption" were men's most common high-risk lifestyle patterns. "Physical activity and dietary intake" were women's most common high-risk lifestyle patterns. A total of four common high-risk dietary behavior patterns were found in both males and females. Conclusions This research reveals that the likelihood of cardiometabolic multimorbidity increases as high-risk lifestyle factors accumulate. Taste preferences and unhealthy dietary behaviors were found to be associated with an increased risk of developing cardiometabolic multimorbidity and this association differed between genders. Several common lifestyle and dietary behavior patterns suggest that patients with cardiometabolic multimorbidity may achieve better health outcomes if those with certain high-risk lifestyle patterns are identified and managed.
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Affiliation(s)
- Yuanjie Zheng
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Research Center for Public Health Security, Chongqing Medical University, Chongqing, China,Public Health Department, Chongqing Medical University, Chongqing, China
| | - Zhongqing Zhou
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Research Center for Public Health Security, Chongqing Medical University, Chongqing, China,Public Health Department, Chongqing Medical University, Chongqing, China
| | - Tingting Wu
- Department of Food and Nutrition, College of Medical and Life Sciences, Silla University, Busan, South Korea,Chongqing College of Traditional Chinese Medicine, Chongqing, China
| | - Kailuo Zhong
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Research Center for Public Health Security, Chongqing Medical University, Chongqing, China,Public Health Department, Chongqing Medical University, Chongqing, China
| | - Hailing Hu
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Research Center for Public Health Security, Chongqing Medical University, Chongqing, China,Public Health Department, Chongqing Medical University, Chongqing, China
| | - Hengrui Zhang
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Research Center for Public Health Security, Chongqing Medical University, Chongqing, China,Public Health Department, Chongqing Medical University, Chongqing, China
| | - Rong Sun
- Department of Physical Examination, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weiwei Liu
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Research Center for Public Health Security, Chongqing Medical University, Chongqing, China,Public Health Department, Chongqing Medical University, Chongqing, China,Chongqing College of Traditional Chinese Medicine, Chongqing, China,*Correspondence: Weiwei Liu ✉
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23
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Chen W, Wang X, Chen J, You C, Ma L, Zhang W, Li D. Household air pollution, adherence to a healthy lifestyle, and risk of cardiometabolic multimorbidity: Results from the China health and retirement longitudinal study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 855:158896. [PMID: 36150596 DOI: 10.1016/j.scitotenv.2022.158896] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The adverse health effects of household air pollution have been widely explored, but few studies have evaluated the effects of household air pollution on the risk of cardiometabolic multimorbidity (CMM), a pressing public health concern worldwide. Thus, we aimed to investigate whether exposure to household use of polluting fuels is associated with morbid CMM and, if so, whether a healthy lifestyle could mitigate this association. METHODS In this prospective, nationwide representative cohort of the China Health and Retirement Longitudinal Study (CHARLS), participants free of CMM (defined as the coexistence of 2 or more of the following: heart disease, stroke, and diabetes or high blood sugar) were included in 2011-2012 and followed for CMM incidence until 2018. Household air pollution was measured as the use of solid fuels for cooking and heating. The healthy lifestyle score was determined by six factors, physical activity, smoking, body mass index, total cholesterol, blood glucose, and blood pressure, and categorized into three groups (unhealthy, 0-1 factors; intermediate, 2-4; and healthy, 5-6). Cox proportional hazards models investigated associations between household air pollution and incident CMM. The potential modifier effect of a healthy lifestyle score was tested through stratified analyses. RESULTS Among 7125 eligible participants, 239 incident cases of CMM were identified over a median follow-up of 7.0 years. After adjustment for potential confounders, the use of solid household fuels for heating was associated with more significant hazards of CMM (adjusted hazard ratio [HR] 1.71, 95 % confidence interval [CI] 1.28 to 2.28), while use for cooking (HR, 1.14; 95 % CI, 0.85 to 1.52) was not. Compared with participants in the unhealthy group, those in the healthy and intermediate groups had considerably lower CMM risk, with adjusted HRs (95 % CI) of 0.17 (0.09 to 0.31) and 0.39 (0.29 to 0.53), respectively, regardless of the household air pollution category. Importantly, when participants adhered to a healthy lifestyle, exposure to household air pollution was no longer significantly associated with a higher risk of CMM (adjusted HR 1.77, 95 % CI 0.51 to 6.12; P = 0.369). CONCLUSIONS Household usage of polluting fuels was significantly associated with a higher risk of CMM, and adherence to a healthy lifestyle may mitigate this adverse effect. From a broader perspective, our findings underscore the importance of public health policies and interventions targeting multiple exposures (air pollution, physical activity, smoking, etc.) in enhancing the prevention of detrimental cardiometabolic health effect.
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Affiliation(s)
- Wei Chen
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China; West China Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China
| | - Xiaoyu Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Chen
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Chao You
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Lu Ma
- Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital of Sichuan University, Chengdu, China; Med-X Center for Informatics, Sichuan University, Chengdu, China.
| | - Dong Li
- Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.
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Somi M, Ostadrahimi A, Gilani N, Haji Kamanaj A, Hassannezhad S, Faramarzi E. Patterns and Predictors of Multimorbidity in the Azar Cohort. ARCHIVES OF IRANIAN MEDICINE 2023; 26:8-15. [PMID: 37543916 PMCID: PMC10685807 DOI: 10.34172/aim.2023.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 02/27/2022] [Indexed: 08/08/2023]
Abstract
BACKGROUND The co-existence of chronic diseases (CDs), a condition defined as multimorbidity (MM), is becoming a major public health issue. Therefore, we aimed to determine the patterns and predictors of MM in the Azar Cohort. METHODS We evaluated the prevalence of MM in 15,006 (35-70-year old) subjects of the Azar Cohort Study. MM was defined as the co-existence of two or more CDs. Data on the subjects' socioeconomic status, demographics, sleeping habits, and physical activity were collected using questionnaires. RESULTS The overall prevalence of MM was 28.1%. The most prevalent CDs, in decreasing order, were obesity, hypertension, depression, and diabetes. Obesity, depression, and diabetes were the most co-occurring CDs. The MM risk increased significantly with age, illiteracy, and in females. Also, the subjects within the lowest tertile of physical activity level (OR=1.89; 95% CI: 1.75-2.05) showed higher MM risk than those with the highest level of physical activity. Findings regarding current smoking status indicated that being an ex-smoker or smoker of other types of tobacco significantly increased the risk of MM. CONCLUSION The reduction of MM is possible by promoting public health from an early age among people of various socioeconomic conditions. It is vital to offer the necessary health support to the aging population of Iran.
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Affiliation(s)
- Mohammdhossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Ostadrahimi
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Gilani
- Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arash Haji Kamanaj
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sina Hassannezhad
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elnaz Faramarzi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Páscoa R, Teixeira A, Monteiro H, Prazeres F, Martins C. Association of lifestyle and sociodemographic factors on multimorbidity: a cross-sectional study in Portugal. BMC Public Health 2022; 22:2341. [DOI: 10.1186/s12889-022-14640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 11/15/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Lifestyle factors are widely recognized as modifiers and major risk factors for non-communicable diseases. Previous studies on the prevalence of multimorbidity in Portugal predict an unfavourable reality. The aim of the present study was to analyse 1) the prevalence of multimorbidity in Portugal and 2) the association of individuals’ lifestyles and sociodemographic factors with multimorbidity.
Methods
A cross-sectional, population-wide study was conducted on a representative sample of the general population of Portuguese adults aged ≥ 20 years. Categorical variables were described by their respective absolute and relative frequencies (n (%)). All variables with a p-value < 20% were included in the multiple logistic regression model. The variables were removed one by one in descending order of p-value (p) until the model contained only significant variables. The results are presented using the odds ratio and 95% confidence intervals. P-values < 5% were considered significant.
Results
The prevalence of multimorbidity was 48.9% (n = 436), and the odds of multimorbidity increased 4% (p < 0.001) for each year of increase in age. Participants with reasonable general health status had higher odds of multimorbidity (Odds ratio (OR) = 3.04; p < 0.001), and those with poor or very poor general health status had even higher odds (OR = 9.14; p < 0.001). Compared to those who never smoked, participants who quit smoking ≥ 1 year presented an increase of 91% (p = 0.005) in the odds of multimorbidity. Individuals with no good-quality sleep, non-moderate screen time, or non-moderate stress level had higher odds of multimorbidity (OR = 1.98; OR = 1.88; OR = 2.22, respectively. p < 0.001).
Conclusions
This study presented a new approach to multimorbidity in Portugal. Population-based, multidimensional lifestyle interventions are needed. It seems necessary to optimize and adjust measures to prevent non-communicable diseases to improve health in Portugal. In the future, longitudinal studies will be an asset to reinforce and clarify these conclusions.
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Brady E, Castelli M, Walker R, Grayling M, Alaba O, Chola L. The prevalence and social determinants of multimorbidity in South Africa. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Elise Brady
- Population Health Sciences Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK
| | - Michele Castelli
- Population Health Sciences Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK
| | - Richard Walker
- Department of Medicine North Tyneside General Hospital, Rake Lane North Shields Tyne and Wear UK
| | - Michael Grayling
- Population Health Sciences Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne UK
| | - Olufunke Alaba
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences University of Cape Town Cape Town South Africa
| | - Lumbwe Chola
- Department of Public Health Science Univeristy of Oslo Oslo Norway
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Khowaja S, Hashmi S, Zaheer S, Shafique K. Patterns of smoked and smokeless tobacco use among multimorbid and non-multimorbid middle-aged and older-aged adults in Karachi, Pakistan: a cross-sectional survey. BMJ Open 2022; 12:e060090. [PMID: 36600352 PMCID: PMC9730344 DOI: 10.1136/bmjopen-2021-060090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The objective of this study was to compare the patterns of smoked and smokeless tobacco use among multimorbid and non-multimorbid middle-aged and older-aged individuals in Karachi, Pakistan. STUDY DESIGN This was an observational cross-sectional study conducted during 2015-2016. STUDY SETTING AND PARTICIPANTS A total of 3250 participants aged 30 years and above, residing in the Gulshan-e-Iqbal town, Karachi, Pakistan were enrolled in the study through systematic random sampling. The selected area of residence represents diverse socioeconomic and ethnic groups of the city. People who could speak and write English or Urdu, and those who provided written informed consent were included in the study. OUTCOME MEASURES The primary outcome measure of the study was to determine the differences in patterns of tobacco consumption among multimorbid and non-multimorbid adult individuals. RESULTS We found no difference in patterns of smoked (adjusted OR (aOR) 1.15, 95% CI 0.88 to 1.50, p=0.289) or smokeless tobacco (aOR 1.13, 95% CI 0.86 to 1.48, p= 0.379) use among multimorbid and non-multimorbid individuals. Individuals who perceived tobacco as a risk were less likely to consume smokeless tobacco products. CONCLUSION There was no difference in tobacco consumption among individuals with and without multimorbidity. Evidenced-based guidelines are required to implement mental and behavioural interventions in patients with multiple chronic diseases to help them modify their behaviours.
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Affiliation(s)
- Salima Khowaja
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Shahkamal Hashmi
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Sidra Zaheer
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Kashif Shafique
- School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
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Granic A, Martin-Ruiz C, Rimmer L, Dodds RM, Robinson LA, Spyridopoulos I, Kirkwood TBL, von Zglinicki T, Sayer AA. Immunosenescence profiles of lymphocyte compartments and multiple long-term conditions (multimorbidity) in very old adults: The Newcastle 85+ Study. Mech Ageing Dev 2022; 208:111739. [PMID: 36152894 DOI: 10.1016/j.mad.2022.111739] [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: 03/25/2022] [Revised: 07/22/2022] [Accepted: 09/18/2022] [Indexed: 12/30/2022]
Abstract
Immunosenescence, a decline in immune system function, has been linked to several age-related diseases and ageing syndromes. Very old adults (aged ≥ 85 years) live with multiple long-term conditions (MLTC, also known as multimorbidity)-a complex phenomenon of poor health defined by either counts, indices, or patterns, but little is known about the relationship between an ageing immune system and MLTC in this age group. We utilised baseline data from the Newcastle 85+ Study to investigate the associations between previously defined immunosenescence profiles of lymphocyte compartments and MLTC counts and patterns (from 16 chronic diseases/ageing syndromes). Seven hundred and three participants had MLTC and complete data for all 16 conditions, a median and mean of 5 (range 2-11) and 62.2% had ≥ 5 conditions. Three distinct MLTC patterns emerged by clustering: Cluster 1 ('Low frequency cardiometabolic-cerebrovascular diseases', n = 209), Cluster 2 ('High ageing syndromes-arthritis', n = 240), and Cluster 3 ('Hypertensive-renal impairment', n = 254). Although having a more senescent phenotype, characterised by higher frequency of CD4 and CD8 senescence-like effector memory cells and lower CD4/CD8 ratio, was not associated with MLTC compared with less senescent phenotype, the results warrant further investigation, including whether immunosenescence drives change in MLTC and influences MLTC severity in late adulthood.
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Affiliation(s)
- Antoneta Granic
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Carmen Martin-Ruiz
- Bio Screening Core Facility, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lucy Rimmer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard M Dodds
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Louise A Robinson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ioakim Spyridopoulos
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Thomas B L Kirkwood
- National Innovation Centre for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Thomas von Zglinicki
- Biosciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Avan A Sayer
- AGE Research Group, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom; NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, United Kingdom.
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Ricket IM, Brown JR, MacKenzie TA, Ma Y, Grewal D, Ailawadi KL, Emond JA. Quantifying differences in packaged food and drink purchases among households with diet-related cardiometabolic multi-morbidity: a cross-sectional analysis. BMC Public Health 2022; 22:2101. [PMID: 36397061 PMCID: PMC9670385 DOI: 10.1186/s12889-022-14626-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diet is important for chronic disease management, with limited research understanding dietary choices among those with multi-morbidity, the state of having 2 or more chronic conditions. The objective of this study was to identify associations between packaged food and drink purchases and diet-related cardiometabolic multi-morbidity (DRCMM). METHODS Cross-sectional associations between packaged food and drink purchases and household DRCMM were investigated using a national sample of U.S. households participating in a research marketing study. DRCMM households were defined as household head(s) self-reporting 2 or more diet-related chronic conditions. Separate multivariable logistic regression models were used to model the associations between household DRCMM status and total servings of, and total calories and nutrients from, packaged food and drinks purchased per month, as well as the nutrient density (protein, carbohydrates, and fat per serving) of packaged food and drinks purchased per month, adjusted for household size. RESULTS Among eligible households, 3795 (16.8%) had DRCMM. On average, households with DRCMM versus without purchased 14.8 more servings per capita, per month, from packaged foods and drinks (p < 0.001). DRCMM households were 1.01 times more likely to purchase fat and carbohydrates in lieu of protein across all packaged food and drinks (p = 0.002, p = 0.000, respectively). DRCMM households averaged fewer grams per serving of protein, carbohydrates, and fat per month across all food and drink purchases (all p < 0.001). When carbonated soft drinks and juices were excluded, the same associations for grams of protein and carbohydrates per serving per month were seen (both p < 0.001) but the association for grams of fat per serving per month attenuated. CONCLUSIONS DRCMM households purchased greater quantities of packaged food and drinks per capita than non-DRCMM households, which contributed to more fat, carbohydrates, and sodium in the home. However, food and drinks in DRCMM homes on average were lower in nutrient-density. Future studies are needed to understand the motivations for packaged food and drink choices among households with DRCMM to inform interventions targeting the home food environment.
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Affiliation(s)
- Iben M Ricket
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Jeremiah R Brown
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Todd A MacKenzie
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Yu Ma
- Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada
| | - Dhruv Grewal
- Marketing Division, Babson College, Babson Park, MA, USA
| | | | - Jennifer A Emond
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Delpino FM, de Lima APM, da Silva BGC, Nunes BP, Caputo EL, Bielemann RM. Physical Activity and Multimorbidity Among Community-Dwelling Older Adults: A Systematic Review With Meta-Analysis. Am J Health Promot 2022; 36:1371-1385. [PMID: 35621359 DOI: 10.1177/08901171221104458] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study evaluated the relationship between physical activity (PA) and multimorbidity in community-dwelling older adults. DATA SOURCE A systematic review and meta-analysis in the following databases: Pubmed, Lilacs, Scielo, Web of Science, Scopus, and AgeLine. STUDY INCLUSION AND EXCLUSION CRITERIA It included observational studies investigating the association between physical activity and multimorbidity, with older adults, published until May 2021. Studies with institutionalized individuals or that assessed specific diseases were excluded. DATA EXTRACTION Two reviewers independently extracted the studies based on previous inclusion and exclusion criteria, started by selecting titles, followed by abstracts and full-text reading. DATA SYNTHESIS Meta-analysis results were reported as Odds Ratio (OR) with a 95% confidence interval using R language. The Newcastle Ottawa scale was used to assess the quality of the studies. RESULTS Fifteen studies were included in the systematic review, from which 12 reported an inverse association between physical activity and multimorbidity. In the meta-analysis, from over 77 000 older adults, there was an inverse association between physical activity and multimorbidity [OR: .81; 95% CI: .73-.89]. We found significant results only for men in the analysis by sex. CONCLUSIONS Low levels of physical activity were associated with a higher risk of multimorbidity in older adults. It is expected that public policies will be conducted aimed at the practice of physical activity among older adults.
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Affiliation(s)
- Felipe Mendes Delpino
- Postgraduate Program in Nutrition and Food, Faculty of Nutrition, 37902Federal University of Pelotas, Pelotas, Brazil
| | - Ana Paula Maciel de Lima
- Postgraduate Program in Nutrition and Food, Faculty of Nutrition, 37902Federal University of Pelotas, Pelotas, Brazil
| | | | - Bruno Pereira Nunes
- Postgraduate Program in Nursing, 37902Federal University of Pelotas, Pelotas, Brazil
| | - Eduardo Lucia Caputo
- Postgraduate Program in Physical Education, 37902Federal University of Pelotas, Pelotas, Brazil
| | - Renata Moraes Bielemann
- Postgraduate Program in Nutrition and Food, Faculty of Nutrition, 37902Federal University of Pelotas, Pelotas, Brazil
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Xie H, Li J, Zhu X, Li J, Yin J, Ma T, Luo Y, He L, Bai Y, Zhang G, Cheng X, Li C. Association between healthy lifestyle and the occurrence of cardiometabolic multimorbidity in hypertensive patients: a prospective cohort study of UK Biobank. Cardiovasc Diabetol 2022; 21:199. [PMID: 36183084 PMCID: PMC9526960 DOI: 10.1186/s12933-022-01632-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiometabolic multimorbidity (CMM) is becoming increasingly common in patients with hypertension, and it is well established that healthy lifestyle plays a key role in the prevention of hypertension. However, the association between combined lifestyle factors and CMM in patients with hypertension is uncertain. METHODS This prospective analysis included the data (obtained from the UK biobank) of participants with hypertension who did not have coronary heart disease (CHD), stroke, or diabetes. The outcome was the occurrence of CMM, defined as ≥ 1 disease of CHD, stroke, and diabetes that occurred in participants with hypertension. Four lifestyle factors (smoking, alcohol consumption, diet, and physical activity) were assessed using a weighted healthy lifestyle score, and participants were divided into four groups: the very unhealthy, unhealthy, healthy, and very healthy groups. The flexible parameter Royston-Parmar proportional hazard model was used to estimate hazard ratios (HRs) between lifestyles and CMM, as well as the difference in CMM-free life expectancy. RESULTS During a median follow-up of 12.2 years, 9812 (18.4%) of the 53,397 hypertensive patients occurred CMM. Compared with the very unhealthy group, the very healthy group had a 41% reduction in the risk for CMM in hypertensive patients and a 32-50% reduction in the risk for specific cardiometabolic diseases such as CHD, stroke, and diabetes. For each lifestyle factor, non-smoking had the greatest protective effect against CMM (HR: 0.64, 95% confidence interval (CI) 0.60-0.68). A lifestyle combining multiple healthy factors extended CMM-free life expectancy (e.g., six years longer at age 45 years for participants in the very healthy group). CONCLUSIONS Combined healthy lifestyle factors were associated with a lower risk for CMM in hypertensive patients. This suggests that combined healthy lifestyle should be supported to decrease disease burden.
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Affiliation(s)
- Hejian Xie
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jinchen Li
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Xuanmeng Zhu
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jing Li
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jinghua Yin
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Tianqi Ma
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yi Luo
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Lingfang He
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yongping Bai
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha, 410008, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Guogang Zhang
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, China.,Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Xunjie Cheng
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha, 410008, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Chuanchang Li
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Xiangya Road 87#, Changsha, 410008, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Li D, Wang L, Zhou Z, Song L, Chen S, Yang Y, Hu Y, Wang Y, Wu S, Tian Y. Role of socioeconomic, lifestyle, and clinical factors in the progression of cardiometabolic multimorbidity in China: A 10-year prospective cohort study. Nutr Metab Cardiovasc Dis 2022; 32:2383-2391. [PMID: 35965247 DOI: 10.1016/j.numecd.2022.06.016] [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: 01/05/2022] [Revised: 05/27/2022] [Accepted: 06/17/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Cardiometabolic multimorbidity has become increasingly common over the past few decades. Little is known about how risk factors affect temporal progression of cardiometabolic multimorbidity. We aim to explore the role of socioeconomic, lifestyle, and clinical risk factors in the progression of cardiometabolic multimorbidity. METHODS AND RESULTS This prospective cohort study included 56,587 participants aged ≥45 years who were free of diabetes, stroke, and heart disease. Three clusters of risk factors were assessed and each on a 5-point scale: socioeconomic, lifestyle, and clinical factors. We used multi-state models (MSMs) to examine the roles of risk factors in five transitions of multimorbidity trajectory: from healthy to first cardiometabolic disease, first cardiometabolic disease to cardiometabolic multimorbidity, health to mortality, first cardiometabolic disease to mortality, and cardiometabolic multimorbidity to mortality. In MSMs, socioeconomic (HR: 1.21; 95% CI: 1.19-1.25) and clinical (HR: 1.53; 95% CI: 1.51-1.56) scales were associated with the transition from health to first cardiometabolic. Socioeconomic (HR: 2.39; 95% CI: 2.24-2.54) and lifestyle (HR: 1.22; 95% CI: 1.18-1.26) scales were associated with the transitions from first disease to cardiometabolic multimorbidity. In addition, socioeconomic and lifestyle scales were associated with increased risk of mortality in people without cardiometabolic disease, with first cardiometabolic disease, and with cardiometabolic multimorbidity. CONCLUSIONS Socioeconomic and lifestyle factors were not only important predictors of multimorbidity in those with existing cardiometabolic disease, but also important in shaping risk of mortality. However, clinical factors were the only key determinants of incidence of a first cardiometabolic disease.
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Affiliation(s)
- Dankang Li
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Lulin Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Ziyi Zhou
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Lulu Song
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, No.57 Xinhua East Road, Tangshan City, 063001, China
| | - Yingping Yang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, Beijing, 100191, China
| | - Youjie Wang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, North China University of Science and Technology, No.57 Xinhua East Road, Tangshan City, 063001, China.
| | - Yaohua Tian
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China; Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No.13 Hangkong Road, Wuhan, 430030, China.
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Wister A, Li L, Whitmore C, Ferris J, Klasa K, Linkov I. Multimorbidity resilience and health behaviors among older adults: A longitudinal study using the Canadian Longitudinal Study on Aging. Front Public Health 2022; 10:896312. [PMID: 36211713 PMCID: PMC9539554 DOI: 10.3389/fpubh.2022.896312] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/01/2022] [Indexed: 01/22/2023] Open
Abstract
Objective There has been a growing interest in examining why some individuals adapt and bounce back from multimorbidity (resilience) better than others. This paper investigates the positive role of protective health behaviors on multimorbidity resilience (MR) among older adults focusing on older persons with two or more concurrent chronic conditions, and separately for three multimorbidity chronic illness clusters. Methods Using Baseline and Follow-up One data from the Comprehensive Cohort of the Canadian Longitudinal Study on Aging, we studied 10,628 participants aged 65 years and older who reported two or more of 27 chronic conditions, and three multimorbidity clusters: Cardiovascular/metabolic, Musculoskeletal, and Mental health. Associations between health behaviors and MR were evaluated using Linear Mixed Models, adjusting for socio-demographic, social/environmental, and illness context social determinants of health. Results Among older adults with two or more illnesses, smoking, satisfaction with sleep, appetite, and skipping meals were associated with MR in the expected direction. Also, obesity (compared to normal weight) and skipping meals showed longitudinal interaction effects with survey wave. Most of the results were replicated for the physical multimorbidity clusters (Cardiovascular/metabolic and Musculoskeletal) compared to the full 2+ multimorbidity analyses; however, for the Mental health cluster, only satisfaction with sleep was supported as a lifestyle predictor of MR. Discussion Several modifiable health behaviors identified in the broader health and aging literature are important in affecting levels of multimorbidity resilience in older age. These factors are important strength-based areas to target. Additionally, several social determinants of health are also supported and parallel research on multimorbidity risk. The effects of lifestyle factors for resilience among older adults is dependent on the type of multimorbidity measured. We conclude that the results have significant public health, program intervention, and clinical implications for healthy aging among persons coping with multimorbidity.
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Affiliation(s)
- Andrew Wister
- Department of Gerontology, Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
| | - Lun Li
- School of Social Work, MacEwan University, Edmonton, AB, Canada
| | - Carly Whitmore
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Jennifer Ferris
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC, Canada
- BC Observatory for Population and Public Health, BC Centre for Disease Control, Vancouver, BC, Canada
| | - Katarzyna Klasa
- University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Igor Linkov
- United States Army Corps of Engineers, Engineering Research and Development Center, Vicksburg, MS, United States
- Carnegie Mellon University, Pittsburg, PA, United States
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Behera S, Pradhan J. A combination of moderate and vigorous physical activities reduces the burden of multimorbidity: findings from Longitudinal Ageing Study in India. JOURNAL OF HEALTH, POPULATION AND NUTRITION 2022; 41:42. [PMID: 36096879 PMCID: PMC9465913 DOI: 10.1186/s41043-022-00323-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/01/2022] [Indexed: 06/14/2024] Open
Abstract
Abstract
Background
Physical inactivity is a significant factor contributing to the prevalence of non-communicable diseases (NCDs). The objective of this study is to examine the association between physical activity and multimorbidity among Indian adults aged 45 years and above by residence.
Methods
Data from Longitudinal Ageing Study in India (LASI) 2017–2018, wave 1, a nationally representative study, are used to examine the above objective. A total of 59,073 adults aged 45 years and above are enlisted in the study. Physical activities and other demographic and socioeconomic variables have been used to describe the distribution of multimorbidity and investigate their relationship. Logistic regression is employed to examine the adjusted impact of physical activity on multimorbidity among Indian adults (45 + years) by residence.
Results
The level of physical activity is inversely related to the prevalence of multimorbidity in India. The rate of multimorbidity ranges from 4 to 12% among moderately active individuals in rural areas, whereas it ranges from 9 to 34% in urban areas across the age groups of 45 to 75+ years. Notably, the individuals who engage in both moderate and vigorous activities have a lower prevalence of multimorbidity than those who engage in only moderate activities.
Conclusion
Our study shows that physical inactivity has an association with the rise in multimorbidity in both rural and urban areas; however, the intensity of multimorbidity is higher in urban areas. The policymakers should consider the influence of moderate and vigorous physical activity as a key prevention measure of non-communicable disease and multimorbidity.
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Zhang H, Duan X, Rong P, Dang Y, Yan M, Zhao Y, Chen F, Zhou J, Chen Y, Wang D, Pei L. Effects of potential risk factors on the development of cardiometabolic multimorbidity and mortality among the elders in China. Front Cardiovasc Med 2022; 9:966217. [PMID: 36158847 PMCID: PMC9502033 DOI: 10.3389/fcvm.2022.966217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesTo examine the impact of demographic, socioeconomic, and behavioral factors on the development of cardiometabolic multimorbidity and mortality in Chinese elders.MethodsData from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2002–2018 was used in the study. Cardiometabolic multimorbidity was defined as the presence of two or more cardiometabolic disorders, such as hypertension, diabetes, cardiovascular disease (CVD), heart disease, or stroke. Cox regression model and multi-state Markov model were developed to evaluate the association of the study factors with the progression of cardiometabolic conditions and mortality. The outcomes included three states (first cardiometabolic disease, cardiometabolic multimorbidity, and all-cause mortality) and five possible transitions among the three states.ResultsOf the 13,933 eligible individuals, 7,917 (56.8%) were female, and 9,540 (68.50%) were over 80 years old. 2,766 (19.9%) participants had their first cardiometabolic disease, 975 (7.0%) participants suffered from cardiometabolic multimorbidity, and 9,365 (67.2%) participants died. The progression to cardiometabolic multimorbidity was positively associated with being female (HR = 1.42; 95%CI, 1.10 − 1.85), living in the city (HR = 1.41; 95%CI, 1.04 − 1.93), overweight (HR = 1.43; 95%CI, 1.08 − 1.90), and obesity (HR = 1.75; 95% CI, 1.03 − 2.98). A higher risk for the first cardiometabolic disease was associated with being female (HR = 1.26; 95% CI, 1.15 − 1.39), higher socioeconomic status (SES, HR = 1.17; 95%CI, 1.07 − 1.28), lack of regular physical activity (HR = 1.13; 95%CI, 1.04 − 1.23), smoking (HR = 1.20; 95%CI, 1.08 − 1.33), ≤ 5 h sleep time (HR = 1.15; 95%CI, 1.02 − 1.30), overweight (HR = 1.48; 95% CI, 1.32 − 1.66), and obesity (HR = 1.34; 95%CI, 1.06 − 1.69). It also should be noted that not in marriage, lower SES and unhealthy behavioral patterns were risk factors for mortality.ConclusionThis study emphasized the importance of lifestyle and SES in tackling the development of cardiometabolic conditions among Chinese elders and provided a reference for policy-makers to develop a tailored stage-specific intervention strategy.
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Affiliation(s)
- Huihui Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Xinyu Duan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Peixi Rong
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Yusong Dang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Mingxin Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Yaling Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Fangyao Chen
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
| | - Jing Zhou
- Department of Pediatrics, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yulong Chen
- Shaanxi Key Laboratory of Ischemic Cardiovascular Disease, Shaanxi Key Laboratory of Brain Disorders, Institute of Basic and Translational Medicine, Xi’an Medical University, Xi’an, China
| | - Duolao Wang
- Biostatistics Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Leilei Pei
- Department of Epidemiology and Health Statistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, China
- *Correspondence: Leilei Pei,
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Yang HL, Mo BR, Molassiotis A, Wang M, He GL, Xie YJ. Relationship between multimorbidity and composite lifestyle status in Shenzhen, China. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221123990. [PMID: 36090662 PMCID: PMC9449505 DOI: 10.1177/26335565221123990] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The study aimed to understand multimorbidity among adults in a high-tech city in southern coastal China that has undergone rapid economic development and to investigate its relationship with lifestyle status. Methods A population-based survey was conducted among 24 community centers in the Nanshan District of Shenzhen from February to December of 2018. Participants were recruited using a stratified random sampling approach. A self-administered questionnaire on typical chronic diseases, lifestyle factors, body composition, and social demographics was used to collect data. Multimorbidity was defined as two or more chronic diseases coexisting in a single person. An algorithm on body mass index, physical activity, drinking, smoking, and sleep quality was used to calculate lifestyle scores (0-9), with higher scores predicting a healthier lifestyle. Results A total of 2,905 participants were included in the analysis, with men accounting for 52.4%, and single for 25%. The prevalence of multimorbidity was 4.8%, and the mean lifestyle score was 4.79 ± 1.55. People who were old, retired, married, and had less education were more likely to have multimorbidity (all P < .05). A higher prevalence of multimorbidity was found among those who were obese, less engaged in physical activity, consumed more alcohol, and had poorer sleep quality (all p < .05). After adjusting for age, employment, education, and marital status, one unit increase in lifestyle score was associated with 0.74 times lower to have multimorbidity (OR: 0.74; 95% CI: 0.63-0.87, p < .05). Conclusion The prevalence of multimorbidity was relatively low in economically developed Shenzhen. Keeping a healthy lifestyle was related to the lower possibility of suffering from multiple chronic diseases.
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Affiliation(s)
- Hua-Lu Yang
- Department of Nursing, Huazhong University of Science and
Technology Union Shenzhen Hospital, Shenzhen, China,School of Nursing, The Hong Kong Polytechnic
University, Hong Kong SAR, China
| | - Bei-Rong Mo
- Department of Nursing, Huazhong University of Science and
Technology Union Shenzhen Hospital, Shenzhen, China
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic
University, Hong Kong SAR, China
| | - Mian Wang
- School of Nursing, The Hong Kong Polytechnic
University, Hong Kong SAR, China
| | - Gui-Lan He
- Department of Nursing, Huazhong University of Science and
Technology Union Shenzhen Hospital, Shenzhen, China
| | - Yao Jie Xie
- School of Nursing, The Hong Kong Polytechnic
University, Hong Kong SAR, China,Yao Jie Xie, School of Nursing, The Hong
Kong Polytechnic University, FG424, PolyU, Hong Kong SAR 999077, China.
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Debsarma D, Saha J, Choudhary BK. Prevalence, pattern, and correlates of multimorbidity among adult and old aged women in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Prospective Association between Multimorbidity and Falls and Its Mediators: Findings from the Irish Longitudinal Study on Ageing. J Clin Med 2022; 11:jcm11154470. [PMID: 35956086 PMCID: PMC9370027 DOI: 10.3390/jcm11154470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/21/2022] Open
Abstract
This study including older adults from Ireland aimed to analyze the prospective association between multimorbidity and falls and to identify the mediators in this relationship. The present study used data from two consecutive waves of the Irish Longitudinal Study on Ageing (TILDA) survey. Multimorbidity was assessed at Wave 1 (2009–2011) and was defined as the presence of at least two chronic conditions. Falls occurring at Wave 2 (2012–2013) were self-reported. Mediating variables considered were polypharmacy, cognitive impairment, sleep problems, pain, low handgrip strength, difficulty in activities of daily living (ADL), obesity, and underweight. Multivariable binary logistic regression and mediation analysis using the Karlson Holm Breen method were conducted. This study included 6900 adults aged ≥50 years (51.6% women; mean [SD] age 63.1 [8.9] years). Compared to no chronic conditions at baseline, there was a positive and significant association between multimorbidity and falls at follow-up, with ORs ranging from 1.32 (95% CI = 1.06–1.64) for 2 conditions to 1.92 (95% CI = 1.54–2.38) for ≥4 conditions. Pain (23.5%), polypharmacy (13.3%), and difficulty in ADL (10.7%) explained the largest proportion of the multimorbidity-fall relationship. Multimorbidity increased risk for incident falls in older adults from Ireland. Interventions should be implemented to reduce fall risk in people with multimorbidity, especially targeting the identified mediators.
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Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, Boyd CM, Pati S, Mtenga S, Smith SM. Multimorbidity. Nat Rev Dis Primers 2022; 8:48. [PMID: 35835758 PMCID: PMC7613517 DOI: 10.1038/s41572-022-00376-4] [Citation(s) in RCA: 233] [Impact Index Per Article: 116.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 02/06/2023]
Abstract
Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual's carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient's values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.
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Affiliation(s)
- Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark.
| | - Frances S Mair
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruno P Nunes
- Postgraduate Program in Nursing, Faculty of Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Epidemiology and Health Policy & Management, Johns Hopkins University, Baltimore, MD, USA
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sally Mtenga
- Department of Health System Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Susan M Smith
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Building, Tallaght Cross, Dublin, Ireland
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Abstract
Patients’ emotions toward health IT can play an important role in explaining their usage of it. One form of health IT is self-managing care IT, such as activity trackers that can be used by chronic patients to adopt a healthy lifestyle. The goal of this study is to understand the factors that influence the arousal of emotions in chronic patients while using these tools. Past studies, in general, tend to emphasize how IT shapes emotions, underplaying the role of the individual user’s identity and, specifically, how central health is to the user’s self in shaping emotions. In this research, the authors argue that patients’ health identity centrality (i.e., the extent to which they consider health as central to their sense of self) can play an important role in forming their dependence on health IT by affecting their use of it directly and shaping their emotions around it.
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Jääskeläinen T, Koponen P, Lundqvist A, Suvisaari J, Järvelin J, Koskinen S. Study protocol for an epidemiological study 'Multimorbidity - identifying the most burdensome patterns, risk factors and potentials to reduce future burden (MOLTO)' based on the Finnish health examination surveys and the ongoing register-based follow-up. BMJ Open 2022; 12:e056073. [PMID: 35654460 PMCID: PMC9163539 DOI: 10.1136/bmjopen-2021-056073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Multimorbidity, defined as the co-occurrence of two or more long-term medical conditions, is an increasing public health concern worldwide causing enormous burden to individuals, healthcare systems and societies. The most effective way of decreasing the burden caused by multimorbidity is to find tools for its successful prevention but gaps in research evidence limit capacities to develop prevention strategies. The aim of the MOLTO study (Multimorbidity - identifying the most burdensome patterns, risk factors and potentials to reduce future burden) is to provide novel evidence required for cost-effective prevention of multimorbidity by defining the multimorbidity patterns causing the greatest burden at the population level, by examining their risk and protective factors and by estimating the potentials to reduce the future burden. METHODS AND ANALYSIS The MOLTO study is based on the data from the Finnish population-based cross-sectional (FINRISK 2002-2012, FinHealth 2017 the Migrant Health and Well-being Study 2010-2012) and longitudinal (Health 2000/2011) health examination surveys with individual-level link to administrative health registers, allowing register-based follow-up for the study participants. Both cross-sectional and longitudinal study designs will be used. Multimorbidity patterns will be defined using latent class analysis. The burden caused by multimorbidity as well as risk and protective factors for multimorbidity will be analysed by survival analysis methods such as Cox proportional hazards and Poisson regression models. ETHICS AND DISSEMINATION The survey data have been collected following the legislation at the time of the survey. The ethics committee of the Hospital District of Helsinki and Uusimaa has approved the data collection and register linkages for each survey. The results will be published as peer-reviewed scientific publications.
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Affiliation(s)
- Tuija Jääskeläinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Päivikki Koponen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Annamari Lundqvist
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jaana Suvisaari
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jutta Järvelin
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Seppo Koskinen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
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Homing in on cognition with cross-sectional analysis of sarcopenia-related measurements: the SARCOG study. Aging Clin Exp Res 2022; 34:2149-2154. [PMID: 35583720 DOI: 10.1007/s40520-022-02145-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/24/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cognitive impairment may cause significant decline in muscle function and physical performance via affecting the neuromotor control. AIM To investigate the relationship between cognition and sarcopenia-related parameters in middle-aged and older adults. METHODS Demographic data and comorbidities of adults ≥ 45-year-old were noted. The Mini-Mental State Examination (MMSE) was used to evaluate global cognitive function. Sonographic anterior midthigh muscle thickness, handgrip strength, chair stand test (CST) and gait speed were measured. The diagnosis of sarcopenia was established if low muscle mass was combined with low muscle function. Dynapenia was defined as low grip strength or increased CST duration. RESULTS Among 1542 subjects (477 M, 1065 F), sarcopenia and dynapenia were detected in 22.6 and 17.2% of males, and 17.2 and 25.3% of females, respectively. Sarcopenic patients were older and had higher body mass index, higher frequencies of hypertension, diabetes mellitus and obesity. They had lower muscle thickness, grip strength in males only, CST performance in females only and gait speed than the other groups (all p < 0.05). Sarcopenic and dynapenic patients had similar MMSE scores which were lower than those of normal subjects (both p < 0.001). After adjusting for confounding factors, MMSE values were positively related with grip strength in females only, CST performance and gait speed (all p < 0.001); but not with muscle thickness in either gender. CONCLUSION Cognitive impairment may unfavorably affect muscle function and physical performance, but not muscle mass. Accordingly, its prompt management can help to decrease patient morbidity and mortality.
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Boro B, Saikia N. Association of multimorbidity and physical activity among older adults in India: an analysis from the Longitudinal Ageing Survey of India (2017-2018). BMJ Open 2022; 12:e053989. [PMID: 35580974 PMCID: PMC9115039 DOI: 10.1136/bmjopen-2021-053989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine the association of multimorbidity and physical activity among older adults in India. DESIGN A cross-sectional study was conducted using large representative survey data. SETTING AND PARTICIPANTS The study used data from the nationally representative 'Longitudinal Ageing Study in India (LASI),' conducted during 2017-2018. The study included a total sample of 65 336 older adults aged 45 years and above in India. METHODS Moderate and vigorous physical activities were measured separately by self-reported questionnaires. Physical activity was calculated as minutes of metabolic equivalent tasks per week. The outcome variable was a categorical variable where 2=the prevalence of more than one morbidity, 1=presence of one morbidity and 0=none. Bivariate analysis and multinomial logistic regression were applied to fulfil the objectives. RESULTS 27.39% of older adults in India had multimorbidity. 31.02% of older adults did not engage in any moderate physical activities. Also, 59.39% of older adults did not engage in any vigorous physical activities. Older adults reporting low (adjusted relative risk ratio (A RRR): 1.10, 95% CI 1.03 to 1.18) and moderate (A RRR): 1.05, 95% CI 0.98 to 1.13) level of moderate physical activity were significantly more likely to suffer from multimorbidity compared with no involvement in moderate physical activity. However, older adults who reported high (A RRR: 0.79, 95% CI 0.75 to 0.84), moderate (A RRR: 0.88, 95% CI 0.80 to 0.98) and low level of vigorous physical activity (A RRR: 0.94, 95% CI 0.86 to 1.02) had significantly less multimorbidity in comparison to those who never engaged in vigorous physical activity. CONCLUSION Lack of physical activity is associated with multimorbidity among older adults. Physical activity promotion should be adopted as a primary strategy in reducing the burden of morbidity and multimorbidity.
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Affiliation(s)
- Bandita Boro
- Centre for the Study of Regional Development, Jawaharlal Nehru University, New Delhi, Delhi, India
| | - Nandita Saikia
- Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, Maharashtra, India
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Franken DL, Olinto MTA, Dias-da-Costa JS, Bairros FSD, Paniz VMV. Lifestyle, high Body Mass Index, and markers of socioeconomic conditions associated with multimorbidity in women. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022; 25:e220007. [PMID: 35475903 DOI: 10.1590/1980-549720220007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 02/17/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study aimed to identify the prevalence of multimorbidity and its associated factors in women in southern Brazil. METHODS We conducted a cross-sectional, population-based study with a sample of 1,128 women (age 20-69 years), living in São Leopoldo, southern Brazil. Multimorbidity was defined as two or more chronic conditions measured using the therapeutic and chemical anatomical classification of continuous use medications prescribed by a physician. Poisson regression model with robust variance was used to assess the association between sociodemographic and lifestyle variables and multimorbidity. RESULTS The prevalence of multimorbidity was 21.7% (95%CI 19.3-24.2), and 26 chronic conditions were identified. A direct linear association was observed with age and income and an inverse association with education. Being unemployed was a risk factor for multimorbidity (PR 1.95; 95%CI 1.51-2.52). Alcohol consumption (moderate or excessive) had a protective effect. Overweight and obese women were 53% (PR 1.53; 95%CI 1.09-2.15) and 76% (PR 1.76; 95%CI 1.27-2.45) more likely to have multimorbidity than eutrophic women. CONCLUSION Over 20% of the adult women had multimorbidity, and its occurrence was strongly associated with socioeconomic characteristics, such as fewer years of schooling, higher income, and not having an occupation. The results regarding alcohol consumption are still insufficient to propose a public policy for the prevention of multimorbidity. Excess weight was an independent risk factor and should be addressed in public health policies for the prevention and management of multimorbidity.
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Affiliation(s)
- Débora Luiza Franken
- Universidade do Vale do Rio dos Sinos, Post-graduate Programme in Collective Health - São Leopoldo (RS), Brazil
| | - Maria Teresa Anselmo Olinto
- Universidade do Vale do Rio dos Sinos, Post-graduate Programme in Collective Health - São Leopoldo (RS), Brazil.,Universidade Federal do Rio Grande do Sul, Department of Nutrition - Porto Alegre (RS), Brazil
| | | | - Fernanda Souza de Bairros
- Universidade Federal do Rio Grande do Sul, Department of Collective Health - Porto Alegre (RS), Brazil
| | - Vera Maria Vieira Paniz
- Universidade do Vale do Rio dos Sinos, Post-graduate Programme in Collective Health - São Leopoldo (RS), Brazil
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Abdin E, Chong SA, Vaingankar JA, Shafie S, Seah D, Chan CT, Ma S, James L, Heng D, Subramaniam M. Changes in the prevalence of comorbidity of mental and physical disorders in Singapore between 2010 and 2016. Singapore Med J 2022; 63:196-202. [PMID: 32798362 PMCID: PMC9251260 DOI: 10.11622/smedj.2020124] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Few studies have examined the changes in the prevalence of comorbidity of mental and physical disorders in recent years. The present study sought to examine whether the prevalence of comorbidity of mental and physical disorders in Singapore showed any changes between 2010 and 2016. METHODS We extracted data from two repeated nationally representative cross-sectional surveys conducted among resident adults aged ≥ 18 years in Singapore. Significant changes were tested using pooled multinomial logistic regression analyses. RESULTS The prevalence of comorbid mental and physical disorders increased significantly from 5.8% in 2010 to 6.7% in 2016. Among those with physical disorders, there were significant increases over time in the prevalence of comorbid generalised anxiety disorder (GAD) (0.1% vs. 0.4%) and obsessive-compulsive disorder (OCD) (1.4% vs. 3.9%) in diabetes mellitus, and alcohol dependence in cardiovascular disorders (0.1% vs. 1.3%). Among those with mental disorders, there were significant increases over time in the prevalence of comorbid diabetes mellitus in OCD (4.1% vs. 10.9%), cancer in major depressive disorder (0.4% vs. 2.4%), and cardiovascular disorders in GAD (0.4% vs. 6.7%) and alcohol dependence (0.9% vs. 11.8%). Significant changes in the overall prevalence of comorbid mental and physical disorders were also observed across age group, education and employment status. CONCLUSION The prevalence of comorbid mental and physical disorders increased significantly over time. This finding supports the need for more appropriate clinical management with better integration between mental health and general medical care professionals across all aspects of the healthcare system to treat this comorbidity in Singapore.
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Affiliation(s)
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore
| | | | - Saleha Shafie
- Research Division, Institute of Mental Health, Singapore
| | - Darren Seah
- Family Medicine Department, National Healthcare Group Polyclinics, Singapore
| | - Chun Ting Chan
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore
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Hynes L, Murphy AW, Hart N, Kirwan C, Mulligan S, Leathem C, McQuillan L, Maxwell M, Carr E, Walkin S, McCarthy C, Bradley C, Byrne M, Smith SM, Hughes C, Corry M, Kearney PM, McCarthy G, Cupples M, Gillespie P, Newell J, Glynn L, Alvarez-Iglesias A, Sinnott C. The MultimorbiditY COllaborative Medication Review And DEcision Making (MyComrade) study: a protocol for a cross-border pilot cluster randomised controlled trial. Pilot Feasibility Stud 2022; 8:73. [PMID: 35346380 PMCID: PMC8958932 DOI: 10.1186/s40814-022-01018-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/02/2022] [Indexed: 12/12/2022] Open
Abstract
Background While international guidelines recommend medication reviews as part of the management of multimorbidity, evidence on how to implement reviews in practice in primary care is lacking. The MultimorbiditY Collaborative Medication Review And Decision Making (MyComrade) intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care. Our aim in this pilot study is to evaluate the feasibility of a trial of the intervention with unique modifications accounting for contextual variations in two neighbouring health systems (Republic of Ireland (ROI) and Northern Ireland (NI)). Methods A pilot cluster randomised controlled trial will be conducted, using a mixed-methods process evaluation to investigate the feasibility of a trial of the MyComrade intervention based on pre-defined progression criteria. A total of 16 practices will be recruited (eight in ROI; eight in NI), and four practices in each jurisdiction will be randomly allocated to intervention or control. Twenty people living with multimorbidity and prescribed ≥ 10 repeat medications will be recruited from each practice prior to practice randomisation. In intervention practices, the MyComrade intervention will be delivered by pairs of general practitioners (GPs) in ROI, and a GP and practice-based pharmacist (PBP) in NI. The GPs/GP and PBP will schedule the time to review the medications together using a checklist. Usual care will proceed in practices in the control arm. Data will be collected via electronic health records and postal questionnaires at recruitment and 4 and 8 months after randomisation. Qualitative interviews to assess the feasibility and acceptability of the intervention and explore experiences related to multimorbidity management will be conducted with a purposive sample of GPs, PBPs, practice administration staff and patients in intervention and control practices. The feasibility of conducting a health economic evaluation as part of a future definitive trial will be assessed. Discussion The findings of this pilot study will assess the feasibility of a trial of the MyComrade intervention in two different health systems. Evaluation of the progression criteria will guide the decision to progress to a definitive trial and inform trial design. The findings will also contribute to the growing evidence-base related to intervention development and feasibility studies. Trial registration ISRCTN Registry, ISRCTN80017020. Date of confirmation is 4/11/2019. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01018-y.
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Affiliation(s)
- Lisa Hynes
- Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Ireland.
| | - Andrew W Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Ireland
| | - Nigel Hart
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - Collette Kirwan
- Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Ireland
| | - Sarah Mulligan
- Sligo Medical Academy, National University of Ireland, Galway, Ireland
| | - Claire Leathem
- Northern Ireland Clinical Research Network (Primary Care), Belfast, Northern Ireland
| | - Laura McQuillan
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - Marina Maxwell
- Northern Ireland Clinical Research Network (Primary Care), Belfast, Northern Ireland
| | - Emma Carr
- Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Ireland
| | - Scott Walkin
- Sligo Medical Academy, National University of Ireland, Galway, Ireland
| | - Caroline McCarthy
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Susan M Smith
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carmel Hughes
- School of Pharmacy, Queen's University, Belfast, Northern Ireland
| | - Maura Corry
- General Practice Federation, Belfast, Northern Ireland
| | | | | | - Margaret Cupples
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - Paddy Gillespie
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
| | - John Newell
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Carol Sinnott
- THIS Institute, University of Cambridge, Cambridge, UK
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Antiinflammatory and Anticancer Properties of Grewia asiatica Crude Extracts and Fractions: A Bioassay-Guided Approach. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2277417. [PMID: 35386306 PMCID: PMC8979695 DOI: 10.1155/2022/2277417] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 01/09/2023]
Abstract
The study was an extension of our earlier work on antiinflammatory and anticancer properties of G. asiatica fruit. We aimed to develop a bioassay guided multistep purification technique for producing bioactive fractions of G. asiatica crude extracts. Dried fruit powder was sequentially fractionated with 100% dichloromethane, 100% methanol (MeOH), and 50% MeOH. Active extracts were subjected to liquid-liquid partitioning followed by subfractionation using RP-HPLC. Antioxidant, antiinflammatory, and anticancer activities of the fruit extracts, and their potent fractions were evaluated in vitro, while identification of compounds from the bioactive fractions was performed by ESI-MS/MS analysis. The amount of the identified compounds present was confirmed using external standards adopting a simple, accurate, and rapid analytical HPLC method. The results showed that 100% and 50% MeOH extracts possessed bioactivity; one of which (the 50% MeOH extract) displayed potent activity in all in vitro bioassays. MeOH extract (50%) derived fraction C and hydroalcoholic fraction 5 (GAHAF5) were observed to possess higher antioxidant, antiinflammatory, and in vitro anticancer activity. IC50 of GAHAF5 against MCF-7, HEp-2, and NCI-H522 cancer cells was recorded as 26.2, 51.4, and 63 μg/mL, respectively. ESI-MS/MS and HPLC analysis identified catechin, chlorogenic acid, caffeic acid, and morin as potential bioactive compounds in the GAHAF5 fraction with concentrations of 1230, 491, 957, and 130 μg/g, respectively. The findings indicated that G. asiatica bioactive fractions possessed antiinflammatory activity in vitro and were cytotoxic against breast cancer, lung cancer, and laryngeal cancer cell lines.
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Prevalence of and factors associated with hypertension, diabetes, stroke and heart attack multimorbidity in Botswana: Evidence from STEPS 2014 survey. PLoS One 2022; 17:e0265722. [PMID: 35324986 PMCID: PMC8947240 DOI: 10.1371/journal.pone.0265722] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 03/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background Botswana, like other Sub-Saharan Africa (SSA) countries is currently undergoing demographic and epidemiological transitions which are shown by an increase in chronic non-communicable diseases (NCDs) and their associated risk factors. The aim of this study was to examine the prevalence of and factors associated with hypertension, diabetes and stroke/heart attack multimorbidity in Botswana. The definition of multimorbidity used in this study is the presence of two or more NCDs in an individual. Methods This study used secondary data derived from the Botswana WHO STEPS 2014 survey. The survey employed a nationally representative multi-stage sampling design. The study sample consisted of 3527 respondents aged 20–69 years of age who had successfully completed the questionnaire and met the inclusion criteria. Multivariable logistic regression analyses were used to assess factors associated with multimorbidity. All comparisons were considered to be statistically significant at 5% level. Statistical tests were performed using Statistical Package for Social Sciences (SPSS) version 25. Results Prevalence of hypertension, diabetes and stroke/heart attack multimorbidity was estimated to be at 3.5% in the sampled population. The odds of reporting multimorbidity were highest among females (AOR = 9.73, 95% CI = 8.30–11.42) than males and among respondents aged 35–49 (AOR = 1.20, 95% C.I. = 1.10–1.31) and 50–69 years (AOR = 1.52, 95% C.I. = 1.23–1.67) than individuals aged 20–24 years. Moreover, the odds of multimorbidity were significantly higher among married (AOR = 15.92, 95% C.I. = 13.40–18.92) and living together (AOR = 6.68, 95% C.I. = 5.72–7.81) couples; and individuals who reported that they earn an average annual household income of BWP ≥20 000 (AOR = 2.25, 95% CI = 1.84–2.75) compared to their counterparts. Behavioural risk factors significantly associated with higher odds of multimorbidity were obesity (AOR = 6.79, 95% C.I. = 6.20–7.90), physical inactivity (AOR = 4.41, 95% C.I. = 3.65–5.31) and hazardous alcohol consumption (AOR = 1.49, 95% CI = 1.23–1.81). On the other hand the odds of reporting multimorbidity were significantly low among individuals with sufficient consumption of fruits and vegetables (AOR = 0.47, 95% C.I. = 0.39–0.56) and non-tobacco users (AOR = 0.58, 95% CI = 0.49–0.68). Conclusion Multimorbidity was more common among females, the elderly people and was associated with obesity, poor fruit and vegetable intake, and tobacco use. Strategies to combat NCDs and multimorbidity should be aimed to target early stages of life since behavioural factors and lifestyles that increase the likelihood of disease are entrenched in earlier stages of life.
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Rautiainen E, Ryynänen OP, Rautiainen P, Laatikainena T. How do individuals with alcohol problems use social and healthcare services in Finland? Comparison of service use patterns between two high-need patient groups. NORDIC STUDIES ON ALCOHOL AND DRUGS 2022; 38:450-465. [PMID: 35308819 PMCID: PMC8900183 DOI: 10.1177/14550725211018593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
Aims: Alcohol use disorders (AUDs) are associated with high risk of comorbidities and excess use of social and healthcare services. We examined health service use (HSU) frequencies of patients with AUD in comparison to those with type 2 diabetes mellitus (T2DM). Design: A random sample of individuals with AUD (n = 396) were identified based on ICD-10 codes and HSU patterns, morbidity and mortality were compared with age- and gender-matched T2DM controls (n = 792) using logistic regression analysis. Six years (2011–2016) of electronic health record (EHR) data from the North Karelia district in Finland were used. Results: Similarities in comorbidity patterns existed, although mental health comorbidity (odds ratio [OR] 1.86) was more prevalent in the AUD group. The average annual HSU varied according to the groups: T2DM patients had more continuous contact with public health nurses in primary care, whereas AUD patients were more likely to experience somatic specialised care hospitalisations (OR 11.30) and have frequent somatic primary healthcare doctor visits (OR 3.30) and frequent emergency room doctor visits in specialised care (OR 8.89). Furthermore, patients with AUD had a 7.5 times higher risk of death compared with T2DM patients. Conclusions: This study identified rather similar comorbidity status for the AUD and T2DM patients, but their HSU patterns differed noticeably. AUD patients had higher frequencies of hospitalisation periods and emergency service use and were at a higher risk of death compared with T2DM patients, indicating greater challenges in the organisation of care for AUD patients compared with those having T2DM.
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Affiliation(s)
- Elina Rautiainen
- University of Eastern Finland, Kuopio, Finland; and National Institute for Health and Welfare, Helsinki, Finland
| | - Olli-Pekka Ryynänen
- University of Eastern Finland, Kuopio, Finland; and Kuopio University Hospital, Finland
| | - Päivi Rautiainen
- Joint Municipal Authority for North Karelia Social and Health Services (Siun sote), Tikkamäentie, Joensuu, Finland
| | - Tiina Laatikainena
- Joint Municipal Authority for North Karelia Social and Health Services (Siun sote), Tikkamäentie, Joensuu, Finland; and National Institute for Health and Welfare, Helsinki, Finland
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Tomita S, Aoki T, Ohde S, Takahashi O, Kimura T, Matsushima M. Association between health literacy and multimorbidity: a nationwide, cross-sectional study of a Japanese population. BMJ Open 2022; 12:e052731. [PMID: 35046000 PMCID: PMC8772427 DOI: 10.1136/bmjopen-2021-052731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To examine the relationship between health literacy and multimorbidity. DESIGN Nationwide cross-sectional study. SETTING Community settings across Japan. PARTICIPANTS Community-dwelling participants aged 20 years or older were selected based on a quota sampling method that adjusted for age, sex and residential area. In total, 3678 participants from the Health Diary Study, with a mean age of 52.3 years (SD, 18.2 years; 1943 (52.8%) female participants), were included. PRIMARY OUTCOME MEASURE Multimorbidity, the primary outcome measure, was defined as the presence of two or more chronic diseases. RESULTS Of the 3678 participants, 824 (22.4%) had multimorbidity. The mean functional health literacy (FHL) and communicative and critical health literacy (CCHL) scores were 3.2 (SD, 0.7) and 3.6 (SD, 0.9), respectively. In the univariable analysis, both scores were associated with multimorbidity (p<0.001). However, in the multivariable modified Poisson regression analysis, only the FHL score was significantly associated with multimorbidity (per 1-point increase, 0.91; 95% CI 0.84 to 0.99). CONCLUSIONS After adjusting for confounding variables, FHL, not CCHL, was significantly related to the presence of multimorbidity. Further longitudinal studies are required to examine the causal relationship between health literacy and multimorbidity.
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Affiliation(s)
- Shiori Tomita
- Department of General Internal Medicine, St Luke's International University, Chuo-ku, Tokyo, Japan
- Division of Clinical Epidemiology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takuya Aoki
- Division of Clinical Epidemiology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- Department of Community Medicine, Kyoto University, Kyoto, Japan
| | - Sachiko Ohde
- Graduate School of Public Health, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Osamu Takahashi
- Graduate School of Public Health, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Takeshi Kimura
- Center for Preventive Medicine, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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