Chronic disease prevalence and associations in a cohort of Australian men: the Florey Adelaide Male Ageing Study (FAMAS)

Demographic and Clinical Factors Associated with Development of Type 2 Diabetes: A Review of the Literature

Diabetes mellitus is a complex and chronic condition that requires lifelong management and interaction with a healthcare system. Failure to control risk factors through preventive care may lead to a host of diabetes-related complications. Underperforming healthcare systems and poor awareness among the general population/healthcare professionals has been suggested as reasons why so many patients remain undiagnosed. Due to the asymptomatic nature of early and even intermediate diabetes mellitus, several years may pass without any diagnosis before complications begin to manifest. Other factors include age, gender, ethnicity, education, marital and unemployment status which may also increase the risk of developing morbidity and mortality associated with diabetes mellitus. This review summarizes the current demographic risk factors and clinical characteristics associated with diabetes mellitus. A literature search was conducted using PubMed, MEDLINE, and Sabinet by using the following search terms: diabetes mellitus, risk factors, characteristics and complications.

Is exposure to family member incarceration during childhood linked to diabetes in adulthood? Findings from a representative community sample

Objectives:

Diabetes is a prevalent and serious public health problem, particularly among older adults. A robust literature has shown that adverse childhood experiences contribute to the development of health problems in later life, including diabetes. Family member incarceration during childhood is an under-investigated yet increasingly common adverse childhood experience in the United States. The purpose of this study was to investigate the relationship between family member incarceration during childhood and diabetes in adulthood, while considering the role of gender as well as the impact of a range of potential confounds.

Methods:

A large representative community sample of adults aged 40 and older (n = 8790 men, 14,255 women) was drawn from the Behavioral Risk Factor Surveillance System 2012 optional adverse childhood experiences module to investigate the association between family member incarceration during childhood and diabetes. For each gender, nine logistic regression analyses were conducted using distinct clusters of variables (e.g. socioeconomic status and health behaviors).

Results:

Among males, the odds of diabetes among those exposed to family member incarceration during childhood ranged from 2.00 to 1.59. In the fully adjusted model, they had elevated odds of 1.64 (95% confidence interval = 1.27, 2.11). Among women, the odds of diabetes was much lower, hovering around 1.00.

Conclusion:

Findings suggest that family member incarceration during childhood is associated with diabetes in men, even after adjusting for a wide range of potential risk factors (e.g. sociodemographics, health behaviors, healthcare access, and childhood risk factors). Future research should explore the mechanisms linking family member incarceration during childhood and long-term negative health outcomes in men.

Cluster Analysis of Unhealthy Lifestyles among Elderly Adults with Prediabetes: A Cross-Sectional Study in Rural China

INTRODUCTION

To explore the clustering and influencing factors of unhealthy lifestyles among elderly adults with prediabetes in rural China.

METHODS

A cross-sectional study was conducted in Yiyang, Hunan Province, China. Through multistage cluster random sampling and an oral glucose tolerance test, we screened 461 elderly adults aged 60 years and older with prediabetes out of 2144 elderly adults who were sampled. The prediabetic adults completed a survey examining four common lifestyle factors: diet, exercise, smoking, alcohol use and the ability to acquire diabetes-related knowledge and thereby promote one's own health-diabetes health literacy. The influencing factors were analyzed retrospectively with the Kruskal-Wallis test and ordinal logistic regression.

RESULTS

A total of 425 elderly adults completed the survey, of whom 325 were identified with unhealthy lifestyle clustering. The Kruskal-Wallis test showed significant differences between unhealthy lifestyle clusters by age, gender, marital status, occupation and hyperlipidemia (P < 0.05). Ordinal logistic regression showed that female gender (OR = 0.23, 95% CI: 0.15 0.37), personal annual income ≥ 2800 CNY (OR = 0.61, 95% CI: 0.38 0.99) and occupation as a worker (OR = 0.56, 95% CI: 0.34 0.92) were protective factors against unhealthy lifestyle clustering. An unsatisfactory marital status (OR = 1.60, 95% CI: 1.02 2.51) and low diabetes health literacy (OR = 3.17, 95% CI: 1.03 9.81) were risk factors.

CONCLUSION

In total, 76.47% of the prediabetic elderly adults in rural China showed unhealthy lifestyle clusters. Being male and having an unsatisfactory marital status, a low personal annual income, an occupation as a farmer and low diabetes health literacy were the main risk factors for unhealthy lifestyle clustering. More effective interventions should be implemented based on these risk factors to prevent diabetes in rural elderly adults.

The association of unemployment with glucose metabolism: a systematic review and meta-analysis

OBJECTIVES

Unemployment has been linked with poor health. We hypothesized that being unemployed is associated with disorders of glucose metabolism and performed a systematic review and meta-analysis of the literature to ascertain the relationship.

METHODS

We searched the databases of Scopus, Medline Ovid and Web of Science for population-based original studies for past 20 years. Random effects meta-analyses were used to estimate odds ratios (OR) with 95% confidence intervals (CI) for prediabetes and type 2 diabetes among the unemployed as compared to those employed, separately for men and women when possible.

RESULTS

Out of 981 articles found, 12 articles were included in the systematic review and eight articles in the meta-analyses. Unemployment was associated with 1.6-fold odds for prediabetes (OR 1.58; 95% CI 1.07-2.35), and 1.7-fold odds for type 2 diabetes (OR 1.72; 95% CI 1.14-2.58) in the total sample. The corresponding associations for type 2 diabetes were also found stratified for men (OR 1.53; 95% CI 1.47-1.60) and women (OR 1.60; 95% CI 1.33-1.92).

CONCLUSIONS

Unemployment is associated with prediabetes and type 2 diabetes, global concerns of public health with potential for prevention.

Bachelors, divorcees, and widowers: does marriage protect men from type 2 diabetes?

While research has suggested that being married may confer a health advantage, few studies to date have investigated the role of marital status in the development of type 2 diabetes. We examined whether men who are not married have increased risk of incident type 2 diabetes in the Health Professionals Follow-up Study. Men (n = 41,378) who were free of T2D in 1986, were followed for ≤22 years with biennial reports of T2D, marital status and covariates. Cox proportional hazard models were used to compare risk of incident T2D by marital status (married vs unmarried and married vs never married, divorced/separated, or widowed). There were 2,952 cases of incident T2D. Compared to married men, unmarried men had a 16% higher risk of developing T2D (95%CI:1.04,1.30), adjusting for age, family history of diabetes, ethnicity, lifestyle and body mass index (BMI). Relative risks (RR) for developing T2D differed for divorced/separated (1.09 [95%CI: 0.94,1.27]), widowed (1.29 [95%CI:1.06,1.57]), and never married (1.17 [95%CI:0.91,1.52]) after adjusting for age, family history of diabetes and ethnicity. Adjusting for lifestyle and BMI, the RR for T2D associated with widowhood was no longer significant (RR:1.16 [95%CI:0.95,1.41]). When allowing for a 2-year lag period between marital status and disease, RRs of T2D for widowers were augmented and borderline significant (RR:1.24 [95%CI:1.00,1.54]) after full adjustment. In conclusion, not being married, and more specifically, widowhood was more consistently associated with an increased risk of type 2 diabetes in men and this may be mediated, in part, through unfavorable changes in lifestyle, diet and adiposity.

A survey of retirement intentions of Baby Boomers: an overview of health, social and economic determinants

BACKGROUND

Governments have been implementing policies aimed at halting the trend towards early retirement for Baby Boomers. Public policies can have a strong effect on when a person retires and this analysis contributes to an improved understanding of retirement aspirations in regards to health, social, workplace and economic determinants.

METHODS

In October 2011 a telephone survey was undertaken with participants aged 50 to 65 years who were in paid employment and who had been in the workforce for the previous three years. Participants were obtained from two identical South Australian cohort studies - the North West Adelaide Health Study and the Florey Adelaide Male Ageing Study. The results of the telephone survey were linked to the original cohort data. Data were weighted by sex, age, postcode and probability of selection in the household. Work related questions included how much they thought about their retirement, current occupation, employment status, type of workplace and hours worked per week. Health related questions included current smoking status, physical activity, body mass index, self-reported health status and overall life satisfaction. Uni-variable and multi-variable analyses were undertaken to compare the different associations between people who were and were not intending to retire.

RESULTS

In total, 25.9% (n = 210) of people who were currently in paid employment indicated that they intend to retire completely from the workforce. The remainder indicated that they will continue to work (41.8% retire from full-time work but work part-time, 25.7% continue working part-time but reduce their current hours, and 6.7% never retire). The multi-variable results indicate that those with lower education, having a savings habit, and sales workers more likely to anticipate complete retirement. The self-employed, and those thinking only moderately about retirement, were more likely to extend their working life beyond age 65.

CONCLUSION

An important finding of this study is the large number of Baby Boomers who indicated that they would be happy to work part-time or never retire. Policies and continued dialogue aimed at making the workplace a safe, flexible and welcoming environment to accommodate this wish, and to entice others to take up this option over complete withdrawal from the labour force, is required.

A survey of retirement intentions of Baby Boomers: an overview of health, social and economic determinants

BACKGROUND

Governments have been implementing policies aimed at halting the trend towards early retirement for Baby Boomers. Public policies can have a strong effect on when a person retires and this analysis contributes to an improved understanding of retirement aspirations in regards to health, social, workplace and economic determinants.

METHODS

In October 2011 a telephone survey was undertaken with participants aged 50 to 65 years who were in paid employment and who had been in the workforce for the previous three years. Participants were obtained from two identical South Australian cohort studies - the North West Adelaide Health Study and the Florey Adelaide Male Ageing Study. The results of the telephone survey were linked to the original cohort data. Data were weighted by sex, age, postcode and probability of selection in the household. Work related questions included how much they thought about their retirement, current occupation, employment status, type of workplace and hours worked per week. Health related questions included current smoking status, physical activity, body mass index, self-reported health status and overall life satisfaction. Uni-variable and multi-variable analyses were undertaken to compare the different associations between people who were and were not intending to retire.

RESULTS

In total, 25.9% (n = 210) of people who were currently in paid employment indicated that they intend to retire completely from the workforce. The remainder indicated that they will continue to work (41.8% retire from full-time work but work part-time, 25.7% continue working part-time but reduce their current hours, and 6.7% never retire). The multi-variable results indicate that those with lower education, having a savings habit, and sales workers more likely to anticipate complete retirement. The self-employed, and those thinking only moderately about retirement, were more likely to extend their working life beyond age 65.

CONCLUSION

An important finding of this study is the large number of Baby Boomers who indicated that they would be happy to work part-time or never retire. Policies and continued dialogue aimed at making the workplace a safe, flexible and welcoming environment to accommodate this wish, and to entice others to take up this option over complete withdrawal from the labour force, is required.

The Australian Baby Boomer Population—Factors Influencing Changes to Health-Related Quality of Life Over Time

Objectives: Identify factors associated with changes to health-related quality of life (HRQoL) in baby boomers. Methods: Panel data were collected on baby boomers at two time points, 2000-2002 and 2004-2006. A fixed-effects model was used to identify associations between changes in the dependent variable (SF-36 summary scales) and changes in independent variables (health indicators/employment status). Results: Mental health problems, being out of labor force, sedentary behavior, and severe lung disease were associated with deterioration in physical and mental HRQoL. Obesity was associated with deterioration in physical HRQoL whereas cardiovascular disease was associated with deterioration in mental HRQoL. Unemployment, full-time employment, and absence of lung disease symptoms were associated with improvements in physical and mental HRQoL. Discussion: If we are to maximize the future labor participation, and HRQoL, of this cohort, it will be necessary to reduce obesity and sedentary behavior and to further investigate the association between health and employment.

Influence of asthma definition on the asthma-obesity relationship

Background

Epidemiological studies suggest an association between obesity and asthma in adults and children. Asthma diagnosis criteria are different among studies. The aim of this study was to test the influence of asthma definition on the asthma-obesity relationship.

Methods

In a cross-sectional analysis of 1922 men and women, subjects completed a translated questionnaire from the European Community Respiratory Health Survey and underwent spirometry and a bronchial challenge test. Weight, height and waist circumference were measured. Multiple logistic regression analysis was carried out to assess the association of variables related to obesity and asthma. Asthma was defined either by the presence of symptoms with bronchial hyperresponsiveness (BHR) or by a self-report of a physician-made diagnosis. The following variables were separately tested for associations with asthma: socioeconomic characteristics, schooling, physical activity, smoking status, anthropometry and spirometry.

Results

No association was detected between asthma confirmed by BHR and obesity indicators, odds ratio (OR) = 1.08 (95% confidence interval: 0.69 - 1.68) for obesity assessed by body mass index ≥ 30 kg/m²; OR = 1.02 (0.74 - 1.40) for obesity assessed by abnormal waist-to-height ratio; and, OR = 0.96 (0.69 - 1.33) for abnormal waist circumference. On the contrary, a previous diagnosis of asthma was associated with obesity, OR = 1.48 (1.01 - 2.16) for body mass index ≥ 30 kg/m²; OR = 1.48 (1.13 - 1.93) for abnormal waist-to-height ratio; and, OR = 1.32 (1.00 – 1.75) for abnormal waist circumference. Female gender, schooling ≥ 12 years and smoking were associated with BHR-confirmed asthma. Physically inactive subjects were associated with a previous diagnosis of asthma.

Conclusions

Our findings indicate that the relationship between asthma and obesity in epidemiological studies depends on the definition adopted. Certain components of asthma, for instance, symptoms may be more prone to the obesity influence than other ones, like bronchial hyperresponsiveness.

The association of disability and pain with individual and community socioeconomic status in people with hip osteoarthritis

Objective:

To examine associations between disability and socioeconomic status (SES) in persons with hip radiographic OA (rOA) or symptomatic OA (sxOA) in the Johnston County Osteoarthritis Project.

Methods:

Cross-sectional analyses were conducted on individuals with hip rOA (708) or sxOA (251). rOA was defined as Kellgren-Lawrence ≥ 2. Educational attainment (<12 years or ≥12 years) and occupation (managerial or non-managerial) were individual SES measures. Census block group poverty rate (<12%, 12-25%, ≥25%) was the community SES measure. Disability was measured by the HAQ-DI and the WOMAC (function, pain, total). Covariates included age, gender, race, BMI, and presence of knee symptoms. Analyses examined associations of disability with each SES effect separately, followed by multivariable analyses using all SES variables, adjusting for covariates.

Results:

In models with single SES variables adjusted for covariates, WOMAC scores were associated significantly (p<0.05) with low educational attainment and non-managerial occupation in rOA and sxOA. HAQ was significantly associated with low educational attainment in rOA and sxOA and with high community poverty in rOA. In models including all SES variables, the patterns of association were similar although with diminished significance. There was indication that education was more strongly associated with HAQ and WOMAC function, while occupation was more strongly associated with WOMAC pain.

Conclusion:

Our data provide evidence that individual SES is an important factor to consider when examining disability and pain outcomes in older adults with hip OA.

Neuroticism, extraversion, stressful life events and asthma: a cohort study of middle-aged adults

BACKGROUND

Stressful life events can trigger asthma exacerbations, but could also contribute to the development of incident asthma. However, only few studies have investigated the association between stressful life events and adult asthma prospectively. Likewise, stress-related personality traits (e.g. neuroticism and extraversion) may increase asthma risk, but this has been examined in only one prospective study. We therefore aimed to investigate the association between neuroticism, extraversion, stressful life events and incident asthma.

METHODS

A population-based sample of 5114 middle-aged adults completed questionnaires between 1992 and 1995. Among those alive in 2002/2003, 4010 (83%) were followed-up by questionnaires. Exposures of interest included neuroticism, extraversion and three stressful life events (unemployment, having broken off a life partnership and death of a close person). Associations with incident asthma were estimated by multivariable risk ratios (RR) and 95% confidence intervals (95% CI) using Poisson regression.

RESULTS

High vs low neuroticism predisposed to developing asthma (RR = 3.07, 95% CI = 1.71-5.48), but high extraversion did not (RR = 1.30, 95% CI = 0.79-2.15). Having broken off a life partnership significantly increased asthma risk (RR = 2.24, 95% CI = 1.20-4.21) in contrast to death of a close person (RR = 1.06, 95% CI = 0.64-1.75) or unemployment (RR = 1.65, 95% CI = 0.72-3.78).

CONCLUSIONS

High levels of neuroticism may increase the risk of asthma in middle-aged adults. Having broken off a life partnership was the only stressful event, which was associated with incident asthma. Synthesized with evidence from earlier studies, this could reflect that interpersonal conflicts may increase asthma risk, possibly along an immunological pathway.

Healthy Eating Index and abdominal obesity

Objective

Although diet is a modifiable lifestyle factor to reduce abdominal obesity risk, the relationship between the Health Eating Index (HEI) and waist circumference (WC) has not been studied. The present study aimed to describe relationships between the HEI and abdominal obesity among adults.

Design

Secondary data analysis of a cross-sectional national survey, the Third National Health and Nutrition Examination Survey (NHANES III). The HEI data, including the total HEI score and HEI component scores, were collected with a 24 h recall. WC measures were taken during a physical examination. Abdominal obesity was defined as WC ≥ 102 cm for men and WC ≥ 88 cm for women. Other covariates were collected during an interview.

Subjects

In total 15 658 US adults, men (n 7470) and non-pregnant women (n 8188).

Results

The odds of abdominal obesity was 8·3 % (95 % CI 1·8, 14·9 %, P = 0·014) lower for women and 14·5 % (95 % CI 6·8, 21·9 %, P ≤ 0·001) lower for men with each 10-unit increase in total HEI score (HEI scale, 0–100). For each point increase for the fruit score, abdominal obesity risk decreased by 2·6 % (95 % CI 0·8, 4·4 %, P = 0·007) for women. Abdominal obesity risk decreased for men with each point increase in saturated fat and variety scores, by 3·1 % (95 % CI 0·1, 6·0 %, P = 0·042) and 4·0 % (95 % CI 0·1, 7·7 %, P = 0·043) respectively.

Conclusions

Dietary consumption that follows the HEI is associated with a lower risk for abdominal obesity.