The association between childhood conditions and heart disease among middle-aged and older population in China: a life course perspective

Racial Discrimination and Multimorbidity Among Older Adults in Colombia: A National Data Analysis

INTRODUCTION

Multimorbidity is a prevalent worldwide problem among older adults. Our objective was to assess the association between life-course racial discrimination and multimorbidity among older adults in Colombia.

METHODS

We used data from the SABE (Salud, Bienestar y Envejecimiento) Colombia Study in 2015 (N = 18,873), a national cross-sectional survey among adults aged 60 years or older. The outcome was multimorbidity, defined as having 2 or more chronic conditions. The main independent variables were 3 racial discrimination measures: 1) everyday racial discrimination (yes or no), 2) childhood racial discrimination score (scored from 0 [never] to 3 [many times]), and 3) situations of racial discrimination in the last 5 years (scored from 0 to 4 as a sum of the number of situations [group activities, public places, inside the family, health centers]). Other variables were sociodemographic characteristics, diseases, economic or health adversity during childhood, and functional status. We used weighted logistic regression analyses to adjust for differences between groups.

RESULTS

Multivariate logistic regression models showed that multimorbidity was significantly associated with experiencing everyday racial discrimination (OR, 2.21; 95% CI, 1.62-3.02), childhood racial discrimination (OR, 1.27; 95% CI, 1.10-1.47), and the number of situations of racial discrimination (OR= 1.56; 95% CI, 1.22-2.00). Multimorbidity was also independently associated with multimorbidity during childhood.

CONCLUSION

Racial discrimination experiences were associated with higher odds of multimorbidity among older adults in Colombia. Strategies to decrease life course experiences of racial discrimination may improve the health of older adults.

Childhood experiences and frailty trajectory among middle-aged and older adults in China

This study examined the associations between childhood experiences and frailty trajectory among middle-aged and older Chinese adults. Data were derived from the China Health and Retirement Longitudinal Study. We used data from all four waves (i.e., 2011, 2013, 2015, 2018) and the life history survey in 2014. Data for 10,963 respondents were included. Latent growth curve models were conducted to examine the proposed model. The results show that adverse childhood experiences, self-rated childhood socioeconomic status, and the objective indicators of childhood health and health care were associated with both the baseline level and change rate of frailty. The educational attainment of fathers and perceived childhood health and healthcare conditions were associated with baseline frailty only. Our findings highlight the crucial role of childhood antecedents in the progression of frailty in later life. We further found strong evidence that childhood is an essential life stage for human development. Future social policies and interventions should use childhood experiences as a screening tool and promote child protection, health education, and life course interventions.

Can the WHO 's recommendations of physical activity volume decrease the risk of heart disease in middle and older aged Chinese People: the evidence from a seven year longitudinal survey

Background

At present, there is a lack of direct evidence to confirm whether the recommendations of the World Health Organization can play a role in fitness and disease prevention in the Chinese population. Therefore, we aimed to analyse 7-year longitudinal survey data to explore whether the physical activity volume recommended by the World Health Organization can help Chinese middle-aged and elderly people reduce the risk of heart disease.

Methods

Data for the 8327 participants who were finally included in this study were derived from the 7-year data of the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018. The physical activity volume is expressed by the product of physical frequency and duration, and heart disease is screened according to self-reported diagnosis and related treatment. The relationship between different physical activity volume groups and the incidence rate of heart disease was determined by a multivariate Cox proportional hazards regression model.

Results

After adjusting for all covariates, participants meeting the WHO’s recommendations had a 20% lower risk of heart disease than those who did not meet the WHO’s recommendations (HR = 0.80, 95% = 0.68–0.96). Subgroup analysis showed that among the participants meeting the WHO’s recommendations, men (HR = 0.71) had a lower risk of heart disease than women (HR = 0.74); in addition, the risk of heart disease was significantly reduced in participants who were middle-aged (26%), had a normal BMI range (49%), did not have hypertension (24%), did not have hyperlipidaemia (21%) and did not have lung disease (21%). It should be noted that the risk of heart disease was reduced by 72 and 67% in participants with untreated hyperlipidaemia and untreated lung disease, respectively.

Conclusions

This study revealed that meeting the WHO’s recommendations for physical activity volume can reduce the risk of heart disease in middle-aged and older people in China and can also effectively prevent heart disease for people with some common chronic diseases, such as hyperlipidaemia and lung disease. The results showed that physical activity for leisure and exercise had a lower preventive effect on heart disease than physical activity for a job, which may be related to the inappropriate leisure and exercise methods of the participants.

Trial registration

IRB00001052–11015.

Early-life exposure to Chinese famine and stroke risk in mid- to late life: the mediating roles of cognitive function and depression

BACKGROUND

Limited research has examined the role that famine exposure plays in adulthood stroke risk. We aim to explore the causal implications of early exposure to the Great Chinese Famine on stroke risk and determine whether these associations were mediated by cognitive function, and depression.

METHODS

We sampled 12,681 individuals aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS) and divided them into fetally exposed, childhood-exposed, adolescence/adulthood-exposed and unexposed groups. Stroke was defined by self- or proxy-reported physician diagnosis. Based on a counterfactual framework, marginal structural models were used to estimate the natural direct effect and the natural indirect effects through cognitive function and depression for causal inference.

RESULTS

We found that early-life exposure to Chinese famine was directly related to increased stroke risk in mid- to late life. Cognitive function and depression accounted for a greater part of the effect for childhood famine exposure, mediating 36.35% (95%CI: 14.19, 96.19%) of the overall association between famine exposure and incident stroke, than for the fetal, adolescence/adulthood famine exposure groups. However, the natural indirect effect through depression was not significant in the fetally exposed group. The results were robust in the sensitivity analysis of model specification and unobserved confounding.

CONCLUSIONS

Our findings are consistent with the latency, pathway, and accumulation models, supporting the life-course theory. Early stages of life exposed to the Chinese Famine were associated with higher risk of stroke in mid- to late life. Enhanced cognitive and depression interventions may reduce stroke risk in middle-aged and older Chinese adults who exposure to famine in early life.

Association between height loss and cardiovascular disease in the Korean elderly

Shorter people are at risk for cardiovascular disease (CVD), but data remain limited. This study sought to determine whether height loss is associated with an increased incidence of CVD. From the Korean National Health Insurance Service—Senior database (2002–2015), data of 134,952 individuals with available information on height loss was obtained. Height loss as percentages was measured 3–5 years from the baseline height. To assess hazard ratios for CVD incidence, multivariable Cox proportional hazard regression models were used before and after applying propensity score matching. The unmatched cohort consisted of 109,546 participants without height loss (< 1%): 20,208 participants with 1–2% height loss, and 5126 participants with ≥ 2% height loss. During a median follow-up period of 6.5 years (interquartile range, 3.7–8.5 years), 21,921 were newly diagnosed with CVD. Adults with height loss of > 2% had a greater risk of incident CVD than those with no height loss. This finding was statistically significant both in the original- and propensity score-matched cohorts. The increased risk for ischemic stroke was significant in the male subgroups, in line with degree of height loss. Overall, height loss is associated with an increased risk of subsequent ischemic stroke in Korean men.