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Druffner N, Egan D, Ramamurthy S, O'Brien J, Davis AF, Jack J, Symester D, Thomas K, Palka JM, Thakkar VJ, Brown ES. IQ in high school as a predictor of midlife alcohol drinking patterns. Alcohol Alcohol 2024; 59:agae035. [PMID: 38804536 DOI: 10.1093/alcalc/agae035] [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: 06/28/2023] [Revised: 04/27/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024] Open
Abstract
AIMS The aim of the present study was to assess the relationship between adolescent IQ and midlife alcohol use and to explore possible mediators of this relationship. METHODS Study data were from 6300 men and women who participated in the Wisconsin Longitudinal Study of high-school students graduating in 1957. IQ scores were collected during the participants' junior year of high school. In 2004, participants reported the number of alcoholic beverages consumed (past 30 days) and the number of binge-drinking episodes. A multinomial logistic regression was conducted to determine the relationship between adolescent IQ and future drinking pattern (abstainer, moderate drinker, or heavy drinker), and Poisson regression was used to examine the number of binge-drinking episodes. Two mediators-income and education-were also explored. RESULTS Every one-point increase in IQ score was associated with a 1.6% increase in the likelihood of reporting moderate or heavy drinking as compared to abstinence. Those with higher IQ scores also had significantly fewer binge-drinking episodes. Household income, but not education, partially mediated the relationship between IQ and drinking pattern. CONCLUSIONS The present study suggests that higher adolescent IQ may predict a higher likelihood of moderate or heavy drinking in midlife, but fewer binge-drinking episodes. The study also suggests that this relationship is mediated by other psychosocial factors, specifically income, prompting future exploration of mediators in subsequent studies.
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Affiliation(s)
- Natalie Druffner
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8849, United States
| | - Donald Egan
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8849, United States
| | - Swetha Ramamurthy
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8849, United States
| | - Justin O'Brien
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8849, United States
| | - Allyson Folsom Davis
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8849, United States
| | - Jasmine Jack
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8849, United States
| | - Diona Symester
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8849, United States
| | - Kelston Thomas
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8849, United States
| | - Jayme M Palka
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8849, United States
| | - Vishal J Thakkar
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8849, United States
| | - Edson Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390-8849, United States
- The Altshuler Center for Education & Research, Metrocare Services, 1345 River Bend Dr, Suite 200, Dallas, Texas, 75247, United States
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Oliveira LM, Sfreddo CS, Ardenghi TM, Nascimento GG, Demarco FF, Zanatta FB. The role of differential exposure and susceptibility to heavy drinking linking income inequalities and tooth loss: An investigation of the alcohol harm paradox using a four-way decomposition analysis. Community Dent Oral Epidemiol 2024; 52:239-247. [PMID: 37822131 DOI: 10.1111/cdoe.12920] [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: 11/07/2022] [Revised: 07/24/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVES To examine the extent to which the effect of income inequalities on tooth loss is attributable to differential exposure and susceptibility to heavy drinking in older Brazilian adults. METHODS We conducted a secondary analysis using data from The Brazilian Longitudinal Study of Ageing (ELSI-Brazil 2015-2016), a nationally representative sample of community-dwelling people aged 50 years and over. Causal mediation analysis based on the counterfactual outcome framework decomposed the effect of income on tooth loss mediated by heavy drinking into four components (four-way decomposition): controlled direct effect (neither mediation nor interaction), reference interaction (interaction only), mediated interaction (both mediation and interaction) and pure indirect effect (mediation only). Proportions of effect attributable to each component were calculated to estimate the differential exposure (the sum of the third and fourth components) and differential susceptibility (the sum of the second and third components) to heavy drinking. RESULTS The analytical sample comprised 8114 participants. After adjusting for covariates, 7.3% (95% CI: 3.8%; 10.9%) and -39.5% (95% CI: -75.8%; -3.3%) of the effects of income on tooth loss were attributable to differential exposure and susceptibility to heavy drinking, respectively, consistent with the alcohol harm paradox. When setting non-functional dentition as outcome, only the effect of differential susceptibility remained (-81.7% [95% CI: -128.2%; -35.2%]). CONCLUSION Our findings suggest that individuals of low-income groups appear to be more susceptible to the effects of heavy drinking on tooth loss.
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Affiliation(s)
- Leandro Machado Oliveira
- Department of Stomatology, Postgraduate Program in Dentistry, Emphasis on Periodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
- Department of Stomatology, School of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Camila Silveira Sfreddo
- Department of Semiology and Clinic, Faculty of Dentistry, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Thiago Machado Ardenghi
- Department of Stomatology, School of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
| | - Gustavo G Nascimento
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore, Singapore
- Oral Health Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Flávio Fernando Demarco
- Graduate Program in Dentistry, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
- Graduate Program in Epidemiology, Universidade Federal de Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil
| | - Fabrício Batistin Zanatta
- Department of Stomatology, Postgraduate Program in Dentistry, Emphasis on Periodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
- Department of Stomatology, School of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Rio Grande do Sul, Brazil
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Zhu Y, Llamosas-Falcón L, Kerr W, Puka K, Probst C. Differential Associations of Alcohol Use With Ischemic Heart Disease Mortality by Socioeconomic Status in the US, 1997-2018. JAMA Netw Open 2024; 7:e2354270. [PMID: 38300620 PMCID: PMC10835511 DOI: 10.1001/jamanetworkopen.2023.54270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/11/2023] [Indexed: 02/02/2024] Open
Abstract
Importance People with low socioeconomic status (SES) experience greater burden from alcohol-attributable health conditions and mortality at equal levels of alcohol consumption compared with those with high SES. A U-shaped association has been established between alcohol use and ischemic heart disease (IHD), but no study has explored how such an association differs by SES in the US. Objective To investigate how the association of alcohol use with ischemic heart disease mortality differs by SES in the general US population. Design, Setting, and Participants This cohort study used record-linked, cross-sectional National Health Interview Survey data for US adults aged 25 years and older, covering 1997 to 2018 with mortality follow-up until 2019. Data analysis was performed from March to June 2023. Exposures SES (operationalized using education attainment) and alcohol consumption were obtained from self-reported questionnaires. Main Outcomes and Measures The outcome was time to IHD mortality or last presumed alive by December 31, 2019. Cox proportional hazard models were applied to evaluate the interaction of SES and alcohol use on IHD mortality, with age as the time scale. Sex-stratified analyses were performed, adjusting for race and ethnicity, marital status, smoking, body mass index, physical activity, and survey year. Fine-Gray subdistribution models were applied to account for competing risks. Results This cohort study of 524 035 participants (mean [SD] age at baseline, 50.3 [16.2] years; 290 492 women [51.5%]) found a statistically significantly greater protective association of drinking less than 20 g per day (vs lifetime abstinence) with IHD mortality in the high-SES group compared with the low-SES group (interaction term hazard ratio [HR], 1.22 [95% CI, 1.02-1.45] in men; HR, 1.35 [95% CI, 1.09-1.67] in women). In addition, the differential associations of drinking less than 20 g per day with IHD mortality by SES were observed only among people with less than monthly heavy episodic drinking (HED) (interaction term, HR, 1.20 [95% CI, 1.01-1.43] in men; HR, 1.34 [95% CI, 1.08-1.67] in women); no difference was found in people with at least monthly HED. Among women there was a greater protective association of drinking less than 20 g per day with IHD mortality in the high-SES group than the middle-SES group (interaction term, HR, 1.35 [95% CI, 1.06-1.72]). Among men, the harmful association of drinking more than 60 g per day with IHD mortality in the low-SES group was largely explained by other behavioral risk factors (ie, smoking, body mass index, and physical activity). Conclusions and Relevance This cohort study found a greater protective association between drinking less than 20 g per day with less than monthly HED and IHD mortality in the high-SES group compared with the low-SES group, in both sexes even after adjusting for key covariables and behavioral risk factors. The findings suggest that public health interventions on alcohol use should account for different socioeconomic backgrounds when assessing the level of risk related to alcohol exposure, bearing in mind that levels of consumption deemed safe regarding a specific outcome such as IHD may indeed be less safe or not safe across all sociodemographic groups.
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Affiliation(s)
- Yachen Zhu
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Laura Llamosas-Falcón
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - William Kerr
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Klajdi Puka
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
- Heidelberg Institute of Global Health, Universitätsklinikum Heidelberg, Heidelberg, Germany
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Wu Q, Zhao Y, Liu L, Liu Y, Liu J. Trend, regional variation and socioeconomic inequality in cardiovascular disease among the elderly population in China: evidence from a nationwide longitudinal study during 2011-2018. BMJ Glob Health 2023; 8:e013311. [PMID: 38101937 PMCID: PMC10729065 DOI: 10.1136/bmjgh-2023-013311] [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: 07/05/2023] [Accepted: 10/21/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Cardiovascular disease (CVD) continues to pose a significant burden among the elderly population in China. There is a knowledge gap in the temporal trends, regional variations and socioeconomic inequalities among this vulnerable population. METHODS This study conducted cross-sectional and cohort analyses based on four survey waves of the China Health and Retirement Longitudinal Study among adults aged ≥60 years spanning 2011-2018 across 28 provinces. Cross-sectional analyses examined temporal trends, regional variations and socioeconomic inequalities in CVD prevalence. Cohort analyses identified individuals without CVD in 2011 and followed them up until 2018 to calculate CVD incidence. Generalised estimating equations (GEE) were employed to identify associated factors. RESULTS A total of 5451, 7258, 8820 and 11 393 participants were eligible for cross-sectional analyses, and 4392 and 5396 participants were included in cohort analyses of CVD and comorbid CVD. In 2018, the age-adjusted and sex-adjusted prevalence of CVD and comorbid CVD was 31.21% (95% CI 27.25% to 35.17%) and 3.83% (95% CI 2.85% to 4.81%), respectively. Trend analyses revealed a significant increase in the adjusted prevalence from 2011 to 2018 (p for trend <0.001). There were substantial provincial variations in the adjusted prevalence of CVD and comorbid CVD. Higher socioeconomic status (SES) participants exhibited higher prevalence, and the concentration curves and concentration indices suggested persistent but narrowing inequalities in CVD and comorbid CVD across survey waves. Cohort analyses from 2011 to 2018 yielded overall CVD and comorbid CVD incidence densities of 17.96 and 2.65 per 1000 person-years, respectively. GEE results indicated increased CVD risks among older individuals, women, higher SES participants and northern residents. CONCLUSION More efforts should be taken to optimise strategies for high-quality CVD prevention and management in China's elderly population. Future interventions and policies should address age-specific and gender-specific, geographical, and socioeconomic disparities to ensure equitable access and outcomes for all.
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Affiliation(s)
- Qiong Wu
- Graduate School of the PLA General Hospital, Chinese PLA General Hospital, Beijing, China
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Zhao
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lihua Liu
- Hospital Management Institute, Department of Innovative Medical Research, Chinese PLA General Hospital, Beijing, China
| | - Yuehui Liu
- Hospital Management Institute, Department of Innovative Medical Research, Chinese PLA General Hospital, Beijing, China
| | - Jianchao Liu
- Hospital Management Institute, Department of Innovative Medical Research, Chinese PLA General Hospital, Beijing, China
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Oliveira LM, Pelissari TR, Moreira CHC, Ardenghi TM, Demarco FF, Zanatta FB. The alcohol harm paradox and tooth loss among Brazilian older adults. Oral Dis 2023; 29:2971-2978. [PMID: 36578214 DOI: 10.1111/odi.14489] [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: 08/25/2022] [Revised: 12/11/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate whether the association between alcohol consumption and tooth loss is modified across socioeconomic positions (SEPs) in Brazilian older adults. METHODS We conducted a secondary analysis using data of The Brazilian Longitudinal Study of Ageing (ELSI-Brazil 2015-2016). Effect Measure Modification (EMM) analyses using multivariable Poisson regression models tested whether the association between heavy drinking and lack of functional dentition (FD) varies in magnitude and direction according to levels of Household Wealth index (HWI) and educational attainment, assessed by the Relative Excess Risk due to Interaction (RERI). Sensitivity analyses using lifetime exposure to alcohol were performed. RESULTS The analytical sample comprised 8078 participants. Heavy drinkers living in low-wealth households and with lower education presented 7% (95% CI: 1.01-1.14) and 36% (95% CI: 1.28-1.44) higher prevalence of lack of FD, respectively, than their counterparts, and super-additive associations were detected [RERI for HWI: 0.12 (95% CI: 0.02-0.21); RERI for educational attainment: 0.20 (95% CI: 0.09-0.30)]. The associations were also super-additive in the sensitivity analyses when controlling for abstainer reference group bias. CONCLUSION We suggest that alcohol consumption disproportionately impacts the prevalence of tooth loss in Brazilian older adults from lower SEP groups.
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Affiliation(s)
- Leandro Machado Oliveira
- Department of Stomatology, Postgraduate Program in Dentistry; Emphasis on Periodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
- Department of Stomatology, School of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Thayná Regina Pelissari
- Department of Stomatology, Postgraduate Program in Dentistry; Emphasis on Endodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Carlos Heitor Cunha Moreira
- Department of Stomatology, Postgraduate Program in Dentistry; Emphasis on Periodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
- Department of Stomatology, School of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Thiago Machado Ardenghi
- Department of Stomatology, School of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Flávio Fernando Demarco
- Graduate Program in Dentistry, Universidade Federal de Pelotas (UFPel), Pelotas, Brazil
- Graduate Program in Epidemiology, Universidade Federal de Pelotas (UFPel), Pelotas, Brazil
| | - Fabrício Batistin Zanatta
- Department of Stomatology, Postgraduate Program in Dentistry; Emphasis on Periodontics, Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
- Department of Stomatology, School of Dentistry, Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
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Dalene KE, Lergenmuller S, Sund ER, Hopstock LA, Robsahm TE, Nilssen Y, Nystad W, Larsen IK, Ariansen I. Clustering and trajectories of key noncommunicable disease risk factors in Norway: the NCDNOR project. Sci Rep 2023; 13:14479. [PMID: 37660221 PMCID: PMC10475033 DOI: 10.1038/s41598-023-41660-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/29/2023] [Indexed: 09/04/2023] Open
Abstract
Noncommunicable diseases (NCDs) are a leading cause of premature death globally and have common preventable risk factors. In Norway, the NCDNOR-project aims at establishing new knowledge in the prevention of NCDs by combining information from national registries with data from population-based health studies. In the present study, we aimed to harmonize data on key NCD risk factors from the health studies, describe clustering of risk factors using intersection diagrams and latent class analysis, and identify long-term risk factor trajectories using latent class mixed models. The harmonized study sample consisted of 808,732 individuals (1,197,158 participations). Two-thirds were exposed to ≥ 1 NCD risk factor (daily smoking, physical inactivity, obesity, hypertension, hypercholesterolaemia or hypertriglyceridaemia). In individuals exposed to ≥ 2 risk factors (24%), we identified five distinct clusters, all characterized by fewer years of education and lower income compared to individuals exposed to < 2 risk factors. We identified distinct long-term trajectories of smoking intensity, leisure-time physical activity, body mass index, blood pressure, and blood lipids. Individuals in the trajectories tended to differ across sex, education, and body mass index. This provides important insights into the mechanisms by which NCD risk factors can occur and may help the development of interventions aimed at preventing NCDs.
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Affiliation(s)
- Knut Eirik Dalene
- Department of Chronic Diseases, Norwegian Institute of Public Health, PO Box 222, 0213, Oslo, Skøyen, Norway.
| | - Simon Lergenmuller
- Department of Registration, Cancer Registry of Norway, PO Box 5313, 0304, Oslo, Majorstuen, Norway
| | - Erik R Sund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Oslo, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Laila A Hopstock
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Oslo, Norway
| | | | - Yngvar Nilssen
- Department of Registration, Cancer Registry of Norway, PO Box 5313, 0304, Oslo, Majorstuen, Norway
| | - Wenche Nystad
- Department of Chronic Diseases, Norwegian Institute of Public Health, PO Box 222, 0213, Oslo, Skøyen, Norway
| | - Inger Kristin Larsen
- Department of Registration, Cancer Registry of Norway, PO Box 5313, 0304, Oslo, Majorstuen, Norway
| | - Inger Ariansen
- Department of Chronic Diseases, Norwegian Institute of Public Health, PO Box 222, 0213, Oslo, Skøyen, Norway
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Choi HJ, LeBlanc M, Moger TA, Valberg M, Page CM, Aamodt G, Næss Ø. Geographical variation in cardiovascular disease mortality in Norway: The role of life course socioeconomic position and parental health. Health Place 2023; 83:103095. [PMID: 37659155 DOI: 10.1016/j.healthplace.2023.103095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 07/15/2023] [Accepted: 07/19/2023] [Indexed: 09/04/2023]
Abstract
Despite substantial geographical variation in cardiovascular (CVD) mortality within countries, little is known about whether this variation can be explained by individuals' life course socioeconomic position (SEP) or differences in family history of premature CVD deaths. Cox proportional hazards models were used to investigate the association between the county of residence at ages 50-59 and CVD death in Norwegians born between 1940 and 1959 and survived to at least age 60, using national data. Individual life course SEP and family history of premature CVD death reduced the geographical variation in CVD mortality across Norwegian counties, but some significant differences remained. Furthermore, CVD risk varied by residents' migration histories between two counties with distinct CVD and socioeconomic profiles.
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Affiliation(s)
- Hye Jung Choi
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Marissa LeBlanc
- Oslo Centre for Biostatistics and Epidemiology, University of Oslo, Oslo, Norway; Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Tron Anders Moger
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Morten Valberg
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway; Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Christian M Page
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway; Department of Mathematics, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Geir Aamodt
- Department of Public Health Science, LANDSAM, Norwegian University of Life Science, Ås, Norway
| | - Øyvind Næss
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway; Norwegian Institute of Public Health, Oslo, Norway
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Boyd J, Hayes K, Green D, Angus C, Holmes J. The contribution of health behaviour to socioeconomic inequalities in alcohol harm: Analysis of the UK biobank, a large cohort study with linked health outcomes. SSM Popul Health 2023; 23:101443. [PMID: 37334333 PMCID: PMC10275713 DOI: 10.1016/j.ssmph.2023.101443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/20/2023] Open
Abstract
This is the first study to use the UK Biobank database to: 1) test whether participants of a low socioeconomic position (SEP) are less likely to drink, but more likely to suffer alcohol-related harm, and 2) test the contribution of behavioural factors. The database contains health-related information from 500,000 UK residents that were recruited aged 40-69 between 2006 and 2010. Our analysis focuses on participants resident in England (86% of the total sample). We obtained baseline demographics, survey data regarding alcohol consumption and other behaviours, and linked death and hospital-admission records. The primary outcome was time from study entry to experiencing an alcohol-attributable event (hospital admission or death). The relationship between alcohol-attributable harm and five measures of SEP (area-level deprivation, housing tenure, employment status, household income and qualifications) was investigated using time-to-event analysis. Average weekly alcohol consumption, other drinking behaviours (drinking history and beverage preference), and lifestyle factors (BMI and smoking status) were added incrementally as covariates in nested regression models to investigate whether they could explain the relationship between harm and SEP. 432,722 participants (197,449 men and 235,273 women) were included in the analysis with 3,496,431 person-years of follow-up. Those of a low SEP were most likely to be never/former drinkers or high-risk drinkers. However, alcohol consumption could not explain experiences of alcohol-attributable harm between SEP groups (Hazard Ratio (HR) 1.48; 95% Confidence Interval 1.45-1.51, after adjusting for alcohol consumption). Drinking history, drinking mostly spirits, an unhealthy Body Mass Index and smoking all increased the risk of alcohol-attributable harm. However, these factors only partially explain SEP differences in alcohol harm as the HR for the most deprived vs the least deprived was still 1.28 after adjustment. This suggests that improving wider health behaviour of the most deprived could reduce alcohol-related inequalities. However, a substantial proportion of the variance in alcohol harm remains unexplained.
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Affiliation(s)
- Jennifer Boyd
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kate Hayes
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Dan Green
- College of Health and Life Sciences, Aston University, B4 7ET, Birmingham, UK
| | - Colin Angus
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - John Holmes
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Di Castelnuovo A, Bonaccio M, Costanzo S, McElduff P, Linneberg A, Salomaa V, Männistö S, Ferrières J, Dallongeville J, Thorand B, Brenner H, Ferrario M, Veronesi G, Tamosiunas A, Grimsgaard S, Drygas W, Malyutina S, Söderberg S, Nordendahl M, Kee F, Grassi G, Dabboura S, Borchini R, Westermann D, Schrage B, Zeller T, Kuulasmaa K, Blankenberg S, Donati MB, Iacoviello L, de Gaetano G. Drinking alcohol in moderation is associated with lower rate of all-cause mortality in individuals with higher rather than lower educational level: findings from the MORGAM project. Eur J Epidemiol 2023; 38:869-881. [PMID: 37386255 DOI: 10.1007/s10654-023-01022-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/24/2023] [Indexed: 07/01/2023]
Abstract
The association between socioeconomic status (SES) and alcohol-related diseases has been widely explored. Less is known, however, on whether the association of moderate drinking with all-cause mortality is modified by educational level (EL). Using harmonized data from 16 cohorts in the MORGAM Project (N = 142,066) the association of pattern of alcohol intake with hazard of all-cause mortality across EL (lower = primary-school; middle = secondary-school; higher = university/college degree) was assessed using multivariable Cox-regression and spline curves. A total of 16,695 deaths occurred in 11.8 years (median). In comparison with life-long abstainers, participants drinking 0.1-10 g/d of ethanol had 13% (HR = 0.87; 95%CI: 0.74-1.02), 11% (HR = 0.89; 0.84-0.95) and 5% (HR = 0.95; 0.89-1.02) lower rate of death in higher, middle and lower EL, respectively. Conversely, drinkers > 20 g/d had 1% (HR = 1.01; 0.82-1.25), 10% (HR = 1.10; 1.02-1.19) and 17% (HR = 1.17; 1.09-1.26) higher rate of death. The association of alcohol consumption with all-cause mortality was nonlinear, with a different J-shape by EL levels. It was consistent across both sexes and in various approaches of measuring alcohol consumption, including combining quantity and frequency and it was more evident when the beverage of preference was wine. We observed that drinking in moderation (≤ 10 g/d) is associated with lower mortality rate more evidently in individuals with higher EL than in people with lower EL, while heavy drinking is associated with higher mortality rate more evidently in individuals with lower EL than in people with higher EL, suggesting that advice on reducing alcohol intake should especially target individuals of low EL.
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Affiliation(s)
| | - Marialaura Bonaccio
- Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077, Pozzilli, IS, Italy
| | - Simona Costanzo
- Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077, Pozzilli, IS, Italy
| | - Patrick McElduff
- Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Allen Linneberg
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Veikko Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Satu Männistö
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jean Ferrières
- Department of Cardiology and INSERM UMR 1295, Toulouse University Hospital, Toulouse, France
| | - Jean Dallongeville
- Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1167 - RID-AGE, 59000, Lille, France
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research and Division of Preventive Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Marco Ferrario
- Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
| | - Giovanni Veronesi
- Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy
| | | | - Sameline Grimsgaard
- Department of Community Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Wojciech Drygas
- Department of Epidemiology CVD Prevention and Health Promotion, National Institute of Cardiology, Warsaw, Poland
- Calisia University, 62-800, Kalisz, Poland
| | - Sofia Malyutina
- The Institute of Internal and Preventive Medicine -Branch of the "FRC Institute of Cytology and Genetics SB RAS", Novosibirsk, Russia
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine and Heart Centre, Umeå University, Umeå, Sweden
| | - Maria Nordendahl
- Department of Public Health and Clinical Medicine and Heart Centre, Umeå University, Umeå, Sweden
| | - Frank Kee
- Centre for Public Health, Queens University of Belfast, Belfast, Northern Ireland
| | - Guido Grassi
- Clinica Medica, Università Milano-Bicocca, Milan, Italy
| | - Salim Dabboura
- Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for Cardiovascular Research, partner site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | | | - Dirk Westermann
- Department for Cardiology and Angiology, Medical Faculty of Medicine, University Heart Center Freiburg-Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Benedikt Schrage
- Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for Cardiovascular Research, partner site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Tanja Zeller
- Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for Cardiovascular Research, partner site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Kari Kuulasmaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Stefan Blankenberg
- Clinic of General and Interventional Cardiology, University Heart & Vascular Center Hamburg, Germany, and German Center for Cardiovascular Research, partner site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | | | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077, Pozzilli, IS, Italy.
- Department of Medicine and Surgery, Research Center in Epidemiology and Preventive Medicine (EPIMED), University of Insubria, Varese, Italy.
| | - Giovanni de Gaetano
- Department of Epidemiology and Prevention, IRCCS NEUROMED, 86077, Pozzilli, IS, Italy
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Norström T, Landberg J. The association between population drinking and ischemic heart disease mortality in educational groups. Alcohol Alcohol 2023:7161016. [PMID: 37208001 DOI: 10.1093/alcalc/agad033] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 05/21/2023] Open
Abstract
A large number of observational studies have found a J-shaped relationship between alcohol intake and ischemic heart disease (IHD) risk. However, some studies suggest that the alleged cardio-protective effect may be an artifact in the way that the elevated risk for abstainers is due to self-selection on risk factors for IHD. The aim of this paper is to estimate the association between alcohol and IHD-mortality on the basis of aggregate time-series data, where the problem with selection effects is not present. In addition, we will analyze SES-specific mortality to investigate whether there is any socio-economic gradient in the relationship at issue. SES was measured by educational level. We used IHD-mortality in three educational groups as outcome. Per capita alcohol consumption was proxied by Systembolaget's alcohol sales (litres of alcohol 100% per capita 15+). Swedish quarterly data on mortality and alcohol consumption spanned the period 1991Q1-2020Q4. We applied SARIMA time-series analysis. Survey data were used to construct an indicator of heavy SES-specific episodic drinking. The estimated association between per capita consumption and IHD-mortality was positive and statistically significant in the two groups with primary and secondary education, but not in the group with postsecondary education. The association was significantly stronger the lower the educational group. Although the associations were generally stronger for males than for females, these differences were not statistically significant (P > 0.05). Our findings suggest that the detrimental impact of per capita consumption on IHD-mortality was stronger the lower the educational group.
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Affiliation(s)
- Thor Norström
- Swedish Institute for Social Research (SOFI), Stockholm University, Stockholm 109 91, Sweden
| | - Jonas Landberg
- Department of Public Health Sciences, Stockholm University, Stockholm 106 91, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm 171 77, Sweden
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11
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Makama M, Brown WJ, Lim S, Skouteris H, Harrison CL, Joham AE, Mishra GD, Teede H, Moran LJ. Levels of physical activity and sitting time in women with infants, toddlers and preschoolers: a population-based cross-sectional study. Public Health 2023; 214:1-9. [PMID: 36417813 DOI: 10.1016/j.puhe.2022.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/29/2022] [Accepted: 10/14/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Insufficient physical activity (PA) and prolonged sitting time (ST) increase the risk of chronic disease and mortality. Caring for young children can potentially impact maternal PA and sedentary behaviours. The aims of this study were to explore the levels of PA and ST in women with young children (infants, toddlers and preschoolers) and sociodemographic and behavioural factors associated with these. STUDY DESIGN This was a population-based cross-sectional study. METHODS Survey 5 data collected in 2009 (n = 4290) of the 1973-1978 birth cohort of the Australian Longitudinal Study on Women's Health were used. Multiple linear and logistic regression models were used to examine associations. RESULTS In adjusted models, compared with women with preschoolers, women whose youngest child was an infant aged 0-6 months, aged >6-12 months or toddler had lower PA (-321.3 MET.min/week [95% confidence interval (CI) -416.2, -226.4], -147.9 MET.min/week [95% CI -237.6, -58.1] and -106.4 MET.min/week [95% CI -172.3, -40.5]). ST was higher in women whose youngest child was an infant aged 0-6 months (0.48 h/day; 95% CI 0.19, 0.77) but lower with infants aged >6-12 months (-0.33 h/day; 95% CI -0.60, -0.05) and toddlers (-0.40 h/day; 95% CI -0.60, -0.20) than in those with preschoolers. The findings were similar in the logistic model. Sociodemographic and behavioural factors such as occupation and marital status also influenced PA and ST. CONCLUSIONS Women with infants and toddlers have lower PA than women with preschoolers. Women are more likely to sit more in the first 6 months after childbirth. These findings can inform resources and intervention development to improve activity levels in women with young children through consideration of the age of the youngest child, sociodemographic and behavioural factors.
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Affiliation(s)
- M Makama
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia
| | - W J Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, St Lucia, Queensland, Australia; Faculty of Health Science and Medicine, Bond University, Gold Coast, Australia
| | - S Lim
- Health Systems and Equity, Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - H Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Warwick Business School, Warwick University, Coventry, United Kingdom
| | - C L Harrison
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia; Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
| | - A E Joham
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia; Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
| | - G D Mishra
- Centre for Longitudinal and Life Course Research, University of Queensland, Brisbane, Queensland, Australia
| | - H Teede
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia; Warwick Business School, Warwick University, Coventry, United Kingdom; Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
| | - L J Moran
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Victoria, Australia.
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12
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Wang D, Dai X, Mishra SR, Lim CCW, Carrillo-Larco RM, Gakidou E, Xu X. Association between socioeconomic status and health behaviour change before and after non-communicable disease diagnoses: a multicohort study. Lancet Public Health 2022; 7:e670-e682. [PMID: 35907418 DOI: 10.1016/s2468-2667(22)00157-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/23/2022] [Accepted: 06/10/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Behavioural risk factors of non-communicable diseases (NCDs) are socially patterned. However, the direction and the extent to which socioeconomic status (SES) influences behaviour changes before and after the diagnosis of NCDs is not clearly understood. We aimed to investigate the influence of SES on behaviour changes (physical inactivity and smoking) before and after the diagnosis of major NCDs. METHODS In this multicohort study, we pooled individual-level data from six prospective cohort studies across 17 countries. We included participants who were diagnosed with either diabetes, cardiovascular disease, chronic lung disease, or cancer after recruitment. Participants were surveyed every 2 years. Education and total household wealth were used to construct SES. We measured behaviour changes as whether or not participants continued or initiated physical inactivity or smoking after NCD diagnosis. We used multivariable logistic regression models to estimate odds ratios (ORs), prevalence ratios (PRs), and 95% CIs for the associations between SES and continuation or initiation of unfavourable behaviours. FINDINGS We included 8107 individuals recruited between March, 2002, and January, 2016. Over the 4-year period before and after NCD diagnosis, 886 (60·4%) of 1466 individuals continued physical inactivity and 1018 (68·8%) of 1480 participants continued smoking; 1047 (15·8%) of 6641 participants with physical activity before diagnosis initiated physical inactivity after diagnosis and 132 (2·0%) of 6627 non-smokers before diagnosis initiated smoking after diagnosis. Compared with participants with high SES, those with low SES were more likely to continue physical inactivity (244 [70·3%] of 347 vs 23 [50.0%] of 46; PR 1·41 [95% CI 1·05-1·99]; OR 2·28 [1·18-4·41]), continue smoking (214 [75·4%] of 284 vs 39 [60·9%] of 64; PR 1·27 [1·03-1·59]; OR 2·08 [1·14-3·80]), but also to initiate physical inactivity (188 [26·1%] of 720 vs 47 [7·4%] of 639; PR 3·59 [2·58-4·85]; OR 4·31 [3·02 - 6·14]). INTERPRETATION Low SES was associated with continuing or initiating physical inactivity and continuing smoking after NCD diagnosis. Reducing socioeconomic inequality in health behaviour changes should be prioritised and integrated into NCD-prevention programmes. FUNDING Zhejiang University and Fundamental Research Funds for the Central Universities.
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Affiliation(s)
- Danyang Wang
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaochen Dai
- Department of Health Metrics Sciences, School of Medicine, School of Public Health, University of Washington, Seattle, USA; Institute for Health Metrics and Evaluation, School of Public Health, University of Washington, Seattle, USA
| | - Shiva Raj Mishra
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Academy for Data Sciences and Global Health, Kathmandu, Nepal
| | - Carmen C W Lim
- National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, QLD, Australia; School of Psychology, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Rodrigo M Carrillo-Larco
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Emmanuela Gakidou
- Department of Health Metrics Sciences, School of Medicine, School of Public Health, University of Washington, Seattle, USA; Institute for Health Metrics and Evaluation, School of Public Health, University of Washington, Seattle, USA; Department of Global Health, School of Public Health, University of Washington, Seattle, USA; Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, USA
| | - Xiaolin Xu
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China; School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
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13
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Tesli M, Degerud E, Plana‐Ripoll O, Gustavson K, Torvik FA, Ystrom E, Ask H, Tesli N, Høye A, Stoltenberg C, Reichborn‐Kjennerud T, Nesvåg R, Næss Ø. Educational attainment and mortality in schizophrenia. Acta Psychiatr Scand 2022; 145:481-493. [PMID: 35152418 PMCID: PMC9305099 DOI: 10.1111/acps.13407] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Individuals suffering from schizophrenia have a reduced life expectancy with cardiovascular disease (CVD) as a major contributor. Low educational attainment is associated with schizophrenia, as well as with all-cause and CVD mortality. However, it is unknown to what extent low educational attainment can explain the increased mortality in individuals with schizophrenia. AIM Here, we quantify associations between educational attainment and all-cause and CVD mortality in individuals with schizophrenia, and compare them with the corresponding associations in the general population. METHOD All Norwegian citizens born between January 1, 1925, and December 31, 1959, were followed up from January 1, 1990, to December 31, 2014. The total sample included 1,852,113 individuals, of which 6548 were registered with schizophrenia. We estimated hazard ratios (HR) for all-cause and CVD mortality with Cox models, in addition to life years lost. Educational attainment for index persons and their parents were included in the models. RESULTS In the general population individuals with low educational attainment had higher risk of all-cause (HR: 1.48 [95% CI: 1.47-1.49]) and CVD (HR: 1.59 [95% CI: 1.57-1.61]) mortality. In individuals with schizophrenia these estimates were substantially lower (all-cause: HR: 1.13 [95% CI: 1.05-1.21] and CVD: HR: 1.12 [95% CI: 0.98-1.27]). Low educational attainment accounted for 3.28 (3.21-3.35) life years lost in males and 2.48 (2.42-2.55) years in females in the general population, but was not significantly associated with life years lost in individuals with schizophrenia. Results were similar for parental educational attainment. CONCLUSIONS Our results indicate that while individuals with schizophrenia in general have lower educational attainment and higher mortality rates compared with the general population, the association between educational attainment and mortality is smaller in schizophrenia subjects than in the general population.
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Affiliation(s)
- Martin Tesli
- Norwegian Institute of Public HealthOsloNorway,Norwegian Centre for Mental Disorders ResearchOslo University HospitalOsloNorway
| | | | - Oleguer Plana‐Ripoll
- Department of Economics and Business EconomicsNational Centre for Register‐Based ResearchAarhus UniversityAarhus VDenmark,Department of Clinical EpidemiologyAarhus University and Aarhus University HospitalAarhus NDenmark
| | - Kristin Gustavson
- Norwegian Institute of Public HealthOsloNorway,Department of PsychologyUniversity of OsloOsloNorway
| | - Fartein Ask Torvik
- Norwegian Institute of Public HealthOsloNorway,Department of PsychologyUniversity of OsloOsloNorway
| | - Eivind Ystrom
- Norwegian Institute of Public HealthOsloNorway,Department of PsychologyUniversity of OsloOsloNorway,PharmacoEpidemiology and Drug Safety Research GroupSchool of PharmacyUniversity of OsloOsloNorway
| | - Helga Ask
- Norwegian Institute of Public HealthOsloNorway
| | - Natalia Tesli
- Norwegian Centre for Mental Disorders ResearchOslo University HospitalOsloNorway
| | - Anne Høye
- Division of Mental Health and Substance AbuseUniversity Hospital of North NorwayTromsøNorway,Department of Clinical MedicineThe Arctic University of NorwayTromsøNorway
| | - Camilla Stoltenberg
- Norwegian Institute of Public HealthOsloNorway,Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
| | - Ted Reichborn‐Kjennerud
- Norwegian Institute of Public HealthOsloNorway,Institute of Clinical MedicineUniversity of OsloOsloNorway
| | | | - Øyvind Næss
- Norwegian Institute of Public HealthOsloNorway,Institute of Health and SocietyUniversity of OsloOsloNorway
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14
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BMI, Blood Pressure, and Plasma Lipids among Centenarians and Their Offspring. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3836247. [PMID: 35096109 PMCID: PMC8794670 DOI: 10.1155/2022/3836247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/30/2021] [Indexed: 11/20/2022]
Abstract
Background The burden of cardiovascular diseases (CVDs) is increasing substantially due to population growth and aging. Determining effective prevention and understanding the underlying mechanisms remain desirable pursuits for increasing the quality of life. As centenarians and their offspring may have genetic advantages, they may present with healthier cardiovascular-related profiles. Methods We launched a cross-sectional household-based survey of centenarian families, including 253 centenarians, 217 centenarian offspring, and 116 offspring spouses without centenarian parents from county-level Chinese longevity city Rugao. Among offspring and offspring spouses were the following arrangements: 101 paired offspring and offspring spouses who lived together, 116 unpaired offspring, and 16 unpaired spouses. We investigated their cardiovascular-related health status including waist circumference, body mass index (BMI), blood pressure, and plasma lipids and compared results among centenarians, centenarian offspring, and offspring spouses. Results Centenarians ranged from 99 to 109 years with a median age of 100 years. Centenarian offspring, with a median age of 70 years, and offspring spouses, with a median age of 69 years, shared similar age. Results of blood pressure, plasma lipid levels, and BMI displayed no significant difference between centenarian offspring and offspring spouses. However, centenarians appeared to have lower waist circumference, BMI, TC, LDL-C, TG, and diastolic blood pressure but higher levels of systolic blood pressure (p < 0.05). Multivariate analysis showed the prevalence of obesity, hypertension, and dyslipidemia was similar between centenarian offspring and offspring spouses, while centenarians appeared to have a lower prevalence of obesity and a higher prevalence of hypertension (p < 0.05). Conclusions Centenarians and centenarian offspring did not present healthier BMI, blood pressure, or plasma lipids than offspring spouses. Further research on longevity and cardiovascular diseases are desirable.
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15
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Boyd J, Sexton O, Angus C, Meier P, Purshouse RC, Holmes J. Causal mechanisms proposed for the alcohol harm paradox-a systematic review. Addiction 2022; 117:33-56. [PMID: 33999487 PMCID: PMC8595457 DOI: 10.1111/add.15567] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/17/2020] [Accepted: 04/28/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS The alcohol harm paradox (AHP) posits that disadvantaged groups suffer from higher rates of alcohol-related harm compared with advantaged groups, despite reporting similar or lower levels of consumption on average. The causes of this relationship remain unclear. This study aimed to identify explanations proposed for the AHP. Secondary aims were to review the existing evidence for those explanations and investigate whether authors linked explanations to one another. METHODS This was a systematic review. We searched MEDLINE (1946-January 2021), EMBASE (1974-January 2021) and PsycINFO (1967-January 2021), supplemented with manual searching of grey literature. Included papers either explored the causes of the AHP or investigated the relationship between alcohol consumption, alcohol-related harm and socio-economic position. Papers were set in Organization for Economic Cooperation and Development high-income countries. Explanations extracted for analysis could be evidenced in the empirical results or suggested by researchers in their narrative. Inductive thematic analysis was applied to group explanations. RESULTS Seventy-nine papers met the inclusion criteria and initial coding revealed that these papers contained 41 distinct explanations for the AHP. Following inductive thematic analysis, these explanations were grouped into 16 themes within six broad domains: individual, life-style, contextual, disadvantage, upstream and artefactual. Explanations related to risk behaviours, which fitted within the life-style domain, were the most frequently proposed (n = 51) and analysed (n = 21). CONCLUSIONS While there are many potential explanations for the alcohol harm paradox, most research focuses on risk behaviours while other explanations lack empirical testing.
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Affiliation(s)
- Jennifer Boyd
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Olivia Sexton
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Colin Angus
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Petra Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Robin C. Purshouse
- Department of Automatic Control and Systems Engineering, University of Sheffield, Sheffield, UK
| | - John Holmes
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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16
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Donat M, Barrio G, Pulido J, Pérez C, Belza MJ, Regidor E. The limits of measuring binge drinking prevalence for epidemiological surveillance: An example from Spain. Drug Alcohol Depend 2021; 228:109022. [PMID: 34507008 DOI: 10.1016/j.drugalcdep.2021.109022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/16/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The public health impact of binge drinking depends on its population prevalence and its frequency and intensity among binge drinkers. The objective is to assess the consistency of time trends and age-sex disparities between binge-drinking prevalence and binge-drinking exposure indicators that combine such prevalence with the number of binge-drinking days among binge drinkers. METHODS Data come from 11 biennial national household surveys from 1997 to 2017 in young (15-34 years) and middle-aged adults (35-64 years) in Spain (n = 211,961). Binge-drinking was the intake of 5+ standard drinks (4+ in women from 2009 onwards) in approximately two hours. Three monthly indicators were analyzed: binge-drinking prevalence, population rate of binge-drinking days, and proportion of drinking days with binge drinking. Results were stratified for sex and two age groups. Annual percent changes (APCs), ratios of young to middle-aged people (age ratios) and men-to-women ratios were obtained from negative binomial regression. RESULTS Although the three indicators showed considerable consistency as an intense increase in binge drinking from 2009 to 2017 among middle-aged people, especially women, there were relevant inconsistencies. In 2009-2017 the APCs for prevalence and rate were +1.3 % and -1.6 %, respectively, in young women, and -0.6 % and -3.0 % in young men. Age ratios were significantly higher for prevalence and proportional ratio than rates, while men-to-women ratios were lower, especially in middle-aged people. CONCLUSIONS Adequate monitoring of binge drinking should incorporate indicators of absolute exposure, which better reflect its impact on public health, such as the population rate of binge-drinking days.
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Affiliation(s)
- Marta Donat
- National School of Public Health, Carlos III Health Institute, Madrid, Spain; Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Gregorio Barrio
- National School of Public Health, Carlos III Health Institute, Madrid, Spain; Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - José Pulido
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense, Madrid, Spain.
| | - César Pérez
- National School of Public Health, Carlos III Health Institute, Madrid, Spain.
| | - María J Belza
- National School of Public Health, Carlos III Health Institute, Madrid, Spain; Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - Enrique Regidor
- Biomedical Research Center Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense, Madrid, Spain; Health Research Institute of San Carlos (IdISSC), Madrid, Spain.
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17
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Alcohol's Impact on the Cardiovascular System. Nutrients 2021; 13:nu13103419. [PMID: 34684419 PMCID: PMC8540436 DOI: 10.3390/nu13103419] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/21/2022] Open
Abstract
Alcohol consumption has been shown to have complex, and sometimes paradoxical, associations with cardiovascular diseases (CVDs). Several hundred epidemiological studies on this topic have been published in recent decades. In this narrative review, the epidemiological evidence will be examined for the associations between alcohol consumption, including average alcohol consumption, drinking patterns, and alcohol use disorders, and CVDs, including ischaemic heart disease, stroke, hypertension, atrial fibrillation, cardiomyopathy, and heart failure. Methodological shortcomings, such as exposure classification and measurement, reference groups, and confounding variables (measured or unmeasured) are discussed. Based on systematic reviews and meta-analyses, the evidence seems to indicate non-linear relationships with many CVDs. Large-scale longitudinal epidemiological studies with multiple detailed exposure and outcome measurements, and the extensive assessment of genetic and confounding variables, are necessary to elucidate these associations further. Conflicting associations depending on the exposure measurement and CVD outcome are hard to reconcile, and make clinical and public health recommendations difficult. Furthermore, the impact of alcohol on other health outcomes needs to be taken into account. For people who drink alcohol, the less alcohol consumed the better.
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Degerud E, Høiseth G, Mørland J, Ariansen I, Graff-Iversen S, Ystrom E, Zuccolo L, Tell GS, Næss Ø. Associations of Binge Drinking With the Risks of Ischemic Heart Disease and Stroke: A Study of Pooled Norwegian Health Surveys. Am J Epidemiol 2021; 190:1592-1603. [PMID: 33720294 PMCID: PMC8489425 DOI: 10.1093/aje/kwab063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 03/04/2021] [Accepted: 03/10/2021] [Indexed: 11/14/2022] Open
Abstract
Norwegian health survey data (1987-2003) were analyzed to determine if binge drinking increases the risk of incident major events from ischemic heart disease (IHD) and stroke. Among current drinkers reporting average alcohol intakes of 2.00-59.99 g/day (n = 44,476), frequent binge drinking (≥5 units at least once per month) was not associated with a greater risk of IHD (adjusted hazard ratio (HR) = 0.91, 95% confidence interval (CI): 0.76, 1.09) or stroke (adjusted HR = 0.98, 95% CI: 0.81, 1.19), in comparison with participants who reported that they never or only infrequently (less than once per month) had episodes of binge drinking. Participants with an average alcohol intake of 2.00-59.99 g/day had a lower risk of IHD in comparison with participants with very low intakes (<2.00 g/day), both among frequent binge drinkers (adjusted HR = 0.67, 95% CI: 0.56, 0.80) and among never/infrequent binge drinkers (adjusted HR = 0.75, 95% CI: 0.67, 0.84). The findings suggest that frequent binge drinking, independent of average alcohol intake, does not increase the risk of incident IHD or stroke events. However, the findings should be interpreted in light of the limitations of the study design.
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Affiliation(s)
- Eirik Degerud
- Correspondence to Dr Eirik Degerud, Department of Chronic Diseases and Ageing, Division of Mental and Physical Health, Norwegian Institute of Public Health, PO Box 222, Skøyen, N-0213 Oslo, Norway (e-mail: )
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Boyd J, Bambra C, Purshouse RC, Holmes J. Beyond Behaviour: How Health Inequality Theory Can Enhance Our Understanding of the 'Alcohol-Harm Paradox'. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6025. [PMID: 34205125 PMCID: PMC8199939 DOI: 10.3390/ijerph18116025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/24/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022]
Abstract
There are large socioeconomic inequalities in alcohol-related harm. The alcohol harm paradox (AHP) is the consistent finding that lower socioeconomic groups consume the same or less as higher socioeconomic groups yet experience greater rates of harm. To date, alcohol researchers have predominantly taken an individualised behavioural approach to understand the AHP. This paper calls for a new approach which draws on theories of health inequality, specifically the social determinants of health, fundamental cause theory, political economy of health and eco-social models. These theories consist of several interwoven causal mechanisms, including genetic inheritance, the role of social networks, the unequal availability of wealth and other resources, the psychosocial experience of lower socioeconomic position, and the accumulation of these experiences over time. To date, research exploring the causes of the AHP has often lacked clear theoretical underpinning. Drawing on these theoretical approaches in alcohol research would not only address this gap but would also result in a structured effort to identify the causes of the AHP. Given the present lack of clear evidence in favour of any specific theory, it is difficult to conclude whether one theory should take primacy in future research efforts. However, drawing on any of these theories would shift how we think about the causes of the paradox, from health behaviour in isolation to the wider context of complex interacting mechanisms between individuals and their environment. Meanwhile, computer simulations have the potential to test the competing theoretical perspectives, both in the abstract and empirically via synthesis of the disparate existing evidence base. Overall, making greater use of existing theoretical frameworks in alcohol epidemiology would offer novel insights into the AHP and generate knowledge of how to intervene to mitigate inequalities in alcohol-related harm.
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Affiliation(s)
- Jennifer Boyd
- School of Health and Related Research, The University of Sheffield, S1 4DA Sheffield, UK;
| | - Clare Bambra
- Population Heath Sciences Institute, Faculty of Medical Sciences, Newcastle University, NE2 4HH Newcastle upon Tyne, UK;
| | - Robin C. Purshouse
- Department of Automatic Control and Systems Engineering, The University of Sheffield, S1 3JD Sheffield, UK;
| | - John Holmes
- School of Health and Related Research, The University of Sheffield, S1 4DA Sheffield, UK;
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20
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Molina-de la Fuente I, Pastor A, Conde P, Sandín Vázquez M, Ramos C, Bosque-Prous M, Franco M, Sureda X. Residents perceptions of the alcohol environment: A participatory photovoice project in two districts with different socio-economic status in a large city. Health Place 2021; 69:102566. [PMID: 33873132 DOI: 10.1016/j.healthplace.2021.102566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to present the alcohol environment as perceived by its residents in two districts of Madrid using the Photovoice participatory methodology. Secondly, we compared the results according to the socio-economic status of the districts. The study was conducted in the city of Madrid, Spain, in two districts with different socio-economic status. A total of 26 people participated, who took and discussed photographs about their alcohol environment. They grouped them into 33 final categories, such as the socialising role of alcohol or the alcohol advertising. Co-authors further grouped participants final categories into seven general areas. The participants in the Photovoice project have helped to deepen the understanding of the alcohol urban environment. These results may help to design more effective policies to prevent hazardous alcohol consumption.
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Affiliation(s)
- Irene Molina-de la Fuente
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, 28871, Spain; Department of Biomedicine and Biotechnology, University of Alcalá, Alcalá de Henares, Madrid, Spain; Malaria and Neglected Diseases Laboratory, National Centre of Tropical Medicine, Institute of Health Carlos III, Madrid, 28029, Spain
| | - Andrea Pastor
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, 28871, Spain
| | - Paloma Conde
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, 28871, Spain
| | - María Sandín Vázquez
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, 28871, Spain; Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, USA
| | - Carmen Ramos
- Public Health Institute of Madrid, Madrid City Council, 28007, Madrid, Spain
| | - Marina Bosque-Prous
- Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Manuel Franco
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, 28871, Spain; Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, 10027, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health. 615 North Wolfe Street, Baltimore, 21205, Maryland, USA
| | - Xisca Sureda
- Public Health and Epidemiology Research Group, School of Medicine, University of Alcalá, Alcalá de Henares, Madrid, 28871, Spain; Department of Epidemiology & Biostatistics, Graduate School of Public Health & Health Policy, City University of New York, New York, NY, 10027, USA; Tobacco Control Research Group, Institut D'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Consortium for Biomedical Research in Respirarory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain.
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21
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Grønbæk M, Ellison RC, Skovenborg E. The J-shaped curve-conceptual and methodological challenges. DRUGS AND ALCOHOL TODAY 2021. [DOI: 10.1108/dat-09-2020-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to review the conceptual and methodological challenges of a J-shaped association between alcohol consumption (AC), coronary heart disease (CHD) and all-cause mortality. In associated papers in this journal, Skovenborg et al., 2021 reviews the evidence for the J-shaped curve, and Ellison et al., 2021 examines the advantages and drawbacks of Mendelian randomization studies of the J-shaped curve.
Design/methodology/approach
A number of methodological problems are common in observational research in general, and some of the methodological problems suggested for the J-shaped alcohol-CHD-associations are discussed. The extent of the methodological problems in studies of the J-shaped curve is reviewed, and the possibility that the J-shaped curve is an artifact created by reverse causality and residual confounding is discussed. Further, the issue of interaction with drinking pattern and type of alcohol is discussed.
Findings
Imprecise categorization of alcohol intake information seems to have had little effect on the J-shaped alcohol-CHD-associations, nor has it affected the ability of these studies to show increasing mortality from a range of causes with increasing AC. The problem of “sick quitters” has been resolved by large studies using lifelong abstainers or infrequent drinkers as reference group. Many studies lack information on drinking patterns with regard to regular, moderate consumption versus binge drinking. Stratified analyses by important risk factors for CHD have not significantly changed the J-shaped association observed in most epidemiologic studies.
Originality/value
Potential biases and residual confounding probably do not overcome the J-shaped alcohol-CDH-association observed in most epidemiologic studies; however, the existence of a J-shaped curve is challenged by some degree of uncertainty. The actual review together with the associated papers by Skovenborg et al., 2021 and Ellison et al., 2021 offers a possibility to “update your priors” and achieve greater certainty when giving your patients information on the pros and cons of alcohol intake.
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22
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Rautenbach PH, Nienaber-Rousseau C, Pieters M. The association of alcohol with circulating total fibrinogen and plasma clot density is mediated by fibrinogen and FXIII genotypes. Thromb J 2020; 18:35. [PMID: 33292263 PMCID: PMC7706066 DOI: 10.1186/s12959-020-00249-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/12/2020] [Indexed: 01/01/2023] Open
Abstract
Background Alcohol consumption is associated with haemostasis and so may influence cardiovascular conditions. It is unknown whether the association of alcohol with total and γ’ fibrinogen concentrations, as well as clot structure, are modulated by fibrinogen and factor (F) XIII single nucleotide polymorphisms (SNPs). Methods Total fibrinogen, γ’ fibrinogen and clot properties of 2010 healthy Africans residing in South Africa were measured in relation to alcohol intake as well as its markers – gamma-glutamyltransferase (GGT), percentage carbohydrate deficient transferrin (%CDT), aspartate aminotransferase (AST), and alanine aminotransferase (ALT). Fourteen fibrinogen and two SNPs in the FXIII gene were genotyped to determine their influence. Results Alcohol intake and its markers correlated negatively with fibrinogen and clot lysis time (CLT) as well as with most of the clot properties. Percentage γ’ fibrinogen correlated positively with AST and negatively with alcohol intake. We then stratified for alcohol intake and found inverse associations between γ’ fibrinogen and both %CDT and GGT–CDT in consumers, but the positive association with AST remained only in abstainers. Alcohol intake and its markers modulated the influence of fibrinogen SNPs on total fibrinogen concentrations and the fibrinogen SNPs as well as an FXIII SNP on clot density (all p < 0.004). Conclusion/s We show for the first time that some individuals harbour certain genotypes that, in combination with alcohol consumption, might predispose or protect them from haemostatic factors that might lead to the development of cardiovascular disease. Studies are needed to clarify the mechanisms related to the interplay between alcohol and the gene variants observed here.
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Affiliation(s)
- Petro Hannie Rautenbach
- Centre of Excellence for Nutrition, North-West University, Private bag x6001, Nutrition, Box 594, Potchefstroom, 2520, South Africa
| | - Cornelie Nienaber-Rousseau
- Centre of Excellence for Nutrition, North-West University, Private bag x6001, Nutrition, Box 594, Potchefstroom, 2520, South Africa. .,Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa.
| | - Marlien Pieters
- Centre of Excellence for Nutrition, North-West University, Private bag x6001, Nutrition, Box 594, Potchefstroom, 2520, South Africa.,Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
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23
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Ariansen I, Degerud E, Gjesdal K, Tell GS, Næss Ø. Examining the lower range of the association between alcohol intake and risk of incident hospitalization with atrial fibrillation. IJC HEART & VASCULATURE 2020; 31:100679. [PMID: 34095445 PMCID: PMC8164130 DOI: 10.1016/j.ijcha.2020.100679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/05/2020] [Accepted: 11/13/2020] [Indexed: 01/19/2023]
Abstract
Background Evidence is sparse on the association between alcohol intakes in the lower range and risk of atrial fibrillation (AF). We aimed to investigate self-reported low and moderate alcohol intakes and subsequent risk of incident AF among current drinkers. Methods Norwegian population-based health examination surveys assessing self-reported daily alcohol intake (mean grams per day) were linked to health and population registers. Hazard ratios (HR) (95% confidence interval) for time to incident (first) hospitalization with AF by alcohol intake level were assessed by Cox regression, with adjustment for educational level and cardiovascular risk factors except blood pressure. Results The study population included 234,392 participants (49% men). Incident hospitalization with AF was identified in 5043 (2.2%) persons during a mean follow-up of 9 years. Compared to a very low alcohol intake of <1 unit weekly, a moderate consumption in the range of 1 to <2 units daily increased the risk of incident AF by 18% (HR 1.18 [1.06-1.32]). The average risk of incident AF increased by 9% per daily alcohol unit of 12 g (HR 1.09 [1.03, 1.14]). In sex-stratified analyses significant associations were found in men only. Conclusions We found that less than two alcohol units/day significantly increased the risk of incident AF, however, in men only. Reduction of even a moderate alcohol intake may thus reduce the risk of AF at the population level.
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Affiliation(s)
- Inger Ariansen
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Eirik Degerud
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.,Department of Occupational Health Surveillance, National Institute of Occupational Health, Oslo, Norway
| | - Knut Gjesdal
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Øyvind Næss
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
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24
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Mahtta D, Khalid U, Misra A, Samad Z, Nasir K, Virani SS. Premature Atherosclerotic Cardiovascular Disease: What Have We Learned Recently? Curr Atheroscler Rep 2020; 22:44. [PMID: 32671484 DOI: 10.1007/s11883-020-00862-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW In contrast to patients with non-premature atherosclerotic cardiovascular disease (ASCVD), patients with premature ASCVD have not observed a similar decline in cardiovascular mortality and recurrent adverse events. We sought to review the underlying risk factors, potential gaps in medical management, associated outcomes, and tools for risk prognostication among patients with premature ASCVD. RECENT FINDINGS In addition to traditional cardiovascular risk factors (i.e., diabetes, familial hypercholesterolemia), non-traditional risk factors such as chronic inflammatory conditions, recreational drug use, genetics, and pregnancy-related complications play a key role in development and progression of premature ASCVD. Patients with premature ASCVD, and especially women, receive less optimal medical management as compared to their non-premature counterparts. There is an increasing prevalence of cardiovascular risk factors among young adults. Hence, this population remains at an elevated risk for premature ASCVD and subsequent adverse cardiovascular events. Future studies evaluating different risk assessment tools and focusing on young patients across all three major domains of ASCVD are needed.
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Affiliation(s)
- Dhruv Mahtta
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA.,Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Umair Khalid
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Arunima Misra
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA.,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA
| | - Zainab Samad
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Khurram Nasir
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Salim S Virani
- Health Policy, Quality & Informatics Program, Michael E. DeBakey VA Medical Center Health Services Research & Development Center for Innovations in Quality, Effectiveness, and Safety, Houston, TX, USA. .,Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA. .,Section of Cardiology, Health Services Research and Development (152), Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX, 77030, USA.
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25
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Probst C, Kilian C, Sanchez S, Lange S, Rehm J. The role of alcohol use and drinking patterns in socioeconomic inequalities in mortality: a systematic review. LANCET PUBLIC HEALTH 2020; 5:e324-e332. [DOI: 10.1016/s2468-2667(20)30052-9] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/21/2020] [Accepted: 02/26/2020] [Indexed: 12/21/2022]
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26
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Huang S, Xie X, Sun Y, Zhang T, Cai Y, Xu X, Li H, Wu S. Development of a nomogram that predicts the risk for coronary atherosclerotic heart disease. Aging (Albany NY) 2020; 12:9427-9439. [PMID: 32421687 PMCID: PMC7288976 DOI: 10.18632/aging.103216] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 04/17/2020] [Indexed: 02/06/2023]
Abstract
Studies seldom combine biological, behavioral and psychological factors to estimate coronary atherosclerotic heart disease (CHD) risk. Here, we evaluated the associations between these factors and CHD to develop a predictive nomogram to identify those at high risk of CHD. This case-control study included 4392 participants (1578 CHD cases and 2814 controls) in southeast China. Thirty-three biological, behavioral and psychological variables were evaluated. Following multivariate logistic regression analysis, which revealed eight risk factors associated with CHD, a predictive nomogram was developed based on a final model that included the three non-modifiable (sex, age and family history of CHD) and five modifiable (hypertension, hyperlipidemia, diabetes, recent experience of a major traumatic event, and anxiety) variables. The higher total nomogram score, the greater the CHD risk. Final model accuracy (as estimated from the area under the receiver operating characteristic curve) was 0.726 (95% confidence interval: 0.709-0.747). Validation analysis confirmed the high accuracy of the nomogram. High risk of CHD was associated with several biological, behavioral and psychological factors. We have thus developed an intuitive nomogram that could facilitate development of preliminary prevention strategies for CHD.
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Affiliation(s)
- Shuna Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Xiaoxu Xie
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Yi Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Tingxing Zhang
- Department of Cardiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
| | - Yingying Cai
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Xingyan Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Huangyuan Li
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou 350122, China
| | - Siying Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou 350122, China
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27
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Zheng PF, Yin RX, Liu CX, Deng GX, Guan YZ, Wei BL. SYNE1-QK1 SNPs, G × G and G × E interactions on the risk of hyperlipidaemia. J Cell Mol Med 2020; 24:5772-5785. [PMID: 32281752 PMCID: PMC7214174 DOI: 10.1111/jcmm.15239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 01/21/2020] [Accepted: 03/12/2020] [Indexed: 12/18/2022] Open
Abstract
This study aimed to assess the relationship of 3 spectrin repeat containing nuclear envelope protein 1 (SYNE1) and 4 KH domain containing RNA binding (QK1) single nucleotide polymorphisms (SNPs), their haplotypes, gene‐gene (G × G), gene‐environment (G × E) interactions and hypercholesterolaemia (HCH) and hypertriglyceridaemia (HTG) in the Chinese Maonan minority. The genetic make‐up of the SYNE1‐QK1 SNPs in 1932 unrelated subjects (normal, 641; HCH, 649; and HTG, 642) was obtained by next‐generation sequencing technologies. The genotypic frequencies of following SNPs were suggestively distinctive between the control and HCH groups (rs2623963, rs7745725, rs9459317, rs16897566), or between the control and HTG groups (rs2623963, rs1358317, rs7745725, rs1923608, rs16897566 SNPs; P < .05, respectively). Multiple‐locus linkage disequilibrium analysis indicated that the identified SNPs were not inherited independently. Several haplotypes and gene‐gene interaction haplotypes among the detected SNPs may be related with an increased morbidity of HCH (C‐G‐A, C‐G‐G and C‐G‐G‐T‐C‐A‐T) and HTG (C‐G‐G, G‐T‐G‐C, C‐G‐G‐G‐T‐G‐C and C‐G‐G‐T‐C‐A‐T), whereas others may be related with an decreased risk of HCH (G‐A‐A, G‐C‐A‐T, C‐A‐A‐T‐C‐A‐T and G‐A‐A‐G‐C‐A‐T) and HTG (G‐A‐A, G‐C‐A‐T, C‐A‐A‐T‐C‐A‐T and G‐A‐A‐G‐C‐A‐T). The association evaluation based on haplotypes and gene‐gene interactions could improve the power of detecting the risk of dyslipidaemia than anyone of SNP alone. There was significant three‐locus model involving SNP‐SNP, haplotype‐haplotype/environment and G × G interactions (P < .05‐0.001) that were detected by GMDR in HCH and HTG groups. Different interactions between genetic and environmental factors would produce different redundancy or synergy effects on the morbidity of HCH and/or HTG.
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Affiliation(s)
- Peng-Fei Zheng
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Rui-Xing Yin
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, China.,Guangxi Key Laboratory Base of Precision Medicine in Cardio-cerebrovascular Disease Control and Prevention, Nanning, China.,Guangxi Clinical Research Center for Cardio-cerebrovascular Diseases, Nanning, China
| | - Chun-Xiao Liu
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Guo-Xiong Deng
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Yao-Zong Guan
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Bi-Liu Wei
- Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital, Guangxi Medical University, Nanning, China
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Green MJ, Popham F. Interpreting mutual adjustment for multiple indicators of socioeconomic position without committing mutual adjustment fallacies. BMC Public Health 2019; 19:10. [PMID: 30606167 PMCID: PMC6319005 DOI: 10.1186/s12889-018-6364-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/21/2018] [Indexed: 11/10/2022] Open
Abstract
Research into the effects of Socioeconomic Position (SEP) on health will sometimes compare effects from multiple, different measures of SEP in "mutually adjusted" regression models. Interpreting each effect estimate from such models equivalently as the "independent" effect of each measure may be misleading, a mutual adjustment (or Table 2) fallacy. We use directed acyclic graphs (DAGs) to explain how interpretation of such models rests on assumptions about the causal relationships between those various SEP measures. We use an example DAG whereby education leads to occupation and both determine income, and explain implications for the interpretation of mutually adjusted coefficients for these three SEP indicators. Under this DAG, the mutually adjusted coefficient for education will represent the direct effect of education, not mediated via occupation or income. The coefficient for occupation represents the direct effect of occupation, not mediated via income, or confounded by education. The coefficient for income represents the effect of income, after adjusting for confounding by education and occupation. Direct comparisons of mutually adjusted coefficients are not comparing like with like. A theoretical understanding of how SEP measures relate to each other can influence conclusions as to which measures of SEP are most important. Additionally, in some situations adjustment for confounding from more distal SEP measures (like education and occupation) may be sufficient to block unmeasured socioeconomic confounding, allowing for greater causal confidence in adjusted effect estimates for more proximal measures of SEP (like income).
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Affiliation(s)
- Michael J. Green
- MRC/CSO Social & Public Health Sciences Unit, 200 Renfield Street, Glasgow, G2 3AX UK
| | - Frank Popham
- MRC/CSO Social & Public Health Sciences Unit, 200 Renfield Street, Glasgow, G2 3AX UK
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29
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Luben R, Hayat S, Mulligan A, Lentjes M, Wareham N, Pharoah P, Khaw KT. Alcohol consumption and future hospital usage: The EPIC-Norfolk prospective population study. PLoS One 2018; 13:e0200747. [PMID: 30020973 PMCID: PMC6051641 DOI: 10.1371/journal.pone.0200747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/01/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Heavy drinkers of alcohol are reported to use hospitals more than non-drinkers, but it is unclear whether light-to-moderate drinkers use hospitals more than non-drinkers. OBJECTIVE We examined the relationship between alcohol consumption in 10,883 men and 12,857 women aged 40-79 years in the general population and subsequent admissions to hospital and time spent in hospital. METHODS Participants from the EPIC-Norfolk prospective population-based study were followed for ten years (1999-2009) using record linkage. RESULTS Compared to current non-drinkers, men who reported any alcohol drinking had a lower risk of spending more than twenty days in hospital multivariable adjusted OR 0.80 (95%CI 0.68-0.94) after adjusting for age, smoking status, education, social class, body mass index and prevalent diseases. Women who were current drinkers were less likely to have any hospital admissions multivariable adjusted OR 0.84 (95%CI 0.74-0.95), seven or more admissions OR 0.77 (95% CI 0.66-0.88) or more than twenty hospital days OR 0.70 (95%CI 0.62-0.80). However, compared to lifelong abstainers, men who were former drinkers had higher risk of any hospital admissions multivariable adjusted OR 2.22 (95%CI 1.51-3.28) and women former drinkers had higher risk of seven or more admissions OR 1.30 (95%CI 1.01-1.67). CONCLUSION Current alcohol consumption was associated with lower risk of future hospital usage compared with non-drinkers in this middle aged and older population. In men, this association may in part be due to whether former drinkers are included in the non-drinker reference group but in women, the association was consistent irrespective of the choice of reference group. In addition, there were few participants in this cohort with very high current alcohol intake. The measurement of past drinking, the separation of non-drinkers into former drinkers and lifelong abstainers and the choice of reference group are all influential in interpreting the risk of alcohol consumption on future hospitalisation.
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Affiliation(s)
- Robert Luben
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Shabina Hayat
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Angela Mulligan
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Marleen Lentjes
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Nicholas Wareham
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge United Kingdom
| | - Paul Pharoah
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
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30
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Golubev AG. Commentary: Is Life Extension Today a Faustian Bargain? Front Med (Lausanne) 2018; 5:73. [PMID: 29617010 PMCID: PMC5867305 DOI: 10.3389/fmed.2018.00073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/05/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Aleksei G Golubev
- N.N. Petrov Research Institute of Oncology, Saint Petersburg, Russia
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31
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Abstract
In a Perspective, Jürgen Rehm and Charlotte Probst examine the links between socioeconomic status, alcohol use, and cardiovascular mortality and discuss implications for policy.
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Affiliation(s)
- Jürgen Rehm
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
- Campbell Family Mental Health Research Institute, CAMH, Toronto, Ontario, Canada
- Institute of Medical Science (IMS), University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
- * E-mail:
| | - Charlotte Probst
- Institute for Mental Health Policy Research, CAMH, Toronto, Ontario, Canada
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany
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