Health Impact Index. Development and Validation of a Method for Classifying Comorbid Disease Measured against Self-Reported Health

Socioeconomic, Health Services, and Multimorbidity Disparities in Chinese Older Adults

INTRODUCTION

As one of the world's most populous countries, China persistently confronts a significant multimorbidity burden. This study aimed to elucidate the multimorbidity burden experienced by Chinese older adults, explore its interplay with socioeconomic disparity, and investigate potential correlations between these provincial disparities and health services availability.

METHODS

The fourth wave of China's national Urban and Rural Elderly Population study, conducted in 2015, was used to construct a multimorbidity index and elucidate the geographic differences in the multimorbidity burden. Incorporating macrolevel indicators about socioeconomic and health services availability, quantile regression and Spearman correlation analyses were employed to investigate the relationship between multimorbidity and socioeconomic disparities and examine the potential linkages between these provincial disparities and health services availability. Analyses were performed in 2023.

RESULTS

The final analysis included a total of 213,857 older adults. At the provincial level, significant geographic disparities in multimorbidity burden were identified. After adjusting for individual social determinants of health, an independent association was found between the human development index and a higher multimorbidity index (coefficient= -0.22; 95% CI= -0.24, -0.19). Furthermore, a significant positive correlation emerged between human development index and both population and geographic densities of health services availability. Notably, geographic density displayed greater inequality (Gini coefficients=0.45-0.48) than population density (Gini coefficients=0.03-0.10).

CONCLUSIONS

This study demonstrates that multimorbidity burden in China is linked to provincial socioeconomic disparities and that inequality in health services availability may account for this, which would advocate for a need to reduce disparities in health services availability.

Psychometric evaluation of the modified quality of recovery score for the postanaesthesia care unit (QoR-PACU2)-A prospective validation study

BACKGROUND

To date, there is no instrument to adequately assess self-reported quality of recovery (QoR) in the post-anesthesia care unit (PACU). We previously developed the QoR-PACU, a 13-item questionnaire specifically applicable to the PACU. The feasibility, acceptance, and validity of the QoR-PACU were promising. However, measures of reliability were slightly lower than expected.

METHODS

We modified the QoR-PACU and evaluated its psychometric properties in a cohort of adult patients scheduled for non-cardiac surgery with general anesthesia. The modified QoR-PACU (termed QoR-PACU2) was administered before surgery and postoperatively in the PACU at the time of the decision to discharge.

RESULTS

A total of 307 patients were included in the final analysis. Postoperative QoR-PACU2 sum scores differed across categories of sex, perioperative and surgical risk, and modes of airway management. The duration of anesthesia and surgery, maximum pain intensity and analgesic requirement in the PACU, and length of PACU stay were all inversely correlated with QoR in the PACU. Cronbach's alpha was 0.70 (95%CI: 0.66-0.75). The intra-class correlation coefficient was 0.86 (95%CI: 0.70-0.94, p < 0.001) for intra-rater reliability (n = 24) and 0.94 (95%CI 0.90 to 0.97, p < 0.001) for inter-rater reliability (n = 31). Cohen's effect size was 0.68 and the standardized response mean was 0.57.

CONCLUSION

The QoR-PACU2 assesses self-reported QoR after surgery in the PACU. Measures of feasibility, validity, and reliability were consistently high. Measures of responsiveness were moderate, which might be attributable to the heterogeneity of the study population. Future studies should include aspects of ethnicity and cross-cultural applicability.

An individually adjusted approach for communicating epidemiological results on health and lifestyle to patients

If scientific research on modifiable risk factors was more accessible to the general population there is a potential to prevent disease and promote health. Mobile applications can automatically combine individual characteristics and statistical models of health to present scientific information as individually tailored visuals, and thus there is untapped potential in incorporating scientific research into apps aimed at promoting healthier lifestyles. As a proof-of-concept, we develop a statistical model of the relationship between Self-rated-health (SRH) and lifestyle-related factors, and a simple app for conveying its effects through a visualisation that sets the individual as the frame of reference. Using data from the 6th (n = 12 981, 53.4% women and 46.6% men) and 7th (n = 21 083, 52.5% women and 47.5% men) iteration of the Tromsø population survey, we fitted a mixed effects linear regression model that models mean SRH as a function of self-reported intensity and frequency of physical activity (PA), BMI, mental health symptoms (HSCL-10), smoking, support from friends, and HbA1c ≥ 6.5%. We adjusted for socioeconomic and demographic factors and comorbidity. We designed a simple proof-of-concept app to register relevant user information, and use the SRH-model to translate the present status of the user into suggestions for lifestyle changes along with predicted health effects. SRH was strongly related to modifiable health factors. The strongest modifiable predictors of SRH were mental health symptoms and PA. The mean adjusted difference in SRH between those with 10-HSCL index = 1.85 (threshold for mental distress) and HSCL-10 = 1 was 0.59 (CI 0.61-0.57). Vigorous physical activity (exercising to exhaustion ≥ 4 days/week relative to sedentary) was associated with an increase on the SRH scale of 0.64 (CI 0.56-0.73). Physical activity intensity and frequency interacted positively, with large PA-volume (frequency ⨯ intensity) being particularly predictive of high SRH. Incorporating statistical models of health into lifestyle apps have great potential for effectively communicating complex health research to a general audience. Such an approach could improve lifestyle apps by helping to make the recommendations more scientifically rigorous and personalised, and offer a more comprehensive overview of lifestyle factors and their importance.

The effects of exceeding low-risk drinking thresholds on self-rated health and all-cause mortality in older adults: the Tromsø study 1994-2020

BACKGROUND

Based on findings of increasing alcohol consumption in older adults, it is important to clarify the health consequences. Using data from the Tromsø study, we aimed to investigate the relationship between different levels of alcohol consumption in old adulthood and self-rated health trajectories and all-cause mortality.

METHODS

This is an epidemiological study utilizing repeated measures from the Tromsø study cohort. It allows follow-up of participants from 1994 to 2020. A total of 24,590 observations of alcohol consumption were made in older adults aged 60-99 (53% women).

PRIMARY OUTCOME MEASURES

Self-rated health (SRH) and all-cause mortality. SRH was reported when attending the Tromsø study. Time of death was retrieved from the Norwegian Cause of Death Registry. The follow-up time extended from the age of study entry to the age of death or end of follow-up on November 25, 2020.

PREDICTOR

Average weekly alcohol consumption (non-drinker, < 100 g/week, ≥100 g/week). We fitted two-level logistic random effects models to examine how alcohol consumption was related to SRH, and Cox proportional hazards models to examine its relation to all-cause mortality. Both models were stratified by sex and adjusted for sociodemographic factors, pathology, biometrics, smoking and physical activity. In addition, all the confounders were examined for whether they moderate the relationship between alcohol and the health-related outcomes through interaction analyses.

RESULTS

We found that women who consumed ≥100 g/week had better SRH than those who consumed < 100 g/week; OR 1.85 (1.46-2.34). This pattern was not found in men OR 1.18 (0.99-1.42). We identified an equal mortality risk in both women and men who exceeded 100 g/week compared with those who consumed less than 100 g/week; HR 0.95 (0.73-1.22) and HR 0.89 (0.77-1.03), respectively.

CONCLUSIONS

There was no clear evidence of an independent negative effect on either self-rated health trajectories or all-cause mortality for exceeding an average of 100 g/week compared to lower drinking levels in this study with up to 25 years follow-up. However, some sex-specific risk factors in combination with the highest level of alcohol consumption led to adverse effects on self-rated health. In men it was the use of sleeping pills or tranquilisers and ≥ 20 years of smoking, in women it was physical illness and older age.

[Cross-cultural adaptation and clinical application of Meniere's disease outcomes questionnaire]

Objective:To cross-culturally adapt the Meniere's Disease Outcomes Questionnaire（MDOQ） into Chinese language, to evaluate its reliability and validity, and to apply in clinical. Methods:The MDOQ was translated according to the Brislin model. Cross-cultural adaption was done by expert discussion and pilot study. The MDOQ was applied to 101 patients to test its reliability and validity. The quality of life（QOL） of 272 patients was measured by MDOQ-C, analyzing the influence factors of QOL of patients with Meniere's disease. Results:The CR value of each item of MDOQ-C exceeded 3.00, the Cronbach's α coefficient was 0.88, and the Spearman Brown coefficient was 0.90. The Pearson correlation coefficient of MDOQ-C and the DHI was 0.803（P<0.01）. Three factors were extracted by factor analysis, which could explain 60.503% of the total variance. The dimension composition was different from the original scale. The average QOL score of Meniere's disease patients was 52.94±13.87. The main influence factors were age, marital status, work status, with tinnitus and the number of vertigo attacks. Conclusion:The MDOQ-C is reliable and valid. After dimension reconstruction, MDOQ-C can be used to evaluate the QOL of patients with Meniere's disease. Through the preliminary clinical application, the influence factors of quality of life of patients with Meniere's disease were identified, thus providing reference for optimizing clinical management strategies.

Assessment of mental health trajectories before and after myocardial infarction, atrial fibrillation or stroke: analysis of a cohort study in Tromsø, Norway (Tromsø Study, 1994-2016)

OBJECTIVES

The increased survival rate of cardiovascular disease (CVD) implies a higher proportion of individuals who live with CVD. Using data from the Tromsø Study, we aimed to investigate mental health symptom trajectories before and after myocardial infarction, atrial fibrillation or stroke in a general population and to explore factors that contribute to the association.

DESIGN

Cohort study.

SETTING

Sample drawn from inhabitants of the municipality of Tromsø, Norway, who participated in the Tromsø Study (1994-2016).

PARTICIPANTS

A total of 18 719 participants (52.3% women) were included, and of these 2098 (32.9% women) were diagnosed with myocardial infarction, 1896 (41.9% women) with atrial fibrillation and 1263 (42.9% women) with stroke.

PRIMARY OUTCOME MEASURES

Mental health symptoms were assessed using the Hopkins Symptom Checklist-10 and the Conor Mental Health Index.

RESULTS

The participants who were diagnosed with either myocardial infarction or stroke had a significant monotonous increase in mental health symptoms before myocardial infarction (p=0.029) and stroke (p=0.029) that intensified at the time of diagnosis. After the event, the study found a higher prevalence of mental health symptoms with a decline in symptom levels over time for myocardial infarction (p<0.001) and stroke (p=0.004), but not for atrial fibrillation (before: p=0.180, after: p=0.410). The risk of elevated mental health symptoms with myocardial infarction, atrial fibrillation and stroke was associated with sex (p<0.001), age (p<0.01), physical activity (p<0.001), diabetes (p<0.05) and other comorbidities (p<0.001).

CONCLUSION

The study indicates that mental health problems among individuals with myocardial infarction, atrial fibrillation and stroke may have started to develop several years before the cardiovascular event and suggests that successful CVD rehabilitation may need to consider previous life factors. Future research is recommended to examine whether health promotion measures in a general population also create mental health resilience after a CVD event.

Patient-Reported Morbidity Instruments: A Systematic Review

OBJECTIVES

Although comorbidities play an essential role in risk adjustment and outcomes measurement, there is little consensus regarding the best source of this data. The aim of this study was to identify general patient-reported morbidity instruments and their measurement properties.

METHODS

A systematic review was conducted using multiple electronic databases (Embase, Medline, Cochrane Central, and Web of Science) from inception to March 2018. Articles focusing primarily on the development or subsequent validation of a patient-reported morbidity instrument were included. After including relevant articles, the measurement properties of each morbidity instrument were extracted by 2 investigators for narrative synthesis.

RESULTS

A total of 1005 articles were screened, of which 34 eligible articles were ultimately included. The most widely assessed instruments were the Self-Reported Charlson Comorbidity Index (n = 7), the Self-Administered Comorbidity Questionnaire (n = 3), and the Disease Burden Morbidity Assessment (n = 3). The most commonly included conditions were diabetes, hypertension, and myocardial infarction. Studies demonstrated substantial variability in item-level reliability versus the gold standard medical record review (κ range 0.66-0.86), meaning that the accuracy of the self-reported comorbidity data is dependent on the selected morbidity.

CONCLUSIONS

The Self-Reported Charlson Comorbidity Index and the Self-Administered Comorbidity Questionnaire were the most frequently cited instruments. Significant variability was observed in reliability per comorbid condition of patient-reported morbidity questionnaires. Further research is needed to determine whether patient-reported morbidity data should be used to bolster medical records data or serve as a stand-alone entity when risk adjusting observational outcomes data.

A prospective study on the effect of self-reported health and leisure time physical activity on mortality among an ageing population: results from the Tromsø study

Background

The prevailing Western ideal of ageing in place, with the option to stay at home as one ages, has led to the development of physical activity guidelines for people of advanced age to increase their quality of life and promote their functional abilities. This study investigates the effect of self-reported health and physical activity on mortality and examines how levels of age-specific physical activity affect self-reported health trajectories in an ageing cohort.

Methods

The sample cohort of the population-based Tromsø Study consists of 24,309 participants aged 25–97 years at baseline. This study involved a survival analysis from 1994 to 2015 and included those who completed two or more surveys (n = 12,241) between 1994 and 2008. The purpose was to examine the relationship between physical activity and self-reported health throughout life using a random coefficient model analysis.

Results

Being sedentary was associated with an increased risk of mortality in the ageing cohort. Subjects who reported neither light physical activity nor hard physical activity had a 57% (OR 1.57, 1.07–2.31) increased risk of all-cause death. Both hard (OR 2.77, 2.35–3.26) and light (OR 1.52, 1.32–1.76) physical activity were positively associated with self-reported health. The effect was age dependent. Vigorous physical activity was most beneficial for individuals younger than 40 years old, while moderate physical activity levels prolonged the period in which good self-reported health was likely.

Conclusions

Poor self-reported health and being sedentary were independently associated with an increased risk of mortality in the participants. Furthermore, physical activity prolonged the period of good self-reported health among older adults in two ways: physical activity habits from early adulthood and onwards were beneficial to self-reported health at an advanced age, and self-reported health was dependent on engagement in moderate intensity physical activity after approximately 65 years of age.

Residents in a Remote Island Having Family Members in Distant Areas Showed Higher Preference for Place of End-of-Life Care: The Ajishima Study

INTRODUCTION

To investigate the proportion of those having preferred place for end-of-life care among residents in a remote island and its association with family composition.

METHODS

Cross-sectional questionnaire survey was conducted in Ajishima, an island 23 km away from the coast of Ishinomaki City, northeast of Japan. Between October 2017 and February 2018, the questionnaire was distributed to 288 eligible residents and 113 valid responses were analyzed. Primary outcome was whether the subjects had preferred place for end-of-life care. The explanatory variable was family composition defined as whether having family members inside or outside the island [none (In-/Out-), only inside the island (In+/Out-), only outside the island (In-/Out+), and both inside and outside (In+/Out+)]. Poisson regression analysis was used to calculate the prevalence ratios (PRs) and 95% confidence intervals (CIs) of showing preferred place in each group.

RESULTS

The proportion of those having preferred place for end-of-life care was 72.6% in total. This rate significantly differed across family composition groups: 67.6%, 40.0%, and 82.9% for In+/Out+, In+/Out-, and In-/Out+ groups, respectively. The PR (95%CI) of having preferred place was 0.66 (0.33, 1.36) and 1.26 (1.01, 1.56) for In+/Out- and In-/Out+ groups, respectively, compared with In+/Out+ group.

CONCLUSIONS

This study showed that significantly higher preference for place of end-of-life care was seen among residents who had family members only outside the island compared with those who had families both inside and outside. Health care professionals should consider family compositions when initiating end-of-life discussion to residents in remote areas.

Self-reported health as a predictor of mortality: A cohort study of its relation to other health measurements and observation time

Self-reported health (SRH) is widely used as an epidemiological instrument given the changes in public health since its introduction in the 1980s. We examined the association between SRH and mortality and how this is affected by time and health measurements in a prospective cohort study using repeated measurements and physical examinations of 11652 men and 12684 women in Tromsø, Norway. We used Cox proportional hazard regression to estimate hazard ratios (HRs) of death for SRH, controlling for pathology, biometrics, smoking, sex and age. SRH predicted mortality independently of other, more objective health measures. Higher SRH was strongly associated with lower mortality risk. Poor SRH had HR 2.51 (CI: 2.19, 2.88). SRH is affected by disease, mental health and other risk factors, but these factors had little impact on HRs (Poor SRH: HR 1.99; CI: 1.72, 2.31). SRH predicted mortality, but with a time-dependent effect. Time strongly affected the hazard ratio for mortality, especially after ten-year follow-up (Poor SRH HR 3.63 at 0-5 years decreased to HR 1.58 at 15-21 years). SRH has both methodological and clinical value. It should not be uncritically utilised as a replacement instrument when measures of physical illness and other objective health measures are lacking.

Measuring multimorbidity beyond counting diseases: systematic review of community and population studies and guide to index choice

OBJECTIVES

To identify and summarise existing indices for measuring multimorbidity beyond disease counts, to establish which indices include mental health comorbidities or outcomes, and to develop recommendations based on applicability, performance, and usage.

DESIGN

Systematic review.

DATA SOURCES

Seven medical research databases (Medline, Web of Science Core Collection, Cochrane Library, Embase, PsycINFO, Scopus, and CINAHL Plus) from inception to October 2018 and bibliographies and citations of relevant papers. Searches were limited to English language publications.

ELIGIBILITY CRITERIA FOR STUDY SELECTION

Original articles describing a new multimorbidity index including more information than disease counts and not focusing on comorbidity associated with one specific disease. Studies were of adults based in the community or at population level.

RESULTS

Among 7128 search results, 5560 unique titles were identified. After screening against eligibility criteria the review finally included 35 papers. As index components, 25 indices used conditions (weighted or in combination with other parameters), five used diagnostic categories, four used drug use, and one used physiological measures. Predicted outcomes included mortality (18 indices), healthcare use or costs (13), hospital admission (13), and health related quality of life (7). 29 indices considered some aspect of mental health, with most including it as a comorbidity. 12 indices are recommended for use.

CONCLUSIONS

35 multimorbidity indices are available, with differing components and outcomes. Researchers and clinicians should examine existing indices for suitability before creating new ones.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017074211.

Patient-Reported Experiences in Discussing Prescribed Medications with a Health Care Provider: Evidence for Racial/Ethnic Disparities in a Large Health Care Delivery System

The objective was to understand patient-reported experiences in communicating with a health care provider about prescribed medications in a health care setting serving diverse racial/ethnic groups. Adult patients who completed a patient-experience survey and received a prescription for a hypertension, hyperlipidemia, or diabetes medication at the surveyed encounter were studied (N = 19,006). Data were collected in a large mixed-payer outpatient health care system in northern California between 2011 and 2014. Surveys were linked to the electronic health records of the office visit to which the survey refers, with detailed information on visit content, provider, and patient characteristics. The focus was on 2 survey questions asking about providers' efforts to include patients in treatment decisions and the information received about medications. Logistic regression was used to assess factors associated with survey responses, which were dichotomized as very good or not (ie, good, fair, poor, very poor). Chinese (OR: 0.59; 95% CI: 0.50-0.70), Asian Indians (0.68; 0.54-0.84), Japanese (0.74; 0.57-0.98), Koreans (0.46; 0.25-0.83), Vietnamese (0.51; 0.27-0.98), and African Americans (0.74; 0.55-0.99) vs. non-Hispanic whites (NHWs) reported poorer experiences of involvement in treatment decisions. Similarly, Chinese (0.59; 0.49-0.70), Asian Indians (0.67; 0.54-0.83), Koreans (0.38; 0.21-0.70), Vietnamese (0.46; 0.25-0.87), African Americans (0.65; 0.49-0.87), and Mexicans (0.77; 0.61-0.98) vs. NHWs reported poorer experiences for information received about medications. Almost all racial/ethnic groups report poorer experiences with involvement in treatment decisions and information received about medications than NHWs in the same clinical setting, which may contribute to poorer adherence and outcomes among racial/ethnic minority groups.

The Patient's Comorbidity Burden Correlates with the Erectile Dysfunction Severity

OBJECTIVE

To explore the potential relationship between erectile dysfunction (ED), low testosterone levels, and the Charlson Comorbidity Index (CCI).

MATERIAL AND METHODS

Cross-sectional study on patients referred to the andrology unit in 7 Spanish centers. The ED was diagnosed and graded using the International Index of Erectile Function (IIEF-5) score. Total testosterone, the prevalence of each comorbidity, and the CCI were compared between patients with different grades of ED. Besides, the correlation between total testosterone and the CCI score, the influence of each comorbidity, and the ED severity on the CCI was assessed in a multiple linear regression.

RESULTS

The study included 430 men with a mean age of 61 years. The mean CCI was 3.5, and mean total testosterone 15.2 nmol/L; 389 (91%) subjects had some grade of ED: 97 (23%) mild, 149 (35%) mild-to-moderate, 86 (20%) moderate, and 57 (13%) severe. The increase in ED severity was significantly associated with a decrease in total testosterone (P=.002), and an increase in the CCI score (P<.001). Testosterone levels were significantly lower in patients with obesity, diabetes, hypercholesterolemia, and hypertriglyceridemia (P<.05). However, only the prevalence of diabetes and hypertension was significantly associated with the severity of ED. The multivariate analysis including variables related to all assessed comorbidities, total testosterone levels, and the DE severity significantly predicted the CCI score (P<.001, R²=.426). The severity of ED significantly contributed to this model (P=.011), but total testosterone did not (P=.204).

CONCLUSIONS

The CCI is significantly associated with the ED severity, but it shows a weak correlation with the testosterone levels.

What is the impact of underweight on self-reported health trajectories and mortality rates: a cohort study

Background

Utilizing a cohort study design combining a survey approach with repeated physical examinations, we examined the independent effects of BMI on mortality and self-reported health (SRH) and whether these independent effects change as people grow older.

Methods

The Tromsø Study consists of six surveys conducted in the municipality of Tromsø, Norway, with large representative samples of a general population. In total, 31,985 subjects participated in at least one of the four surveys administered between 1986 and 2008. Outcomes of interest were SRH and all-cause mortality.

Results

Overweight and underweight subjects reported significantly lower levels of SRH, but age affected the thinnest subjects more than all others. The SRH trajectory of underweight subjects at age 25 was slightly above the other categories (0.08), but it fell to −.30 below the reference category at age 90. For obese subjects, the difference was −0.15 below the reference category at age 25 and −0.18 below at age 90. This implies that even though a low BMI was slightly beneficial at a young age, it represented an increasing risk with age that crossed the reference curve at age 38 and even crossed the obese trajectory at age 67 in the full fitted model. The proportional hazard ratio for those who were underweight was 1.69 (95% CI: 1.38-2.06) for all-cause death as compared to 1.12 (95% CI: 1.02-1.23) for obese subjects.

Conclusion

BMI affected SRH and all-cause mortality independently from comorbidity, mental health, health-related behaviors and other biological risk factors. Being underweight was associated with excess mortality as compared to all others, and age affected the thinnest subjects more than all others. Weight increase was beneficial for mortality but not for SRH among the underweight. The rapid decline of SRH with increasing age suggests that particular attention should be paid to underweight after 38 years of age.

Electronic supplementary material

The online version of this article (10.1186/s12955-017-0766-x) contains supplementary material, which is available to authorized users.

Bone Density Loss Is Associated With Blood Cell Counts

Hematopoiesis depends on a supportive microenvironment. Preclinical studies in mice have demonstrated that osteoblasts influence the development of blood cells, particularly erythrocytes, B lymphocytes, and neutrophils. However, it is unknown whether osteoblast numbers or function impact blood cell counts in humans. We tested the hypothesis that men with low BMD or greater BMD loss have decreased circulating erythrocytes and lymphocytes and increased myeloid cells. We performed a cross-sectional analysis and prospective analysis in the Osteoporotic Fractures in Men (MrOS) study, a multisite longitudinal cohort study. A total of 2571 community-dwelling men (≥65 years) who were able to walk without assistance, did not have a hip replacement or fracture, and had complete blood counts (CBCs) at the third study visit were analyzed. Multivariable (MV)-adjusted logistic regression estimated odds of white blood cell (WBC) subtypes (highest and lowest quintile versus middle), and anemia (clinically defined) associated with BMD by DXA scan (at visit 3), annualized percent BMD change (baseline to visit 3), and high BMD loss (>0.5%/year, from baseline to visit 3) at the femoral neck (FN) and total hip (TH). MV-adjusted models included age, BMI, cancer history, smoking status, alcohol intake, corticosteroid use, self-reported health, thiazide use, and physical activity. At visit 3 greater TH BMD loss (per 1 SD) was associated with increased odds of anemia, high neutrophils, and low lymphocytes. Annualized BMD loss of >0.5% was associated with increased odds of anemia, high neutrophils, and low lymphocytes. Similar results were observed for FN BMD regarding anemia and lymphocytes. We conclude that community-dwelling older men with declining hip BMD over about 7 years had increased risks of anemia, lower lymphocyte count, and higher neutrophil count, consistent with preclinical studies. Bone health and hematopoiesis may have greater interdependency than previously recognized. © 2016 American Society for Bone and Mineral Research.

Ageing and mental health: changes in self-reported health due to physical illness and mental health status with consecutive cross-sectional analyses

OBJECTIVES

It is known that self-reported health (SRH) declines with increasing age and that comorbidity increases with age. We wished to examine how age transfers its effect to SRH through comorbid disease and mental illness and whether these processes remained stable from 1994 until 2008. The hypothesis is that ageing and/or the increased age-related burden of pathology explains the declining SRH.

SETTING

The Tromsø Study (TS) is a cohort study using a survey approach with repeated physical examinations. It was conducted in the municipality of Tromsø, Norway, from 1974 to 2008.

PARTICIPANTS

A total of 21 199 women and 19 229 men participated.

PRIMARY AND SECONDARY OUTCOME MEASURES

SRH is the outcome of interest. We calculated and compared the effect sizes of age, comorbidity and mental health symptoms using multimediator analysis based on OLS regression.

RESULTS

Ageing had a negative impact on SRH, but the total effect of age decreased from 1994 to 2007. We assessed the direct effect of age and then the proportion of indirect age-related effects through physical illness and mental health symptoms on the total effect. The direct effect of age represented 79.3% of the total effect in 1994 and decreased to 58.8% in 2007. Physical illness emerged as an increasingly important factor and increased its influence from 15.7% to 41.2% of the total effect. Age alone had a protective effect on mental health symptoms and this increased (2.5% to 17.3%), but we found a stronger association between mental health symptoms and physical disease in the later waves of the study (increasing from 3.7% to 14.8%).

CONCLUSIONS

The results suggest that the effect on SRH of mental health symptoms caused by physical illness is an increasing public health problem. Treatment and care for specific medical conditions must therefore focus more strongly on how these conditions affect the patient's mental health and address these concerns accordingly.