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Santos Salas A, LeGuerrier B, Horvath L, Bassah N, Adewale B, Bardales O, Duggleby W, Salami B, Watanabe SM. The impact of socioeconomic inequality on access to health care for patients with advanced cancer: A qualitative study. Asia Pac J Oncol Nurs 2024; 11:100520. [PMID: 39027088 PMCID: PMC11255108 DOI: 10.1016/j.apjon.2024.100520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/17/2024] [Indexed: 07/20/2024] Open
Abstract
Objective In Canada, populations experiencing socioeconomic inequality have lower rates of access to screening and diagnosis and higher mortality rates than people from higher-income areas. Limited evidence exists concerning their experiences when living with advanced cancer. We explored how socioeconomic inequality shapes the experiences of patients with advanced cancer. Methods We utilized a qualitative study design that combined tenets of hermeneutic phenomenological inquiry and critical theory. Four individuals with advanced cancer from low-income neighborhoods, three family members, and six cancer care providers were accrued through a tertiary cancer center in a western Canadian city. One-on-one interviews and brief notes were used for data collection. Data were analyzed through thematic analysis. Results Three interrelated themes were identified: 'Lack of access to socioeconomic supports,' 'Gaps in access to health care resources and services,' and 'Limited access to symptom relief.' Patients experienced inadequate finances, housing, and transportation. Most patients lived alone and had limited family and social support. Patients reported lack of knowledge of available resources and health system navigation issues, including communication problems with providers and among levels of care. Cancer care providers and patients described issues achieving symptom relief as well as challenges associated with extensive disease. Conclusions Study findings suggest that socioeconomic inequality interferes with the ability of persons with advanced cancer to access health care and contributes to less optimal cancer outcomes. Socioeconomic inequality may increase symptom severity. Findings call for the development of tailored interventions for populations with advanced cancer and socioeconomic inequality.
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Affiliation(s)
- Anna Santos Salas
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Bronwen LeGuerrier
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Lucas Horvath
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Nahyeni Bassah
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Bisi Adewale
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Olga Bardales
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy Duggleby
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Bukola Salami
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Sharon M. Watanabe
- Department of Symptom Control and Palliative Care, Cross Cancer Institute, Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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2
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Bodelet J, Potente C, Blanc G, Chumbley J, Imeri H, Hofer S, Harris KM, Muniz-Terrera G, Shanahan M. A Bayesian functional approach to test models of life course epidemiology over continuous time. Int J Epidemiol 2024; 53:dyad190. [PMID: 38205821 PMCID: PMC10859158 DOI: 10.1093/ije/dyad190] [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: 12/15/2022] [Accepted: 12/23/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Life course epidemiology examines associations between repeated measures of risk and health outcomes across different phases of life. Empirical research, however, is often based on discrete-time models that assume that sporadic measurement occasions fully capture underlying long-term continuous processes of risk. METHODS We propose (i) the functional relevant life course model (fRLM), which treats repeated, discrete measures of risk as unobserved continuous processes, and (ii) a testing procedure to assign probabilities that the data correspond to conceptual models of life course epidemiology (critical period, sensitive period and accumulation models). The performance of the fRLM is evaluated with simulations, and the approach is illustrated with empirical applications relating body mass index (BMI) to mRNA-seq signatures of chronic kidney disease, inflammation and breast cancer. RESULTS Simulations reveal that fRLM identifies the correct life course model with three to five repeated assessments of risk and 400 subjects. The empirical examples reveal that chronic kidney disease reflects a critical period process and inflammation and breast cancer likely reflect sensitive period mechanisms. CONCLUSIONS The proposed fRLM treats repeated measures of risk as continuous processes and, under realistic data scenarios, the method provides accurate probabilities that the data correspond to commonly studied models of life course epidemiology. fRLM is implemented with publicly-available software.
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Affiliation(s)
- Julien Bodelet
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
- Department of Laboratory Medicine and Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Cecilia Potente
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Guillaume Blanc
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Justin Chumbley
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
- Biostatistics and Research Decision Sciences, MSD, Zurich, Switzerland
| | - Hira Imeri
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Scott Hofer
- Institute On Aging & Lifelong Health, University of Victoria, Victoria, BC, Canada
| | - Kathleen Mullan Harris
- Carolina Population Center, University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
| | - Graciela Muniz-Terrera
- Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Ohio University Heritage College of Osteopathic Medicine, Ohio University, Athens, OH, USA
| | - Michael Shanahan
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
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3
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Meng Y, Sharman JE, Koskinen JS, Juonala M, Viikari JSA, Buscot MJ, Wu F, Fraser BJ, Rovio SP, Kähönen M, Rönnemaa T, Jula A, Niinikoski H, Raitakari OT, Pahkala K, Magnussen CG. Blood Pressure at Different Life Stages Over the Early Life Course and Intima-Media Thickness. JAMA Pediatr 2024; 178:133-141. [PMID: 38048127 PMCID: PMC10696511 DOI: 10.1001/jamapediatrics.2023.5351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/17/2023] [Indexed: 12/05/2023]
Abstract
Importance Although cardiovascular disease (CVD) begins in early life, the extent to which blood pressure (BP) at different life stages contributes to CVD is unclear. Objective To determine the relative contribution of BP at different life stages across the early-life course from infancy to young adulthood with carotid intima-media thickness (IMT). Design, setting, and participants The analyses were performed in 2022 using data gathered from July 1989 through January 2018 within the Special Turku Coronary Risk Factor Intervention Project, a randomized, infancy-onset cohort of 534 participants coupled with annual BP (from age 7 months to 20 years), biennial IMT measurements (from ages 13 to 19 years), who were followed up with again at age 26 years. Exposures BP measured from infancy (aged 7 to 13 months), preschool (2 to 5 years), childhood (6 to 12 years), adolescence (13 to 17 years), and young adulthood (18 to 26 years). Main outcomes and measures Primary outcomes were carotid IMT measured in young adulthood at age 26 years. Bayesian relevant life-course exposure models assessed the relative contribution of BP at each life stage. Results Systolic BP at each life stage contributed to the association with young adulthood carotid IMT (infancy: relative weight, 25.3%; 95% credible interval [CrI], 3.6-45.8; preschool childhood: relative weight, 27.0%; 95% CrI, 3.3-57.1; childhood: relative weight, 18.0%; 95% CrI, 0.5-40.0; adolescence: relative weight, 13.5%; 95% CrI, 0.4-37.1; and young adulthood: relative weight, 16.2%; 95% CrI, 1.6-46.1). A 1-SD (at single life-stage) higher systolic BP accumulated across the life course was associated with a higher carotid IMT (0.02 mm; 95% CrI, 0.01-0.03). The findings for carotid IMT were replicated in the Cardiovascular Risk in Young Finns Study that assessed systolic BP from childhood and carotid IMT in adulthood (33 to 45 years). Conclusion and relevance In this cohort study, a life-course approach indicated that accumulation of risk exposure to BP levels at all life stages contributed to adulthood carotid IMT. Of those, the contribution attributed to each observed life stage was approximately equal. These results support prevention efforts that achieve and maintain normal BP levels across the life course, starting in infancy.
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Affiliation(s)
- Yaxing Meng
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Juhani S. Koskinen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, Satakunta Central Hospital, Pori, Finland
| | - Markus Juonala
- Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - Jorma S. A. Viikari
- Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - Marie-Jeanne Buscot
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Feitong Wu
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Baker Department of Cardiometabolic Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Brooklyn J. Fraser
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, South Australia, Australia
| | - Suvi P. Rovio
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tapani Rönnemaa
- Division of Medicine, Turku University Hospital, Turku, Finland
- Department of Medicine, University of Turku, Turku, Finland
| | - Antti Jula
- Department of Chronic Disease Prevention, Institute for Health and Welfare, Turku, Finland
| | - Harri Niinikoski
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Olli T. Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Paavo Nurmi Centre, Unit of Health and Physical Activity, University of Turku, Turku, Finland
| | - Costan G. Magnussen
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
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4
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Alli BY, Durán D, Madathil SA, Nicolau B. Occupation as a measure of life course socioeconomic position and the risk of oral cancers in India. Community Dent Oral Epidemiol 2023; 51:976-984. [PMID: 36380447 DOI: 10.1111/cdoe.12797] [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: 04/19/2021] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 09/19/2023]
Abstract
OBJECTIVES Evidence suggests that different indicators of socioeconomic position (SEP) contribute to oral cancer risk. Occupational status, as a measure of SEP, may be able to capture aspects of social hierarchy in societies in which employment is highly correlated with other social structures such as caste systems. Often in such societies, the life course of an individual is also influenced by this hierarchy. However, the influence of life course occupational status on the risk of oral cancer is not well understood. This study aims to identify the life course model that is best supported by the data using life course SEP-as represented by occupation-on oral cancer risk in a population in the South of India. METHODS Data from the HeNCe Life study, Indian site were used. Incident oral cancer cases (N = 350) were recruited from two major referral hospitals in Kozhikode, Kerala, South India, from 2008 to 2012. Controls (N = 371), frequency-matched by age (5 years) and sex were recruited from the outpatient clinics at the same hospitals as the cases. Life grid-based structured interviews collected information on an array of exposures throughout the life course of the participant. Occupation was coded with the 1988 International Standard Classification of Occupations, transformed to the simplified European Socioeconomic Classification, and further dichotomized into advantageous and disadvantageous SEP at three different life periods (childhood, early adulthood and late adulthood). The analysis was conducted using the Bayesian relevant life course exposure model with a Dirichlet noninformative prior and a weakly informative Cauchy prior to the overall lifetime effect and confounders. RESULTS Participants in disadvantaged SEP throughout their life had 3.6 times higher risk of oral cancer than those in advantaged SEP (OR = 3.6; 95% CrI = 1.6-7.2), after adjusting for potential confounders. While the crude and sex- and age-adjusted models showed a clear childhood sensitive period for this risk, the model further adjusted for behavioural factors could not distinguish the specific life course period best explained by data. CONCLUSION Occupation status alone could provide a similar overarching risk estimate for oral cancer to those obtained from more complex measures of SEP.
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Affiliation(s)
- Babatunde Y Alli
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Doris Durán
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Instituto de Investigación en Ciencias Odontológicas (ICOD), Facultad de Odontología, Universidad de Chile, Santiago, Chile
| | - Sreenath A Madathil
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Belinda Nicolau
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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5
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Salmon C, Quesnel-Vallée A, Barnett TA, Benedetti A, Cloutier MS, Datta GD, Kestens Y, Nicolau B, Parent MÉ. Neighbourhood social deprivation and risk of prostate cancer. Br J Cancer 2023; 129:335-345. [PMID: 37188877 PMCID: PMC10338528 DOI: 10.1038/s41416-023-02299-7] [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: 07/13/2022] [Revised: 04/24/2023] [Accepted: 04/28/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Striking geographic variations in prostate cancer incidence suggest an aetiological role for spatially-distributed factors. We assessed whether neighbourhood social deprivation, which can reflect limited social contacts, unfavourable lifestyle and environmental exposures, is associated with prostate cancer risk. METHODS In 2005-2012, we recruited 1931 incident prostate cancer cases and 1994 controls in a case-control study in Montreal, Canada. Lifetime residential addresses were linked to an area-based social deprivation index around recruitment (2006) and about 10 years earlier (1996). Logistic regression estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Men residing in areas characterised by greater social deprivation had elevated prostate cancer risks (ORs of 1.54 and 1.60 for recent and past exposures, respectively; highest vs lowest quintiles), independently from area- and individual-level confounders and screening patterns. The increase in risk with recent high social deprivation was particularly elevated for high-grade prostate cancer at diagnosis (OR 1.87, 95% CI 1.32-2.64). Associations were more pronounced for neighbourhoods with higher proportions of separated/divorced or widowed individuals in the past, and with higher percentages of residents living alone recently. CONCLUSIONS These novel findings, suggesting that neighbourhood-level social deprivation increases the risk of prostate cancer, point out to potential targeted public health interventions.
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Affiliation(s)
- Charlotte Salmon
- Unité d'épidémiologie et de biostatistique, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, Université du Québec, 531 Boulevard des Prairies, Laval, QC, H7V 1B7, Canada
| | - Amélie Quesnel-Vallée
- Department of Sociology, McGill University, 3460 McTavish Street, Montreal, QC, H3A 0E6, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1G1, Canada
| | - Tracie A Barnett
- Department of Family Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1G1, Canada
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, 5252 Maisonneuve Boulevard, Montreal, QC, H4A 3S5, Canada
| | - Marie-Soleil Cloutier
- Centre Urbanisation Culture Société, Institut national de la recherche scientifique, Université du Québec, 385 Sherbrooke Street East, Montreal, QC, H2X 1E3, Canada
| | - Geetanjali D Datta
- Department of Medicine and Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada
- Centre de recherche en santé publique, 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada
| | - Yan Kestens
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada
- Centre de recherche en santé publique, 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada
| | - Belinda Nicolau
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1G1, Canada
| | - Marie-Élise Parent
- Unité d'épidémiologie et de biostatistique, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique, Université du Québec, 531 Boulevard des Prairies, Laval, QC, H7V 1B7, Canada.
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada.
- Research Centre of the Centre Hospitalier de l'Université de Montréal, 850 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada.
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6
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Meng Y, Buscot MJ, Juonala M, Wu F, Armstrong MK, Fraser BJ, Pahkala K, Hutri-Kähönen N, Kähönen M, Laitinen T, Viikari JSA, Raitakari OT, Magnussen CG, Sharman JE. Relative Contribution of Blood Pressure in Childhood, Young- and Mid-Adulthood to Large Artery Stiffness in Mid-Adulthood. J Am Heart Assoc 2022; 11:e024394. [PMID: 35699171 PMCID: PMC9238667 DOI: 10.1161/jaha.121.024394] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Blood pressure associates with arterial stiffness, but the contribution of blood pressure at different life stages is unclear. We examined the relative contribution of childhood, young‐ and mid‐adulthood blood pressure to mid‐adulthood large artery stiffness. Methods and Results The sample comprised 1869 participants from the Cardiovascular Risk in Young Finns Study who had blood pressure measured in childhood (6–18 years), young‐adulthood (21–30 years), and mid‐adulthood (33–45 years). Markers of large artery stiffness were pulse wave velocity and carotid distensibility recorded in mid‐adulthood. Bayesian relevant life course exposure models were used. For each 10‐mm Hg higher cumulative systolic blood pressure across the life stages, pulse wave velocity was 0.56 m/s higher (95% credible interval: 0.49 to 0.63) and carotid distensibility was 0.13%/10 mm Hg lower (95% credible interval: −0.16 to −0.10). Of these total contributions, the highest contribution was attributed to mid‐adulthood systolic blood pressure (relative weights: pulse wave velocity, childhood: 2.6%, young‐adulthood: 5.4%, mid‐adulthood: 92.0%; carotid distensibility, childhood: 5.6%; young‐adulthood: 10.1%; mid‐adulthood: 84.3%), with the greatest individual contribution coming from systolic blood pressure at the time point when pulse wave velocity and carotid distensibility were measured. The results were consistent for diastolic blood pressure, mean arterial pressure, and pulse pressure. Conclusions Although mid‐adulthood blood pressure contributed most to mid‐adulthood large artery stiffness, we observed small contributions from childhood and young‐adulthood blood pressure. These findings suggest that the burden posed by arterial stiffness might be reduced by maintaining normal blood pressure levels at each life stage, with mid‐adulthood a critical period for controlling blood pressure.
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Affiliation(s)
- Yaxing Meng
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Australia
| | - Marie-Jeanne Buscot
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Australia
| | - Markus Juonala
- Department of Medicine University of Turku Turku Finland.,Division of Medicine Turku University Hospital Turku Finland
| | - Feitong Wu
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Australia
| | - Matthew K Armstrong
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Australia
| | - Brooklyn J Fraser
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Australia
| | - Katja Pahkala
- Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Turku Finland.,Centre for Population Health Research University of TurkuTurku University Hospital Turku Finland.,Paavo Nurmi Centre Sports & Exercise Medicine Unit Department of Physical Activity and Health University of Turku Turku Finland
| | - Nina Hutri-Kähönen
- Tampere Centre for Skills Training and Simulation Tampere University Tampere Finland
| | - Mika Kähönen
- Department of Clinical Physiology Tampere University HospitalFaculty of Medicine and Health TechnologyTampere University Tampere Finland
| | - Tomi Laitinen
- Department of Clinical Physiology and Nuclear Medicine Kuopio University HospitalUniversity of Eastern Finland Kuopio Finland
| | - Jorma S A Viikari
- Department of Medicine University of Turku Turku Finland.,Division of Medicine Turku University Hospital Turku Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Turku Finland.,Centre for Population Health Research University of TurkuTurku University Hospital Turku Finland.,Department of Clinical Physiology and Nuclear Medicine Turku University Hospital Turku Finland
| | - Costan G Magnussen
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Australia.,Research Centre of Applied and Preventive Cardiovascular Medicine University of Turku Turku Finland.,Centre for Population Health Research University of TurkuTurku University Hospital Turku Finland.,Baker Heart and Diabetes Institute Melbourne Victoria Australia
| | - James E Sharman
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Australia
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7
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Chumbley J, Xu W, Potente C, Harris KM, Shanahan M. A Bayesian approach to comparing common models of life-course epidemiology. Int J Epidemiol 2021; 50:1660-1670. [PMID: 33969390 PMCID: PMC8580273 DOI: 10.1093/ije/dyab073] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Life-course epidemiology studies people's health over long periods, treating repeated measures of their experiences (usually risk factors) as predictors or causes of subsequent morbidity and mortality. Three hypotheses or models often guide the analyst in assessing these sequential risks: the accumulation model (all measurement occasions are equally important for predicting the outcome), the critical period model (only one occasion is important) and the sensitive periods model (a catch-all model for any other pattern of temporal dependence). METHODS We propose a Bayesian omnibus test of these three composite models, as well as post hoc decompositions that identify their best respective sub-models. We test the approach via simulations, before presenting an empirical example that relates five sequential measurements of body weight to an RNAseq measure of colorectal-cancer disposition. RESULTS The approach correctly identifies the life-course model under which the data were simulated. Our empirical cohort study indicated with >90% probability that colorectal-cancer disposition reflected a sensitive process, with current weight being most important but prior body weight also playing a role. CONCLUSIONS The Bayesian methods we present allow precise inferences about the probability of life-course models given the data and are applicable in realistic scenarios involving causal analysis and missing data.
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Affiliation(s)
- Justin Chumbley
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Wenjia Xu
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Cecilia Potente
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Kathleen M Harris
- University of North Carolina at Chapel Hill, Carolina Population Center, Chapel Hill, NC, USA
| | - Michael Shanahan
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
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8
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Armstrong MK, Fraser BJ, Hartiala O, Buscot MJ, Juonala M, Wu F, Koskinen J, Hutri-Kähönen N, Kähönen M, Laitinen TP, Lehtimäki T, Viikari JSA, Raitakari OT, Magnussen CG. Association of Non-High-Density Lipoprotein Cholesterol Measured in Adolescence, Young Adulthood, and Mid-Adulthood With Coronary Artery Calcification Measured in Mid-Adulthood. JAMA Cardiol 2021; 6:661-668. [PMID: 33502454 DOI: 10.1001/jamacardio.2020.7238] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Elevated non-high-density lipoprotein cholesterol (non-HDL-C) is associated with the presence of coronary artery calcification (CAC), a marker of heart disease in adulthood. However, the relative importance of non-HDL-C levels at specific life stages for CAC remains unclear. Objective To identify the relative association of non-HDL-C measured at distinct life stages (adolescence, young adulthood, mid-adulthood) with the presence of CAC measured in mid-adulthood. Design, Setting, and Participants The Cardiovascular Risk in Young Finns Study is a population-based prospective cohort study that started in 1980 with follow-up over 28 years. Participants from 3 population centers (Kuopio, Tampere, and Turku in Finland) represent a convenience sample drawn from the 3 oldest cohorts at baseline (aged 12-18 years in 1980). Data were collected from September 1980 to August 2008. Analysis began February 2020. Exposures Non-HDL-C levels were measured at 3 life stages including adolescence (aged 12-18 years), young adulthood (aged 21-30 years), and mid-adulthood (aged 33-45 years). Main Outcomes and Measures In 2008, CAC was determined from computed tomography and dichotomized as 0 (no CAC, Agatston score = 0) and 1 (presence of CAC, Agatston score ≥1) for analysis. Using a bayesian relevant life course exposure model, the relative association was determined between non-HDL-C at each life stage and the presence of CAC in mid-adulthood. Results Of 589 participants, 327 (56%) were female. In a model adjusted for year of birth, sex, body mass index, systolic blood pressure, blood glucose level, smoking status, lipid-lowering and antihypertensive medication use, and family history of heart disease, cumulative exposure to non-HDL-C across all life stages was associated with CAC (odds ratio [OR], 1.50; 95% credible interval [CrI], 1.14-1.92). At each life stage, non-HDL-C was associated with CAC and exposure to non-HDL-C during adolescence had the strongest association (adolescence: OR, 1.16; 95% CrI, 1.01-1.46; young adulthood: OR, 1.14; 95% CrI, 1.01-1.43; mid-adulthood: OR, 1.12; 95% CrI, 1.01-1.34). Conclusions and Relevance These data suggest that elevated non-HDL-C levels at all life stages are associated with coronary atherosclerosis in mid-adulthood. However, adolescent non-HDL-C levels showed the strongest association with the presence of CAC in mid-adulthood, and greater awareness of the importance of elevated non-HDL-C in adolescence is needed.
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Affiliation(s)
- Matthew K Armstrong
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Brooklyn J Fraser
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Olli Hartiala
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| | - Marie-Jeanne Buscot
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Juha Koskinen
- Heart Center, Kymenlaakso Central Hospital, Kotka, Finland
| | - Nina Hutri-Kähönen
- Tampere University Hospital, Department of Pediatrics, Tampere University, Tampere, Finland
| | - Mika Kähönen
- Tampere University Hospital, Department of Clinical Physiology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tomi P Laitinen
- Kuopio University Hospital, Department of Clinical Physiology and Nuclear Medicine, University of Eastern Finland, Kuopio, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center-Tampere, Tampere University, Tampere, Finland
| | - Jorma S A Viikari
- Department of Medicine, University of Turku, Turku, Finland.,Division of Medicine, Turku University Hospital, Turku, Finland
| | - Olli T Raitakari
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
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9
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Fraser BJ, Blizzard L, Buscot MJ, Schmidt MD, Dwyer T, Venn AJ, Magnussen CG. The Association Between Grip Strength Measured in Childhood, Young- and Mid-adulthood and Prediabetes or Type 2 Diabetes in Mid-adulthood. Sports Med 2021; 51:175-183. [PMID: 32813182 PMCID: PMC7806554 DOI: 10.1007/s40279-020-01328-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Although low child and adult grip strength is associated with adverse cardiometabolic health, how grip strength across the life course associates with type 2 diabetes is unknown. This study identified the relative contribution of grip strength measured at specific life stages (childhood, young adulthood, mid-adulthood) with prediabetes or type 2 diabetes in mid-adulthood. METHODS Between 1985 and 2019, 263 participants had their grip strength measured using an isometric dynamometer in childhood (9-15 years), young adulthood (28-36 years) and mid-adulthood (38-49 years). In mid-adulthood, a fasting blood sample was collected and tested for glucose and glycated haemoglobin (HbA1c). Participants were categorized as having prediabetes or type 2 diabetes if fasting glucose levels were ≥ 5.6 mmol or if HbA1c levels were ≥ 5.7% (≥ 39 mmol/mol). A Bayesian relevant life course exposure model examined the association between lifelong grip strength and prediabetes or type 2 diabetes. RESULTS Grip strength at each time point was equally associated with prediabetes or type 2 diabetes in mid-adulthood (childhood: 37%, young adulthood: 36%, mid-adulthood: 28%). A one standard deviation increase in cumulative grip strength was associated with 34% reduced odds of prediabetes or type 2 diabetes in mid-adulthood (OR 0.66, 95% credible interval 0.40, 0.98). CONCLUSIONS Greater grip strength across the life course could protect against the development of prediabetes and type 2 diabetes. Strategies aimed at increasing muscular strength in childhood and maintaining behaviours to improve strength into adulthood could improve future cardiometabolic health. The Association Between Grip Strength Measured in Childhood, Young- and Mid-adulthood and Prediabetes or Type 2 Diabetes in Mid-adulthood.
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Affiliation(s)
- Brooklyn J Fraser
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Marie-Jeanne Buscot
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | | | - Terence Dwyer
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
- George Institute for Global Health, Oxford Martin School and Nuffield Department of Obstetrics and Gynaecology, Oxford University, Oxford, UK
- Murdoch Children's Research Institute, Melbourne, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Alison J Venn
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7001, Australia.
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.
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10
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Lan T, Park Y, Colditz GA, Liu J, Wang M, Wu K, Giovannucci E, Sutcliffe S. Adolescent dairy product and calcium intake in relation to later prostate cancer risk and mortality in the NIH-AARP Diet and Health Study. Cancer Causes Control 2020; 31:891-904. [PMID: 32743740 DOI: 10.1007/s10552-020-01330-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 07/24/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Although a growing body of evidence supports an early-life contribution to prostate cancer (PCa) development, few studies have investigated early-life diet, and only three have examined early-life dairy product intake, a promising candidate risk factor because of its known/suspected influence on insulin-like growth factor levels and height. METHODS We used recalled dietary data from 162,816 participants in the NIH-AARP Diet and Health Study to investigate associations for milk, cheese, ice cream, total dairy, and calcium intake at ages 12-13 years with incident total (n = 17,729), advanced (n = 2,348), and fatal PCa (n = 827) over 14 years of follow-up. We calculated relative risks (RRs) and 95% confidence intervals (CIs) by Cox proportional hazards regression. RESULTS We observed suggestive positive trends for milk, dairy, and calcium intake with total and/or advanced PCa (p-trends = 0.016-0.148). These trends attenuated after adjustment for additional components of adolescent diet, particularly red meat and vegetables/potatoes. In contrast, suggestive inverse trends were observed for cheese and ice cream intake with total and/or advanced PCa (p-trends = 0.043-0.153), and for milk, dairy, and calcium intake with fatal PCa (p-trend = 0.045-0.117). CONCLUSION Although these findings provide some support for a role of adolescent diet in increasing PCa risk, particularly for correlates of milk intake or overall dietary patterns, our protective findings for cheese and ice cream intake with PCa risk and mortality, and for all dairy products with PCa mortality, suggest alternative explanations, such as the influence of early-life socioeconomic status, and increased PCa screening, earlier detection, and better PCa care.
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Affiliation(s)
- Tuo Lan
- Department of Occupational and Environmental Health, College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - Yikyung Park
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Molin Wang
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA
| | - Kana Wu
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Edward Giovannucci
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.,Channing Division of Network Medicine, Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA.,Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA. .,Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
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