Self-Rated Health Status and Risk of Incident Stroke in 0.5 Million Chinese Adults: The China Kadoorie Biobank Study

Prospective Effects of Self-Rated Health on Dementia Risk in Two Twin Studies of Aging

Subjective health ratings are associated with dementia risk such that those who rate their health more poorly have increased risk for dementia. The genetic and environmental mechanisms underlying this association are unclear, as prior research cannot rule out whether the association is due to genetic confounds. The current study addresses this gap in two samples of twins, one from Sweden (N = 548) and one from Denmark (N = 4,373). Using genetically-informed, bivariate regression models, we assessed whether additive genetic effects explained the association between subjective health and dementia risk as indexed by a latent variable proxy measure. Age at intake, sex, education, depressive symptomatology, and follow-up time between subjective health and dementia risk assessments were included as covariates. Results indicate that genetic variance and other sources of confounding accounted for the majority of the effect of subjective health ratings on dementia risk. After adjusting for genetic confounding and other covariates, a small correlation was observed between subjective health and latent dementia risk in the Danish sample (rE = - .09, p < .05). The results provide further support for the genetic association between subjective health and dementia risk, and also suggest that subjective ratings of health measures may be useful for predicting dementia risk.

Cost-Effectiveness of a Workplace-Based Hypertension Management Program in Real-World Practice in the Kailuan Study

BACKGROUND

In 2009, a workplace-based hypertension management program was launched among men with hypertension in the Kailuan study. This program involved monitoring blood pressure semimonthly, providing free antihypertensive medications, and offering personalized health consultations. However, the cost-effectiveness of this program remains unclear.

METHODS AND RESULTS

This analysis included 12 240 participants, with 6120 in each of the management and control groups. Using a microsimulation model derived from 10-year follow-up data, we estimated costs, quality-adjusted life years (QALYs), life-years, and incremental cost-effectiveness ratios (ICERs) for workplace-based management compared with routine care in both the study period and over a lifetime. Analyses are conducted from the societal perspective. Over the 10-year follow-up, patients in the management group experienced an average gain of 0.06 QALYs with associated incremental costs of $633.17 (4366.85 RMB). Projecting over a lifetime, the management group was estimated to increase by 0.88 QALYs or 0.92 life-years compared with the control group, with an incremental cost of $1638.64 (11 301.37 RMB). This results in an incremental cost-effectiveness ratio of $1855.47 per QALY gained and $1780.27 per life-year gained, respectively, when comparing workplace-based management with routine care. In probabilistic sensitivity analyses, with a threshold willingness-to-pay of $30 765 per QALY (3 times 2019 gross domestic product per capita), the management group showed a 100% likelihood of being cost-effective in 10 000 samples.

CONCLUSIONS

Workplace-based management, compared with routine care for Chinese men with hypertension, could be cost-effective both during the study period and over a lifetime, and might be considered in working populations in China and elsewhere.

Analysis of depression incidence and influence factors among middle-aged and elderly diabetic patients in China: based on CHARLS data

BACKGROUND

To investigate the incidence of depression in middle-aged and elderly patients with diabetes in China and the influencing factors to provide a theoretical basis to improve the mental health of middle-aged and elderly patients with diabetes and formulate prevention, control, and intervention strategies.

METHODS

The sample of this study was obtained from the China Health and Aging Tracking Survey (CHARLS) 2018 survey data, and middle-aged and older patients with diabetes(responding "Yes" to the questionnaire: "Have you ever been told by a doctor that you have diabetes or elevated blood glucose [including abnormal glucose tolerance and elevated fasting glucose]?") aged ≥ 45 years were selected as study subjects (n = 2,613 ). Depressive symptoms of the study subjects were determined using the simplified version of the Depression Scale for Epidemiological Surveys scores(a score ≥ 10 was defined as depression), influence factors were analyzed using binary logistic regression, and proportion of depressive symptoms was standardized using the sex ratio of the seventh census.

RESULTS

Among the 2,613 middle-aged and elderly patients with diabetes, 1782 (68.2%) had depressive symptoms and 831 (31.8%) had no depressive symptoms. There were 481 (27.0%) patients aged 45-59 years, 978 (54.9%) aged 60-74 years, and 323 (18.1%) aged ≥ 75 years. The depression rate among middle-aged and elderly Chinese patients with diabetes after standardization correction was 67.5%. Binary logistic regression results showed that age, education level, life satisfaction, marital satisfaction, self-rated health grade, somatic pain, visual impairment, physical disability, and the presence of comorbid chronic diseases were factors that influenced the onset of depression in middle-aged and elderly Chinese patients with diabetes (P < 0.05).

CONCLUSION

According to a survey analysis of the CHARLS 2018 data, depression is influenced by a combination of factors among middle-aged and elderly patients with diabetes in China. Therefore, for this population, targeted prevention and control should be carried out for key populations, such as middle-aged and elderly people, poor physical health, and low life satisfaction and marital satisfaction, from various dimensions (e.g., demographic and sociological factors, physical health status, and life satisfaction and marital satisfaction).

Cost-effectiveness of treatment in adults with blood pressure of 130-139/80-89 mmHg and high cardiovascular risk in China: a modelling study

Background

The most recent updated hypertension guidelines recommend individuals with systolic blood pressure (SBP)/diastolic blood pressure (DBP) of 130-139/80-89 mmHg and high cardiovascular risk should receive antihypertensive drug treatment. This study aimed to assess the benefits and cost-effectiveness of medication for people aged ≥35 years with this blood pressure stratum and high cardiovascular risk in China.

Methods

The benefits of drug treatment in adults aged ≥35 years with SBP/DBP of 130-139/80-89 mmHg and high cardiovascular risk were evaluated in decision-analytic simulation models. Decreasing numbers of cardiovascular disease (CVD) events and premature deaths from all causes and increasing quality-adjusted life-years (QALYs) from drug treatment were estimated in 10-year and lifetime horizons. The incremental cost-effectiveness ratios (ICER) for drug treatment were calculated.

Findings

Among approximately 106.60 million Chinese adults aged ≥35 years with this blood pressure stratum and high cardiovascular risk, drug treatment was estimated to prevent 2,060,000 strokes and 660,000 myocardial infarctions over a 10-year time horizon. Adults prescribed antihypertensive drugs could gain 0.034 incremental QALYs. Over a lifetime horizon, adults who start treatment earlier could benefit more in preventing CVD and gaining incremental QALYs. The medication treatment is cost-effective either over a 10-year time horizon with an ICER of Int$13321.29 per QALY gained or over the remaining lifetime.

Interpretation

Antihypertensive treatment of adults with SBP/DBP of 130-139/80-89 mmHg and high cardiovascular risk would gain substantial benefits with cost-effectiveness. The young and middle-aged population would derive the most benefit.

Funding

National Natural Science Foundation of China, and Beijing Natural Science Foundation.

Domain-specific physical activity, sedentary behavior, subjective health, and health-related quality of life among older adults

PURPOSE

This study aims to investigate the association between domain-specific physical activity (PA), sedentary behavior, subjective health perception, and health-related quality of life (HR-QoL) in Korean adults aged ≥ 65 years.

METHODS

This cross-sectional study analyzed 6,004 older adults from the Korean National Health and Nutrition Examination Survey 2017-2020. PA and sedentary behavior were measured using a global PA questionnaire, and HR-QoL was assessed using the EuroQol-5 Dimension (EQ-5D, three-level version). Multiple logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) after adjusting for confounding parameters.

RESULTS

Older adults who were physically active at work showed a negative association with subjectively good health and HR-QoL, whereas those physically active in transport or leisure time showed a positive association with subjectively good health and HR-QoL. Older adults highly engaged in sedentary behavior showed a worse perception of health and HR-QoL. Compared to high sedentary behavior and physical activity during leisure time or transport, the EQ-5D index was higher than that of their counterparts.

CONCLUSION

Both domain-specific PA and sedentary behavior were significantly associated with older adults' perception of health and HR-QoL. Interventions are needed to improve HR-QoL by reducing sedentary behavior and encouraging physical activity in transportation or leisure time among adults aged 65 years and above.

Development, validation and comparison of multivariable risk scores for prediction of total stroke and stroke types in Chinese adults: a prospective study of 0.5 million adults

BACKGROUND AND PURPOSE

Low-income and middle-income countries have the greatest stroke burden, yet remain understudied. This study compared the utility of Framingham versus novel risk scores for prediction of total stroke and stroke types in Chinese adults.

METHODS

China Kadoorie Biobank (CKB) is a prospective study of 512 726 adults, aged 30-79 years, recruited from 10 areas in China in 2004-2008. By 1 January 2018, 43 234 incident first stroke cases (36 310 ischaemic stroke (IS); 8865 haemorrhagic stroke (HS)) were recorded in 503 842 participants with no history of stroke at baseline. We compared the predictive utility of the Framingham Stroke Risk Profile (FSRP) with novel CKB stroke risk scores and included recalibration, refitting, stratifying by study area and addition of other risk factors. Discrimination was assessed using area under the receiver operating characteristic curve (AUC) and calibration was assessed using Greenwood-Nam-D'Agostino χ² statistics.

RESULTS

Incidence of total stroke varied fivefold by area in China. The FSRP had good discrimination for total stroke (AUC (95% CI); men: 0.78 (0.77 to 0.79), women: 0.77 (95% CI 0.76 to 0.78)), but poor calibration (χ²; men: 1,825, women: 3,053), substantially underestimating absolute risks. Recalibration reduced χ² by >80%, but did not improve discrimination. Refitting the FSRP did not materially improve discrimination, but further improved calibration. Stratification by area improved discrimination (AUC; men: 0.82 (0.82 to 0.83); women: 0.82 (0.82 to 0.83)), but not calibration. Adding other risk factors yielded modest, but statistically significant, improvements in the AUCs. The findings for IS and HS were similar to those for total stroke.

CONCLUSIONS

The FSRP reliably differentiated Chinese adults with incident stroke, but substantially underestimated the absolute risks of stroke. Novel local risk prediction equations that took account of differences in stroke incidence within China enhanced risk prediction of total stroke and major stroke pathological types.

Self-rated health, socioeconomic status and all-cause mortality in Chinese middle-aged and elderly adults

Our study aims to investigate the association between SRH and all-cause mortality, and to investigate whether the SRH-mortality association varies across different socioeconomic status (SES) groups among middle-aged and older Chinese adults. We used data from China Health and Retirement Longitudinal Study (CHARLS), including 11,762 participants for the final analysis. Cox proportional hazards regression was conducted to investigate the association between SRH status and subsequent mortality. There were 724 death events occurred. The results were shown that fair/poor SRH participants tend to die than better SRH peers (HR 1.46, 95% CI 1.12–1.91). The association only occurred in those with rural residency (HR 1.46, 95% CI 1.05–2.04), those who were literate (HR 1.65, 95% CI 1.17–2.33), those with above-average household income (HR 1.95, 95% CI 1.15–3.29) and those working in agriculture and below (HR 1.38, 95% CI 1.02–1.88). In conclusion, worse SRH may be a predictor of all-cause mortality among middle-aged and elderly Chinese, especially in people with rural residency, literacy, above-average household income and working in agriculture and below.

Impact of temperature changes between neighboring days on cardiovascular disease hospital admissions among suburban farmers in Qingyang, Northwest China

BACKGROUND

No studies focused on impact of temperature changes between neighboring days (TCN) on cardiovascular disease (CVD) hospital admissions among suburban farmers although CVD has been the main cause to global mortality and disability especially in undeveloped and developing countries/areas.

METHOD

Daily data of CVD hospital admissions on suburban farmers and daily data of meteorology in Qingyang (China) were collected during 2011-2015. A distributed lag non-linear model (DLNM) was applied to explore the exposure-response relations and lagged effects between TCN and CVD hospital admissions with stratified analyses by age and gender. Extreme low TCN effects and burden analysis were conducted.

RESULTS

Based on 25,984 cases in Qingyang (China) during 2011-2015 among suburban farmers, we found that, first, nonlinear relationship was observed between TCN and CVD hospital admissions and adverse impact in negative TCN (temperature dropping between neighboring days) while protective effect in positive TCN (temperature rising between neighboring days) were discovered; third, during lag0-27, the cumulative relative risk (RR) for extreme low TCN (5th percentile, - 3.5 °C) and extreme high TCN (95th percentile, 3 °C) was 29.55 (95% CI 4.709-185.436) and 0.040 (95% CI 0.009-0.169), respectively; fourth, the age < 65 and females were more vulnerable to negative TCN than the age ≥ 65 and males among suburban farmers, respectively; last, moderate low TCN contributed the most fractions and numbers on CVD hospital admissions.

CONCLUSIONS

Among Qingyang suburban farmers in Northwest China, negative TCN should be paid more attention.

Short-Term Effects of Low-Level Ambient Air NO2 on the Risk of Incident Stroke in Enshi City, China

Previous studies found that exposure to ambient nitrogen dioxide (NO₂) was associated with an increased risk of incident stroke, but few studies have been conducted for relatively low NO₂ pollution areas. In this study, the short-term effects of NO₂ on the risk of incident stroke in a relatively low-pollution area, Enshi city of Hubei Province, China, were investigated through time-series analysis. Daily air-pollution data, meteorological data, and stroke incidence data of residents in Enshi city from 1 January 2015 to 31 December 2018 were collected. A time-series analysis using a generalised additive model (GAM) based on Poisson distribution was applied to explore the short-term effects of low-level NO₂ exposure on the risk of incident stroke and stroke subtypes, as well as possible age, sex, and seasonal differences behind the effects. In the GAM model, potential confounding factors, such as public holidays, day of the week, long-term trends, and meteorological factors (temperature and relative humidity), were controlled. A total of 9122 stroke incident cases were included during the study period. We found that NO₂ had statistically significant effects on the incidence of stroke and ischemic stroke, estimated by excess risk (ER) of 0.37% (95% CI: 0.04–0.70%) and 0.58% (95% CI: 0.18–0.98%), respectively. For the cumulative lag effects, the NO₂ still had a statistically significant effect on incident ischemic stroke, estimated by ER of 0.61% (95% CI: 0.01–1.21%). The two-pollutant model showed that the effects of NO₂ on incident total stroke were still statistically significant after adjusting for other air pollutants (PM_2.5, PM₁₀, SO₂, CO, and O₃). In addition, the effects of NO₂ exposure on incident stroke were statistically significant in elderly (ER = 0.75%; 95% CI: 0.11–1.40%), males (ER = 0.47%; 95% CI: 0.05–0.89%) and cold season (ER = 0.83%; 95% CI: 0.15–1.51%) subgroups. Our study showed that, as commonly observed in high-pollution areas, short-term exposure to low-level NO₂ was associated with an increased risk of incident stroke, including ischemic stroke. Males and elderly people were more vulnerable to the effects of NO₂, and the adverse effects might be promoted in the cold season.

The longitudinal relation between depressive symptoms and change in self-rated health: A nationwide cohort study

OBJECTIVE

This study aimed to prospectively assess the relationship between depressive symptoms and change in self-rated health (SRH) in middle-aged and elderly Chinese adults.

METHODS

We used data from the China Health and Retirement Longitudinal Study (CHARLS). The final analysis included 8169 participants (≥45 years old) and a multinomial logistic regression model was used to assess the association between baseline depression and follow-up change in SRH.

RESULTS

Taking no change in SRH as the reference, depressive symptoms at baseline were positively associated with a 2-year decline in SRH (OR: 1.38, 95% CI: 1.15-1.65) and negatively associated with a 2-year improvement in SRH (OR: 0.74, 95% CI: 0.63-0.85). Over a 4-year period, the OR (95% CI) values increased to 1.41 (1.19-1.67) and decreased to 0.69 (0.59-0.80) for decline and improvement in SRH, respectively. In stratified analyses, the association between depression and 2- or 4-year decline/improvement in SRH persisted in all sex and age subgroups.

CONCLUSIONS

Baseline depression is an independent predictor of change in SRH among Chinese people aged 45 and above. Early monitoring and management of depressive symptoms may be worthwhile to maintain and improve SRH in the middle-aged and elderly population.

Quality of Life and Associated Factors in Young Workers

BACKGROUND

This study aimed to identify the factors associated with the quality of life of young workers of a Social Work of Industry Unit.

METHODS

This was a cross-sectional study conducted on 1270 workers. Data were collected using a digital questionnaire built on the KoBoToolbox platform that included the EUROHIS-QOL eight-item index to assess quality of life. Demographic, socioeconomic, behavioral, and clinical variables were considered explanatory. The associations were analyzed using the ordinal logistic regression model at a 5% significance level.

RESULTS

Men and women had a mean quality of life of 31.1 and 29.4, respectively. Workers that rated their health as "very good" had an odds ratio of 7.4 (95% confidence interval (CI) = 5.17-10.81), and those who rated it as "good" had an odds ratio of 2.9 (95% CI = 2.31-3.77). Both these groups of workers were more likely to have higher levels of quality of life as compared to workers with "regular", "poor", or "very poor" self-rated health. Physically active individuals were 30% more likely to have higher levels of quality of life (odds ratio = 1.3; 95% CI = 1.08-1.65). After adjusting the model by gender, age group, marital status, socioeconomic class, self-rated health, nutritional status, and risky alcohol consumption, the odds ratio of active individuals remained stable (odds ratio = 1.3; 95% CI = 1.05-1.66).

CONCLUSIONS

In the present study, self-rated health, physical activity, and gender were associated with young workers' quality of life.

Trends and Challenges of Wearable Multimodal Technologies for Stroke Risk Prediction

We review in this paper the wearable-based technologies intended for real-time monitoring of stroke-related physiological parameters. These measurements are undertaken to prevent death and disability due to stroke. We compare the various characteristics, such as weight, accessibility, frequency of use, data continuity, and response time of these wearables. It was found that the most user-friendly wearables can have limitations in reporting high-precision prediction outcomes. Therefore, we report also the trend of integrating these wearables into the internet of things (IoT) and combining electronic health records (EHRs) and machine learning (ML) algorithms to establish a stroke risk prediction system. Due to different characteristics, such as accessibility, time, and spatial resolution of various wearable-based technologies, strategies of applying different types of wearables to maximize the efficacy of stroke risk prediction are also reported. In addition, based on the various applications of multimodal electroencephalography-functional near-infrared spectroscopy (EEG-fNIRS) on stroke patients, the perspective of using this technique to improve the prediction performance is elaborated. Expected prediction has to be dynamically delivered with high-precision outcomes. There is a need for stroke risk stratification and management to reduce the resulting social and economic burden.

The association between subjective health perception and lifestyle factors in Shiga prefecture, Japan: a cross-sectional study

Background

The Ministry of Health has reported that in Japan, the Shiga prefecture has the highest life expectancy. Subjective health perception is a predictive indicator of mortality. For this study, we examined the association between subjective health perception and multiple lifestyle factors.

Methods

Data were obtained from the 2015 Health and Nutrition Survey in Shiga prefecture. The analytic sample comprised 6057 adults aged 20 or older. Information on subjective health perception and lifestyle behaviors was obtained from a self-administered questionnaire. As for subjective health perception, participants were divided into 2 groups: (1) Excellent or Good and (2) Average, Poor, or Very Poor. A 1-day dietary survey was also administered. The health behaviors score (HBS) was calculated based on 5 factors: consuming a healthy diet, never smoking, low-risk alcohol drinking, regular exercise, and moderate sleep duration. HBS scores ranged from 0 to 5. Multiple logistic regression was used to calculate the sex-, age- BMI- and energy intake-adjusted odds ratios (ORs) of poor subjective health across HBS, with 0 points as the reference.

Results

Among all participants, 2397 (39.6%) individuals were classified into the good subjective health group. Participants with an HBS of 3 (OR 0.59, 95% CI 0.37–0.96), 4 (OR 0.40, 95% CI 0.24–0.65) or 5 (OR 0.33, 95% CI 0.19–0.59) had a lower OR of rating themselves as being average/poor health compared with those having zero. The association with a higher HBS was remarkable (p for trend: < 0.001). Additional analyses revealed that the combinations including regular exercise were particularly associated with a lower risk of subjective average/poor health.

Conclusions

This study showed that the higher the number of healthy lifestyle factors, the lower risk of subjective average/poor health. Combinations of healthy lifestyle factors, especially those involving exercise, suggest good subjective health for individuals living in the Shiga prefecture.

Cost-Effectiveness of Drug Treatment for Chinese Patients With Stage I Hypertension According to the 2017 Hypertension Clinical Practice Guidelines

Systolic/diastolic blood pressure of 130 to 139/80 to 89 mm Hg has been defined as stage I hypertension by the 2017 Hypertension Clinical Practice Guidelines. Drug treatment is recommended for stage I hypertensive patients aged ≥65 years without cardiovascular disease in the 2017 Hypertension Clinical Practice Guidelines but not in the 2018 Chinese guidelines. However, the cost-effectiveness of drug treatment among this subgroup of Chinese patients is unclear. This study developed a microsimulation model to compare costs and effectiveness of drug treatment and nondrug treatment for the subgroup of stage I hypertensive patients over a lifetime horizon from a government affordability perspective. Event rates of mortality and cardiovascular complications were estimated from 3 cohorts in the Chinese population. Costs and health utilities were obtained from the national statistics report and published literature. The model predicted that drug treatment generated quality-adjusted life-years of 13.52 and associated with expected costs of $6825 in comparison with 13.81 and $7328 produced by nondrug treatment over a lifetime horizon among stage I hypertensive patients aged ≥65 years without cardiovascular disease. At a willingness-to-pay threshold of $8836/quality-adjusted life-year (the GDP per capita in 2017), drug treatment only had a 1.8% probability of being cost-effective compared with nondrug treatment after 10 000 probabilistic simulations. Sensitivity analysis of treatment costs, benefits expected from treatment, health utilities, and discount rates did not change the results. Our results suggested that drug treatment was not cost-effective compared with nondrug treatment for stage I hypertensive patients aged ≥65 years without cardiovascular disease in China.

The Relationship Between Meaningful Occupation and Self-Rated Health in Japanese Individuals: The Wakayama Study

In this study, we conducted a quantitative cross-sectional evaluation of the relationships between self-related health and occupational form, occupational performance, and occupational satisfaction. The participants were 675 community-dwelling subjects (283 men, 392 women) who completed a self-administered questionnaire. From this data, we performed a multiple logistic regression analysis using the high and low values of self-rated health as the dependent variables and the characteristics of occupational form, occupational performance, and occupational satisfaction as the independent variables. There were three analysis models: Model 1, which mutually adjusted for all the independent variables; Model 2, with adjustment of the basic attributes, in addition to the first model; and Model 3, which was based on Model 2, but also adjusted for diseases. In all three models, high self-rated health was significantly correlated with high occupational performance scores. These findings confirmed that supporting occupational performance improvement is useful for improving self-rated health.

Self-rated health after stroke: a systematic review of the literature

BACKGROUND

Self-rated health (SRH) allows for comparison and identification of the health status of various populations. The aim of this study was to conduct a systematic review of the literature to expand the understanding of SRH after stroke.

METHODS

This systematic review was registered with PROSPERO (CRD42017056194) and conducted according to PRISMA guidelines. Studies published until December 2018 that evaluated the SRH of adults with stroke were included.

RESULTS

Of the 2132 identified studies, 51 were included. Only four studies had experimental designs (7.8%). In 60.7% of the studies, SRH was assessed by variations on direct questions (i.e., general and comparative SRH). Analog visual scales and quality of life instruments were also used to evaluate SRH, but there is no consensus regarding whether they are appropriate for this purpose. The results of cross-sectional and longitudinal studies revealed significant associations between poor SRH and stroke as well as between SRH, function, and disability. The power of SRH to predict stroke mortality is still uncertain. Two interventions (a home-based psychoeducational program concerning stroke health care and family involvement in functional rehabilitation) effectively improved SRH.

CONCLUSIONS

Direct questions are the most common method of evaluating SRH after stroke. Studies reported significant associations between the SRH of individuals with stroke and several relevant health outcomes. However, few experimental studies have evaluated SRH after stroke. Interventions involving health education and family involvement had a significant impact on SRH.

Relative deprivation of assets defined at multiple geographic scales, perceived stress and self-rated health in China

Relative deprivation (RD) may increase psychosocial stress, which could result in poor health. We examined the associations between asset-based RD indicators, defined at multiple geographic scales (i.e., within community; within area (urban/rural) of a province; within province; and across country), and self-rated health in China. A generalized structural equation model was used to estimate both the direct association between RD and self-related health and the indirect association through psychological stress measures. Results showed that higher RD was associated with the higher odds of reporting poor or very poor health, both directly and indirectly through psychological stress. This association was observed irrespective of the geographic scale at which reference groups were defined.