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Ren Z, Xia S, Sun J, Wang D, Du Y, Li N, Liu J. Internet use, cardiometabolic multimorbidity, and death in older adults: a multi-cohort study spanning developing and developed countries. Global Health 2023; 19:81. [PMID: 37932770 PMCID: PMC10626678 DOI: 10.1186/s12992-023-00984-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Internet use is a double-edged sword for older adults' health. Whether internet use can prevent cardiometabolic diseases and death in older adults remains controversial. METHODS Four cohorts across China, Mexico, the United States, and Europe were utilized. Internet use was defined using similar questions. Cardiometabolic diseases included diabetes, heart diseases, and stroke, with 2 or more denoting cardiometabolic multimorbidity. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale and Europe-depression scale. The competing risk analysis based on subdistribution hazard regression, random-effects meta-analysis, and mediation analysis were utilized. RESULTS A total of 104,422 older adults aged 50 or older were included. Internet users (vs. digital exclusion) were at lower risks of diabetes, stroke, and death, with pooled sHRs (95% CIs) of 0.83 (0.74-0.93), 0.81 (0.71-0.92), and 0.67 (0.52-0.86), respectively, which remained significant in sensitivity analyses. The inverse associations of internet use with new-onset cardiometabolic diseases and death were progressively significant in Mexico, China, the United States, and Europe. For instance, older internet users in Europe were at 14-30% lower cardiometabolic risks and 40% lower risk of death. These associations were partially mediated by reduced depressive symptoms and were more pronounced in those with high socioeconomic status and women. Furthermore, patients with prior cardiometabolic conditions were at about 30% lower risk of death if they used the internet, which was also mediated by reduced depressive symptoms. However, certain cardiometabolic hazards of internet use in those aged < 65 years, with low socioeconomic status, men, and single ones were also observed. CONCLUSION Enhancing internet usage in older adults can reduce depressive symptoms and thus reduce the risks of cardiometabolic diseases and death. The balance of internet use, socioeconomic status, and health literacy should be considered when popularizing the internet in older adults.
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Affiliation(s)
- Ziyang Ren
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, No 38 College Rd, Haidian District, Beijing, 100191, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No 38 College Rd, Haidian District, Beijing, 100191, China
| | - Shuangbo Xia
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, No 38 College Rd, Haidian District, Beijing, 100191, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No 38 College Rd, Haidian District, Beijing, 100191, China
| | - Jinfang Sun
- Office of Epidemiology, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Duoduo Wang
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, No 38 College Rd, Haidian District, Beijing, 100191, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No 38 College Rd, Haidian District, Beijing, 100191, China
| | - Yushan Du
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, No 38 College Rd, Haidian District, Beijing, 100191, China
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No 38 College Rd, Haidian District, Beijing, 100191, China
| | - Ning Li
- Institute of Population Research, Peking University, No 38 College Rd, Haidian District, Beijing, 100191, China
| | - Jufen Liu
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, No 38 College Rd, Haidian District, Beijing, 100191, China.
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No 38 College Rd, Haidian District, Beijing, 100191, China.
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Du Y, Luo Y, Nie L, Ren Z, Sun J, Liu J. A Link between Prenatal Stage of Life during the Great Chinese Famine and Subsequent Depressive Symptoms among Middle-Aged and Older Adults. Nutrients 2023; 15:4600. [PMID: 37960253 PMCID: PMC10647632 DOI: 10.3390/nu15214600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
Prenatal malnutrition may increase the risk of depressive symptoms in adulthood. This study investigated the association between prenatal exposure to malnutrition with risk of depressive symptoms in middle-aged and older adults using the Chinese Great Famine of 1959-1961 as a natural experiment. Data were obtained from the China Health and Retirement Longitudinal Study baseline survey (2011). A total of 5391 individuals born from 1956 to 1965 were included in the study. Depressive symptoms were ascertained via the Center for Epidemiological Studies Depression Scale short form. Famine severity was measured using the cohort size shrinkage index. Difference-in-differences models were used to explore the association between prenatal famine exposure and later-life depressive symptoms. Compared with the post-famine cohort (1963-1965), famine cohorts (1959-1962) were 4.74 times (95% CI = 1.28-8.20) as likely to develop depressive symptoms. The stratified analysis found that prenatal exposure to famine was associated with depressive symptoms in rural residents but not those living in urban areas. In rural females, prenatal malnutrition was associated with a higher risk of depressive symptoms. However, there was no significant association between prenatal malnutrition and depressive symptoms in rural males. Our results indicated that prenatal malnutrition may contribute to a higher risk for depressive symptoms in later life among female rural residents.
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Affiliation(s)
- Yushan Du
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.D.); (L.N.); (Z.R.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing 100191, China;
| | - Lirong Nie
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.D.); (L.N.); (Z.R.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Ziyang Ren
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.D.); (L.N.); (Z.R.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Jinfang Sun
- Office of Epidemiology, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Jufen Liu
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University, Beijing 100191, China; (Y.D.); (L.N.); (Z.R.)
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
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