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Davies CR, Budgeon CA, Murray K, Hunter M, Knuiman M. The art of aging well: a study of the relationship between recreational arts engagement, general health and mental wellbeing in cohort of Australian older adults. Front Public Health 2023; 11:1288760. [PMID: 38098824 PMCID: PMC10720704 DOI: 10.3389/fpubh.2023.1288760] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/31/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction Evidence of the benefits of arts engagement to community wellbeing has been mounting since the 1990s. However, large scale, quantitative, epidemiological studies of the "arts-healthy aging" relationship, or the types of arts older adults voluntarily choose to engage in as part of their everyday life, for enjoyment, entertainment or as a hobby (vs. therapy or interventions) are limited. The aims of this study were to describe older adult recreational arts engagement via the Busselton Healthy Ageing Study (BHAS) cohort, and to determine if there was an association between arts engagement, general health and mental wellbeing. Methods Overall, 2,843 older adults (born 1946-1964) from the BHAS cohort (n = 5,107) who had completed a supplementary arts survey (n = 3,055, 60%) and had data on required variables were included in this study (93% of those eligible). The dependent variable was general health (SF12) and subjective mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale, WEMWBS). The independent variable was hours engaged in recreational arts in the last 12 months. A descriptive analysis followed by a linear regression analysis was conducted. Results The prevalence of recreational arts engagement in the last 12 months was 85% (mean = 132 h/year). Older adults engaged in the arts in a number of ways including attending events (79%), actively participating/making art (40%), as an arts society/club/organization member (20%), by learning about the arts (13%) or by volunteering/working in the arts (non-professional, 11%). When general health was assessed via the SF12, the average physical component score (PCS) was 50.1 (SD 8.9) and the average mental component score (MCS) was 53.6 (SD 8.3). When mental wellbeing was assessed, the average WEMWBS score was 54.9 (SD = 8.6). After adjustment for 12 demographic and lifestyle covariates, it was found that older adults who engaged in any recreational arts in the last 12 months had significantly higher WEMWBS scores and higher SF12 physical component scores than those who did not engage in the arts (0 h/year). Discussion Evidence of an arts-health relationship was found in this study. The suitability of the arts as a population based, healthy aging strategy to influence the mental wellbeing and general health of older adults should be investigated further.
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Affiliation(s)
- Christina R. Davies
- Centre for Arts, Mental Health and Wellbeing WA, School of Allied Health and the School of Humanities, The University of Western Australia, Perth, WA, Australia
| | - Charley A. Budgeon
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Michael Hunter
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
- Busselton Population Medical Research Institute, Busselton, WA, Australia
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
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Janjua M, Knuiman M, Divitini M, McQuillan B, Olynyk JK, Jeffrey GP, Adams LA. Alcohol Consumption and Cardiovascular Outcomes in Patients With Nonalcoholic Fatty Liver Disease: A Population-Based Cohort Study. Hepatol Commun 2022; 6:526-534. [PMID: 34931492 PMCID: PMC8870048 DOI: 10.1002/hep4.1828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/30/2021] [Accepted: 09/08/2021] [Indexed: 11/29/2022] Open
Abstract
Low-level alcohol consumption is associated with reduced cardiovascular disease (CVD) in the general population. It is unclear whether this association is seen in patients with nonalcoholic fatty liver disease (NAFLD) who have an increased risk of CVD. We examined the association between alcohol consumption and CVD-related outcomes in subjects with NAFLD from a general population cohort. Subjects participating in the 1994-1995 Busselton Health survey underwent clinical and biochemical assessment. NAFLD was identified using the Fatty Liver Index of >60, and alcohol consumption quantified using a validated questionnaire. CVD hospitalizations and death during the ensuing 20 years were ascertained using the Western Australian data linkage system. A total of 659 of 4,843 patients were diagnosed with NAFLD. The average standard drinks per week was 8.0 for men and 4.0 for women. Men consuming 8-21 drinks per week had a 38% (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.43-0.90) lower risk of CVD hospitalization as compared with men consuming 1-7 drinks per week. With both men and women combined, consumption of 8-21 drinks per week was associated with a 32% (HR 0.68, 95% CI 0.49-0.93) reduction in CVD hospitalization in minimally adjusted and 29% (HR 0.71, 95% CI 0.51-0.99) in fully adjusted models. No protective association was observed with binge drinking. There was no association between alcohol consumption and CVD death. Conclusion: Low to moderate alcohol consumption is associated with fewer CVD hospitalizations but not CVD death in subjects with NAFLD.
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Affiliation(s)
- Malik Janjua
- Department of HepatologySir Charles Gairdner HospitalNedlandsWAAustralia
| | - Matthew Knuiman
- School of Population and global HealthUniversity of Western AustraliaNedlandsWAAustralia
| | - Mark Divitini
- School of Population and global HealthUniversity of Western AustraliaNedlandsWAAustralia
| | - Brendan McQuillan
- Medical SchoolUniversity of Western AustraliaNedlandsWAAustralia.,Department of Cardiovascular MedicineSir Charles Gairdner HospitalNedlandsWAAustralia
| | - John K Olynyk
- Department of GastroenterologyFiona Stanley HospitalMurdochWAAustralia.,School of Medical and Health SciencesEdith Cowan UniversityJoondalupWAAustralia
| | - Gary P Jeffrey
- Department of HepatologySir Charles Gairdner HospitalNedlandsWAAustralia.,Medical SchoolUniversity of Western AustraliaNedlandsWAAustralia
| | - Leon A Adams
- Department of HepatologySir Charles Gairdner HospitalNedlandsWAAustralia.,Medical SchoolUniversity of Western AustraliaNedlandsWAAustralia
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Cunningham J, Hunter M, Budgeon C, Murray K, Knuiman M, Hui J, Hillman D, Singh B, James A. The prevalence and comorbidities of obstructive sleep apnea in middle-aged men and women: the Busselton Healthy Ageing Study. J Clin Sleep Med 2021; 17:2029-2039. [PMID: 34606440 DOI: 10.5664/jcsm.9378] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
STUDY OBJECTIVES Population surveys suggest the prevalence of obstructive sleep apnea (OSA) is high and increasing and that risk factors and outcomes differ between sexes. To explore these relationships we assessed current OSA prevalence, potential risk factors and comorbidities, and their changes relative to previous estimates in the same community. METHODS All adults on the Busselton, Australia, electoral roll born 1946-1964 were invited to participate in a general health survey. Of the 5,037 (62% response rate) respondents, 3,686 successfully completed overnight 2-channel (oximetry, airflow) sleep studies. These were scored and categorized as nil, mild, moderate, or severe OSA based on apnea-hypopnea index (< 5, ≥ 5 to < 15, ≥ 15 to < 30, and ≥ 30 events/h, respectively). Sleep scores were related to participant characteristics and health profiles. OSA prevalence was compared with previous surveys in the community. RESULTS Prevalences of any and moderate-severe OSA were 57.7% and 20.2% in males and 41.7% and 10.0% in females. Matched for age group, the prevalence of moderate-severe OSA was similar to that in 2007 (males 24.6%, females 9.8%) and was higher than in 1995 (males 4.7%). OSA was associated with age, body mass index, and alcohol intake in males and age and body mass index in females. Conditions associated with OSA included hypertension and current depression in males and hypertension, skin cancer, and diabetes in females. CONCLUSIONS Prevalence of OSA in a middle-aged, predominantly White population in 2010-2015 was high, has increased since 1995, and has remained stable since 2007. Sex differences exist in associated features, including potential risk factors and comorbidities. CITATION Cunningham J, Hunter M, Budgeon C, et al. The prevalence and comorbidities of obstructive sleep apnea in middle-aged men and women: the Busselton Healthy Ageing Study. J Clin Sleep Med. 2021;17(10):2029-2039.
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Affiliation(s)
- Jordan Cunningham
- West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Nedlands, Western Australia.,Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia
| | - Michael Hunter
- Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia
| | - Charley Budgeon
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia
| | - Jennie Hui
- Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia.,PathWest Laboratory Medicine of Washington, Queen Elizabeth II Medical Centre, Nedlands, Western Australia
| | - David Hillman
- West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Nedlands, Western Australia
| | - Bhajan Singh
- West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Nedlands, Western Australia.,Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia
| | - Alan James
- West Australian Sleep Disorders Research Institute, Queen Elizabeth II Medical Centre, Nedlands, Western Australia.,Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Nedlands, Western Australia.,School of Medicine and Pharmacology, The University of Western Australia, Nedlands, Western Australia; *Contributed equally
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Wallace MC, Samuelson S, Khoo T, Ooi J, Tibballs J, Ferguson J, Preen DB, Knuiman M, Garas G, MacQuillan G, Adams LA, Jeffrey GP. The MAAPE score in intermediate and advanced hepatocellular carcinoma treated with Yttrium-90 resin microsphere radioembolization. J Gastroenterol Hepatol 2020; 35:1945-1952. [PMID: 32036614 DOI: 10.1111/jgh.15008] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/06/2020] [Accepted: 02/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Yttrium-90 resin microsphere radioembolization (RE) is not recommended for routine use in intermediate or advanced hepatocellular carcinoma (HCC) by recent guidelines. This study aims to establish pre-treatment variables which predict survival in HCC patients treated with RE to identify those who will benefit most from it, and to inform patient selection for future trials. METHODS Single center, retrospective study of consecutive patients with HCC treated with RE from 2007 to 2018. Patients included if undergoing their first RE treatment for intermediate or advanced HCC; a Child-Pugh score of B7 or less; and a performance status of 1 or less. Multivariable Cox regression identified variables that were significantly associated with survival. A predictive score was developed based upon coefficients from the fitted Cox regression model, and cubic spline regression was used to identify prognostic groups. RESULTS One hundred thirteen patients with intermediate (53.1%) and advanced HCC (45.1%) followed for a median of 13.2 months were included. Variables associated with superior survival used to derive the MAAPE score were lower Model for End-Stage Liver Disease score (≤ 7), lower Alpha-fetoprotein (≤ 150 IU/L), higher serum Albumin (> 37 g/L), absence of Portal vein tumor thrombus, and better performance status (Eastern Cooperative Oncology Group = 0). Three survival prognostic groups were identified: good (median overall survival 25.0 months), average (15.3 months), and poor (6.3 months) (overall log-rank test, P < 0.001). CONCLUSION The MAAPE score accurately identifies HCC patients in whom RE is safe and effective. This will allow for optimal patient selection for future trials of RE versus systemic therapy.
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Affiliation(s)
- Michael C Wallace
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia.,Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.,School of Population and Global Health, University of Western Australia, Nedlands, Western Australia, Australia
| | - Shaun Samuelson
- Department of Radiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Tiffany Khoo
- Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Jacob Ooi
- Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Jonathan Tibballs
- Department of Radiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - John Ferguson
- Department of Radiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, University of Western Australia, Nedlands, Western Australia, Australia
| | - Matthew Knuiman
- School of Population and Global Health, University of Western Australia, Nedlands, Western Australia, Australia
| | - George Garas
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia.,Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Gerry MacQuillan
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia.,Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Leon A Adams
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia.,Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Gary P Jeffrey
- Medical School, University of Western Australia, Nedlands, Western Australia, Australia.,Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Bivoltsis A, Trapp G, Knuiman M, Hooper P, Ambrosini GL. Do Changes in the Local Food Environment Within New Residential Developments Influence the Diets of Residents? Longitudinal Results from RESIDE. Int J Environ Res Public Health 2020; 17:ijerph17186778. [PMID: 32957529 PMCID: PMC7576477 DOI: 10.3390/ijerph17186778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/11/2020] [Accepted: 09/12/2020] [Indexed: 12/21/2022]
Abstract
Background: There is limited longitudinal evidence supporting a link between food outlet locations and dietary outcomes to inform policy and urban planning. This study examined how longitudinal changes in the local food environment within new residential developments influenced changes in adult dietary intake. Methods: Adult participant data (n = 3223 person-observations) were sourced from the RESIDential Environments (RESIDE) project across three time points between 2004 to 2012 in Perth, Western Australia. Fixed effects regression estimated the relationship between change in spatial exposure to the local food environment, individual behaviours and perceptions of the local food environment with dietary outcome variables (healthy diet score, unhealthy diet score, diet quality score and fruit/vegetable intake). Results: An increase over time in the percentage of healthy food outlets around the home was significantly (p ≤ 0.05) associated with an increase in healthy diet scores and an increase in the distance from home to the nearest café restaurant was significantly (p ≤ 0.05) associated with an increase in diet quality scores. Conclusions: Modifying the local food environment by increasing the relative proportion of healthy food outlets around the home may support healthier dietary intake.
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Affiliation(s)
- Alexia Bivoltsis
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; (G.T.); (M.K.); (G.L.A.)
- Correspondence:
| | - Gina Trapp
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; (G.T.); (M.K.); (G.L.A.)
- Telethon Kids Institute, PO Box 855, West Perth, WA 6872, Australia
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; (G.T.); (M.K.); (G.L.A.)
| | - Paula Hooper
- Australian Urban Design Centre, School of Design, The University of Western Australia, 1002 Hay Street, Perth, WA 6000, Australia;
| | - Gina L. Ambrosini
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; (G.T.); (M.K.); (G.L.A.)
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Foster S, Hooper P, Divitini M, Knuiman M, Trapp G. Over the limit? Testing non-linear associations between alcohol outlets and young adults' alcohol consumption. Drug Alcohol Rev 2020; 39:664-670. [PMID: 32567116 DOI: 10.1111/dar.13115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS By specifying a threshold at which the number of liquor licences has the most impact on local populations, authorities can work to restrict licence approvals and help prevent alcohol-related harm. DESIGN AND METHODS Raine Study Generation 2 participants reported their alcohol intake at 22 years (n = 843) and liquor licences within 1600 m of participants' homes were mapped. Analyses examined associations between licences (all licences, on-premise licences, liquor stores) and alcohol intake (g ethanol per day). Two models were fitted: (i) forced a straight-line relationship; and (ii) allowed a curved relationship via restricted cubic splines. RESULTS The straight-line and curved models showed significant relationships with all licences (P = 0.002 and P = 0.002 respectively) and on-premise licences (P = 0.006 and P = 0.01 respectively), but not liquor stores (P = 0.065 and P = 0.13 respectively). The straight-line model indicated that alcohol consumption increased, on average, by 0.15 g per day for each additional licence and 0.17 g per day for each additional on-premise licence. The curved model indicated that consumption increased by around 0.4 g per day for each additional licence from 0 to 10, but increases were negligible for additional licences beyond 10. The curved model provided a better overall fit to the data than the straight-line model (R2 9.52% vs. 9.18%), but the improvement in fit did not quite reach statistical significance (P = 0.08). The curvature was similar, but less pronounced for on-premise licences (R2 9.11% vs. 8.95%; P = 0.23). DISCUSSION AND CONCLUSIONS Results suggest a possible saturation point at which additional licences have a smaller effect on the alcohol intake of 22-year-olds living in metropolitan Perth.
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Affiliation(s)
- Sarah Foster
- Centre for Urban Research, School of Global, Urban and Social Studies, RMIT University, Melbourne, Australia.,School of Agriculture and Environment, The University of Western Australia, Perth, Australia
| | - Paula Hooper
- Australian Urban Design Research Centre, School of Design, The University of Western Australia, Perth, Australia
| | - Mark Divitini
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Georgina Trapp
- School of Population and Global Health, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, Perth, Australia
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Hooper P, Foster S, Bull F, Knuiman M, Christian H, Timperio A, Wood L, Trapp G, Boruff B, Francis J, Strange C, Badland H, Gunn L, Falconer R, Learnihan V, McCormack G, Sugiyama T, Giles-Corti B. Living liveable? RESIDE's evaluation of the "Liveable Neighborhoods" planning policy on the health supportive behaviors and wellbeing of residents in Perth, Western Australia. SSM Popul Health 2020; 10:100538. [PMID: 32072006 PMCID: PMC7016024 DOI: 10.1016/j.ssmph.2020.100538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The RESIDential Environments (RESIDE) project is a unique longitudinal natural experiment designed to evaluate the health impacts of the "Liveable Neighbourhoods" planning policy, which was introduced by the Western Australian government to create more walkable suburbs. OBJECTIVES To summarize the RESIDE evidence of the impact of the planning policy on a range of health-supportive behaviours and wellbeing outcomes and to assess the consistency and direction of the estimates of associations. METHODS An audit of 26 RESIDE research papers (from 2003 to 2012) identified the number of positive associations (statistically significant and consistent with policy expectations), negative associations (statistically significant and inconsistent with policy expectations), and null findings from multiple-exposure models between objective and perceived measures of 20 policy design requirements and 13 health-supportive behaviors and wellbeing outcomes. RESULTS In total 332 eligible estimates of associations (n = 257 objective measures and n = 75 perceived measures) were identified. Positively significant findings were detected for: 57% of walking estimates with objectively measured policy design features (negative = 3%; null = 40%) (n = 115) and 54% perceived measures (negative = 0%; null = 33%) (n = 27); 42% of sense of community estimates with objectively measured of policy design features (negative = 8%; null = 50%) (n = 12) and 61% perceived measures (negative = 8%; null = 31%) (n = 13); 39% of safety or crime-related estimates with objectively measured of policy design features (negative = 22%; null = 39%) (n = 28) and 100% perceived measures (n = 7). All (n = 4) estimates for mental health outcomes with objectively measured policy-related design features were positively significant. CONCLUSIONS The synthesis of findings suggests that new suburban communities built in accordance with the "Liveable Neighbourhoods" policy have the potential to encourage health supportive behaviors and wellbeing outcomes including transport and recreation walking, and to create neighborhoods with a stronger sense of community where residents may feel safer.
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Affiliation(s)
- Paula Hooper
- Australian Urban Design Research Centre, School of Design, The University of Western Australia, Perth, Australia
| | - Sarah Foster
- Centre for Urban Research, RMIT University, Melbourne, Victoria, Australia
- School of Agriculture and Environment, The University of Western Australia, Perth, Australia
| | - Fiona Bull
- School of Health Sciences, The University of Western Australia, Perth, Australia
- Department of Prevention of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Hayley Christian
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Anna Timperio
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Lisa Wood
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Gina Trapp
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Bryan Boruff
- School of Agriculture and Environment, The University of Western Australia, Perth, Australia
| | - Jacinta Francis
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Cecily Strange
- School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Hannah Badland
- Centre for Urban Research, RMIT University, Melbourne, Victoria, Australia
| | - Lucy Gunn
- Centre for Urban Research, RMIT University, Melbourne, Victoria, Australia
| | | | - Vincent Learnihan
- Centre for Research and Action in Public Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia
| | - Gavin McCormack
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, NW Calgary, Alberta, Canada
| | - Takemi Sugiyama
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria, Australia
- Centre for Urban Transitions, Swinburne University of Technology, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Billie Giles-Corti
- Centre for Urban Research, RMIT University, Melbourne, Victoria, Australia
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Tate J, Knuiman M, Davis WA, Davis TME, Bruce DG. A comparison of obesity indices in relation to mortality in type 2 diabetes: the Fremantle Diabetes Study. Diabetologia 2020; 63:528-536. [PMID: 31838571 DOI: 10.1007/s00125-019-05057-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
AIMS/HYPOTHESIS This prospective association study aimed to compare the relationship between each of four obesity indices and mortality risk in people with type 2 diabetes. METHODS The associations of BMI, waist circumference, WHR and A Body Shape Index (ABSI) with all-cause mortality were analysed in 1282 participants of the Fremantle Diabetes Study, followed for up to 20 years after baseline assessment. Models were adjusted for age and other confounders; assessments as continuous measures and by quintile were carried out for men and women separately. Sensitivity analyses were conducted to minimise reverse causality. RESULTS When indices were assessed as continuous variables, there were significant bivariate associations with mortality for: ABSI, which was greater in both men and women who died (p < 0.001); WHR, which was greater in women only (p = 0.033); and BMI, which was lower in women only (p < 0.001). When assessed by quintile, there were significant bivariate associations with mortality for ABSI in men and women (p < 0.001) and BMI in women only (p = 0.002). In Cox models of time to death, adjusted for age, diabetes duration, ethnicity and smoking, ABSI quintiles showed a linear trend for both men (p = 0.003) and women (p = 0.035). Men in the fifth ABSI quintile had an increased mortality risk compared with those in the first quintile (HR [95% CI]: 1.74 [1.24, 2.44]) and women in the fifth ABSI quintile had an increased mortality risk that approached statistical significance (1.42 [0.97, 2.08], p = 0.08). Men in the fifth WHR quintile had an increased mortality risk (1.47 [1.05, 2.06]). There was no association between mortality and BMI or waist circumference in either sex. CONCLUSIONS/INTERPRETATION ABSI was the obesity index most strongly associated with all-cause mortality in Australians with type 2 diabetes. There was no evidence for an obesity paradox with any of the assessed indices. ABSI may be a better index of central obesity than waist circumference, BMI or WHR when assessing mortality risk in type 2 diabetes.
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Affiliation(s)
- Joel Tate
- School of Population and Global Health, University of Western Australia, Nedlands, WA, Australia
| | - Matthew Knuiman
- School of Population and Global Health, University of Western Australia, Nedlands, WA, Australia
| | - Wendy A Davis
- Medical School, Fremantle Hospital, PO Box 480, Fremantle, WA, 6959, Australia
| | - Timothy M E Davis
- Medical School, Fremantle Hospital, PO Box 480, Fremantle, WA, 6959, Australia
| | - David G Bruce
- Medical School, Fremantle Hospital, PO Box 480, Fremantle, WA, 6959, Australia.
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9
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Lee S, van den Berg N, Divitini M, Sanfilippo F, Knuiman M, Dwivedi G. 459 CMV Antibody Level is an Independent Risk Factor for MACCE and Death in the General Population. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Yiu W, Knuiman M, Wallace H, Hung J. Under-use of appropriate blood pressure-lowering and lipid-lowering therapy in the Busselton baby boomer population. Aust J Gen Pract 2019; 48:883-889. [PMID: 31774993 DOI: 10.31128/ajgp-07-19-4996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Data are sparse on how well the absolute risk approach is implemented in primary healthcare. The aim of this study was to quantify absolute cardiovascular disease (CVD) risk, appropriate use of blood pressure (BP)-lowering and lipid-lowering therapy, and clinical target responses in the Busselton baby boomer population. METHOD This was a cross-sectional study of 5107 people aged 45-69 years (54.6% female) who participated in the 2010-2015 Busselton Healthy Ageing Study. RESULTS Overall, 16.1% of participants had prior CVD (5.8%) or a high primary CVD risk (10.3%). The frequency of use of a guideline-recommended combination of BP-lowering and lipid-lowering therapy was 46.2% in participants with prior CVD, compared with only 16.8% in those with high primary CVD risk (P <0.001). Among the high-risk participants who were receiving recommended combination therapy, only 42.7% achieved target systolic BP levels and 42.1% achieved target total cholesterol levels. DISCUSSION These data confirm substantial under treatment of Australian adults who are at high CVD risk. Enhanced implementation of absolute CVD risk assessment and evidence-based treatment in high-risk adults has potential for substantial health gains.
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Affiliation(s)
- Wai Yiu
- BPharm, MD, medical student, School of Medicine, The University of Notre Dame, WA
| | - Matthew Knuiman
- PhD, Professor, Faculty of Health and Medical Sciences, School of Population and Global Health, The University of Western Australia, WA
| | - Hilary Wallace
- BVMS, PhD, Lecturer Research, School of Medicine, The University of Notre Dame, WA
| | - Joseph Hung
- MB, BS, FRACP, Emeritus Professor, Faculty of Health and Medical Sciences, Medical School, The University of Western Australia, WA.
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11
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Zhu K, Knuiman M, Divitini M, Hung J, Lim EM, Cooke BR, Walsh JP. Lower serum 25-hydroxyvitamin D is associated with colorectal and breast cancer, but not overall cancer risk: a 20-year cohort study. Nutr Res 2019; 67:100-107. [DOI: 10.1016/j.nutres.2019.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/07/2019] [Accepted: 03/15/2019] [Indexed: 02/07/2023]
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12
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Bivoltsis A, Trapp G, Knuiman M, Hooper P, Ambrosini GL. The evolution of local food environments within established neighbourhoods and new developments in Perth, Western Australia. Health Place 2019; 57:204-217. [PMID: 31103776 DOI: 10.1016/j.healthplace.2019.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/01/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022]
Abstract
Temporal changes in the location of food outlets can result in disparities in the availability and access of food across geographic areas, contributing to health inequalities. This study used mixed linear models to investigate how the location of food outlets around the home evolved over time with respect to area-level socio-economic status (SES) and urban design within established neighbourhoods and new residential developments. Food outlet data (supermarket/greengrocers, convenience stores, café restaurants and takeaway/fast food) were sourced from commercial database listings (SENSIS Pty. Ltd.) in 2004, 2006, 2007, and 2011. Using 2468 addresses from the RESIDential Environments Project (RESIDE), in Perth, Western Australia (WA), a count of each food outlet type and percentage of healthy food outlets within a 1.6 km road network buffer around the home, along with the road network distance to nearest food outlet were generated relative to each address at each time point. Proximity to and count of all food outlets increased over time in both new developments and established neighbourhoods. However, unhealthy food outlets were always in greater numbers and proximity to the home. The percentage of healthy food outlets was significantly greater in established neighbourhoods compared to new developments at all four time points. There were significantly more food outlets, and within closer proximity to the home, in established neighbourhoods compared to new developments at each time point. In established neighbourhoods, there were more convenience stores, takeaway/fast food and café restaurants, a lower percentage of healthy food outlets, and closer proximity to convenience stores in lower compared to high SES areas. In new developments there were significantly less supermarket/greengrocers, a lower percentage of healthy food outlets and greater proximity to takeaway/fast food and café restaurants in low compared to high SES areas. New developments designed according to the WA government's "Liveable Neighbourhoods Community Design Guidelines" policy had significantly more of all food outlets compared to other new developments. As such, people living in new developments, and low SES areas of Perth, may be disadvantaged with poorer access to healthy food outlets and greater exposure to unhealthy food outlets. Future urban planning and policy should focus on providing incentives that support the early development of supermarkets and healthy food outlets within new developments and low SES areas of Perth.
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Affiliation(s)
- Alexia Bivoltsis
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.
| | - Gina Trapp
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia; Telethon Kids Institute, PO Box 855, West Perth, Western Australia, 6872, Australia.
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.
| | - Paula Hooper
- School of Agriculture and Environment and the School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.
| | - Gina Leslie Ambrosini
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, Western Australia, 6009, Australia.
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13
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Yeap B, Hui J, Knuiman M, Handelsman D, Flicker L, Divitini M, Arscott G, McLennan S, Twigg S, Almeida O, Hankey G, Golledge J, Norman P, Beilby J. OR18-2 Higher Plasma Estradiol Concentration Is Independently Associated with Lower Biological Age, Assessed as Leucocyte Telomere Length, in Older Men. J Endocr Soc 2019. [PMCID: PMC6554981 DOI: 10.1210/js.2019-or18-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Telomeres are essential DNA-protein complexes comprising TTAGGG repeats binding specific proteins, which protect the physical ends of chromosomes from fusion and degradation. Attrition of telomeres results in cellular senescence. Leucocyte telomere length (LTL) reflects lengths of telomeres in various tissues, and shorter LTL is a marker of advancing biological age. Previous work has associated bioactive metabolites of T, dihydrotestosterone (DHT) and estradiol (E2) with LTL in a population of predominantly middle-aged men [1]. However, the relationship of these hormones to biological age in older men was unclear. We aimed to clarify associations of sex hormones with LTL in a cohort of 2,913 community-dwelling men aged 70-89 years. Early morning blood samples were assayed for T, DHT and E2 using mass spectrometry, and for sex hormone-binding globulin (SHBG) using immunoassay. LTL was measured using a multiplex quantitative PCR method and expressed as the amount of telomeric DNA relative to beta-globin, a single copy control gene (T/S ratio). Cross-sectional analyses utilised multivariable linear regression. Mean (±SD) age was 76.7±3.2 years. The average difference per decade of age was T -0.46 nmol/L, DHT -0.11 nmol/L, E2 -7.5 pmol/L, SHBG +10.2 nmol/L, and LTL (T/S ratio) -0.065. E2 correlated with T/S ratio (r=0.038, p=0.039). After excluding highest and lowest 1% of values, the correlation between E2 and T/S ratio was largely unchanged (r=0.039, p=0.037). SHBG was inversely correlated with T/S ratio (r=-0.053, p=0.004), also unchanged in the trimmed analysis (r=-0.055, p=0.004.) After adjusting for age, BMI, cardiovascular disease, diabetes, alcohol, smoking, physical activity, lipids and hypertension, E2 remained associated with T/S ratio (per 1 SD increase E2: coefficient 0.011, p=0.043). When E2 and SHBG were simultaneously included in the multivariate model, E2 remained positively associated with T/S ratio (coefficient 0.014, p=0.014) and SHBG inversely associated (coefficient -0.013, p=0.037). The magnitude of increase in T/S ratio associated with a 1 SD higher plasma E2 concentration was comparable with having a BMI 3.6 kg/m2 lower, and two thirds that associated with being 3.6 years younger. T, DHT and LH were not associated with LTL in multivariate analyses. To conclude, in older men, neither T nor DHT are associated with LTL while E2 is independently associated with LTL and SHBG is inversely associated. These findings associate activity of the gonadal axis with lower biological age in older men. However, causality cannot be inferred from an observational, cross-sectional study, thus additional research is necessary to determine whether sex hormone exposure modulates male biological ageing. Reference: [1] Yeap BB, et al. J Clin Endocrinol Metab 2016; 101: 1299-1306.
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Affiliation(s)
- Bu Yeap
- University of Western Australia, Perth, , Australia
| | - Jennie Hui
- PathWest Laboratory Medicine, Perth, , Australia
| | | | | | - Leon Flicker
- University of Western Australia, Perth, , Australia
| | | | | | - Susan McLennan
- DEPT OF MEDICINE, University of Sydney, Sydney, , Australia
| | | | | | | | | | - Paul Norman
- University of Western Australia, Perth, , Australia
| | - John Beilby
- PathWest Laboratory Medicine, Perth, , Australia
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14
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Nedkoff L, Goldacre R, Greenland M, Goldacre MJ, Lopez D, Hall N, Knuiman M, Hobbs M, Sanfilippo FM, Wright FL. Comparative trends in coronary heart disease subgroup hospitalisation rates in England and Australia. Heart 2019; 105:1343-1350. [PMID: 30948515 PMCID: PMC6711344 DOI: 10.1136/heartjnl-2018-314512] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/20/2019] [Accepted: 02/12/2019] [Indexed: 12/21/2022] Open
Abstract
Background Population-based coronary heart disease (CHD) studies have focused on myocardial infarction (MI) with limited data on trends across the spectrum of CHD. We investigated trends in hospitalisation rates for acute and chronic CHD subgroups in England and Australia from 1996 to 2013. Methods CHD hospitalisations for individuals aged 35–84 years were identified from electronic hospital data from 1996 to 2013 for England and Australia and from the Oxford Region and Western Australia. CHD subgroups identified were acute coronary syndromes (ACS) (MI and unstable angina) and chronic CHD (stable angina and ‘other CHD’). We calculated age-standardised and age-specific rates and estimated annual changes (95% CI) from age-adjusted Poisson regression. Results From 1996 to 2013, there were 4.9 million CHD hospitalisations in England and 2.6 million in Australia (67% men). From 1996 to 2003, there was between-country variation in the direction of trends in ACS and chronic CHD hospitalisation rates (p<0.001). During 2004–2013, reductions in ACS hospitalisation rates were greater than for chronic CHD hospitalisation rates in both countries, with the largest subgroup declines in unstable angina (England: men: −7.1 %/year, 95% CI −7.2 to –7.0; women: −7.5 %/year, 95% CI −7.7 to –7.3; Australia: men: −8.5 %/year, 95% CI −8.6 to –8.4; women: −8.6 %/year, 95% CI −8.8 to –8.4). Other CHD rates increased in individuals aged 75–84 years in both countries. Chronic CHD comprised half of all CHD admissions, with the majority involving angiography or percutaneous coronary intervention. Conclusions Since 2004, rates of all CHD subgroups have fallen, with greater declines in acute than chronic presentations. The slower declines and high proportion of chronic CHD admissions undergoing coronary procedures requires greater focus.
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Affiliation(s)
- Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Raphael Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, England
| | - Melanie Greenland
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael J Goldacre
- Unit of Health-Care Epidemiology, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, England
| | - Derrick Lopez
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Nick Hall
- Unit of Health-Care Epidemiology, Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, England
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Michael Hobbs
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - F Lucy Wright
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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15
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Gregson J, Kaptoge S, Bolton T, Pennells L, Willeit P, Burgess S, Bell S, Sweeting M, Rimm EB, Kabrhel C, Zöller B, Assmann G, Gudnason V, Folsom AR, Arndt V, Fletcher A, Norman PE, Nordestgaard BG, Kitamura A, Mahmoodi BK, Whincup PH, Knuiman M, Salomaa V, Meisinger C, Koenig W, Kavousi M, Völzke H, Cooper JA, Ninomiya T, Casiglia E, Rodriguez B, Ben-Shlomo Y, Després JP, Simons L, Barrett-Connor E, Björkelund C, Notdurfter M, Kromhout D, Price J, Sutherland SE, Sundström J, Kauhanen J, Gallacher J, Beulens JWJ, Dankner R, Cooper C, Giampaoli S, Deen JF, Gómez de la Cámara A, Kuller LH, Rosengren A, Svensson PJ, Nagel D, Crespo CJ, Brenner H, Albertorio-Diaz JR, Atkins R, Brunner EJ, Shipley M, Njølstad I, Lawlor DA, van der Schouw YT, Selmer RM, Trevisan M, Verschuren WMM, Greenland P, Wassertheil-Smoller S, Lowe GDO, Wood AM, Butterworth AS, Thompson SG, Danesh J, Di Angelantonio E, Meade T. Cardiovascular Risk Factors Associated With Venous Thromboembolism. JAMA Cardiol 2019; 4:163-173. [PMID: 30649175 PMCID: PMC6386140 DOI: 10.1001/jamacardio.2018.4537] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/15/2018] [Indexed: 02/02/2023]
Abstract
Importance It is uncertain to what extent established cardiovascular risk factors are associated with venous thromboembolism (VTE). Objective To estimate the associations of major cardiovascular risk factors with VTE, ie, deep vein thrombosis and pulmonary embolism. Design, Setting, and Participants This study included individual participant data mostly from essentially population-based cohort studies from the Emerging Risk Factors Collaboration (ERFC; 731 728 participants; 75 cohorts; years of baseline surveys, February 1960 to June 2008; latest date of follow-up, December 2015) and the UK Biobank (421 537 participants; years of baseline surveys, March 2006 to September 2010; latest date of follow-up, February 2016). Participants without cardiovascular disease at baseline were included. Data were analyzed from June 2017 to September 2018. Exposures A panel of several established cardiovascular risk factors. Main Outcomes and Measures Hazard ratios (HRs) per 1-SD higher usual risk factor levels (or presence/absence). Incident fatal outcomes in ERFC (VTE, 1041; coronary heart disease [CHD], 25 131) and incident fatal/nonfatal outcomes in UK Biobank (VTE, 2321; CHD, 3385). Hazard ratios were adjusted for age, sex, smoking status, diabetes, and body mass index (BMI). Results Of the 731 728 participants from the ERFC, 403 396 (55.1%) were female, and the mean (SD) age at the time of the survey was 51.9 (9.0) years; of the 421 537 participants from the UK Biobank, 233 699 (55.4%) were female, and the mean (SD) age at the time of the survey was 56.4 (8.1) years. Risk factors for VTE included older age (ERFC: HR per decade, 2.67; 95% CI, 2.45-2.91; UK Biobank: HR, 1.81; 95% CI, 1.71-1.92), current smoking (ERFC: HR, 1.38; 95% CI, 1.20-1.58; UK Biobank: HR, 1.23; 95% CI, 1.08-1.40), and BMI (ERFC: HR per 1-SD higher BMI, 1.43; 95% CI, 1.35-1.50; UK Biobank: HR, 1.37; 95% CI, 1.32-1.41). For these factors, there were similar HRs for pulmonary embolism and deep vein thrombosis in UK Biobank (except adiposity was more strongly associated with pulmonary embolism) and similar HRs for unprovoked vs provoked VTE. Apart from adiposity, these risk factors were less strongly associated with VTE than CHD. There were inconsistent associations of VTEs with diabetes and blood pressure across ERFC and UK Biobank, and there was limited ability to study lipid and inflammation markers. Conclusions and Relevance Older age, smoking, and adiposity were consistently associated with higher VTE risk.
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Affiliation(s)
- John Gregson
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Stephen Kaptoge
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Thomas Bolton
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Lisa Pennells
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Peter Willeit
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- Medical University of Innsbruck, Innsbruck, Austria
| | - Stephen Burgess
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- MRC Biostatistics Unit, Cambridge University, Cambridge, United Kingdom
| | - Steven Bell
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Michael Sweeting
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Eric B. Rimm
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Bengt Zöller
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Gerd Assmann
- Assmann Foundation for Prevention, Münster, Germany
| | | | - Aaron R. Folsom
- University of Minnesota School of Public Health, Minneapolis
| | - Volker Arndt
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Astrid Fletcher
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Paul E. Norman
- University of Western Australia, Perth, Western Australia, Australia
| | - Børge G. Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Bakhtawar K. Mahmoodi
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Matthew Knuiman
- University of Western Australia, Perth, Western Australia, Australia
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Christa Meisinger
- Ludwig Maximilian University of Munich, Munich, Germany
- Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Department of Internal Medicine II–Cardiology, University of Ulm Medical Center, Ulm, Germany
| | - Maryam Kavousi
- Erasmus University Medical Center, Erasmus University, Rotterdam, the Netherlands
| | | | - Jackie A. Cooper
- UCL Medical School, University College London, London, United Kingdom
| | | | | | | | - Yoav Ben-Shlomo
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jean-Pierre Després
- Institute of Nutraceuticals and Functional Foods, Université Laval, Quebec, Quebec, Canada
| | - Leon Simons
- The University of New South Wales, Sydney, New South Wales, Australia
| | | | | | | | - Daan Kromhout
- University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Jackie Price
- University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - John Gallacher
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Joline W. J. Beulens
- VU University Medical Center Amsterdam, Amsterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | | | - Jason F. Deen
- Center of Health Equity, Diversity and Inclusion, University of Washington School of Medicine, Seattle
| | - Agustín Gómez de la Cámara
- Clinical Research and Clinical Trials Unit, Plataforma de Innovación en Tecnologías Médicas y Sanitarias, Madrid, Spain
| | - Lewis H. Kuller
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | | | | | | | | | - Hermann Brenner
- University of Minnesota School of Public Health, Minneapolis
| | | | | | - Eric J. Brunner
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Martin Shipley
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | | | - Deborah A. Lawlor
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | | | - W. M. Monique Verschuren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Philip Greenland
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Gordon D. O. Lowe
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Angela M. Wood
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Adam S. Butterworth
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Simon G. Thompson
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - John Danesh
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Emanuele Di Angelantonio
- MRC/BHF Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, University of Cambridge, Cambridge, United Kingdom
| | - Tom Meade
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Qin X, Hung J, Knuiman M, Teng THK, Briffa T, Sanfilippo FM. Evidence-based pharmacotherapies used in the postdischarge phase are associated with improved one-year survival in senior patients hospitalized with heart failure. Cardiovasc Ther 2018; 36:e12464. [PMID: 30126048 DOI: 10.1111/1755-5922.12464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/27/2018] [Accepted: 08/15/2018] [Indexed: 01/01/2023] Open
Abstract
AIM Hospitalized heart failure (HF) patients have a poor prognosis postdischarge. We determined whether renin-angiotensin system inhibitors (RASI) and β-blockers dispensed to patients within 60 days post-HF hospital discharge are associated with improved 1-year survival. METHODS A retrospective population-based study was conducted in 4897 seniors, aged 65-84 years, alive at 60 days postindex HF hospitalization in Western Australia over 2003-2008. Dispensing of RASI and β-blocker dispensing was identified from the Pharmaceutical Benefits Scheme claims database linked to hospital admission and death records. RESULTS At 1-year posthospital discharge, the all-cause mortality and all-cause death or HF rehospitalization rate was 13.5% (n = 663) and 24.4% (n = 1193), respectively. Postdischarge RASI and β-blocker were dispensed in 77.4% and 53.0% of patients, respectively. Their use was associated with a lower inverse probability treatment weighted (IPTW) HR for 1-year mortality of 0.70, 95% CI 0.61-0.81 and 0.79, 95% CI 0.68-0.92, respectively (both P < 0.0001), with a survival advantage most evident in the subgroup (70.1%) of patients with ischemic HF. In the overall cohort, these therapies were also associated with reduced IPTW HRs for all-cause death or HF rehospitalization (both P < 0.005) but not for HF rehospitalization exclusively. Use of a β-blocker was associated with a reduced IPTW HR for HF rehospitalization in the ischemic HF subgroup only. CONCLUSIONS In a cohort of senior patients hospitalized with HF, dispensing of a RASI or β-blocker within 60 days postdischarge is associated with a 1-year survival benefit. Early postdischarge support programs after recent HF hospitalization should include measures to optimize adherence to evidence-based medications.
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Affiliation(s)
- Xiwen Qin
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Joseph Hung
- Medical School, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Tiew-Hwa K Teng
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.,National Heart Centre Singapore, Singapore, Singapore
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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17
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Teng THK, Katzenellenbogen JM, Geelhoed E, Gunnell AS, Knuiman M, Sanfilippo FM, Hung J, Mai Q, Vickery A, Thompson SC. Patterns of Medicare-funded primary health and specialist consultations in Aboriginal and non-Aboriginal Australians in the two years before hospitalisation for ischaemic heart disease. Int J Equity Health 2018; 17:111. [PMID: 30068346 PMCID: PMC6090923 DOI: 10.1186/s12939-018-0826-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 07/17/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Ischaemic heart disease (IHD) remains the leading cause of morbidity and mortality for both Aboriginal and non-Aboriginal Australians. Patterns of primary and specialist care in patients leading up to the first hospitalisation for IHD potentially impact on prevention and subsequent outcomes. We investigated the differences in general practice (GP), specialist and emergency department (ED) consultations, and associated resource use in Aboriginal and non-Aboriginal people in the two years preceding hospitalisation for IHD. METHODS Linked-data were used to identify first IHD admissions for Western Australians aged 25-74 years in 2002-2007. Person-linked GP, specialist and ED consultations were obtained from the Medicare Benefits Schedule (MBS) and ED records to assess health care access and costs for the preceding 2 years. RESULTS Aboriginal people constituted 4.7% of 27,230 IHD patients, 3.5% of 1,348,238 MBS records, and 14% of 33,170 ED presentations. Aboriginal (vs. non-Aboriginal) people were younger (mean 50.2 vs 60.5 years), more commonly women (45.2% vs 28.4%), had more comorbidities [Charlson index≥1, 35.2% vs 26.3%], were more likely to have had GP visits (adjusted rate-ratio 1.07, 95% CI 1.02-1.12), long/prolonged (16.0% vs 11.9%) consults and non-vocationally registered GP consults (17.1% vs 3.2%), but less likely to received specialist consults (mean 1.0 vs 4.1). Mean number of urgent/semi-urgent ED presentations in the year preceding the IHD admission was higher in Aboriginal people (2.9 vs 1.9). Aboriginal people incurred 2.7% of total associated MBS expenditure (estimated at $59.7 million). Mean total cost per person was 43.3% lower in Aboriginal patients, with cost differentials being greatest in diabetic and chronic kidney disease patients. CONCLUSIONS Despite being over-represented in urgent/semi-urgent ED presentations and admissions for IHD, Aboriginal people were under-resourced compared with the rest of the population, particularly in terms of specialist care prior to first IHD hospitalisation. The findings underscore the need for better primary and specialist shared care delivery models particularly for Aboriginal people.
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Affiliation(s)
- Tiew-Hwa Katherine Teng
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia (M431), 35 Stirling Highway, Perth, WA 6009 Australia
| | - Judith M. Katzenellenbogen
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia (M431), 35 Stirling Highway, Perth, WA 6009 Australia
- School of Population and Global Health, UWA, Perth, Australia
| | | | | | - Matthew Knuiman
- School of Population and Global Health, UWA, Perth, Australia
| | | | - Joseph Hung
- School of Medicine, Sir Charles Gairdner Hospital Unit, UWA, Perth, Australia
| | - Qun Mai
- School of Population and Global Health, UWA, Perth, Australia
- Department of Health, Perth, Western Australia Australia
| | - Alistair Vickery
- Division of General Practice, School of Medicine, Faculty of Health and Medical Sciences, UWA, Perth, Australia
| | - Sandra C. Thompson
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia (M431), 35 Stirling Highway, Perth, WA 6009 Australia
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18
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Sarink D, Nedkoff L, Briffa T, Shaw JE, Magliano DJ, Stevenson C, Mannan H, Knuiman M, Hung J, Hankey GJ, Norman P, Peeters A. Trends in age- and sex-specific prevalence and incidence of cardiovascular disease in Western Australia. Eur J Prev Cardiol 2018; 25:1280-1290. [PMID: 30012003 DOI: 10.1177/2047487318786585] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Temporal trends in incidence and mortality of cardiovascular disease (CVD) have been well described, with recent data suggesting declining improvements in those aged under 55 years. However, little is known about the combined impact of incidence and mortality trends on disease prevalence, an important indicator of disease burden and cost. We analysed changes in age-specific and age-standardised temporal trends in prevalence and incidence of CVD subtypes. Methods Annual prevalence and incidence rates of coronary heart disease, cerebrovascular disease and peripheral arterial disease for the Western Australian population for 1995-2010 were calculated using data from the Western Australian Data Linkage System. Joinpoint regression analyses were used to identify joinpoints in trends in age-specific and age-standardised annual prevalence and incidence rates for each CVD subtype. Results Between 1995 and 2010, age- and sex-specific incidence and prevalence of the CVD subtypes generally decreased among middle-aged and older adults, but were stable or increased among younger adults. In < 55 year olds, increases in incidence tended to occur from 2003, while increases in prevalence were from 2007/2008. Declines in age-standardised incidence were greater than those in crude incidence, with changes in population structure having a greater impact among men than women. Conclusions The majority of CVDs occurs in older adults. Our findings of generally worsening trends in prevalence in younger adults across most CVD subtypes were in contrast to generally declining trends in older age groups. These data highlight the importance of monitoring prevalence and incidence, particularly in younger adults.
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Affiliation(s)
- Danja Sarink
- 1 Baker IDI Heart and Diabetes Institute, Melbourne, Australia.,2 Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
| | - Lee Nedkoff
- 3 School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Tom Briffa
- 3 School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Jonathan E Shaw
- 1 Baker IDI Heart and Diabetes Institute, Melbourne, Australia.,4 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Dianna J Magliano
- 1 Baker IDI Heart and Diabetes Institute, Melbourne, Australia.,4 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christopher Stevenson
- 5 School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, Australia
| | - Haider Mannan
- 6 Translational Health Research Institute, School of Medicine, Western Sydney University, Australia
| | - Matthew Knuiman
- 3 School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Joseph Hung
- 7 School of Medicine, The University of Western Australia, Perth, Australia
| | - Graeme J Hankey
- 7 School of Medicine, The University of Western Australia, Perth, Australia
| | - Paul Norman
- 7 School of Medicine, The University of Western Australia, Perth, Australia
| | - Anna Peeters
- 1 Baker IDI Heart and Diabetes Institute, Melbourne, Australia.,4 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.,8 Deakin University, Geelong, Australia
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19
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Gnatiuc L, Herrington WG, Halsey J, Tuomilehto J, Fang X, Kim HC, De Bacquer D, Dobson AJ, Criqui MH, Jacobs DR, Leon DA, Peters SAE, Ueshima H, Sherliker P, Peto R, Collins R, Huxley RR, Emberson JR, Woodward M, Lewington S, Aoki N, Arima H, Arnesen E, Aromaa A, Assmann G, Bachman DL, Baigent C, Bartholomew H, Benetos A, Bengtsson C, Bennett D, Björkelund C, Blackburn H, Bonaa K, Boyle E, Broadhurst R, Carstensen J, Chambless L, Chen Z, Chew SK, Clarke R, Cox C, Curb JD, D'Agostino R, Date C, Davey Smith G, De Backer G, Dhaliwal SS, Duan XF, Ducimetiere P, Duffy S, Eliassen H, Elwood P, Empana J, Garcia-Palmieri MH, Gazes P, Giles GG, Gillis C, Goldbourt U, Gu DF, Guasch-Ferre M, Guize L, Haheim L, Hart C, Hashimoto S, Hashimoto T, Heng D, Hjermann I, Ho SC, Hobbs M, Hole D, Holme I, Horibe H, Hozawa A, Hu F, Hughes K, Iida M, Imai K, Imai Y, Iso H, Jackson R, Jamrozik K, Jee SH, Jensen G, Jiang CQ, Johansen NB, Jorgensen T, Jousilahti P, Kagaya M, Keil J, Keller J, Kim IS, Kita Y, Kitamura A, Kiyohara Y, Knekt P, Knuiman M, Kornitzer M, Kromhout D, Kronmal R, Lam TH, Law M, Lee J, Leren P, Levy D, Li YH, Lissner L, Luepker R, Luszcz M, MacMahon S, Maegawa H, Marmot M, Matsutani Y, Meade T, Morris J, Morris R, Murayama T, Naito Y, Nakachi K, Nakamura M, Nakayama T, Neaton J, Nietert PJ, Nishimoto Y, Norton R, Nozaki A, Ohkubo T, Okayama A, Pan WH, Puska P, Qizilbash N, Reunanen A, Rimm E, Rodgers A, Saitoh S, Sakata K, Sato S, Schnohr P, Schulte H, Selmer R, Sharp D, Shifu X, Shimamoto K, Shipley M, Silbershatz H, Sorlie P, Sritara P, Suh I, Sutherland SE, Sweetnam P, Tamakoshi A, Tanaka H, Thomsen T, Tominaga S, Tomita M, Törnberg S, Tunstall-Pedoe H, Tverdal A, Ueshima H, Vartiainen E, Wald N, Wannamethee SG, Welborn TA, Whincup P, Whitlock G, Willett W, Woo J, Wu ZL, Yao SX, Yarnell J, Yokoyama T, Yoshiike N, Zhang XH. Sex-specific relevance of diabetes to occlusive vascular and other mortality: a collaborative meta-analysis of individual data from 980 793 adults from 68 prospective studies. Lancet Diabetes Endocrinol 2018; 6:538-546. [PMID: 29752194 PMCID: PMC6008496 DOI: 10.1016/s2213-8587(18)30079-2] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Several studies have shown that diabetes confers a higher relative risk of vascular mortality among women than among men, but whether this increased relative risk in women exists across age groups and within defined levels of other risk factors is uncertain. We aimed to determine whether differences in established risk factors, such as blood pressure, BMI, smoking, and cholesterol, explain the higher relative risks of vascular mortality among women than among men. METHODS In our meta-analysis, we obtained individual participant-level data from studies included in the Prospective Studies Collaboration and the Asia Pacific Cohort Studies Collaboration that had obtained baseline information on age, sex, diabetes, total cholesterol, blood pressure, tobacco use, height, and weight. Data on causes of death were obtained from medical death certificates. We used Cox regression models to assess the relevance of diabetes (any type) to occlusive vascular mortality (ischaemic heart disease, ischaemic stroke, or other atherosclerotic deaths) by age, sex, and other major vascular risk factors, and to assess whether the associations of blood pressure, total cholesterol, and body-mass index (BMI) to occlusive vascular mortality are modified by diabetes. RESULTS Individual participant-level data were analysed from 980 793 adults. During 9·8 million person-years of follow-up, among participants aged between 35 and 89 years, 19 686 (25·6%) of 76 965 deaths were attributed to occlusive vascular disease. After controlling for major vascular risk factors, diabetes roughly doubled occlusive vascular mortality risk among men (death rate ratio [RR] 2·10, 95% CI 1·97-2·24) and tripled risk among women (3·00, 2·71-3·33; χ2 test for heterogeneity p<0·0001). For both sexes combined, the occlusive vascular death RRs were higher in younger individuals (aged 35-59 years: 2·60, 2·30-2·94) than in older individuals (aged 70-89 years: 2·01, 1·85-2·19; p=0·0001 for trend across age groups), and, across age groups, the death RRs were higher among women than among men. Therefore, women aged 35-59 years had the highest death RR across all age and sex groups (5·55, 4·15-7·44). However, since underlying confounder-adjusted occlusive vascular mortality rates at any age were higher in men than in women, the adjusted absolute excess occlusive vascular mortality associated with diabetes was similar for men and women. At ages 35-59 years, the excess absolute risk was 0·05% (95% CI 0·03-0·07) per year in women compared with 0·08% (0·05-0·10) per year in men; the corresponding excess at ages 70-89 years was 1·08% (0·84-1·32) per year in women and 0·91% (0·77-1·05) per year in men. Total cholesterol, blood pressure, and BMI each showed continuous log-linear associations with occlusive vascular mortality that were similar among individuals with and without diabetes across both sexes. INTERPRETATION Independent of other major vascular risk factors, diabetes substantially increased vascular risk in both men and women. Lifestyle changes to reduce smoking and obesity and use of cost-effective drugs that target major vascular risks (eg, statins and antihypertensive drugs) are important in both men and women with diabetes, but might not reduce the relative excess risk of occlusive vascular disease in women with diabetes, which remains unexplained. FUNDING UK Medical Research Council, British Heart Foundation, Cancer Research UK, European Union BIOMED programme, and National Institute on Aging (US National Institutes of Health).
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20
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Foster S, Hooper P, Knuiman M, Lester L, Trapp G. Associations between proposed local government liquor store size classifications and alcohol consumption in young adults. Health Place 2018; 52:170-173. [PMID: 29913358 DOI: 10.1016/j.healthplace.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/23/2018] [Accepted: 06/05/2018] [Indexed: 10/28/2022]
Abstract
The prevalence of warehouse-style liquor stores has prompted alarm from local communities and public health advocates. To increase local government control over liquor stores, one proposed planning response is to distinguish between 'small' (i.e., ≤ 300 m2) and 'large' (i.e., > 300 m2) liquor stores. We mapped the size and location of liquor stores in Perth, Western Australia, and tested associations between liquor store exposure and alcohol consumption (grams ethanol/day) in young adults (n = 990). The count of liquor stores of any size within 1600 m and 1601-5000 m of home were significantly associated with increased alcohol intake, whereas larger stores (i.e., > 300 m2 and > 600 m2) were not associated with alcohol intake. Young adults' alcohol consumption appears to be impacted by liquor store density and convenience, rather than outlet size. However, the presence of multiple stores close to home increases market competition, driving alcohol prices down, and plausibly results in alcohol prices similar to those at liquor superstores.
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Affiliation(s)
- Sarah Foster
- Centre for Urban Research, School of Global Urban and Social Studies, RMIT University, 124 La Trobe St, Melbourne, VIC 3000, Australia; Centre for the Built Environment and Health, School of Agriculture & Environment and School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia.
| | - Paula Hooper
- Centre for the Built Environment and Health, School of Agriculture & Environment and School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Leanne Lester
- School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - Georgina Trapp
- Centre for the Built Environment and Health, School of Agriculture & Environment and School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia; Telethon Kids Institute, 100 Roberts Road, Subiaco, WA 6008, Australia
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21
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Bivoltsis A, Cervigni E, Trapp G, Knuiman M, Hooper P, Ambrosini GL. Food environments and dietary intakes among adults: does the type of spatial exposure measurement matter? A systematic review. Int J Health Geogr 2018; 17:19. [PMID: 29885662 PMCID: PMC5994245 DOI: 10.1186/s12942-018-0139-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 06/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationships between food environments and dietary intake have been assessed via a range of methodologically diverse measures of spatial exposure to food outlets, resulting in a largely inconclusive body of evidence, limiting informed policy intervention. OBJECTIVE This systematic review aims to evaluate the influence of methodological choice on study outcomes by examining the within-study effect of availability (e.g., counts) versus accessibility (e.g., proximity) spatial exposure measures on associations with diet. METHODS (PROSPERO registration: CRD42018085250). PubMed, Web of Science, Scopus and ScienceDirect databases were searched for empirical studies from 1980 to 2017, in the English language, involving adults and reporting on the statistical association between a dietary outcome and spatial exposure measures of both availability and accessibility. Studies were appraised using an eight-point quality criteria with a narrative synthesis of results. RESULTS A total of 205 associations and 44 relationships (i.e., multiple measures of spatial exposure relating to a particular food outlet type and dietary outcome) were extracted from 14 eligible articles. Comparative measures were dominated by counts (availability) and proximity (accessibility). Few studies compared more complex measures and all counts were derived from place-based measures of exposure. Sixteen of the 44 relationships had a significant effect involving an availability measure whilst only 8 had a significant effect from an accessibility measure. The largest effect sizes in relationships were mostly for availability measures. After stratification by scale, availability measure had the greatest effect size in 139 of the 176 pairwise comparisons. Of the 33% (68/205) of associations that reached significance, 53/68 (78%) were from availability measures. There was no relationship between study quality and reported study outcomes. CONCLUSIONS The limited evidence suggests that availability measures may produce significant and greater effect sizes than accessibility measures. However, both availability and accessibility measures may be important concepts of spatial exposure depending on the food outlet type and dietary outcome examined. More studies reporting on multi-method effects are required to differentiate findings by the type of spatial exposure assessment and build an evidence base regarding the appropriateness and robustness of measures under different circumstances.
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Affiliation(s)
- Alexia Bivoltsis
- School of Population and Global Health, The University of Western Australia, M451, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia.
| | - Eleanor Cervigni
- School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Gina Trapp
- School of Population and Global Health, The University of Western Australia, M451, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia.,Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, WA, 6872, Australia
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, M451, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia
| | - Paula Hooper
- School of Agriculture and Environment and the School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia
| | - Gina Leslie Ambrosini
- School of Population and Global Health, The University of Western Australia, M451, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia
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22
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Wood AM, Kaptoge S, Butterworth AS, Willeit P, Warnakula S, Bolton T, Paige E, Paul DS, Sweeting M, Burgess S, Bell S, Astle W, Stevens D, Koulman A, Selmer RM, Verschuren WMM, Sato S, Njølstad I, Woodward M, Salomaa V, Nordestgaard BG, Yeap BB, Fletcher A, Melander O, Kuller LH, Balkau B, Marmot M, Koenig W, Casiglia E, Cooper C, Arndt V, Franco OH, Wennberg P, Gallacher J, de la Cámara AG, Völzke H, Dahm CC, Dale CE, Bergmann MM, Crespo CJ, van der Schouw YT, Kaaks R, Simons LA, Lagiou P, Schoufour JD, Boer JMA, Key TJ, Rodriguez B, Moreno-Iribas C, Davidson KW, Taylor JO, Sacerdote C, Wallace RB, Quiros JR, Tumino R, Blazer DG, Linneberg A, Daimon M, Panico S, Howard B, Skeie G, Strandberg T, Weiderpass E, Nietert PJ, Psaty BM, Kromhout D, Salamanca-Fernandez E, Kiechl S, Krumholz HM, Grioni S, Palli D, Huerta JM, Price J, Sundström J, Arriola L, Arima H, Travis RC, Panagiotakos DB, Karakatsani A, Trichopoulou A, Kühn T, Grobbee DE, Barrett-Connor E, van Schoor N, Boeing H, Overvad K, Kauhanen J, Wareham N, Langenberg C, Forouhi N, Wennberg M, Després JP, Cushman M, Cooper JA, Rodriguez CJ, Sakurai M, Shaw JE, Knuiman M, Voortman T, Meisinger C, Tjønneland A, Brenner H, Palmieri L, Dallongeville J, Brunner EJ, Assmann G, Trevisan M, Gillum RF, Ford I, Sattar N, Lazo M, Thompson SG, Ferrari P, Leon DA, Smith GD, Peto R, Jackson R, Banks E, Di Angelantonio E, Danesh J. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet 2018; 391:1513-1523. [PMID: 29676281 PMCID: PMC5899998 DOI: 10.1016/s0140-6736(18)30134-x] [Citation(s) in RCA: 704] [Impact Index Per Article: 117.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 11/03/2017] [Accepted: 12/05/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Low-risk limits recommended for alcohol consumption vary substantially across different national guidelines. To define thresholds associated with lowest risk for all-cause mortality and cardiovascular disease, we studied individual-participant data from 599 912 current drinkers without previous cardiovascular disease. METHODS We did a combined analysis of individual-participant data from three large-scale data sources in 19 high-income countries (the Emerging Risk Factors Collaboration, EPIC-CVD, and the UK Biobank). We characterised dose-response associations and calculated hazard ratios (HRs) per 100 g per week of alcohol (12·5 units per week) across 83 prospective studies, adjusting at least for study or centre, age, sex, smoking, and diabetes. To be eligible for the analysis, participants had to have information recorded about their alcohol consumption amount and status (ie, non-drinker vs current drinker), plus age, sex, history of diabetes and smoking status, at least 1 year of follow-up after baseline, and no baseline history of cardiovascular disease. The main analyses focused on current drinkers, whose baseline alcohol consumption was categorised into eight predefined groups according to the amount in grams consumed per week. We assessed alcohol consumption in relation to all-cause mortality, total cardiovascular disease, and several cardiovascular disease subtypes. We corrected HRs for estimated long-term variability in alcohol consumption using 152 640 serial alcohol assessments obtained some years apart (median interval 5·6 years [5th-95th percentile 1·04-13·5]) from 71 011 participants from 37 studies. FINDINGS In the 599 912 current drinkers included in the analysis, we recorded 40 310 deaths and 39 018 incident cardiovascular disease events during 5·4 million person-years of follow-up. For all-cause mortality, we recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk around or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke (HR per 100 g per week higher consumption 1·14, 95% CI, 1·10-1·17), coronary disease excluding myocardial infarction (1·06, 1·00-1·11), heart failure (1·09, 1·03-1·15), fatal hypertensive disease (1·24, 1·15-1·33); and fatal aortic aneurysm (1·15, 1·03-1·28). By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction (HR 0·94, 0·91-0·97). In comparison to those who reported drinking >0-≤100 g per week, those who reported drinking >100-≤200 g per week, >200-≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1-2 years, or 4-5 years, respectively. INTERPRETATION In current drinkers of alcohol in high-income countries, the threshold for lowest risk of all-cause mortality was about 100 g/week. For cardiovascular disease subtypes other than myocardial infarction, there were no clear risk thresholds below which lower alcohol consumption stopped being associated with lower disease risk. These data support limits for alcohol consumption that are lower than those recommended in most current guidelines. FUNDING UK Medical Research Council, British Heart Foundation, National Institute for Health Research, European Union Framework 7, and European Research Council.
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Affiliation(s)
- Angela M Wood
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Stephen Kaptoge
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Adam S Butterworth
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Peter Willeit
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Medical University Innsbruck, Innsbruck, Austria
| | - Samantha Warnakula
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Thomas Bolton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ellie Paige
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Dirk S Paul
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Michael Sweeting
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Burgess
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; MRC Biostatistics Unit, Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Steven Bell
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - William Astle
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - David Stevens
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Albert Koulman
- NIHR BRC Nutritional Biomarker Laboratory, University of Cambridge, Cambridge, UK
| | | | - W M Monique Verschuren
- National Institute for Public Health and the Environment, Bilthoven, Netherlands; Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Shinichi Sato
- Chiba Prefectural Institute of Public Health, Chiba, Japan
| | - Inger Njølstad
- Department of Community Medicine, University of Tromsø, Tromsø, Norway
| | - Mark Woodward
- Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK; The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Veikko Salomaa
- THL-National Institute for Health and Welfare, Helsinki, Finland
| | - Børge G Nordestgaard
- Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bu B Yeap
- School of Medicine, University of Western Australia, Perth, WA, Australia; Fiona Stanley Hospital, Perth, WA, Australia; Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | | | - Olle Melander
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
| | - Lewis H Kuller
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Michael Marmot
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Wolfgang Koenig
- 92 Deutsches Herzzentrum München, Technische Universität München, Munich, Germany, DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany; University of Ulm Medical Center, Ulm, Germany
| | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Volker Arndt
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Oscar H Franco
- Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - John Gallacher
- Department of Primary Care and Public Health, Cardiff University, Cardiff, UK
| | | | - Henry Völzke
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Caroline E Dale
- Farr Institute of Health Informatics Research, UCL Institute of Health Informatics, University College London, London, UK
| | | | - Carlos J Crespo
- School of Community Health, Portland State University, Portland, OR, USA
| | - Yvonne T van der Schouw
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Rudolf Kaaks
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Leon A Simons
- St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Pagona Lagiou
- Hellenic Health Foundation, Athens, Greece; National and Kapodistrian University of Athens, Athens, Greece; Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | - Jolanda M A Boer
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Timothy J Key
- Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Beatriz Rodriguez
- Office of Public Health Studies, University of Hawaii, Honolulu, HI, USA
| | - Conchi Moreno-Iribas
- Instituto de Salud Pública de Navarra, IdiSNA - Navarra Institute for Health Research, Pamplona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Pamplona, Spain
| | | | | | | | - Robert B Wallace
- College of Public Health, The University of Iowa, Iowa City, IA, USA
| | - J Ramon Quiros
- Consejería de Sanidad del Principado de Asturias, Oviedo, Asturias, Spain
| | | | - Dan G Blazer
- Duke Divinity School, Duke University, Durham, NC, USA
| | - Allan Linneberg
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Makoto Daimon
- Global Center of Excellence Program Study Group, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Salvatore Panico
- Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy
| | | | - Guri Skeie
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Timo Strandberg
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Elisabete Weiderpass
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway; Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Genetic Epidemiology Group, Folkhälsan Research Center, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Paul J Nietert
- Medical University of South Carolina, Charleston, SC, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Services, University of Washington, Seattle, WA, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Daan Kromhout
- Department of Agrotechnology and Food Sciences, University of Wageningen, Wageningen, Netherlands; Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Elena Salamanca-Fernandez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Domenico Palli
- Cancer Research and Prevention Institute (ISPO), Florence, Italy
| | - José M Huerta
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Jackie Price
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Larraitz Arriola
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Instituto BIO-Donostia, Basque Government, San Sebastian, Spain
| | - Hisatomi Arima
- The University of Sydney and Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Preventive Medicine and Public Health, Kyushu University, Fukuoka, Japan
| | - Ruth C Travis
- Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Anna Karakatsani
- Hellenic Health Foundation, Athens, Greece; National and Kapodistrian University of Athens, Athens, Greece
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece; National and Kapodistrian University of Athens, Athens, Greece
| | - Tilman Kühn
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Diederick E Grobbee
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Natasja van Schoor
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
| | - Heiner Boeing
- German Institute of Human Nutrition, Potsdam-Rehbrüke, Germany
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark; Aalborg University Hospital, Aalborg, Denmark
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Nick Wareham
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Claudia Langenberg
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Nita Forouhi
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Maria Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Mary Cushman
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | - Jackie A Cooper
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Carlos J Rodriguez
- Wake Forest University School of Medicine, Winston-Salem, NC, USA; Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Masaru Sakurai
- Department of Social and Environmental Medicine, Kanazawa Medical University, Ishikawa, Japan
| | - Jonathan E Shaw
- Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Matthew Knuiman
- Busselton Population Medical Research Institute, Busselton, WA, Australia; School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Trudy Voortman
- Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Christa Meisinger
- Helmholtz Zentrum München German Research Center for Environmental Health, Germany
| | | | - Hermann Brenner
- German Cancer Research Center (DKFZ), Heidelberg, Germany; Division of Clinical Epidemiology and Aging Research, University of Heidelberg, Heidelberg, Germany
| | | | | | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Gerd Assmann
- Assmann-Stiftung für Prävention, Münster, Germany
| | | | | | - Ian Ford
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
| | - Mariana Lazo
- School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Simon G Thompson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Pietro Ferrari
- International Agency for Research on Cancer, Lyon, France
| | - David A Leon
- London School of Hygiene & Tropical Medicine, London, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
| | - Richard Peto
- Nuffield Department of Population Health, Medical Sciences Division, University of Oxford, Oxford, UK
| | - Rod Jackson
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | | | - John Danesh
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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Bivoltsis A, Trapp GSA, Knuiman M, Hooper P, Ambrosini GL. Can a Simple Dietary Index Derived from a Sub-Set of Questionnaire Items Assess Diet Quality in a Sample of Australian Adults? Nutrients 2018; 10:E486. [PMID: 29652828 PMCID: PMC5946271 DOI: 10.3390/nu10040486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 03/26/2018] [Accepted: 04/10/2018] [Indexed: 11/16/2022] Open
Abstract
Large, longitudinal surveys often lack consistent dietary data, limiting the use of existing tools and methods that are available to measure diet quality. This study describes a method that was used to develop a simple index for ranking individuals according to their diet quality in a longitudinal study. The RESIDential Environments (RESIDE) project (2004-2011) collected dietary data in varying detail, across four time points. The most detailed dietary data were collected using a 24-item questionnaire at the final time point (n = 555; age ≥ 25 years). At preceding time points, sub-sets of the 24 items were collected. A RESIDE dietary guideline index (RDGI) that was based on the 24-items was developed to assess diet quality in relation to the Australian Dietary Guidelines. The RDGI scores were regressed on the longitudinal sub-sets of six and nine questionnaire items at T4, from which two simple index scores (S-RDGI1 and S-RDGI2) were predicted. The S-RDGI1 and S-RDGI2 showed reasonable agreement with the RDGI (Spearman's rho = 0.78 and 0.84; gross misclassification = 1.8%; correct classification = 64.9% and 69.7%; and, Cohen's weighted kappa = 0.58 and 0.64, respectively). For all of the indices, higher diet quality was associated with being female, undertaking moderate to high amounts of physical activity, not smoking, and self-reported health. The S-RDGI1 and S-RDGI2 explained 62% and 73% of the variation in RDGI scores, demonstrating that a large proportion of the variability in diet quality scores can be captured using a relatively small sub-set of questionnaire items. The methods described in this study can be applied elsewhere, in situations where limited dietary data are available, to generate a sample-specific score for ranking individuals according to diet quality.
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Affiliation(s)
- Alexia Bivoltsis
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
| | - Georgina S A Trapp
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
- Telethon Kids Institute, The University of Western Australia, PO Box 855, West Perth, WA 6872, Australia.
- School of Agriculture and Environment and the School of Human Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
| | - Paula Hooper
- School of Agriculture and Environment and the School of Human Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
| | - Gina L Ambrosini
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
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24
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Peters SAE, Wang X, Lam TH, Kim HC, Ho S, Ninomiya T, Knuiman M, Vaartjes I, Bots ML, Woodward M. Clustering of risk factors and the risk of incident cardiovascular disease in Asian and Caucasian populations: results from the Asia Pacific Cohort Studies Collaboration. BMJ Open 2018; 8:e019335. [PMID: 29511013 PMCID: PMC5855160 DOI: 10.1136/bmjopen-2017-019335] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess the relationship between risk factor clusters and cardiovascular disease (CVD) incidence in Asian and Caucasian populations and to estimate the burden of CVD attributable to each cluster. SETTING Asia Pacific Cohort Studies Collaboration. PARTICIPANTS Individual participant data from 34 population-based cohorts, involving 314 024 participants without a history of CVD at baseline. OUTCOME MEASURES Clusters were 11 possible combinations of four individual risk factors (current smoking, overweight, blood pressure (BP) and total cholesterol). Cox regression models were used to obtain adjusted HRs and 95% CIs for CVD associated with individual risk factors and risk factor clusters. Population-attributable fractions (PAFs) were calculated. RESULTS During a mean follow-up of 7 years, 6203 CVD events were recorded. The ranking of HRs and PAFs was similar for Australia and New Zealand (ANZ) and Asia; clusters including BP consistently showed the highest HRs and PAFs. The BP-smoking cluster had the highest HR for people with two risk factors: 4.13 (3.56 to 4.80) for Asia and 3.07 (2.23 to 4.23) for ANZ. Corresponding PAFs were 24% and 11%, respectively. For individuals with three risk factors, the BP-smoking-cholesterol cluster had the highest HR (4.67 (3.92 to 5.57) for Asia and 3.49 (2.69 to 4.53) for ANZ). Corresponding PAFs were 13% and 10%. CONCLUSIONS Risk factor clusters act similarly on CVD risk in Asian and Caucasian populations. Clusters including elevated BP were associated with the highest excess risk of CVD.
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Affiliation(s)
- Sanne A E Peters
- George Institute for Global Health, University of Oxford, Oxford, UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Xin Wang
- George Institute for Global Health, University of Oxford, Oxford, UK
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- The First Hospital of Jilin University, Changchun, China
| | - Tai-Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
| | - Hyeon Chang Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suzanne Ho
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Toshiharu Ninomiya
- Department of Epidemiology and Public Health, Kyushu University, Fukuoka, Japan
| | - Matthew Knuiman
- School of Population Health, University of Western Australia, Perth, Western Australia, Australia
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mark Woodward
- George Institute for Global Health, University of Oxford, Oxford, UK
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
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25
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Mulrennan S, Knuiman M, Walsh JP, Hui J, Hunter M, Divitini M, Zhu K, Cooke BR, Musk AWB, James A. Vitamin D and respiratory health in the Busselton Healthy Ageing Study. Respirology 2018; 23:576-582. [PMID: 29365367 DOI: 10.1111/resp.13239] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 11/15/2017] [Accepted: 11/23/2017] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND OBJECTIVE The relationship between vitamin D and respiratory disease was examined by cross-sectional analysis of a large community-based sample. METHODS Serum 25-hydroxyvitamin D (25OHD) and history of respiratory disease, symptoms (recorded by questionnaire) and spirometry were measured in 5011 adults aged 45-69 years. Adjustments were made for age, sex, season and smoking (Model A), plus body mass index (BMI) and physical activity level (Model B), plus history of chronic diseases (Model C). RESULTS Mean (SD) age was 58 (SD 6) years with 45% males, 10% current smokers and 12% taking vitamin D supplements. The prevalence of 25OHD level <50 nmol/L was 8.0%. In all the three models, 25OHD <50 nmol/L was significantly associated with asthma (Model C: odds ratio (OR): 1.32; 95% CI: 1.00, 1.73), bronchitis (1.54; 1.17, 2.01), wheeze (1.37; 1.10, 1.71) and chest tightness (1.42; 1.10, 1.83). Participants with vitamin D level > 100 nmol/L had higher forced vital capacity (FVC) in all the three models (1.17% higher, compared with the 50-100 nmol/L group in Model C). CONCLUSION Low levels of serum 25OHD were independently associated with asthma, bronchitis, wheeze and chest tightness after three levels of adjustment for potential confounders. Higher vitamin D levels were associated with higher levels of lung function.
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Affiliation(s)
- Siobhain Mulrennan
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.,Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Matthew Knuiman
- Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - John P Walsh
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.,Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Jennie Hui
- Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Population and Global Health, University of Western Australia, Perth, WA, Australia.,PathWest Laboratory Medicine, Perth, WA, Australia
| | - Michael Hunter
- Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Mark Divitini
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Kun Zhu
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.,Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | | - Arthur W Bill Musk
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.,Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia.,School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Alan James
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia.,Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
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26
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Zhu K, Knuiman M, Divitini M, Hung J, Lim EM, Cooke BR, Walsh JP. Serum 25-hydroxyvitamin D as a predictor of mortality and cardiovascular events: A 20-year study of a community-based cohort. Clin Endocrinol (Oxf) 2018; 88:154-163. [PMID: 28949411 DOI: 10.1111/cen.13485] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Prospective studies, mostly from Europe and North America, suggest that serum 25-hydroxyvitamin D (25(OH)D) is inversely associated with mortality and cardiovascular disease (CVD) risk. Data from other regions are limited, and threshold levels for adverse cardiovascular outcomes are uncertain. We examined serum 25(OH)D as a predictor of total mortality and cardiovascular outcomes in an Australian cohort. DESIGN A 20-year, community-based cohort study. PATIENTS Participants in the 1994/1995 Busselton Health Survey (n = 3946, baseline age 25-84 years). MEASUREMENTS Baseline serum 25(OH)D and mortality and cardiovascular outcomes to 2014 obtained by record linkage. RESULTS The mean serum 25(OH)D concentration was 60.6 ± 18.0 nmol/L. During 20-year follow-up (excluding the first 2 years), 889 participants died (including 363 from CVD) and 944 experienced a CVD event (including 242 with heart failure). In the full cohort, controlling for Framingham risk score variables, higher baseline 25(OH)D was associated with significantly reduced all-cause mortality (adjusted HR 0.83 per SD increment of 25(OH)D, 95% CI 0.77-0.90), CVD death (HR 0.85, 95% CI 0.74-0.96) and heart failure (HR 0.81, 95% CI 0.69-0.94), but not CVD events (HR 0.99, 0.92-1.07). In restricted cubic spline regression models, serum 25(OH)D below 65 and 55 nmol/L was associated with higher total mortality and higher CVD mortality/heart failure, respectively. In participants without CVD at baseline (n = 3220), results were similar, but hazard ratios were attenuated and associations with CVD mortality no longer significant. CONCLUSIONS In an Australian community-based cohort, baseline vitamin D levels below 55-65 nmol/L are predictive of all-cause mortality, CVD death and heart failure.
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Affiliation(s)
- Kun Zhu
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
| | - Matthew Knuiman
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - Mark Divitini
- School of Population and Global Health, University of Western Australia, Crawley, WA, Australia
| | - Joseph Hung
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
| | - Ee Mun Lim
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Nedlands, WA, Australia
| | - Brian R Cooke
- Department of Clinical Biochemistry, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - John P Walsh
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia
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27
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Lopez D, Nedkoff L, Knuiman M, Hobbs MST, Briffa TG, Preen DB, Hung J, Beilby J, Mathur S, Reynolds A, Sanfilippo FM. Exploring the effects of transfers and readmissions on trends in population counts of hospital admissions for coronary heart disease: a Western Australian data linkage study. BMJ Open 2017; 7:e019226. [PMID: 29151055 PMCID: PMC5701992 DOI: 10.1136/bmjopen-2017-019226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To develop a method for categorising coronary heart disease (CHD) subtype in linked data accounting for different CHD diagnoses across records, and to compare hospital admission numbers and ratios of unlinked versus linked data for each CHD subtype over time, and across age groups and sex. DESIGN Cohort study. DATA SOURCE Person-linked hospital administrative data covering all admissions for CHD in Western Australia from 1988 to 2013. MAIN OUTCOME Ratios of (1) unlinked admission counts to contiguous admission (CA) counts (accounting for transfers), and (2) 28-day episode counts (accounting for transfers and readmissions) to CA counts stratified by CHD subtype, sex and age group. RESULTS In all CHD subtypes, the ratios changed in a linear or quadratic fashion over time and the coefficients of the trend term differed across CHD subtypes. Furthermore, for many CHD subtypes the ratios also differed by age group and sex. For example, in women aged 35-54 years, the ratio of unlinked to CA counts for non-ST elevation myocardial infarction admissions in 2000 was 1.10, and this increased in a linear fashion to 1.30 in 2013, representing an annual increase of 0.0148. CONCLUSION The use of unlinked counts in epidemiological estimates of CHD hospitalisations overestimates CHD counts. The CA and 28-day episode counts are more aligned with epidemiological studies of CHD. The degree of overestimation of counts using only unlinked counts varies in a complex manner with CHD subtype, time, sex and age group, and it is not possible to apply a simple correction factor to counts obtained from unlinked data.
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Affiliation(s)
- Derrick Lopez
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Matthew Knuiman
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Michael S T Hobbs
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Thomas G Briffa
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Joseph Hung
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
| | - John Beilby
- School of Biomedical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Sushma Mathur
- Health Group, Australian Institute of Health and Welfare, Canberra, Australia
| | - Anna Reynolds
- Health Group, Australian Institute of Health and Welfare, Canberra, Australia
| | - Frank M Sanfilippo
- School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia
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28
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Zhu K, Knuiman M, Divitini M, Murray K, Lim EM, St John A, Walsh JP, Hung J. High-sensitivity cardiac troponin I and risk of cardiovascular disease in an Australianpopulation-based cohort. Heart 2017; 104:895-903. [DOI: 10.1136/heartjnl-2017-312093] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 12/30/2022] Open
Abstract
ObjectiveHigh-sensitivity cardiac troponin I (hs-cTnI) is an emerging biomarker for cardiovascular risk. We examined hs-cTnI as a predictor of mortality and cardiovascular outcomes in an Australian population-based cohort and evaluated if a sex difference exists.MethodsSerum hs-cTnI was measured in the Busselton Health Study 1994/1995 Cohort (n=3939). Outcome measures were total and cardiovascular mortality, cardiovascular disease (CVD) and coronary heart disease (CHD) events, heart failure and stroke.ResultsHs-cTnI was detectable (>1.2 ng/L) in 66.1% of participants (males 81.8%, females 54.4%) at baseline. There were 886 deaths (including 361 from CVD) and 940 CVD events during 20-year follow-up. Adjusting for Framingham Risk Score variables, hs-cTnI was a significant predictor of total mortality (HR (95% CI): 1.16 (1.09 to 1.24)), CVD mortality (1.33 (1.23 to 1.44)), CVD events (1.18 (1.11 to 1.25)), CHD events (1.11 (1.03 to 1.20)), heart failure (1.44 (1.31 to 1.58)) and stroke (1.13 (1.03 to 1.24)) per doubling of hs-cTnI at baseline. HRs remained significant in CVD-free individuals at baseline (n=3215), except for CHD events. There were no significant interactions between sex and hs-cTnI as a predictor of outcomes. Compared with individuals with hs-cTnI ≤1.2 ng/L, men with hs-cTnI ≥6.0 ng/L and women with hs-cTnI ≥4.0 ng/L had an HR of 2.18 (1.42 to 3.37) and 1.84 (1.30 to 2.62), respectively, for any CVD event, which persisted in the CVD-free subgroup.ConclusionsCardiac troponin I, measured with a high-sensitive assay, is an independent predictor of fatal and non-fatal CVD events and may help identify at-risk individuals in a general population.
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29
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Paige E, Barrett J, Pennells L, Sweeting M, Willeit P, Di Angelantonio E, Gudnason V, Nordestgaard BG, Psaty BM, Goldbourt U, Best LG, Assmann G, Salonen JT, Nietert PJ, Verschuren WMM, Brunner EJ, Kronmal RA, Salomaa V, Bakker SJL, Dagenais GR, Sato S, Jansson JH, Willeit J, Onat A, de la Cámara AG, Roussel R, Völzke H, Dankner R, Tipping RW, Meade TW, Donfrancesco C, Kuller LH, Peters A, Gallacher J, Kromhout D, Iso H, Knuiman M, Casiglia E, Kavousi M, Palmieri L, Sundström J, Davis BR, Njølstad I, Couper D, Danesh J, Thompson SG, Wood A. Use of Repeated Blood Pressure and Cholesterol Measurements to Improve Cardiovascular Disease Risk Prediction: An Individual-Participant-Data Meta-Analysis. Am J Epidemiol 2017; 186:899-907. [PMID: 28549073 PMCID: PMC5860526 DOI: 10.1093/aje/kwx149] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 02/14/2017] [Accepted: 02/24/2017] [Indexed: 01/03/2023] Open
Abstract
The added value of incorporating information from repeated blood pressure and cholesterol measurements to predict cardiovascular disease (CVD) risk has not been rigorously assessed. We used data on 191,445 adults from the Emerging Risk Factors Collaboration (38 cohorts from 17 countries with data encompassing 1962-2014) with more than 1 million measurements of systolic blood pressure, total cholesterol, and high-density lipoprotein cholesterol. Over a median 12 years of follow-up, 21,170 CVD events occurred. Risk prediction models using cumulative mean values of repeated measurements and summary measures from longitudinal modeling of the repeated measurements were compared with models using measurements from a single time point. Risk discrimination (C-index) and net reclassification were calculated, and changes in C-indices were meta-analyzed across studies. Compared with the single-time-point model, the cumulative means and longitudinal models increased the C-index by 0.0040 (95% confidence interval (CI): 0.0023, 0.0057) and 0.0023 (95% CI: 0.0005, 0.0042), respectively. Reclassification was also improved in both models; compared with the single-time-point model, overall net reclassification improvements were 0.0369 (95% CI: 0.0303, 0.0436) for the cumulative-means model and 0.0177 (95% CI: 0.0110, 0.0243) for the longitudinal model. In conclusion, incorporating repeated measurements of blood pressure and cholesterol into CVD risk prediction models slightly improves risk prediction.
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Affiliation(s)
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- Correspondence to Dr. Angela Wood, Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, United Kingdom (e-mail: )
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Christian H, Knuiman M, Divitini M, Foster S, Hooper P, Boruff B, Bull F, Giles-Corti B. A Longitudinal Analysis of the Influence of the Neighborhood Environment on Recreational Walking within the Neighborhood: Results from RESIDE. Environ Health Perspect 2017; 125:077009. [PMID: 28728139 PMCID: PMC5744655 DOI: 10.1289/ehp823] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 01/29/2017] [Accepted: 02/10/2017] [Indexed: 05/12/2023]
Abstract
BACKGROUND There is limited longitudinal evidence confirming the role of neighborhood environment attributes in encouraging people to walk more or if active people simply choose to live in activity-friendly neighborhoods. Natural experiments of policy changes to create more walkable communities provide stronger evidence for a causal effect of neighborhood environments on residents' walking. OBJECTIVES We aimed to investigate longitudinal associations between objective and perceived neighborhood environment measures and neighborhood recreational walking. METHODS We analyzed longitudinal data collected over 8 yr (four surveys) from the RESIDential Environments (RESIDE) Study (Perth, Australia, 2003-2012). At each time point, participants reported the frequency and total minutes of recreational walking/week within their neighborhood and neighborhood environment perceptions. Objective measures of the neighborhood environment were generated using a Geographic Information System (GIS). RESULTS Local recreational walking was influenced by objectively measured access to a medium-/large-size park, beach access, and higher street connectivity, which was reduced when adjusted for neighborhood perceptions. In adjusted models, positive perceptions of access to a park and beach, higher street connectivity, neighborhood esthetics, and safety from crime were independent determinants of increased neighborhood recreational walking. Local recreational walking increased by 9 min/wk (12% increase in frequency) for each additional perceived neighborhood attribute present. CONCLUSIONS Our findings provide urban planners and policy makers with stronger causal evidence of the positive impact of well-connected neighborhoods and access to local parks of varying sizes on local residents' recreational walking and health. https://doi.org/10.1289/EHP823.
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Affiliation(s)
- Hayley Christian
- School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
- Centre for the Built Environment and Health, School of Earth and Environment & School of Sports Science, Exercise and Health, The University of Western Australia, Perth, Western Australia, Australia
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew Knuiman
- School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Mark Divitini
- School of Population Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Sarah Foster
- Centre for the Built Environment and Health, School of Earth and Environment & School of Sports Science, Exercise and Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Paula Hooper
- Centre for the Built Environment and Health, School of Earth and Environment & School of Sports Science, Exercise and Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Bryan Boruff
- Centre for the Built Environment and Health, School of Earth and Environment & School of Sports Science, Exercise and Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Fiona Bull
- Centre for the Built Environment and Health, School of Earth and Environment & School of Sports Science, Exercise and Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Billie Giles-Corti
- Centre for the Built Environment and Health, School of Earth and Environment & School of Sports Science, Exercise and Health, The University of Western Australia, Perth, Western Australia, Australia
- McCaughey VicHealth Community Wellbeing Unit, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Nossent J, Raymond W, Divitini M, Knuiman M. Rheumatoid factors do not predict cardiovascular disease and mortality in the general population in the Busselton Health Survey. BMC Musculoskelet Disord 2017; 18:221. [PMID: 28549428 PMCID: PMC5446675 DOI: 10.1186/s12891-017-1598-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 05/22/2017] [Indexed: 11/25/2022] Open
Abstract
Background Rheumatoid Factors (RF) are antibodies directed against the Fc portion of IgG and are involved in clearance of immune complexes. While RF can develop in a wide range of conditions, higher RF levels indicate a greater risk for a severe disease course in Rheumatoid Arthritis (RA) patients including cardiovascular complications and premature death. We investigated whether RF also constitute a risk factor for these outcomes in the general population. Methods We included 2,323 participants (46% male, mean age 50 years) free of CVD at baseline in 1972. RF positivity was defined as a score of ≥2 by latex agglutination (scale 0–5). All outcomes during 42-year follow-up were obtained from state-wide registries. The predictive value of RF for coronary heart disease, all cardiovascular disease and all-cause mortality was estimated by adjusted hazard ratios (HR) from Cox regression models. Results After adjustment for standard risk factors, RF positivity was not predictive of future CHD (HR 1.05, p = 0.61), CVD (HR 1,04, p = 0.63) or mortality (HR 1.03, p = 0.70) in the full CVD-free cohort. In an interaction model, RF in 41 out of 355 participants with an RA history was not predictive of CHD (HR 0.92, p = 0.77) or CVD events (HR 1.15, p = 0.51), but there was a borderline significant association with overall mortality (HR 1.41, CI 0.97–2.04, p = 0.07). Conclusions RF detected by Latex agglutination do not independently predict future CHD, CVD or death in the general population. However, the presence of RF in the context of a history of RA is associated with a moderate, borderline significant increase in the long term adjusted risk for all-cause mortality. Electronic supplementary material The online version of this article (doi:10.1186/s12891-017-1598-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johannes Nossent
- School of Medicine & Pharmacology, The University of Western Australia, 35 Stirling Hwy (M503), Crawley, WA, 6009, Australia. .,Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, WA, Australia.
| | - Warren Raymond
- School of Medicine & Pharmacology, The University of Western Australia, 35 Stirling Hwy (M503), Crawley, WA, 6009, Australia
| | - Mark Divitini
- School of Population Health, The University of Western Australia, Perth, WA, Australia
| | - Matthew Knuiman
- School of Population Health, The University of Western Australia, Perth, WA, Australia.,Busselton Population Medical Research Institute, Busselton, WA, Australia
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Foster S, Hooper P, Knuiman M, Trapp G, Wood L. Does alcohol outlet density differ by area-level disadvantage in metropolitan Perth? Drug Alcohol Rev 2017; 36:701-708. [PMID: 28295745 DOI: 10.1111/dar.12469] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Research suggests that there are area-level disparities in alcohol outlets, with greater density in disadvantaged areas. In part, this might be explained by the inequitable distribution of retail, attracted by lower rents to disadvantaged neighbourhoods. This ecological study examines the distribution of liquor licences in Perth, Australia, and whether discrepancies in the distribution of retail land-uses could account for a socio-economic gradient. DESIGN AND METHODS Area disadvantage was determined for each Statistical Area 1 (SA1) using the Australian Bureau of Statistics Index of Relative Socio-economic Disadvantage, and licence locations were mapped in GIS. Negative binomial loglinear models examined whether licence densities within SA1s differed by area disadvantage, controlling for demographics and spatial correlation. Models included an offset term, so the estimated effects of area-level disadvantage were on licences per km2 , or licences per retail destination. RESULTS In the area-based analyses, for every unit increase in disadvantage decile (i.e. a reduction in relative disadvantage), general licences reduced by 15% (P = 0.000) and liquor stores reduced by 7% (P = 0.004). These gradients were not apparent when licences were examined as a function of retail; however, for every unit increase in disadvantage decile, the density of on-premise licences per retail destination increased by 14% (P = 0.000). DISCUSSION AND CONCLUSIONS The direction of the socio-economic gradient for general licences and liquor stores in Perth is concerning, as all licences selling packaged alcohol were more abundant in disadvantaged areas. However, the over-representation of packaged liquor in disadvantaged areas may relate to the increased provision of retail.
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Affiliation(s)
- Sarah Foster
- Centre for the Built Environment and Health, School of Sport Science, Exercise & Health and School of Earth and Environment, The University of Western Australia, Perth, Australia
| | - Paula Hooper
- Centre for the Built Environment and Health, School of Sport Science, Exercise & Health and School of Earth and Environment, The University of Western Australia, Perth, Australia
| | - Matthew Knuiman
- School of Population Health, The University of Western Australia, Perth, Australia
| | - Georgina Trapp
- Centre for the Built Environment and Health, School of Sport Science, Exercise & Health and School of Earth and Environment, The University of Western Australia, Perth, Australia.,School of Population Health, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, Perth, Australia
| | - Lisa Wood
- School of Population Health, The University of Western Australia, Perth, Australia
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Matthews J, Sanfilippo F, Lopez D, Knuiman M, Hobbs M, Hung J, Mathur S, Beilby J, Briffa T, Nedkoff L. Long-Term Trends in Inpatient Hospital Admission Rates for Unspecified Chest Pain in Western Australia, 1998-2013. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lopez D, Katzenellenbogen J, Sanfilippo F, Knuiman M, Hobbs M, Briffa T, Thompson S. Hospital Utilisation Patterns for Cardiovascular Disease (CVD) 12 Months Post First-Ever Acute Coronary Syndrome (ACS) in Aboriginal and Non-Aboriginal Patients. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chasland L, Knuiman M, Divitini M, Chan Y, Handelsman D, Naylor L, Yeap B, Green D. Physical Activity Level and Androgen Concentrations Are Independently and Additively Associated with Lower Cardiometabolic Risk in Men. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nedkoff L, Yi F, Knuiman M, Rankin J, Newman M, Sanfilippo F. Long-Term Population Trends in Coronary Artery Revascularisation Procedures in Western Australia, 1980 to 2013. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nossent J, Raymond W, Divitini M, Knuiman M. Asymptomatic hyperuricemia is not an independent risk factor for cardiovascular events or overall mortality in the general population of the Busselton Health Study. BMC Cardiovasc Disord 2016; 16:256. [PMID: 27978810 PMCID: PMC5160002 DOI: 10.1186/s12872-016-0421-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 11/22/2016] [Indexed: 12/15/2022] Open
Abstract
Background To investigate the impact of uric acid (UA) levels on cardiovascular disease and mortality at a population level. Methods Prospective analysis of baseline serum UA measurement and 15 year follow-up data from the Busselton Health Survey (n = 4,173), stratified by existence or absence of baseline cardiovascular disease. Outcomes were ascertained from state-wide hospital discharge and mortality registries. Cox regression produced adjusted hazard ratios (HR) for UA level as continuous and categorical (low, medium, high) predictor for cardiovascular events (CVE) and mortality. Gout was defined as a patient’s self-reported history of gout. Results After age and gender adjustment each 0.1 mmol/L rise in UA level was associated with increased mortality (HR 1.19, CI 1.04–1.36), cardiovascular mortality (HR 1.27, CI 1.03–1.57) and first CVE (HR 1.28, CI 1.13–1.44) in participants with no history of CVE. Adjustment for behavioural and biomedical risk factors of cardiovascular disease attenuated these associations. Results for participants with a history of CVE and for a subset of 1,632 participants using UA levels (2–6 measurements) averaged over time were similar. The overall prevalence of hyperuricemia was 10.7%. When stratified by history of gout, UA level was significantly associated with increased risk of cardiovascular mortality only in participants with a history of CVE (HR 2.13, CI 1.03–4.43). Conclusions Despite the considerable prevalence of hyperuricemia in 10.7% of the population, single or time averaged measures of UA were not independently predictive of incident cardiovascular disease or mortality. Hyperuricemia did associate with an increased risk of cardiovascular death only in participants with gout and existing cardiovascular disease. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0421-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Johannes Nossent
- School of Medicine & Pharmacology, The University of Western Australia, 35 Stirling Hwy (M503), Perth, 6009, WA, Australia. .,Department of Rheumatology, Sir Charles Gairdner & Osborne Park Hospital Group, Perth, 6009, WA, Australia.
| | - Warren Raymond
- School of Medicine & Pharmacology, The University of Western Australia, 35 Stirling Hwy (M503), Perth, 6009, WA, Australia
| | - Mark Divitini
- School of Population Health, The University of Western Australia, Perth, 6009, WA, Australia
| | - Matthew Knuiman
- School of Population Health, The University of Western Australia, Perth, 6009, WA, Australia
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Westgarth C, Knuiman M, Christian HE. Understanding how dogs encourage and motivate walking: cross-sectional findings from RESIDE. BMC Public Health 2016; 16:1019. [PMID: 27682237 PMCID: PMC5041543 DOI: 10.1186/s12889-016-3660-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 09/12/2016] [Indexed: 11/10/2022] Open
Abstract
Background Many people live with dogs but not all walk with them regularly. This study examines the demographic and behavioural factors that contribute towards owners reporting having a strong sense of encouragement and motivation to walk provided by their dogs, which we call ‘the Lassie effect’. Methods Data was collected from 629 dog owners participating in the RESIDE cross-sectional survey in Perth, Western Australia. Multivariable logistic regression analyses of factors associated with two separate outcome survey items ‘Dog encouragement to walk’ (how often dog encouraged me to go walking in last month) and ‘Dog motivation to walk’ (Having a dog makes me walk more). Results Owning a larger dog; having an increased level of attachment to dog; knowing dog enjoys going for a walk; believing walking keeps dog healthy; and having high social support from family to go walking, were positively associated with both outcomes ‘dog encouragement to walk’ and ‘dog motivation to walk’. Conversely, reporting the presence of children at home; that the child is the main person who walks with the dog; and perceiving dog-specific barriers to walking with dog daily; were negatively associated with both outcomes. In addition, ‘Dog motivation to walk’ only was positively associated with a belief walking reduces barking, and negatively with owning a dog that is overweight or a dog that is too old/sick. Reporting that the spouse/partner is main person who walks with the dog was also negatively associated with ‘dog motivation to walk’, as was increased perceived access to public open spaces with dog-supportive features. Conclusions There are both dog and owner factors that are associated with an owner’s sense of encouragement, and motivation to walk the dog, which in turn has been found to be associated with dog waking behaviour. These factors may be targeted in future interventions to increase and maintain physical activity levels of both people and pets.
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Affiliation(s)
- C Westgarth
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, and School of Veterinary Science, University of Liverpool, Leahurst, Chester High Road, Neston, Cheshire, CH64 7TE, UK.
| | - M Knuiman
- School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia
| | - H E Christian
- School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia.,Centre for the Built Environment and Health, School of Sport Science, Exercise & Health, The Univers'ity of Western Australia, 35 Stirling Highway, Crawley, Perth, WA, 6009, Australia.,Telethon Kids Institute, The University of Western Australia, 100 Roberts Road, Subiaco, Perth, WA, 6008, Australia
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Nedkoff L, Knuiman M, Hobbs MST, Hung J, Mathur S, Beilby J, Reynolds A, Briffa TG, Lopez D, Sanfilippo FM. Is the incidence of heart attack still decreasing in Australia? Developing reliable methods for monitoring trends in myocardial infarction and coronary heart disease (AUS-MOCHA): a study protocol. BMJ Open 2016; 6:e012180. [PMID: 27558904 PMCID: PMC5013363 DOI: 10.1136/bmjopen-2016-012180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/30/2016] [Accepted: 08/01/2016] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Accurate monitoring of acute coronary heart disease (CHD) is essential for understanding the effects of primary and secondary prevention and for planning of healthcare services. The ability to reliably monitor acute CHD has been affected by new diagnostic tests for myocardial infarction (MI) and changing clinical classifications and management of CHD. Our study will develop new and reliable methods for monitoring population trends in incidence, outcomes and health service usage for acute CHD and chest pain. METHODS AND ANALYSIS The study cohort of all CHD will be identified from the Western Australian Data Linkage System using state-wide data sets for emergency department presentation, hospitalisations and mortality data for 2002-2014. This core linked data set will be supplemented with data from hospital medical record reviews, pathology data and hospital pharmacy dispensing databases. The consistency over time of the coding of the different subgroups of CHD/chest pain (ST-elevation MI, non-ST elevation MI, unstable angina, stable angina, other CHD, non-CHD chest pain) in linked data will be assessed using these data sources, and an algorithm developed detailing groups in which temporal trends can be reliably measured. This algorithm will be used for measurement of trends in incidence and outcomes of acute CHD, and to develop further methods for monitoring acute CHD using unlinked and linked data with varying availability of hospitalisation history. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Human Research Ethics Committees of the WA Department of Health (#2016/23) and The University of Western Australia (RA/4/1/7230). Findings will be disseminated via publication in peer-reviewed journals, and presentation at national and international conferences. There will also be a strong platform for dissemination of new monitoring methods via collaboration with the Australian Institute of Health and Welfare which will assist with promotion of these methods at state and national levels.
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Affiliation(s)
- Lee Nedkoff
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Matthew Knuiman
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Michael S T Hobbs
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Joseph Hung
- Sir Charles Gairdner Hospital Unit, School of Medicine and Pharmacology (M503), The University of Western Australia, Crawley, Western Australia, Australia
| | - Sushma Mathur
- Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia
| | - John Beilby
- PathWest Laboratory Medicine WA, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- School of Pathology and Laboratory Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Anna Reynolds
- Australian Institute of Health and Welfare, Canberra, Australian Capital Territory, Australia
| | - Tom G Briffa
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Derrick Lopez
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
| | - Frank M Sanfilippo
- School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
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Nedkoff L, Knuiman M, Hung J, Geelhoed E, Briffa T, Katzenellenbogen J, Rankin J, Ortiz M, Hobbs M, Sanfilippo F. Long-Term Persistence on Statins Following Myocardial Infarction in a Population-Cohort: Age and Gender Perspective. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nossent J, Raymond W, Divitini M, Host L, Knuiman M. OP0018 Hyperuricemia Increases Mortality Only in Patients with Gout and Existing Cardiovascular Disease. A Prospective Analysis from The Busselton Health Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Katzenellenbogen J, Sanfilippo F, Knuiman M, Hobbs M, Teng T, Lopez D, Hung J, Thompson S. PM212 Rheumatic Heart Disease Co-Morbidity in Heart Failure, Atrial Fibrillation and Stroke Among Adult Aboriginal Western Australians: Need for Service Strengthening. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Briffa T, Hung J, Knuiman M, McQuillan B, Chew DP, Eikelboom J, Hankey GJ, Teng THK, Nedkoff L, Weerasooriya R, Liu A, Stobie P. Trends in incidence and prevalence of hospitalization for atrial fibrillation and associated mortality in Western Australia, 1995–2010. Int J Cardiol 2016; 208:19-25. [DOI: 10.1016/j.ijcard.2016.01.196] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 12/18/2015] [Accepted: 01/15/2016] [Indexed: 12/21/2022]
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Sugiyama T, Villanueva K, Knuiman M, Francis J, Foster S, Wood L, Giles-Corti B. Can neighborhood green space mitigate health inequalities? A study of socio-economic status and mental health. Health Place 2016; 38:16-21. [DOI: 10.1016/j.healthplace.2016.01.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 12/22/2015] [Accepted: 01/08/2016] [Indexed: 10/22/2022]
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Nedkoff L, Knuiman M, Hung J, Briffa TG. Long-term all-cause and cardiovascular mortality following incident myocardial infarction in men and women with and without diabetes: Temporal trends from 1998 to 2009. Eur J Prev Cardiol 2016; 23:1273-81. [PMID: 26907793 DOI: 10.1177/2047487316634279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/02/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Long-term mortality following myocardial infarction is higher in diabetic than non-diabetic individuals. Early case-fatality after myocardial infarction has improved but it is unclear whether trends extend to long-term mortality. We aimed to determine whether the disparity in long-term all-cause and cardiovascular disease mortality by diabetes status has decreased. METHODS All incident myocardial infarction cases were identified from Western Australian whole-population linked data for 1998-2009. Mortality follow-up was available until 30 June 2011. Unadjusted survival was estimated using Kaplan-Meier survival curves. Hazard ratios comparing five-year mortality in diabetic versus non-diabetic people across three periods (1998-2001, 2002-2005, 2006-2009) were estimated from multivariable Cox regression models, and adjusted trends calculated from interaction (diabetes status × period) models. RESULTS There were 22,594 30-day survivors of incident MI. There was little change across the three periods in all-cause mortality in diabetic men (27.1%, 28.2%, 25.5%) and women (34.9%, 36.8%, 36.1%), but small declines from first to last periods in non-diabetic men (14.5% to 12.1%, p = 0.03) and women (21.0% to 19.4%, p = 0.08). There was no temporal change in the increased all-cause mortality hazard ratios in diabetic versus non-diabetic men and women. Multivariable-adjusted relative risk for cardiovascular disease mortality remained elevated in diabetic women (2006-2009 hazard ratio 1.73, 95% confidence interval 1.29, 2.32) but not in men (2006-2009 hazard ratio 1.08, 95% confidence interval 0.85, 1.37). CONCLUSIONS The excess long-term mortality associated with diabetes and excess cardiovascular disease mortality in diabetic women indicates a need for improved secondary prevention in diabetic patients, especially women.
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Affiliation(s)
- Lee Nedkoff
- School of Population Health, The University of Western Australia, Perth, Australia
| | - Matthew Knuiman
- School of Population Health, The University of Western Australia, Perth, Australia
| | - Joseph Hung
- School of Medicine and Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, Australia
| | - Tom G Briffa
- School of Population Health, The University of Western Australia, Perth, Australia
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Davies C, Knuiman M, Rosenberg M. The art of being mentally healthy: a study to quantify the relationship between recreational arts engagement and mental well-being in the general population. BMC Public Health 2016; 16:15. [PMID: 26733272 PMCID: PMC4702355 DOI: 10.1186/s12889-015-2672-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/21/2015] [Indexed: 12/19/2023] Open
Abstract
Background Little is known about the dose–response relationship between recreational arts engagement (for enjoyment, entertainment or as a hobby, rather than therapy) and mental well-being in the general population. The quantification of this relationship is of value to: (1) health professionals, clinicians and researchers interested in utilising the arts as a method for improving mental health; (2) to health promoters and policy makers in the development of population based health messages, policy and practice; and (3) to members of the general public in maintaining or improving their own well-being. As guided by theories of social epidemiology and the biopsychosocial model of health, the first aim of this study was to determine if there was a relationship between arts engagement (hours per year) and mental well-being in the general population. If an association was demonstrated, the second aim was to quantify this relationship. Methods A random sample of 702 Western Australian adults aged 18+ years (response rate = 71 %) were invited to take part in a telephone survey. The survey took 15 min to complete and included questions about arts engagement, mental well-being, demographics and potential confounders/effect modifiers. The dependent variable was subjective mental well-being (Warwick-Edinburgh Mental Well-being Scale, WEMWBS). The independent variable was hours engaged in the arts in the last 12 months. Results Respondent engagement in the arts ranged from zero to 1572 hours/year (mean = 100.8 hours/year, SD = 206.0). The prevalence of engagement was 83 %. The average WEMWBS score was 53 (SD = 7.4). After adjustment for demographics (i.e. sex, age group, location, income, education, marital status, children), general health, sports engagement, religious activities and holidays, respondents with high levels of arts engagement (100 or more hours/year, WEMWBS score = 55) had significantly better mental well-being than those with none (0 hours/year, WEMWBS score = 53), low (0.1–22.9 hours/year, WEMWBS score = 52) and medium (23–99.9 hours/year, WEMWBS score = 53) levels of engagement (p = 0.003). Respondents with none, low and medium arts engagement had similar WEMWBS scores (p = 0.358). The relationship between arts engagement and WEMWBS was nonlinear with evidence of a minimum threshold at 100 or more hours/year (p = 0.0006). Conclusion Evidence of an arts-mental health relationship was found in this study. Those who engaged in 100 or more hours/year of arts engagement (i.e. two or more hours/week) reported significantly better mental well-being than other levels of engagement. The suitability of the arts as a population based strategy to influence the mental well-being of the general population should be investigated further.
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Affiliation(s)
- Christina Davies
- School of Population Health (M431), The University of Western Australia, 35 Stirling Hwy, Crawley, 6009, Western Australia, Australia.
| | - Matthew Knuiman
- School of Population Health (M431), The University of Western Australia, 35 Stirling Hwy, Crawley, 6009, Western Australia, Australia.
| | - Michael Rosenberg
- School of Sport Science, Exercise & Health, The University of Western Australia, 35 Stirling Hwy, Crawley, 6009, Western Australia, Australia.
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Sodhi-Berry N, Knuiman M, Preen DB, Alan J, Morgan VA. Predictors of post-sentence mental health service use in a population cohort of first-time adult offenders in Western Australia. Crim Behav Ment Health 2015; 25:355-374. [PMID: 25156966 DOI: 10.1002/cbm.1927] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 02/16/2014] [Accepted: 07/08/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Little is known about whether or how offenders use mental health services after sentence completion. AIM This study aimed to determine the likelihood of such service use by adult (18-44 years) first-time offenders up to 5 years after sentence completion and possible predictor variables. METHODS Pre-sentence and post-sentence mental health service use was obtained from whole-population linked administrative data on 23,661 adult offenders. Cox proportional hazard models were used to determine which socio-demographic, offending and pre-sentence health service variables were associated with such post-sentence service use. RESULTS The estimated 5-year probability of any post-sentence mental health service use was 12% for offenders who had not previously used such services, but still only 42% for those who had. For the latter, best predictors of post-sentence use were past psychiatric diagnosis and history of self-harm; history of self-harm also predicted post-sentence use among new mental health services users and so also did past physical illness. Indigenous offenders had a greater likelihood of service use for any mental disorder or for substance use disorders than non-Indigenous offenders, irrespective of pre-sentence use. Among those with pre-sentence service contact, imprisoned offenders were less likely to use mental health services after sentence than those under community penalties; in its absence, socio-economic disadvantage and geographic accessibility were associated with greater likelihood of post-sentence use. CONCLUSIONS Our findings highlight the discontinuity of mental healthcare for most sentenced offenders, but especially prisoners, and suggest a need for better management strategies for these vulnerable groups with mental disorders.
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Affiliation(s)
- Nita Sodhi-Berry
- Centre for Health Services Research, School of Population Health, The University of Western Australia, Crawley, Australia
| | - Matthew Knuiman
- School of Population Health, The University of Western Australia, Crawley, Australia
| | - David B Preen
- Centre for Health Services Research, School of Population Health, The University of Western Australia, Crawley, Australia
| | - Janine Alan
- Curtin Health Innovation Research Institute, Curtin University, Bentley, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, Australia
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Cadby G, McArdle N, Briffa T, Hillman DR, Simpson L, Knuiman M, Hung J. Severity of OSA Is an Independent Predictor of Incident Atrial Fibrillation Hospitalization in a Large Sleep-Clinic Cohort. Chest 2015; 148:945-952. [DOI: 10.1378/chest.15-0229] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Teng THK, Katzenellenbogen JM, Hung J, Knuiman M, Sanfilippo FM, Geelhoed E, Bessarab D, Hobbs M, Thompson SC. A cohort study: temporal trends in prevalence of antecedents, comorbidities and mortality in Aboriginal and non-Aboriginal Australians with first heart failure hospitalization, 2000-2009. Int J Equity Health 2015; 14:66. [PMID: 26265218 PMCID: PMC4533942 DOI: 10.1186/s12939-015-0197-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 07/29/2015] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND/OBJECTIVES Little is known about trends in risk factors and mortality for Aboriginal Australians with heart failure (HF). This population-based study evaluated trends in prevalence of risk factors, 30-day and 1-year all-cause mortality following first HF hospitalization among Aboriginal and non-Aboriginal Western Australians in the decade 2000-2009. METHODS Linked-health data were used to identify patients (20-84 years), with a first-ever HF hospitalization. Trends in demographics, comorbidities, interventions and risk factors were evaluated. Logistic and Cox regression models were fitted to test and compare trends over time in 30-day and 1-year mortality. RESULTS Of 17,379 HF patients, 1,013 (5.8%) were Aboriginal. Compared with 2000-2002, the prevalence (as history) of myocardial infarction and hypertension increased more markedly in 2006-2009 in Aboriginal (versus non-Aboriginal) patients, while diabetes and chronic kidney disease remained disproportionately higher in Aboriginal patients. Risk factor trends, including the Charlson comorbidity index, increased over time in younger Aboriginal patients. Risk-adjusted 30-day mortality did not change over the decade in either group. Risk-adjusted 1-year mortality (in 30-day survivors) was non-significantly higher in Aboriginal patients in 2006-2008 compared with 2000-2002 (hazard ratio (HR) 1.44; 95% CI 0.85-2.41; p-trend = 0.47) whereas it decreased in non-Aboriginal patients (HR 0.87; 95% CI 0.78-0.97; p-trend = 0.01). CONCLUSIONS Between 2000 and 2009, the prevalence of HF antecedents increased and remained disproportionately higher in Aboriginal (versus non-Aboriginal) HF patients. Risk-adjusted 1-year mortality did not improve in Aboriginal patients over the period in contrast with non-Aboriginal patients. These findings highlight the need for better prevention and post-HF care in Aboriginal Australians.
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Affiliation(s)
- Tiew-Hwa Katherine Teng
- Western Australian Centre for Rural Health, University of Western Australia (UWA), Perth, Australia.
| | | | - Joseph Hung
- School of Medicine & Pharmacology, Sir Charles Gairdner Hospital Unit, UWA, Perth, Australia
| | | | | | | | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, UWA, Perth, Australia
| | | | - Sandra C Thompson
- Western Australian Centre for Rural Health, University of Western Australia (UWA), Perth, Australia
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Nedkoff L, Knuiman M, Hung J, Briffa TG. Improving 30-day case fatality after incident myocardial infarction in people with diabetes between 1998 and 2010. Heart 2015; 101:1318-24. [PMID: 26076939 DOI: 10.1136/heartjnl-2015-307627] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 05/25/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To compare population-level trends in 30-day case fatality following incident myocardial infarction (MI) in people with diabetes and those without diabetes. METHODS We identified all hospitalised incident MIs in 35-84 year olds from the Western Australian Data Linkage System for 1998-2010, stratified by diabetes status. Crude and age- and sex-standardised 30-day case fatality were estimated, and age- and sex-adjusted trends were calculated from logistic regression. We calculated the trend in risk of 30-day death associated with diabetes from multivariable logistic regression, adjusting for demographics, comorbidities and MI type. RESULTS 26 610 hospitalised incident MI cases were identified, 24.8% of whom had diabetes. The prevalence of heart failure fell in people with diabetes, concurrent with increasing chronic kidney disease and prior coronary heart disease and increasing levels of evidence-based therapies. Case fatality in people with diabetes fell from 11.65%, in 1998-2001, to 3.96% by 2008-2010. Age- and sex-standardised case fatality declined at a greater rate in those with diabetes (-10.6%/year, 95% CI -12.8% to -8.2%) compared to non-diabetics (-6.9%/year, 95% CI -8.3% to -5.3%; interaction p=0.005). The adjusted risk of 30-day death after incident MI was 1.23 times higher in diabetics than non-diabetics in 1998-2001 (95% CI 1.01 to 1.50), but was lower by 2008-2010 (OR 0.64, 95% CI 0.46 to 0.88). CONCLUSIONS Greater improvements in 30-day case fatality following incident MI in people with diabetes during the 13-year study period has led to diabetes no longer being an independent predictor of early death following incident MI by 2008-2010.
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Affiliation(s)
- Lee Nedkoff
- School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia
| | - Matthew Knuiman
- School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia
| | - Joseph Hung
- School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia School of Medicine and Pharmacology (M503), Sir Charles Gairdner Hospital Unit, The University of Western Australia, Crawley, Western Australia, Australia
| | - Tom G Briffa
- School of Population Health (M431), The University of Western Australia, Crawley, Western Australia, Australia
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