Relationship between cumulative exposure to occupational lifting throughout working life and risk of ischemic heart disease in men and women. The Copenhagen Aging and Midlife Biobank

Ischemic heart disease (IHD) causes mortality and morbidity. High levels of occupational physical activity (OPA) increases IHD risk, and occupational lifting (OL) is suggested as a detrimental OPA exposure. This study investigated the association between accumulated OL throughout working life, and risk for IHD, and potential sex and hypertension differences. Data from Copenhagen Ageing and Midlife Biobank linked to register-based information on incident IHD during 9 years follow-up in the Danish National Patient Registry were included. The outcome was the odds of IHD from baseline (2009-2011) to end of follow-up (2018), among participants without IHD at baseline. Accumulated OL was assessed by linking occupational codes to a Job Exposure Matrix, creating a measure in ton-years (lifting 1,000 kg/day/year). Multivariable logistic regression tested associations between level of accumulated OL and IHD, among the 6,606 included individuals (68% men). During follow-up, 7.3% men and 3.6% women were hospitalized with IHD. Among all participants, the odds for IHD were 47% (OR 1.47, 95% CI 1.05-2.06) higher among those with ≥5 to <10 ton-years, 39% (OR 1.39, 95% CI 1.06-1.83) higher among those with ≥10 to <30 ton-years, and 62% (OR 1.62, 95% CI 1.18-2.22) higher among those with ≥30 ton-years, compared to no accumulated OL. However, these increased odds were in the same direction in the fully-adjusted model but statistically insignificant, ≥5 to <10 ton-years OR 1.28, 95% CI 0.88-1.88; ≥10 to <30 ton-years OR 1.20, 95% CI 0.85-1.69; and ≥30 ton-years OR 1.22, 95% CI 0.81-1.84. No statistically significant interactions, nor any associations, between OL and sex, or hypertension were seen.

The relationship between self-perceived fatigue, muscle endurance, and circulating markers of inflammation in participants of the Copenhagen aging and Midlife Biobank (CAMB)

BACKGROUND

Fatigue, low muscle endurance, muscle weakness and low-grade inflammation are strongly related to frailty at higher age. When signs of self-perceived fatigue and low muscle endurance are interrelated with low-grade inflammation at midlife, they might be used as early markers for frailty. This study investigated whether the interrelationships among self-perceived fatigue, muscle endurance and inflammation can be observed at midlife.

METHODS

A total of 965 participants of the Copenhagen Aging and Midlife Biobank (aged 52 ± 4 years, 536 males, 426 females) were assessed for self-perceived fatigue (20-item multidimensional fatigue inventory), muscle endurance (grip work), circulating markers of inflammation (hsCRP, IL-6, IL-10, TNF-alpha and IFN-γ), daily physical activity (PAS-2), body composition (%body fat assessed by bio-impedance) and self-reported health status. Participants were categorised (correcting for age and gender) according to high fatigue and/or low muscle endurance, differences in inflammatory profile between fatigue categories were assessed by ANCOVA (corrected for PAS-2, %body fat and presence of inflammatory conditions).

RESULTS

Overall, muscle endurance, fatigue and inflammatory markers were significantly interrelated. Higher levels of hsCRP (p < 0.001), IL-6 (p < 0.001), IL-10 (p = 0.035) and TNF-alpha (p = 0.028) were observed in participants presenting both low muscle endurance and high fatigue. IFN-γ was highest in those with high fatigue but normal muscle endurance (p = 0.015).

CONCLUSIONS

Middle-aged participants with higher fatigue in combination with low muscle endurance show higher levels of inflammation, independently from physical activity, body fat and inflammatory pathology. The underlying mechanisms should be identified and future studies should also investigate whether these individuals show early signs of reduced physiological reserve capacity, which in later life come to full expression by means of frailty.

Is urban regeneration associated with antidepressants or sedative medication users: a registry-based natural experiment

BACKGROUND

Area deprivation is associated with adverse mental health outcomes. In Denmark, urban regeneration is being used to dissolve concentrated socio-economic area deprivation and ethnic segregation. However, evidence on how urban regeneration affects mental health of residents is ambiguous partly due to methodological challenges. This study investigates if urban regeneration affects users of antidepressant and sedative medication among residents in an exposed and control social housing area in Denmark.

METHODS

Using a longitudinal quasi-experimental design we measured users of antidepressant and sedative medication in one area undergoing urban regeneration compared with a control area. We measured prevalent and incident users from 2015 to 2020 among non-Western and Western women and men and used logistic regression to measure annual change in users over time. Analyses are adjusted for a covariate propensity score estimated using baseline socio-demographic characteristics and general practitioner contacts.

RESULTS

Urban regeneration did not affect the proportion of prevalent nor incident users of antidepressant and sedative medication. However, levels were high in both areas compared with the national average. Descriptive levels of prevalent and incident users were generally lower among residents in the exposed area compared with the control area for most years and stratified groups confirmed by the logistic regression analyses.

CONCLUSION

Urban regeneration was not associated with users of antidepressant or sedative medication. We found lower levels of antidepressant and sedative medication users in the exposed area compared with the control area. More studies are needed to investigate the underlying reasons for these findings, and whether they could be related to underuse.

Life course partnership history and objectively measured physical functional ability in Danish middle-aged adults

BACKGROUND

Partnership break-up and living alone is associated with several negative health-related outcomes. Little is known about the association with physical functional ability in a life course perspective. The aim of this study is to investigate (1) the association between number of partnership break-ups and years living alone across 26 years of adult life respectively and objectively measured physical capability in midlife, (2) how the joint exposure of accumulated break-ups or years living alone respectively, and education relates to physical capability in midlife and (3) potential gender differences.

METHODS

Longitudinal study of 5001 Danes aged 48-62. Accumulated number of partnership break-ups and years living alone were retrieved from national registers. Handgrip strength (HGS) and number of chair rises (CR) were recorded as outcomes in multivariate linear regression analyses adjusted for sociodemographic factors, early major life events and personality.

RESULTS

Increasing number of years living alone was associated with poorer HGS and fewer CR. Concomitant exposure to short educational level and break-ups or long duration of time living alone respectively was associated with poorer physical capability compared with the groups with long educational level and no break-ups or few years lived alone.

CONCLUSION

Accumulated number of years living alone but not break-ups was associated with poorer physical functional ability. Joint exposure to a high number of years lived alone or break-ups respectively and having a short education was associated with the lowest levels of functional ability, which points towards an important target group for interventions. No gender differences were suggested.

Social relations and health in an ethnically diverse social housing area selected for large structural changes compared to municipal levels: a Danish survey study

BACKGROUND

This study aims to describe demographics, social relations and health in an ethnically diverse social housing area selected to undergo large structural changes and compare it to the surrounding municipality. Furthermore, to explore the association between social relations and self-rated health (SRH) and the interaction with country of origin in both populations.

METHODS

Data sources include a multilingual interviewer-driven survey study in a social housing area (N = 209) and a municipal health survey (N = 1,638) among residents aged 45 + years. Information on social relations include contact frequency with and support from family, friends, and neighbors. Descriptive and multivariate logistic regression analyses adjusted for age, sex, and country of origin are presented, as well as joint effect analyses of social relations and country of origin on SRH.

RESULTS

In the social housing area, 38.8% of the respondents reported poor SRH compared to 19.5% in the municipality. In both study populations low contact frequency was associated with poor SRH, however insignificantly in the social housing area compared to the municipality sample, OR = 1.50 (0.65-3.46) vs. OR = 2.42 (1.70-3.45). Joint exposure to having non-Western background and low contact frequency was strongly associated with poor SRH in the social housing area, OR = 6.28 (1.80-21.89) but less so in the municipality, OR = 3.67 (1.55-8.69). The same tendency was seen regarding low support from social relations.

CONCLUSIONS

This study provides insight to a population that is generally underrepresented in survey studies. In the social housing area, approximately twice as many reported poor SRH compared to the municipality data. In both populations, low contact frequency and low support were associated with poor SRH. Residents with weak social relations and non-Western origin simultaneously were more likely to report poor SRH in the social housing area specifically but less so in the municipality, indicating a higher vulnerability among the residents in the social housing area.

Loneliness, social isolation, and healthcare utilization in the general population

OBJECTIVES

Due to increasing pressure on healthcare resources, knowledge of factors that affect healthcare utilization (HCU) is important. However, the evidence of a longitudinal association between loneliness and social isolation respectively, and HCU is limited. The present prospective cohort study investigated the association of loneliness and social isolation with HCU in the general population over time.

METHOD

Data from the 2013 Danish "How are you?" survey (n = 27.501) were combined with individual-level register data with almost complete follow-up over a 6-year follow-up period (2013-2018). Negative binomial regression analyses were performed while adjusting for baseline demographics and preexisting chronic disease.

RESULTS

Loneliness measured was significantly associated with more general practice contacts (incident rate ratio [IRR] = 1.03, 95% confidence interval [CI] [1.02, 1.04]), more emergency treatments (IRR = 1.06, [1.03, 1.10]), more emergency admissions (IRR = 1.06, [1.03, 1.10]), and hospital admission days (IRR = 1.05, [1.00, 1.11]) across the 6-year follow-up period. No significant associations were found between social isolation and HCU with one minor exception, in which social isolation was associated with fewer planned outpatient treatments (IRR = 0.97, [0.94, 0.99]). Wald test demonstrated that the association of loneliness with emergency admissions and hospital admissions days was not significantly different from the effects of social isolation on those outcomes.

CONCLUSIONS

Our findings suggest that loneliness slightly increased the number of general practice contacts and emergency room treatments. Overall, the effects of loneliness and social isolation on HCU were small. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

'They are breaking us into pieces': A longitudinal multi-method study on urban regeneration and place-based social relations among social housing residents in Denmark

Urban regeneration often intends to improve the physical, economic, and social environment of disadvantaged neighborhoods. However, evidence on the consequences of such interventions on place-based social relations is limited in Scandinavia. This study investigates the relationship between urban regeneration and diverse forms of place-based social relations among middle-aged and older social housing residents in Denmark. A longitudinal multi-method design was applied using data from administrative registers and semi-structured individual interviews. The quantitative results showed small changes in household-restricted place-based social relations, whereas participants in the qualitative sample described the disruption of place-based social relations to negatively affect their well-being.

The association of loneliness and social isolation with healthcare utilization in Denmark

Objectives

The present prospective cohort study investigated the association of loneliness and social isolation (SI) with healthcare utilization (HCU) in the general population over time.

Methods

Data from the 2013 Danish “How are you?’ survey (n = 29,472) were combined with individual-level register data from the National Danish Patient Registry and the Danish National Health Service Registry over a 6-year follow-up period (2013-2018). Negative binomial regression analyses were performed while adjusting for baseline demographics and chronic disease.

Results

Loneliness measured at baseline was significantly associated with more GP contacts (incident-rate ratio (IRR) = 1.03, 95% confidence interval (CI) [1.02, 1.04]), more emergency treatments (IRR = 1.06, 95% CI [1.03, 1.10]), more emergency admissions (IRR = 1.06, 95% CI [1.03, 1.06]), and hospital admission days (IRR=1.05, 95% CI [1.00, 1.11]) across the 6-year follow-up period. No significant associations were found between social isolation and HCU with one minor exception, in which SI was associated with fewer planned outpatient treatments (IRR = .97, 95% CI [.94, .99]).

Conclusions

Our findings suggest that loneliness is a risk factor for certain types of HCU, independent of social isolation, baseline demographics, and chronic disease.

Key messages

Association Between Urban Regeneration and Healthcare-Seeking Behavior of Affected Residents: A Natural Experiment in two Multi-Ethnic Deprived Housing Areas in Denmark

Area regeneration of deprived neighborhoods is being used to reduce health inequality, socioeconomic deprivation and ethnic segregation. This quasi-experimental study examines if long-term graded exposure to urban regeneration is associated with primary healthcare-seeking behavior among residents. We compared general practitioner (GP) contacts from 2015-2020 in two adjacent, deprived social housing areas, one exposed to area regeneration. Populations were into Western and non-Western males and females aged 15 years and older (N = 3,960). Mean annual GP contact frequency for each group were estimated and a difference-in-difference (DiD) analysis was conducted with adjustments for propensity scores based on baseline characteristics. GP contact frequency increased for all groups across time with a systematically higher level and faster increase in the control groups. In particular, the mean difference between the exposed and control area for non-Western women more than doubled from -0.61 to -1.47 annual contacts across the period. The mean differences in contact frequency increased for all groups but results of the DiD analyses were insignificant. In conclusion, an emerging gap in GP contact frequency, with the highest levels in the control area, was observed for all comparisons across time. More long-term research is needed to understand how the emerging gaps evolve.

The association between social integration and neighborhood dissatisfaction and unsafety: a cross-sectional survey study among social housing residents in Denmark

Background

Social integration and perceived neighborhood environment are recognized as important social determinants of health. However, little is known about the association between social integration and perceived neighborhood environment among underrepresented population groups, such as residents in disadvantaged neighborhoods, in public health research. The aim of this study is to: 1) Describe the levels of social integration and 2) Investigate the association between social integration and neighborhood dissatisfaction and unsafety among middle-aged and older social housing residents.

Methods

A multilingual face-to-face interviewer-administrated survey questionnaire was conducted among 206 residents aged 45 years and above (response rate: 34.1%) of various nationalities in disadvantaged socioeconomic positions in a social housing area in Denmark. The assessment of social integration was based on cohabitation status, frequency of face-to-face and non-face-to-face interaction with social relations and participation in local association activities. Neighborhood dissatisfaction measured the level of dissatisfaction with the neighborhood, and neighborhood unsafety assessed the level of unsafety being outdoors in the neighborhood. Descriptive statistics were conducted to illustrate respondent characteristics and the distribution of social integration among the study population. Logistic regression models were applied to analyze associations between social integration and neighborhood dissatisfaction and unsafety, adjusted for age, sex, country of origin, educational attainment and employment status.

Results

In total, 23.8% of the respondents reported low levels of social integration. A medium level of social integration was associated with higher odds of neighborhood dissatisfaction (OR: 2.36; 95% CI: 1.04–5.38) compared to the highest level of integration. A low frequency of face-to-face interaction was associated with higher odds of neighborhood dissatisfaction (OR: 2.65; 95% CI: 1.16–6.06) and neighborhood unsafety (OR: 2.41; 95% CI: 1.04–5.57) compared to the highest frequency of face-to-face interaction.

Conclusions

Almost one-fourth of respondents reported low levels of social integration. A medium level of social integration was associated with neighborhood dissatisfaction. A low frequency of face-to-face interaction was associated with neighborhood dissatisfaction and unsafety. The results suggest that targeted health promotion interventions designed to foster face-to-face interaction, hold potential to reduce neighborhood dissatisfaction and unsafety among residents in disadvantaged neighborhoods.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13690-022-00945-9.

Use of candles and risk of cardiovascular and respiratory events in a Danish cohort study

Burning candles at home emit small particles and gases that pollute indoor air. Exposure to fine particles in outdoor air has been convincingly linked to cardiovascular and respiratory events, while the associations with fine and ultrafine particles from candle burning remain unexplored. We examined the association between the use of candles and incident cardiovascular and respiratory events. We collected data on 6757 participants of the Copenhagen Aging and Midlife Biobank cohort recruited in 2009 and followed them up for the first hospital contact for incident cardiovascular and respiratory events until 2018. We investigated an association between the self-reported frequency of candle use in wintertime and cardiovascular and respiratory events, using Cox regression models adjusting for potential confounders. During follow-up, 1462 and 834 were admitted for cardiovascular and respiratory events, respectively. We found null associations between candle use and a hospital contact due to cardiovascular and respiratory events, with hazard ratios (HRs) and 95% confidence intervals (CI) of 0.97 (95% CI: 0.84, 1.11) and 0.98 (95% CI: 0.81, 1.18), respectively, among those using candles >4 times/week compared with <1 time/week. For cause-specific cardiovascular diseases, HRs were 1.10 (95% CI: 0.85, 1.43) for ischemic heart disease and 1.18 (95% CI: 0.77, 1.81) for myocardial infarction. For chronic obstructive pulmonary disease, HR was 1.26 (95% CI: 0.81, 1.97). We found no statistically significant associations between candle use and the risk of cardiovascular and respiratory events. Studies with improved exposure assessments are warranted.

Educational attainment in young adulthood and self-rated health in midlife - Does allostatic load mediate the association?

This study aimed to examine the extent to which allostatic load (AL), measured in midlife, mediates the association between educational attainment in young adulthood and self-rated health (SRH) in midlife among women and men. The study used data from the Copenhagen Aging and Midlife Biobank (CAMB; n = 5467 participants, aged 48-62 years, 31.5% women). Educational attainment was assessed as years of education. SRH was assessed with one item: 'In general, how would you say your health is?' with response options from "excellent" to "poor". AL mediated 31.7% and 19.7% of the association between educational attainment and SRH in women and men, respectively. We observed that higher educational attainment was associated with better SRH and lower AL in both women and men. Our study showed that AL partly mediates the association between educational attainment in young adulthood and SRH in adulthood among both men and women. This study indicates that educational attainment in young adulthood affects health throughout life. Such knowledge of a potential mediator may be important in breaking the social heritage.

Social relations and contact with general practitioner in a middle-aged Danish population: a prospective register- and survey-based cohort study

Background

Findings about the relationship between individuals’ social relations and general practitioner (GP) contact are ambiguous as to whether weak social relations are associated with an increased or decreased consultation pattern. Furthermore, social relations may affect GP contact differently for men compared to women, between socioeconomic groups and according to perceived need. The overall aim of the study is to examine the association between functional aspects of social relations, perceived emotional and instrumental social support, the tendency to consult a GP and the frequency of GP contact.

Methods

The study comprised 6911 individuals aged 49–61 at baseline from the Copenhagen Aging and Midlife Biobank (CAMB). We conducted a two-part regression to explore the association between perceived emotional and instrumental social support and GP contact (tendency and frequency), controlling for age, sex, occupational social class, cohabitation status and number of morbidities.

Results

Results show no overall effect of the perceived social support aspects of social relations on GP contact independent of health-related needs.

Conclusions

Our results do not support that perceived social support, reflecting functional aspects of social relations, are associated with general practitioner contact among middle-aged people.

Trial registration

The study has been registered and approved by the Danish Data Protection Agency and the local ethical committee (approval No.H-A-2008-126 and No. 2013-41-1814).Keywords: social relations, perceived social support, healthcare utilisation, general practitioner, middle-aged

Do changes in frailty, physical functioning, and cognitive functioning predict mortality in old age? Results from the Longitudinal Aging Study Amsterdam

Background

The ability to accurately predict survival in older adults is crucial as it guides clinical decision making. The added value of using various health indicators as well as changes in these indicators for predicting mortality remains unclear. The aim of this study was to investigate whether changes in health indicators such as frailty and physical performance improve mortality predictions in old age.

Methods

This is a population based prospective cohort study on 995 community-dwelling people aged 68–92 years from the Longitudinal Aging Study Amsterdam. Two measurements at a three-year interval (1995/1996 and 1998/1999) were available for the frailty index, frailty phenotype, grip strength, walking speed, and Mini-Mental State Examination (MMSE). Cox regression was used to analyze mortality risks associated with the current health status and changes in health, with mortality data up to 2017. The extent to which these health indicators improved mortality predictions compared to models with age and sex only was assessed by the area under the receiver operating characteristic curve (AUC).

Results

The AUC of age and sex for five-year mortality was 72.8% (95% CI 69.0 – 76.5) and was the lowest in the oldest old (age > 80.5 years). The added AUC of the current status of health indicators ranged from 0.7 to 3.3%. The added AUC of the three-year change was lower, ranging from -0.0 to 1.1%, whereas the added AUC of three-year change and current status combined was similar to current status alone, ranging from 0.6 to 3.2%. Across age, the added AUC of current status was highest in the oldest old, however there was no such pattern using three-year change. Overall, the frailty index appeared to improve mortality predictions the most, followed by the frailty phenotype, MMSE, grip strength, and walking speed.

Conclusions

Current health status improved mortality predictions better than changes in health. Its contribution was highest in the oldest old, but the added value to models with age and sex only was limited.

Inflammatory markers and lung function in relation to indoor and ambient air pollution

Ambient air pollution causes a range of adverse health effects, whereas effects of indoor sources of air pollution are not well described in high-income countries. We compared hazards of ambient air pollution and indoor sources with respect to important biomarkers of cardiorespiratory effects in terms of lung function and systemic inflammation in a middle-aged Danish cohort. Our cohort comprised 5199 men and women aged 49-63 years at the recruitment during April 2009 to March 2011, with information on exposure to second-hand smoke (SHS) and use of candles, wood stove, kerosene heater and gas cooker as well as relevant covariates. Ambient air pollution exposure was assessed as 2-year mean nitrogen dioxide (NO₂) at the address (mean ± SD: 17.1 ± 9.9 μg/m³) and 4-day average levels of particulate matter with diameter <2.5 μm (PM_2.5; mean ± SD: 12.5 ± 6.0 μg/m³) in urban background. Lung function was assessed as % predicted forced expiratory volume in the first second (FEV1) and inflammatory markers comprised interleukin-6 (IL-6), IL-10, IL-18, interferon gamma (IFN-γ), tumor necrosis factor alpha (TNF-α), and high sensitivity C-reactive protein (hs-CRP). We used random-effect regression models controlling for potential confounders as well as models with further adjustment for self-reported health or for all other exposures. In models adjusted for confounders FEV1 was inversely associated with exposure to NO₂, (-0,83% per 10 μg/m³; 95% CI: -1.26; -0.41%), SHS (-0.56% per 1 of 5 categories increment; 95% CI: -0.89; -0.23%), and gas cooker without hood (-0.89%; 95% CI: -1.62; -0.17%), whereas use of wood stove and candles showed positive associations, although these attenuated by mutual adjustment for all exposures or self-reported health. IL-6 showed positive associations with NO₂ (6.30% increase in log-transformed values per 10 μg/m³; 95% CI: 3.54; 9.05%), PM_2.5 (7.82% per 10 μg/m³; 95% CI: 3.35; 12.4%), SHS (4.38% per increase of 1 of 5 categories; 95% CI: 2.22; 6.54%) and use of kerosene (13.8%; 95% CI: 2.51; 25.1%), whereas the associations with use of wood stove and candles were inverse. PM_2.5 and NO₂ showed positive associations with IFN-γ and TNF-α, while PM_2.5 further associated with IL-10 and IL-18. Hs-CRP was inversely associated with use of candles. These results suggest that the levels of exposure to ambient air pollution and SHS are more harmful than are the levels of exposure to indoor combustion sources from candles and wood stoves in a high-income setting.

Do partnership dissolutions and living alone affect systemic chronic inflammation? A cohort study of Danish adults

BACKGROUND

Partnership breakups and living alone are associated with several adverse health outcomes. The aim of this study, carried out in Denmark, is to investigate whether accumulated numbers of divorces/partnership breakups or years lived alone across 26 years of adult life are associated with levels of inflammation, and if vulnerability with regards to gender or educational level can be identified.

METHODS

4835 participants from the Copenhagen Aging and Midlife Biobank (CAMB) aged 48-62 years were included. Data on accumulated numbers of partnership breakups and years living alone were retrieved from a national standardised annual register. Inflammatory markers interleukin 6 (IL-6) and high sensitivity C-reactive protein (hsCRP) were measured in blood samples. Multivariate linear regression analyses were adjusted for age, educational level, early major life events, body mass index, chronic diseases, medicinal intake affecting inflammation, acute inflammation and personality scores.

RESULTS

For men, an association was found between an increasing number of partnership breakups or number of years living alone and higher levels of inflammatory markers. No such association was found for women, and no evidence of partnership breakups and educational level having a joint effect was found for either gender.

CONCLUSION

The findings suggest a strong association between years lived alone or accumulated number of partnership breakups and low-grade inflammation for middle-aged men, but not for women. Among those of either sex with a lower level of education, no specific vulnerability to accumulated years lived alone or number of breakups was identified.

OUP accepted manuscript

This study reports on a health promotion intervention (HPI), where graphic facilitation (GF) was used as an innovative method to enable participation in a co-design process in a multi-ethnic and disadvantaged neighbourhood in Denmark. The aim was to enable middle-aged and older residents to participate in the research process of planning and evaluating the HPI, as well as in the activities it constituted. GF was used to document statements and inputs from residents through visual meeting minutes and resident experiences with coronavirus disease 2019 (COVID-19) lockdown were drawn by a graphic facilitator. We use the ladder of participation as a framework to unfold the participation enabled by GF. During the HPI, data were produced through ethnographic field studies in and outside the neighbourhood and in design workshops with residents. The study finds that GF helped in reaching a target group difficult to engage in research and that the engagement of a graphic facilitator shifted the power-balance between the researchers and the residents, redistributing expertise. Carrying out GF in a HPI is a collaborative endeavour and in addition to research competences, it requires the artistic and relational skills of a graphic facilitator. The co-created process of the visual minutes and COVID-19 experiences created a sense of ownership and encouraged the residents to reflect on their interaction with the researchers. The redistribution of expertise was conditioned by the power dynamics present and GF helped unfold these dynamics. This is especially important in an HPI engaging socio-economically vulnerable populations.

Transition kinetics of mixed lipid:photosurfactant assemblies studied by time-resolved small angle X-ray scattering

HYPOTHESIS

Photoswitchable surfactants are used in the design of many light-responsive colloids and/or self-assemblies. Photo-isomerization enables to control molecular equilibrium, and triggers transient reorganizations with possibly out-of-equilibrium intermediate states that have been overlooked. Here, we address this question by an in depth structural investigation of intermediate lipid-surfactant assemblies that occur during fast isothermal photo-triggered transition in lipid:surfactant mixtures.

EXPERIMENTS

The structural parameters of mixed assemblies of azobenzene-containing cationic surfactant (AzoTMA) and dioleoylphosphatidylcholine (DOPC) lipids were studied by light scattering and time-resolved small angle X-ray scattering. Structural and compositional information about the assemblies and unimers in bulk were determined at the photostationary states, as well as at intermediate kinetic states formed during UV or blue light illumination.

FINDINGS

DOPC:AzoTMA systems form mixed assemblies representative of phospholipid:cationic surfactant mixtures, that evolve from spheroid, to rod-like micelles, and vesicles with increasing DOPC fraction. Transient assemblies detected during the photo-triggered kinetics are similar to the ones found in stationary states. But changes of AzoTMA unimers in bulk can be considerably faster than mass reorganizations of the mixed assemblies, suggesting that out-of-equilibrium conditions are transiently reached. Mass reorganization of the surfactant-enriched assemblies is much faster than in the lipid enriched ones, providing insight into the role of lipids in a slow reorganization of the assemblies.

Challenges and lessons learnt from conducting a health survey in an ethnically diverse population

Aim: To document the challenges of developing and executing an interviewer-driven survey questionnaire in an ethnically diverse and deprived social housing area undergoing reconstruction in Denmark. Methods: The survey was initially planned to be conducted in three waves (before, during and after reconstruction of the housing area), based on a questionnaire covering health, wellbeing and social relations. The first two waves took place in 2018 and 2019 (invited n=~600 per wave) and the third wave will be conducted once the reconstruction is finalised. The approach to the third wave is under revision by the research team. The questionnaire was translated from Danish into the seven most common languages in the housing area. A bilingual interview team went door to door interviewing residents. Field notes were collected systematically during each wave to document the process. Results: The response rates were 35% (n=209) and 22% (n=132) for waves 1 and 2, respectively. There was an overall decrease in response rates between waves 1 and 2 for all language groups, but particularly for Arabic and Turkish-speaking men. The most frequently stated reasons for non-participation included illness and language barriers. The key lessons learnt were that overcoming linguistic and cultural barriers to conducting research among residents in this social housing area requires time and resources. Conclusions: Several challenges are associated with conducting a survey in ethnically diverse and deprived social housing areas. Documenting the challenges and learning from experience are both important, in order to include this hard-to-reach population in health research.

Lifecourse partnership breakups or years lived alone and low grade inflammation in middle-aged adults

Background

Divorce and living alone are associated with several adverse health outcomes. There is however very limited knowledge on the potential effects of exposure across the life course. The aim of this study is to investigate whether accumulated number of divorces/partnership breakups or years lived alone across 26 years of adult life, is associated with levels of low grade inflammation and if vulnerability with regards to gender or educational level can be identified.

Methods

4,835 participants from Copenhagen Aging and Midlife Biobank (CAMB) aged 48-62 were included. Accumulated number of partnership breakups and years living alone, were retrieved from a national standardized annual register. Inflammatory markers, Interleukin-6 (IL-6) and high sensitivity C-Reactive Protein (hsCRP), were measured in plasma samples. Multivariate linear regression analyses were adjusted for age, educational level, early major life events, BMI, chronic diseases, medicinal intake that affects inflammation, acute inflammation, and personality scores (neuroticism, agreeableness, conscientiousness).

Results

For men, two or more partnership breakups as well as living alone for 7+ years was associated with significantly higher levels of and inflammatory markers, i.e. 12-17% higher level of hsCRP and IL6 compared to the reference groups (no break-ups/0-1 years living alone) p-values &lt;0.0001-0.024. No associations were found for women, and no joint effect of partnership breakups and educational level was found for either gender.

Conclusions

The findings suggest a strong association between accumulated number of partnership breakups or years lived alone across 26 year of adult life and low grade inflammation for middle-aged men but not for women. No specific vulnerability among the lower was identified. The findings points towards the importance of developing tailored preventive initiatives to males experiencing several partner-break-ups or who lives alone for many years.

Key messages

Two or more partnership breakups or 7+ years lived alone across 26 year of adult life is associated with increased low grade inflammation for middle-aged men but not for women. No increased vulnerability among the low educated was identified.

Educational attainment and trajectories of cognitive decline during four decades-The Glostrup 1914 cohort

Background

The potential association between level of education and age-related cognitive decline remains an open question, partly because of a lack of studies including large subsamples with low education and follow-up intervals covering a substantial part of the adult lifespan.

Objectives

To examine cognitive decline assessed by a comprehensive clinical test of intelligence over a 35-year period of follow-up from ages 50 to 85 and to analyze the effect of education on trajectories of cognitive decline, including the effects of selective attrition.

Methods

A longitudinal cohort study with a 35-year follow-up of community dwelling members of the Glostrup 1914 cohort. The study sample comprised 697 men and women at the 50-year baseline assessment and additional participants recruited at later follow-ups. Verbal, Performance, and Full Scale IQs were assessed using the Wechsler Adult Intelligence Scale at ages 50, 60, 70, 80, and 85. To be able to track cognitive changes between successive WAIS assessments, all IQs were based on the Danish 50-year norms. Information on school education was self-reported. The association between education and cognitive decline over time was examined in growth curve models. Selective attrition was investigated in subsamples of participants who dropped out at early or later follow-ups.

Results

The trajectories for Verbal, Performance, and Full Scale IQ showed higher initial cognitive performance, but also revealed steeper decline among participants with a formal school exam compared to participants without a formal exam. Verbal IQ showed the largest difference in level between the two educational groups, whereas the interaction between education and age was stronger for Performance IQ than for Verbal IQ. In spite of the difference in trajectories, higher mean IQ was observed among participants with a formal school exam compared to those without across all ages, including the 85-year follow-up.

Further analyses revealed that early dropout was associated with steeper decline, but that this effect was unrelated to education.

Conclusion

Comprehensive cognitive assessment over a 35-year period suggests that higher education is associated with steeper decline in IQ, but also higher mean IQ at all follow-ups. These findings are unlikely to reflect regression towards the mean, other characteristics of the employed test battery or associations between educational level and study dropout.

Associations of loneliness and social isolation with physical and mental health among adolescents and young adults

AIMS

The present study investigates whether loneliness and social isolation are associated with poor physical and mental health among adolescents and young adults, and whether age and gender play a role in the associations of loneliness and social isolation with mental and physical health.

METHODS

This study used cross-sectional self-report data from the 2017 Danish Health and Morbidity Surveys titled 'How are you?' (N = 19,890, M = 22.6 years).

RESULTS

Logistic regression analyses showed that loneliness and social isolation were independently associated with poor physical and mental health. Loneliness was associated with increased odds of asthma, migraine, osteoarthritis, rheumatoid arthritis, hypertension, slipped disc/back pain, tinnitus, long-term mental illness, depressive symptomatology, anxiety symptomatology and alcohol problems. Social isolation was associated with decreased odds of having migraine, osteoarthritis and alcohol problems, and an increased risk of long-term mental illness and depressive symptomatology. Small age and gender differences were detected.

CONCLUSIONS

In adolescents and young adults, loneliness and social isolation were associated with poor mental health and loneliness with poor physical health. These findings highlight the need for targeted prevention and intervention initiatives to alleviate loneliness and social isolation.

Loneliness, social isolation, and chronic disease outcomes

Background

Research suggests that loneliness and social isolation are serious public health concerns. However, our knowledge of the associations of loneliness and social isolation with specific chronic diseases is limited. The present prospective cohort study investigated (a) the longitudinal associations of loneliness and social isolation with four chronic diseases (cardiovascular disease [CVD], chronic obstructive pulmonary disease [COPD], diabetes mellitus Type 2 [T2D], and cancer), (b) the synergistic association of loneliness and social isolation with chronic disease, and (c) baseline psychological and behavioral explanatory factors.

Methods

Self-reported data from the 2013 Danish “How are you?” survey (N = 24,607) were combined with individual-level data from the National Danish Patient Registry on diagnoses in a 5 year follow-up period (2013-2018).

Results

Cox proportional hazard regression analyses showed that loneliness and social isolation were independently associated with CVD (loneliness: adjusted hazard ratio (AHR) = 1.20, 95% confidence interval [CI; 1.03, 1.40]; SI: AHR = 1.23, 95% CI [1.04, 146]) and T2D (loneliness: AHR =1.90, 95% CI [1.42, 2.55]; SI: AHR = 1.59, 95% CI [1.15, 2.21]). No significant associations were found between loneliness or social isolation and COPD and cancer, respectively. Likewise, loneliness and social isolation did not demonstrate a synergistic effect on chronic disease. Multiple mediation analysis indicated that loneliness and social isolation had an indirect effect on CVD and T2D through both baseline psychological and behavioral factors.

Conclusions

Loneliness and social isolation were independently associated with a diagnosis of CVD and T2D within a 5 year follow-up period. The associations of loneliness and social isolation with CVD and T2D were fully explained by baseline psychological and behavioral factors.

Key messages

Individuals exposed to loneliness and social isolation constitute vulnerable groups in risk of chronic disease. Psychological and behavioural factors explain the associations with chronic disease.

A qualitative study on resident engagement in a community-based health promotion intervention

Emerging evidence points towards lower quality of life, more fragile social relations and suboptimal health behaviour and health status of residents living in social housing areas characterized by ethnic diversity and socioeconomic disadvantage. Residents from social housing areas are less likely to engage in health promotion interventions compared to the rest of society. Community-based health promotion interventions developed in collaboration with the target group and adjusted to local context can affect the acceptance of and engagement in such interventions. However, few studies have investigated the potential of community-based interventions in social housing areas. This study explores resident perspectives on engagement in a community-based health promotion intervention focusing on enhancing social relations. Engagement was the key foundation for the designing and implementation of the intervention by the use of graphic facilitation. The intervention consisted of social outings to different sights and historical landmarks in Denmark. The study builds on qualitative methods including participant observations combined with pre- and post-intervention interviews with a selected group of residents (n = 9). Data were thematically analysed with a focus on participation in an everyday life context and by concepts of othering and territorial stigmatization. Engagement in the intervention was motivated by a need for establishing and enhancing social relations, and exploring the world outside the housing area. However, barriers including cultural and language differences among residents and competing contextual factors challenged engagement. We conclude that participatory community-based interventions have a potential to enhance social relations in social housing areas. Nevertheless, it is necessary to understand the motives and barriers to ensure feasible and relevant health promotion interventions and future engagement among residents living in social housing areas.

Social relations and self-rated health in a multi-ethnic social housing area undergoing demolition

Background

During the coming years, selected social housing areas in Denmark will undergo large structural changes as part of a political agenda. Previous studies on the effects of such interventions are inconclusive. Residential areas are important for the development of social relations and health. The aim of this study was to explore the associations between social relations and self-rated health (SRH) and the interaction with country of origin in an ethnically diverse social housing area undergoing demolition, and compare results with the municipality.

Methods

Data include multilingual interviewer driven surveys with residents aged 45+ years before demolition began in 2018 (N = 209) and during the demolition in 2019 (N = 132), and a health survey on municipality level (N = 1638). Information on social relations include contact frequency with and support from family, friends and neighbors. SRH was dichotomized into high/low. Descriptive and multivariate logistic regression analyses adjusted for age, sex and Western/non-Western origin are presented.

Results

In cross-sectional analyses from 2018, low contact frequency and low support increased the risk of low SRH, OR = 1.44 (0.63-3.29) and OR = 1.23 (0.62-2.48), especially when also having non-Western origin compared to having high contact frequency or support and Western origin, OR = 6.27 (1.80-21.84) and OR = 4.43 (1.68-11.69), respectively. The same association was seen in 2019 and on municipality level.

Low contact frequency in 2018 was associated with higher risk of developing or maintaining low SRH in 2019 compared to the group with high contact frequency in 2018 in longitudinal analyses, OR = 3.04 (0.91-10.91).

Conclusions

Poor social relations increased the risk of low SRH, especially when also having non-Western origin. Having poor social relations before the demolition was associated with an increased risk of developing or maintaining low SRH during the demolition in an ethnically diverse social housing area.

Key messages

Having low contact frequency before area demolition in a social housing area in Denmark increased the risk of developing or maintaining low self-rated health after demolition had begun. Having poor social relations and non-Western origin is associated with a strong increased risk of low self-rated health in a deprived ethnic diverse social housing area in Denmark.

A difference-in-difference analysis comparing a control and an intervention social housing area

Often an intervention is applied in an area (e.g. community, municipality) without it being an experiment and without a control group, this can be categorized as a natural experiment. Such a situation offers the opportunity to exploit exposure contrasts between areas regarding the specific intervention for evaluation. In the present study, we will employ the difference-in-difference approach to evaluate the natural experiment (the structural intervention) comparing measures of health and social factors retrieved from registers in the two social housing areas before and after the intervention. A 'natural experiment' study comparing individual and aggregated level differences in register-based information on health and social variables across time including the entire study period is included in the research project. The population includes all residents with an address in the study area and the control area at any point during the years 2015-2025 (∼3,000 residents in each area). All residents are linked to the Danish social and health registers by the unique personal identification number, which makes it possible to follow all permanent and former residents over time. Hereby we plan to study if the structural changes (the structural intervention, the 'natural experiment') give rise to differences in health (such as use of general practitioner, hospitalizations, use of selected medications) and social factors (e.g. divorces, income levels, unemployment) compared to the control area. The control area is representing a similar social housing area in the same municipality, which will not undergo structural changes until 2023. Findings will be evaluated drawing upon knowledge gained from the entire study from surveys and qualitative interviews as well experiences from the interventions. In this presentation, we wish to discuss how best to include the knowledge based on other methodologies in the register-based analyses.

Loneliness, social isolation and healthcare utilisation in the general population

Background

The present prospective cohort study investigated the association of loneliness and social isolation with healthcare utilisation in the general population over time. We also investigated the synergistic effect of loneliness and social isolation on healthcare utilisation.

Methods

Data from the 2013 Danish “How are you?' survey (n = 29,472) were combined with individual-level register data from the National Danish Patient Registry and the Danish National Health Service Registry in a 6-year follow-up period (2013-2018). Negative binomial regression analyses were performed while adjusting for baseline demographics, chronic disease, and healthcare utilisation during the follow-up period.

Results

Loneliness was significantly associated with number of GP visits (incident-rate ratio (IRR) = 1.06, 95% confidence interval (CI) [1.01, 1.13]), emergency admissions (IRR = 1.19, 95% CI [1.03, 1.37]) and number of hospital admission days (IRR = 1.32, 95% CI [1.08, 1.62]). No significant associations were found between social isolation and healthcare utilisation with one minor exception, in which social isolation was associated with less planned admissions (IRR = .88, 95% CI [.78, .99]). Finally, loneliness and social isolation demonstrated a synergistic effect on number of visits to the GP (IRR = .87, 95% CI [.78, .98]) and number of hospital admission days (IRR = .67, 95% CI [.45, .98]).

Conclusions

Our findings suggest that loneliness is a risk factor for primary and secondary healthcare utilisation, independently of social isolation, baseline demographics, chronic disease, and healthcare utilisation during the follow-up period.

Key messages

Loneliness is an independent risk factor for healthcare utilisation in the general population. Social isolation is not associated with healthcare utilisation in the general population.

What possibilities and barriers for community engagement does graphical facilitation establish?

Participatory approaches are appropriate to apply in interventions aiming at improving health and wellbeing in the everyday life of people living in deprived areas. However, more research is needed on how participation is staged, what negotiations of power are possible and to what extent the applied methods for engagement are accessible to a less affluent spectrum of residents. We apply an interdisciplinary approach to allow theoretical reflections on the applied strategy of participation. The intervention employs the use of physical materials through the performance of drawing to make participation less dependent of language and writing skills and hereby more equal. With this participatory intervention study, we aim to empower residents to increase their ability to act on their own health, i.e. social relations and life quality. We apply graphical facilitation by using physical drawing materials to explore how this method can give voice to the residents by providing them the opportunity to tell their story - from where they came to where they hope to go. The main component in the study is four participatory workshops in spring 2020: a) two focusing on teaching of basic drawing skills; b) one where the residents individually draw their own life story; c) one where the residents draw their shared vision of their community. This intervention study aims to contribute to health promotion by exploring generic methods to engage residents in deprived areas. The intended outcome is to empower residents by giving them a means of communication transferable to other settings in everyday life.

Experiences and challenges in collecting survey data in an ethnically diverse social housing area

Socio-economically disadvantaged groups are characterised by a higher burden of disease than the background population. Paradoxically, they are often underrepresented in health research. Failing to include socio-economically disadvantaged groups in research impairs the ability to address the social mechanisms creating health disparities. The study describes how we have tried to accommodate identified challenges from the literature in conducting a questionnaire survey in a socio-economically deprived and ethnically diverse social housing area, and which new challenges we identified. The survey is planned before, during and after the structural changes take place. Through innovative approaches, we sought to accommodate identified barriers to reaching participants. The questionnaire was translated from Danish to the seven most prevalent languages in the area, based on data from the national register. A survey corps of native speaking interviewers went door-to-door to perform face-to-face interviews. To encourage participation, we used a recruitment strategy inspired by ethnographic data collection traditions, such as local presence, participation in local activities, and graphic facilitation on invitation letters. Wave 1 and 2 had a response rate of 35% (N = 209) and 22% (N = 132), respectively. 79 respondents participated in both waves. Despite our efforts to accommodate identified challenges such as language, illiteracy, and mistrust, the response rates are low. We identified new challenges in recruiting participants including participation fatigue, frustration with the restructure process, and a feeling of limited individual gain from participation. Many challenges are associated with conducting research among socio-economically disadvantaged groups. Documenting processes and learning from experiences are important steps in including groups with lower socio-economic status in health research in order to address the underlying social mechanisms creating health disparities.

Loneliness, Social Isolation, and Chronic Disease Outcomes

Background

Research suggests that loneliness and social isolation (SI) are serious public health concerns. However, our knowledge of the associations of loneliness and SI with specific chronic diseases is limited.

Purpose

The present prospective cohort study investigated (a) the longitudinal associations of loneliness and SI with four chronic diseases (cardiovascular disease [CVD], chronic obstructive pulmonary disease [COPD], diabetes mellitus Type 2 [T2D], and cancer), (b) the synergistic association of loneliness and SI with chronic disease, and (c) baseline psychological and behavioral explanatory factors.

Methods

Self-reported data from the 2013 Danish “How are you?” survey (N = 24,687) were combined with individual-level data from the National Danish Patient Registry on diagnoses in a 5 year follow-up period (2013–2018).

Results

Cox proportional hazard regression analyses showed that loneliness and SI were independently associated with CVD (loneliness: adjusted hazard ratio (AHR) = 1.20, 95% confidence interval [CI; 1.03, 1.40]; SI: AHR = 1.23, 95% CI [1.04, 146]) and T2D (loneliness: AHR =1.90, 95% CI [1.42, 2.55]; SI: AHR = 1.59, 95% CI [1.15, 2.21]). No significant associations were found between loneliness or SI and COPD and cancer, respectively. Likewise, loneliness and SI did not demonstrate a synergistic effect on chronic disease. Multiple mediation analysis indicated that loneliness and SI had an indirect effect on CVD and T2D through both baseline psychological and behavioral factors.

Conclusion

Loneliness and SI were independently associated with a diagnosis of CVD and T2D within a 5 year follow-up period. The associations of loneliness and SI with CVD and T2D were fully explained by baseline psychological and behavioral factors.

Education and adolescent cognitive ability as predictors of dementia in a cohort of Danish men

BACKGROUND

An association between education and dementia is well-established but it is unclear whether education is associated with dementia after accounting for early life cognitive ability and whether there is a joint effect, such that the risk associated with one of the exposures depends on the value of the other. We examined separate and joint associations of adolescent cognitive ability and educational attainment with risk of dementia among Danish men born between 1939 and 1959.

METHODS

Men (N = 477,421) from the Danish Conscription Database were followed for dementia from the age 60 for up to 17 years via patient and prescription registry linkages. Exposure measures included cognitive ability assessed at the conscript board examination around age 18 and highest educational level (low: 0-10 year, medium: 10-13 years, high: ≥13 years) at age 30 from registry records. Associations with dementia diagnosis were estimated in Cox proportional hazards models adjusted for birth year and age at conscript board examination. Interaction was assessed on the multiplicative scale by including a product term between the two exposure measures and on the additive scale by calculating relative excess risk due to interaction (RERI) between different levels of the exposure measures.

RESULTS

Compared to men in the high education group hazard ratio [HR] for men in the medium and low group were 1.21 (95% confidence interval [CI]: 1.13, 1.30) and 1.34 (95% CI: 1.24, 1.45), respectively when not adjusting for cognitive ability. Additional adjustment for cognitive ability attenuated the magnitude of the associations, but they remained significant (education medium: HR = 1.10, 95% CI: 1.02, 1.19 and education low: HR = 1.12, 95% CI: 1.02, 1.22). A 10% higher cognitive ability score was associated with a 3.8% lower hazard of dementia (HR = 0.962; 95% CI: 0.957, 0.967), and the magnitude of the association only changed marginally after adjustment for education. Men in the low education group with relatively low cognitive ability were identified as a high-risk subgroup for dementia. The increased risk associated with exposure to both risk factors did, however, not significantly depart from the sum of risk experienced by men only exposed to one of the risk factors (estimates of RERI were not significantly different from 0) and no significant evidence of either additive or multiplicative interactions was found.

CONCLUSIONS

In conclusion, the results suggest that education and cognitive ability protect against the risk of dementia independently of one another and that increases in educational attainment may at least partially offset dementia risk due to low cognitive ability.

Smartphone interactions and mental well-being in young adults: A longitudinal study based on objective high-resolution smartphone data

Aims: To investigate the effects of objectively measured smartphone interactions on indicators of mental well-being among men and women in a population of young adults. Methods: A total of 816 young adults (mean±SD age 21.6±2.6 years; 77% men) from the Copenhagen Network Study were followed with objective recordings of smartphone interactions from calls, texts and social media. Participants self-reported on loneliness, depressive symptoms and disturbed sleep at baseline and in a four-month (interquartile range 75-163 days) follow-up survey. Multiple linear regression was used to analyse the association between smartphone interactions and mental well-being separately for men and women. Results: A higher number of smartphone interactions was associated with lower levels of loneliness at baseline and the same pattern appeared for depressive symptoms, although this was less pronounced. A high level of smartphone interaction was associated with lower levels of disturbed sleep for men, but not for women. In follow-up analyses, a high versus low level of smartphone interaction was associated with an increase in loneliness and depressive symptoms over time for women, but not for men. Conclusions: Smartphone interactions are related to better mental well-being, which may be attributed to the beneficial effects of an underlying social network. Over time, accommodating a large network via smartphone communication might, however, have negative effects on mental well-being for women.

Positive and negative aspects of social relations and low-grade inflammation in Copenhagen Aging and Midlife Biobank

The association between social relations and health outcomes is well described, but pathways are relatively poorly understood. Inflammation has been suggested as a potential physiological pathway, linking social relations to adverse health outcomes. However, previous studies have shown ambiguous results and have for the vast majority been based on studies small in sample size. The aim of the present study is to examine the association between comprehensive measures of structural and positive as well as negative functional aspects of social relations, across four relational domains-partner/spouse, children, other family and friends, and the level of systemic low-grade inflammation in a large population-based middle-aged cohort and to examine variation by gender and socioeconomic position in these associations. The study comprised of 5576 participants in the Copenhagen Aging and Midlife Biobank. The inflammatory biomarkers collected in late midlife included C-reactive protein, Interleukin-6, and TNF-alpha. Multiple linear regression models were implemented to explore associations between social relations and inflammatory measures controlling for gender, age, socioeconomic position, marital status, early major lifeevents and morbidity. Results show weak and ambiguous associations in all analyses. There were no strong indications of interaction with socioeconomic position. Concluding cautiously, men appear to be more vulnerable toward living alone and low contact frequency with family compared to women as regards high level of low-grade inflammation. In conclusion, this large-scale population-based study among middle-aged men and women showed no association between social relations and low-grade inflammation.

Midlife Forgetfulness and Risk of Dementia in Old Age: Results from the Danish Working Environment Cohort Study

BACKGROUND

Despite the current evidence of a high prevalence of forgetfulness in middle-aged individuals, and the evidence of a link between midlife memory complaints and biological changes in the brain, no previous study has yet investigated midlife forgetfulness in relation to risk of dementia in old age.

AIMS

We investigated whether midlife forgetfulness was an indicator of an increased risk of dementia in old age.

METHODS

We used data from 3,136 employed men and women who participated in the Danish Work Environment Cohort Study in 1990. These data were linked to Danish national registers. Participants were asked whether their closest relative had ever told them that they were forgetful. Incidence rate ratios (IRR) were estimated using Poisson regression analysis.

RESULTS

At baseline, 749 (24%) study participants were categorized as forgetful, and 86 (2.7%) participants were diagnosed with dementia during a total of 31,724 person-years at risk. After adjusting for sociodemographic factors, comorbidities, and work-related factors, midlife forgetfulness was associated with a higher risk of dementia (IRR = 1.82; 95% CI: 1.12-2.97).

CONCLUSIONS

This study is the first to investigate midlife forgetfulness and dementia, and the results suggest that midlife forgetfulness is an early indicator of an increased risk of dementia in old age.

Changes and correlations in height from 7 to 69 years of age across the birth years of 1930 to 1989

OBJECTIVES

The aims of this study were to describe changes in height during childhood and to investigate potential changes in the proportion of children attaining final height in childhood and in correlations between child and adult height across birth cohorts.

METHODS

We included 363 059 children (179 906 girls) from the Copenhagen School Health Records Register, who were born between 1930 and 1989, with height measurements at ages 7, 10, or 13 years. Linkages to data resources containing adult height values between ages 18 and 69 years were possible for a subpopulation of 96 133 individuals (23 051 women). Birth years were categorized as 1930 to 1939, 1940 to 1949, and 1950 to 1989. Descriptive height statistics were estimated by birth years and birth cohorts. Height correlations were examined using sex- and age-specific partial Pearson correlation analyses and meta-regression techniques.

RESULTS

Across 60 birth years, mean child heights at age 7 increased by 2.9 cm in girls and 3.0 cm in boys, and adult heights increased as well. The proportions of children attaining final height by age 13 remained low across the birth cohorts; nonetheless, there was a significant increase from 0.7% to 1.5% in girls only (P < .0001). Both child-child and child-adult height correlations were strong and remained relatively stable across birth cohorts.

CONCLUSIONS

Mean child and adult height increased during the study period, but the proportion of children attaining final height at age 13 remained low. Child-child and child-adult height correlations were largely unchanged across birth cohorts.

A life course analysis of income and incident AMI - a Danish register based cohort study

Background

Social inequality in ischemic heart disease has been related to socioeconomic position in childhood, early and late adulthood. However, the impact of relative level of accumulated income periods across adult life course and the potential gender and age differences has not been investigated.

The aim was to investigate the association between relative level of accumulated income across the life course and Acute myocardial infarction (AMI) from age 60+ and to study if the associations differ by gender and exposure in different age groups (30-39 years, 40-49 years and 50-59 years).

Methods

All Danes born 1935-54 N = 1,235,139 were followed-up in registers for incident AMI (ICD8: 410, ICD10: I20, I21) from age 60+, (42,669 cases). The The Accumulated Proportional Deviation from Median Equivalized Income = APDMEI for each gender/age /calendar year strata was constructed and divided in quartiles. The analyses stratified by birth cohort included all Danes born in 1955-70 (alive and reached age 40) N = 1,144,264, 1945-64 (alive and reached age 50), N = 1,434,769, 1935-1954 (alive and reached age 60) N = 1,235,139 including outcomes in the following 10 year period. Cox’s proportional hazard models adjusted for educational level, ethnic background and birth cohort.

Results

Among men, those in the lowest APDMEI quartile had a HR 1.40 (1.35-1.45) of AMI compared to the highest quartile, second and third highest quartiles had HR of 1.24 (1.20-1.28) and 1.14 (1.10-1.18), respectively. Among women the lowest quartile had a HR of 1.78 (1.69-1.88), the second 1.45 (1.37-1.53) and the third 1.19 (1.13-1.26). The social gradient was similar across the different age-groups.

Conclusions

The risk of AMI increased with lower levels of relative accumulated income across the life course. While men generally had a higher risk of AMI, the social gradient was steeper in women. There was no indication of a specific sensitive age period for exposure to relative level of accumulated income.

Key messages

Accumulated low income is associated with higher AMI risk in both men and women, but with larger relative differences between high and low accumulated income in women. This study adds a new approach to the study of inequalities in AMI by integrating duration and extent of low income into a relative measure of accumulated income.

Economic hardship over twenty-two consecutive years of adult life and markers of early ageing

Background

The authors examined the associations between annual measures of economic hardship (EH) across 22 years of adulthood and objective measures of early ageing in a Danish late-middle aged population.

Methods

A linkage of longitudinal register data from Statistics Denmark covering the period 1987-2008 and cross-sectional survey data from the Copenhagen Ageing and Midlife Biobank collected in 2009-11 (N = 5,575). EH was defined as &lt; 60% of the National median equivalized household disposable income and two exposures were calculated: 1) a categorical measure of total number if years in EH, and 2) trajectories of the probability of EH being low, declining, rising or high. Early ageing outcomes included four measures of physical capability, three inflammatory markers and one cognitive test. Associations were analyzed using linear regression models adjusted for sex, age, cohort, education, baseline income and long-term parental unemployment/financial problems.

Results

Four or more years in EH (reference=null years in EH) was related to poorer physical capability (chair rise: -1.49 counts/30 seconds [95% confidence interval (CI) -2.36, -0.61], hand grip strength: -1.22 kg [95% CI -2.38, -0.07], jump height: -1.67 cm [95% CI -2.44, -0.91] and balance: 18% [95% CI 9, 28]), poorer cognitive function (Intelligenz-Struktur-Test: -1.50 points [95% CI -2.89, -0.12]) and higher inflammatory levels (C-reactive protein: 22% [95% CI 4, 44], and Interleukin-6: 23% [95% CI 10, 39]). Comparing the four EH trajectories, people with a high vs. low probability of EH over time had poorer physical capability (chair rise: -1.70 counts/30 seconds [95% CI -3.38, -0.01], grip: -4.33 kg [95% CI -6.50, -2.16], jump: -1.68 cm [95% CI -3.12, -0.25], and balance: 31% [95% CI 12, 52]). No associations were observed with Tumor necrosis factor α.

Conclusions

This study suggests that sustained EH across adulthood may lead to early ageing.

Key messages

Sustained economic hardship in adulthood may lead to early ageing. Being in economic hardship for a few years is not associated with early ageing.

Do psychosocial factors modify the negative association between disability and life satisfaction in old age?

CONTEXT

Many assume that having poor physical health in old age lowers life satisfaction, but in fact there are large differences in life satisfaction among older people who experience disability.

OBJECTIVE

To investigate whether psychosocial factors modify the negative association between disability and life satisfaction in older people and whether these differ across the life course.

DESIGN

Cross sectional study.

SETTING

66,561 community-dwelling Survey of Health, Ageing, and Retirement in Europe (SHARE) participants aged 50-106 with a mean age of 67.8 ± 9.9 (SD) years from 17 European countries and Israel.

METHODS

Psychosocial factors included depression (EURO-D scale), perceived loneliness, having a spouse, having children, contact with children, and participation in social activities. Disability was assessed by limitations in (Instrumental) Activities of Daily Living ((I)ADL) and life satisfaction by Cantril's ladder. We also ran the analyses with the Control Autonomy Self-realization Pleasure (CASP-12) Index, a normative measure of quality of life. We used multiple linear regressions to estimate associations and proportion of variance explained.

RESULTS

The variance in life satisfaction that could be attributed uniquely to ADL and IADL disability was 0.17% and 0.33% respectively (both p < 0.001). The impact of (I)ADL disabilities on life satisfaction was strongest at age 50 and gradually decreased with increasing age (p trend < 0.001). Mental health explained more variance; 5.75% for depressive symptoms and 2.50% for loneliness and for social resources this ranged from 0.09% to 0.47% (all p < 0.001). While disability has a negative effect on life satisfaction, the effect was not stronger in older persons who were depressed, neither in those who felt lonely nor in those without social resources. Similar outcomes were found when using CASP-12 as the explained variable.

CONCLUSION

The impact of (I)ADL disabilities on life satisfaction in community-dwelling older people decreases with age. These associations are not affected by psychosocial factors and these patterns cannot be explained by people changing their norms and values.

High perceived stress and social interaction behaviour among young adults. A study based on objective measures of face-to-face and smartphone interactions

Stress and mental health problems impede social functioning and may also complicate relationship formation with peers. The aim was to investigate whether high perceived stress among young adults is associated with social interaction behaviour both via face-to-face interaction and via smartphone interaction. The data was derived from the Copenhagen Network Study, where 535 first-year students (mean age 21.3, 77% male) self-reported on perceived stress at baseline and were subsequently followed for three months with continuous Bluetooth recordings of face-to-face interactions and smartphone interactions (calls and texts) measuring the network size, frequency, and duration of interactions. Logistic regression was used to assess associations between perceived stress (high/low) and social interactions adjusting for sex, age, and personality traits. Participants with high perceived stress were more likely to engage in a larger call and text network and have a higher call and text frequency compared to individuals with low perceived stress. We found a non-statistically significant tendency that participants with a high perceived stress level spend less time meeting face to face with peers. Stressed students engage in frequent smartphone interaction which may be explained by a social support seeking behaviour, or it may be that accommodating a large network via the smartphone is stress-inducing.

Health, well-being and social relations in a changing neighbourhood: protocol for a prospective, multimethods study of the consequences of large structural changes in an ethnic diverse social housing area in Denmark

INTRODUCTION

Residential areas constitute an important arena for health, well-being and social relations. Structural interventions such as demolition and area renewal have been used to reduce inequality in health and well-being in disadvantaged areas. However, the effects of larger structural interventions are inconclusive. In a longitudinal perspective, this study aims to analyse how large-scale structural changes in an ethnic diverse social housing area are associated with the residents' health, well-being and social relations.

METHODS AND ANALYSIS

In this multimethods study, we examine this aim among middle-aged and older residents in a multiethnic social housing area in a Danish municipality by the inclusion of comprehensive survey (in 2018, 2019 and 2020), register (yearly 2015-2025) and qualitative (2018-2020) data. Municipal Health Profile survey data from 2017 and 2021 will be used for comparison. The area will undergo large structural changes in the built environment during 2018-2021. A 'natural experiment' (n=6000) compares differences in health and social outcomes across the study period between the study area and a similar neighbouring area not undergoing structural changes. Through user engagement in the design of the study, throughout the different phases of the study and in the two co-created interventions embedded in the study design, a focus on empowerment and recognition of the resources and perspectives of residents are encouraged.

ETHICS AND DISSEMINATION

The study is registered in the University of Copenhagen's record of biobanks and research projects containing personal data and will be conducted in accordance with the principles of the Helsinki Declaration. Residential and municipal representatives and local non-governmental organisations are engaged in the design and execution of the study to ensure the usefulness, reflexive interpretation of data, and relevance of interventions. Results will be published in international peer-reviewed scientific journals, presented at conferences and as short reports through the use of both written and visual outputs.

Life course analysis on income and incident AMI: a Danish register-based cohort study

BACKGROUND

Social inequality in ischaemic heart disease has been related to socioeconomic position in childhood, early adulthood and late adulthood. However, the impact of relative level of accumulated income periods across adult life course and the potential gender and age differences have not been investigated. The aim was to investigate the association between relative level of accumulated income across the life course and acute myocardial infarction (AMI) from age 60+ years and to study if the associations differ by gender and in different age groups (30-39 years, 40-49 years and 50-59 years).

METHODS

All Danes born 1935-1954 (N=1 235 139) were followed up in registers for incident AMI (42 669 cases). The accumulated proportional deviation from median equivalised income (APDMEI) for each gender/age/calendar year strata was constructed and divided in quartiles. The associations were analysed by means of Cox's proportional hazard models.

RESULTS

Among men, those in the lowest APDMEI quartile had an HR 1.40 (1.35-1.45) of AMI compared with the highest quartile. Those in the second and third highest quartiles had HR of 1.24 (1.20-1.28) and 1.14 (1.10-1.18), respectively. Among women, the lowest quartile had an HR of 1.78 (1.69-1.88), the second 1.45 (1.37-1.53) and the third 1.19 (1.13-1.26). The social gradient was similar across the different age groups.

CONCLUSION

The risk of AMI increased with lower levels of relative accumulated income across the life course. While men generally had a higher risk of AMI, the social gradient was steeper in women. There was no indication of a specific sensitive age period for exposure to relative level of accumulated income.

Mental and physical health effects of meaningful work and rewarding family responsibilities

Positive feelings about work and family responsibilities benefit psychological well-being, but their physical health effects remain unexplored. The study assessed whether meaningful work and reward from taking care of family benefitted physical health to the same degree as mental health. Participants were 181 Danes aged 49–51. Participants reported on working conditions, providing care to family, depressive symptoms, and perceived stress. Physical health was operationalized as a physiological dysregulation (e.g., hypertension, high levels of blood sugar and cholesterol, high body mass index). A multidimensional index of physiological dysregulation was created using parameters of cardiovascular, metabolic, and immune function. As expected, meaningful work and sense of reward from taking care of family members were associated with better mental health. However, in women, the very same factors were positively associated with higher physiological dysregulation. We conclude that work and family factors promoting psychological well-being may have physical health trade-offs, particularly in women.

Lewis and AB0 blood group-phenotypes in periodontitis, cardiovascular disease, obesity and stroke

The AB0 blood group has been linked to ischaemic heart disease, stroke, and periodontal disease, while the Lewis blood group has been linked to ischaemic heart disease and obesity, all of which have been associated with periodontitis. AB0 or Lewis blood group phenotype may therefore constitute common hereditary components predisposing to these disorders. In this study, we investigated if blood group phenotype associated with periodontitis in a subpopulation consisting of 702 participants from a Danish cross-sectional cohort and, secondarily, attempted to confirm their association with hypertension, ischaemic heart disease, stroke, and obesity. No significant association between blood group phenotype and periodontitis was detected, nor were previously reported associations between blood group phenotype and hypertension, ischaemic heart disease, stroke, and obesity confirmed. This may, at least partly, be attributed to differences in study type, outcome definitions, cohort sizes, and population attributable factors. However, our results suggested a strong association between self-reported stroke and the Lewis (a−b−) phenotype (P = 0.0002, OR: 22.28; CI 95: 4.72–131.63).

Maternal infections during pregnancy and offspring midlife inflammation

Background

Microbial exposures early in life have been found to be associated with lower levels of inflammation in adulthood; however, the role of prenatal exposure to infection on offspring inflammatory profiles is unexplored. The aim was to study if maternal infections during pregnancy are associated with inflammation among offspring in later life and to determine if there are sensitive periods of exposure.

Methods

The study was comprised of 1719 participants in the Copenhagen Aging and Midlife Biobank (CAMB) who were also members of the Copenhagen Perinatal Cohort (CPC). When the CPC was established, information on maternal infections during pregnancy was prospectively collected by a trained medical doctor. The inflammatory measures collected in late midlife included, C-reactive protein (CRP), Interleukin-6 (IL-6), TNF-alpha (TNF-α) and Interleukin-10 (IL-10). Multivariable ordinary least squared regression models were implemented to explore associations between maternal infection and inflammatory measures in offspring, controlling for maternal smoking, pre-pregnancy body mass index, age, marital status and parity.

Results

Maternal infection was associated with a 7% lower CRP level (95% CI, − 17,5%) among offspring compared with offspring born to women without an infection and similarly an 8% lower level of IL-6 (95% CI -15,1%), and a 9% lower level of IL-10 (95% CI, − 23,20%). However, differences did not reach significance. The effects of infection during the first trimester did not differ from infections later in the pregnancy.

Conclusions

Our results suggested that prenatal exposure to infection may be associated with lower levels of inflammatory markers among adult offspring. Additional prospective studies are needed to further explore this finding.

The joint effect of unemployment and cynical hostility on all-cause mortality: results from a prospective cohort study

Background

It is hypothesised that hostility accentuates the association between stressful conditions and health. This study aims to test this hypothesis by analysing the joint effect of unemployment and hostility on all-cause mortality among men and women.

Methods

The population was 3677 men and 4138 women from the Danish workforce who participated in a survey in 2000. The joint exposure variable was defined as 1) employed, not hostile, 2) unemployed, not hostile, 3) hostile and employed, 4) unemployed and hostile. Outcome was defined as all-cause mortality between 2000 and 2014. Data was analysed with Cox proportional hazards models with age as the underlying time scale. The interaction between unemployment and hostility was studied using the synergy index.

Results

Compared to employed non-hostile men, men who were both hostile and unemployed were at markedly higher risk of premature death with a hazard ratio (HR) of 3.19 (95% CI 2.22–4.69). A similar picture was found for hostile and unemployed women, with a HR of 1.97 (95% CI 1.24–3.12). However, the mortality in men and women exposed to both did not exceed what was expected from the combination of their individual effects. Hence, we did not find that hostility enhances the association between unemployment and all-cause mortality.

Conclusion

Men and women exposed to both unemployment and hostility were at markedly high risk of premature mortality. However, this study did not support the hypothesis that the deleterious health effect of the combination of unemployment and hostility exceeds their individual effects.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-6622-7) contains supplementary material, which is available to authorized users.

Relational strain in close social relations among older adults with dual sensory loss

Objectives:

The loss of both hearing and vision (dual sensory loss) affects communication and potentially challenges the ability to maintain healthy social relations. The aim of this study was to examine the association between severity of sensory loss and relational strain among older adults with acquired dual sensory loss.

Method:

Data were collected through a national cross-sectional questionnaire survey and an administrative database. A total of 302 individuals with functional dual sensory loss ⩾50 years of age participated (66% response). Relational strain was measured as the perceived experience of excessive demands, worries, and conflicts with children, other relatives, or the personal support worker. Data were analyzed by multivariate logistic regression.

Results:

No associations between severity of dual sensory loss and excessive demands from or worries for children, other relatives, or personal support workers were found. Participants with total blindness and profound deafness had significantly higher odds for experiencing conflicts with children (odds ratio [OR] = 3.09, 95% confidence interval [CI] = [1.02, 9.38]) and the personal support worker (OR = 4.18, 95% CI = [1.23, 4.28]) compared to participants with residuals of both senses.

Discussion:

Individuals with total blindness and profound deafness might require special attention in rehabilitation to support them in maintaining healthy social relations.

Prolonged or serious conflicts at work and incident dementia: a 23-year follow-up of the Copenhagen City Heart Study

PURPOSE

Only a few studies have investigated the impact of negative aspects of social relations on cognitive function, and they have shown mixed results. Conflicts at work are part of the negative aspects of social relations, but the impact of experiencing conflicts at work has not yet been investigated as a risk factor for dementia. Therefore, we investigated whether experiencing prolonged or serious conflicts with a supervisor or colleagues at work was associated with incident dementia in old age.

METHODS

We analyzed data of 6,436 men and women from the third survey of the Copenhagen City Heart Study. At baseline in 1991-1994, the participants reported whether they had ever had a prolonged or serious conflict at work. The participants were followed until 2014. We used Poisson regression to estimate incidence rate ratios (IRR) and their 95% confidence intervals (CI).

RESULTS

After adjusting for potential confounders, the IRR for dementia was 1.53 (95% CI 0.77-3.03) among participants who had reported having prolonged or serious conflicts both with a supervisor and colleagues compared with participants who had never had such conflicts. In separate analyses stratified by sex, the IRRs were 2.14 (95% Cl 0.97-4.71) for men and 0.98 (95% Cl 0.29-3.32) for women.

CONCLUSIONS

Our findings did not support an overall association between experiencing prolonged or serious conflicts at work and incident dementia. However, because of the large differences in the point estimates for men and women, future research could aim at investigating potential sex differences regarding the association between conflicts at work and dementia.

Mobility limitation as determinant of primary care use and ambulatory care sensitive conditions

PURPOSE

First, to investigate associations between mobility limitations and use of general practitioners and hospitalizations of acute care sensitive conditions, respectively. Second, to investigate whether these associations vary by socio-demographic factors.

METHODS

The study included 3574 females and males aged 75 or 80 years from the Danish Intervention Study on Preventive Home Visits. Fixed-effects logistic and poisson regression models were applied to study the relationship between mobility limitations (measured two-four times) and general practitioner consultations and hospitalizations with acute care sensitive conditions each subsequent year, respectively.

RESULTS

Each additional mobility limitation was associated with 15% higher odds of general practitioner home consultation (Odds ratio 1.15, 95% CI 1.07;1.23) and 4% increased incidence rate of general practitioner consultations among those with ≥ 1 consultation (Incidence rate ratio 1.04, 95% CI 1.03;1.04). There were no associations between mobility limitations and whether older adults had at least one general practitioner consultation nor acute care sensitive condition hospitalization. Test of interactions (p < 0.03) showed that more mobility limitations were associated with greater incidence rate of general practitioner consultations among males compared to females, married compared to unmarried, and older adults with high compared to low financial assets.

CONCLUSIONS

Older adults with more mobility limitations had more often a general practitioner home consultation. Mobility limitations were not associated with whether older adults had at least one general practitioner consultation, but increased mobility limitations were associated with higher contact rate among those who had ≥ 1 consultation, especially among males and older adults who were married or had high financial assets.

Grip Work Measurement with the Jamar Dynamometer: Validation of a Simple Equation for Clinical Use

OBJECTIVES

Previously, we developed and validated an easy test to measure muscle fatigability during sustained maximal handgrip contraction in older persons using a Martin Vigorimeter device. This study aimed at validating the equation to estimate grip work (GW) during sustained maximal handgrip contraction, by monitoring continuously the grip strength (GS) decay using a Jamar Dynamometer-like (JD) device.

DESIGN

Cross sectional, explorative study.

SETTING

Data collection took place at The National Research Centre for the Working Environment in Copenhagen, Denmark.

PARTICIPANTS

962 subjects, belonging to a subgroup of the Copenhagen Aging and Midlife Biobank, were enrolled.

METHODS

GS was recorded continuously during sustained maximal contraction until it dropped to 50% of its maximum and fatigue resistance (FR, time to fatigue) was noted. GW, area under the force-time curve, was compared to its estimate which was calculated as GWestimated=GSmax*0.75*FR.

RESULTS

Excellent correlation was found between GWestimated and GWmeasured (R²=0.98 p<0.001). The equation slightly overestimated GW by 6.04 kg*s (95% CI[-0.08, 12.15]) with a coefficient of variation method error of 6%.

CONCLUSION

GW estimation is a valid parameter reflecting muscle work output during a sustained maximal grip effort in healthy middle-aged community-dwelling persons when using a JD. GW estimation is a promising outcome parameter in comprehensive geriatric assessment and its validation for commonly used instruments in geriatric practice will increase its clinical implementation.