1
|
Wen C, Sun S, Huang L, Guo Y, Shi Y, Qi S, Ding G, Wen Z, Wang J, Ruan Y, Zhao Q. Effect of social participation on the trajectories of activities of daily living disability among community-dwelling older adults: a 7-year community-based cohort. Aging Clin Exp Res 2024; 36:104. [PMID: 38713318 PMCID: PMC11076373 DOI: 10.1007/s40520-024-02758-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/16/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Studies examining the effects of social participation on activities of daily living (ADL) disability are still scarce. AIM To assess the reciprocal relationship between ADL disability trajectories and social participation among older Chinese people aged ≥ 60 years. METHODS This study included 2976 participants aged ≥ 60 years in six waves of a community-based survey from 2015 to 2022. Basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were used to assess the ADL disability in each survey. Social participation was assessed by involvement in four social activities and an extensive social participation score. Group-based trajectory modeling was used to identify potential heterogeneity in longitudinal changes over 7 years and explore associations between baseline predictors of group membership and these trajectories. RESULTS Two BADL disability trajectories were identified: stable (94.8%) and increase (5.2%). Additionally, three IADL disability trajectories were distinguished: stable (73.2%), moderate (20.2%), and increase (6.6%). After controlling for the potential covariates, each point increase in the extensive social participation score correlated with a 17% decrease in the odds of older individuals belonging to the increase BADL trajectory group (OR = 0.83, 95% CI = 0.68-1.00). For IADL, it decreased the odds of being assigned to the moderate trajectory group by 16% (OR = 0.84, 95% CI = 0.75-0.95) and to the increase trajectory group by 23% (OR = 0.77, 95% CI = 0.64-0.93). CONCLUSIONS Higher levels of social participation among older individuals were more likely to be classified as stable trajectories in both BADL and IADL. Increased participation in social activities by community-dwelling elderly adults may promote healthy aging.
Collapse
Affiliation(s)
- Cai Wen
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China
| | - Shuangyuan Sun
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Limei Huang
- Songjiang Center of Disease Prevention and Control, Shanghai, China
| | - Yanfei Guo
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Yan Shi
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Shige Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Guomei Ding
- Zhongshan Community Health Care Center, Songjiang District, Shanghai, China
| | - Zhiqin Wen
- Yexie Community Health Service Center, Songjiang District, Shanghai, China
| | - Jiaqi Wang
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Ye Ruan
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
| | - Qi Zhao
- School of Public Health, NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, China.
| |
Collapse
|
2
|
Tang J, Wu C, Zhong Z. Group-Based Trajectory Modeling of Fluid Balance in Elderly Patients with Acute Ischemic Stroke: Analysis from Multicenter ICUs. Neurol Ther 2024:10.1007/s40120-024-00612-x. [PMID: 38635141 DOI: 10.1007/s40120-024-00612-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/21/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Acute ischemic stroke (AIS) significantly contributes to severe disability and mortality among the elderly. This study aims to explore the association between longitudinal fluid balance (FB) trajectories and clinical outcomes in elderly patients with AIS. Our hypothesis posits the existence of multiple latent trajectories of FB in patients with AIS during the initial 7 days following ICU admission. METHODS Patients (age ≥ 65 years) with AIS and continuous FB records were identified from two large databases. Group-based trajectory modeling identified latent groups with similar 7-day FB trajectories. Subsequently, multivariable logistic and quasi-Poisson regression were employed to evaluate the relationship between trajectory groups and outcomes. Additionally, nonlinear associations between maximum fluid overload (FO) and outcomes were analyzed using restricted cubic spline models. To further validate our findings, subgroup and sensitivity analysis were conducted. RESULTS A total of 1146 eligible patients were included in this study, revealing three trajectory patterns were identified: low FB (84.8%), decreasing FB (7.2%), and high FB (7.9%). High FB emerged as an independent risk factor for in-hospital mortality. Compared with those without FO, patients with FO had a 1.57-fold increased risk of hospital mortality (adjusted odd ratio (OR) 1.57, 95% confidence interval (CI) 1.08-2.27), 2.37-fold increased risk of adverse kidney event (adjusted OR 2.37, 95% CI 1.56-3.59), and 1.33-fold increased risk of prolonged ICU stay (adjusted incidence rate ratio (IRR) 1.33, 95% CI 1.19-1.48). The risk of hospital mortality and adverse kidney event increased linearly with rising maximum FO (P for non-linearity = 0.263 and 0.563, respectively). CONCLUSION Daily FB trajectories were associated with adverse outcomes in elderly patients with AIS. Regular assessment of daily fluid status and restriction of FO are crucial for the recovery of critically ill patients.
Collapse
Affiliation(s)
- Jia Tang
- Graduate School of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Changdong Wu
- Xinjiang Emergency Center, People's Hospital of Xinjiang Uygur Autonomous Region, No. 91, Tian-Chi Road, Tianshan District, Urumqi, 830001, Xinjiang, China.
| | - Zhenguang Zhong
- Department of Bioengineering, Imperial College London, London, UK
| |
Collapse
|
3
|
Sun D, Fang H, Wang J, Wu J. Group-based trajectory modeling for fear of cancer recurrence in cancer survivors: a systematic review. J Cancer Surviv 2024:10.1007/s11764-024-01582-7. [PMID: 38584241 DOI: 10.1007/s11764-024-01582-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE We aimed to systematically review studies that used a group-based trajectory modeling approach to explore the categories of fear of cancer recurrence (FCR) trajectories and their predictors in cancer survivors. METHODS MEDLINE, EMBASE, CINAHL, Scopus, and Web of Science were searched. Three authors independently reviewed the literature for predefined eligibility criteria. The Joanna Briggs Institute critical appraisal tools for Cohort Studies and the Guidelines for Reporting on Latent Trajectory Studies were used to assess the quality of included studies. A qualitative synthesis of the included studies was performed. RESULTS Ninety-eight studies were retrieved after removing duplicates, and 11 studies met the criteria for inclusion. There are four types of FCR trajectories: stable, decreasing, increasing, and stable-then-decreasing-then-increasing. The following factors were considered significant predictors of FCR trajectory category in at least one of the included studies: age, race, income, education, employment, cancer stage, physical symptoms, depression, anxiety, satisfaction with medical care, and selected cognitive and behavioral factors. CONCLUSIONS There was considerable heterogeneity among the studies included in study design and FCR trajectory results. Factors that significantly predicted FCR trajectory categories mostly focused on psychological characteristics. The correlation of sociodemographic and disease-related predictors with FCR trajectory categories was not consistent among the included studies. IMPLICATIONS FOR CANCER SURVIVORS We suggest that future scholars should incorporate more psychological factors when identifying cancer survivors who persistently maintain a high level of FCR and developing FCR mitigation measures.
Collapse
Affiliation(s)
- Dandan Sun
- Huadong Hospital Affiliated to Fudan University, Shanghai, China
- School of Nursing, Fudan University, Shanghai, China
| | - Huaying Fang
- Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Jin Wang
- Xinhua Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jinqiu Wu
- Huadong Hospital Affiliated to Fudan University, Shanghai, China.
| |
Collapse
|
4
|
Nili M, Epstein AJ, Nunag D, Olson A, Borah BJ. Association between nintedanib adherence trajectory and healthcare use among idiopathic pulmonary fibrosis patients. BMC Pulm Med 2024; 24:141. [PMID: 38504247 PMCID: PMC10953166 DOI: 10.1186/s12890-024-02929-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 02/23/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Although inverse associations have been found between medication adherence and healthcare use and spending outcomes in many clinical settings, no studies to date have examined these relationships for patients with idiopathic pulmonary fibrosis (IPF) initiating nintedanib. We build on our prior study that used group-based trajectory modeling (GBTM) to compare inpatient hospitalization and medical care spending outcomes between groups of patients with different nintedanib adherence trajectories. METHODS This analysis used 100% Medicare data and included beneficiaries with IPF who initiated nintedanib during 10/01/2014-12/31/2018. The sample consisted of community-dwelling older adults (≥ 66 years) with continuous coverage in Medicare Parts A (inpatient care), B (outpatient care) and D (prescription drugs) for one year before (baseline) and after (follow-up) initiating nintedanib. Patients were assigned to the GBTM-derived adherence trajectory group closest to their own nintedanib adherence experience. All-cause and IPF-related hospitalization events and total medical spending were measured during the follow-up period. Unadjusted and adjusted regression models were estimated to compare outcomes between patients in different nintedanib adherence trajectories. RESULTS Among the 1,798 patients initiating nintedanib, the mean age was 75.4 years, 61.1% were male, and 91.1% were non-Hispanic white. The best-fitting GBTM had five adherence trajectories: high adherence, moderate adherence, high-then-poor adherence, delayed-poor adherence, and early-poor adherence. All-cause hospitalizations and total all-cause medical spending were higher among patients in the high-then-poor, delayed-poor and early-poor adherence trajectories than those in the high adherence trajectory. For example, adjusted total all-cause medical spending was $4,876 (95% CI: $1,470 to $8,282) higher in the high-then-poor adherence trajectory, $3,639 (95% CI: $1,322 to $5,955) higher in the delayed-poor adherence trajectory and $3,907 (95% CI: $1,658 to $6,156) higher in the early-poor adherence trajectory compared with the high adherence trajectory. IPF-related hospitalizations and medical care spending were higher among those in the high-then-poor adherence trajectory compared with those in the high adherence trajectory. CONCLUSIONS Poor adherence to nintedanib was associated with all-cause hospitalizations and medical costs. Therefore, improved adherence programs, such as support programs, can be implemented to reduce economic burden.
Collapse
Affiliation(s)
- Mona Nili
- Boehringer Ingelheim Pharmaceuticals, Inc, 900 Ridgebury Rd, 06877, Ridgefield, CT, USA.
| | | | | | - Amy Olson
- Boehringer Ingelheim Pharmaceuticals, Inc, 900 Ridgebury Rd, 06877, Ridgefield, CT, USA
| | | |
Collapse
|
5
|
Pu Y, Xu W, Dai W, Wei X, Yu H, Yu Q, Su X, Gong R, Zhang Y, Shi Q. Longitudinal patterns of patient-reported sleep disturbances after surgery for lung cancer. Sleep Breath 2024; 28:441-448. [PMID: 37434013 DOI: 10.1007/s11325-023-02877-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE The purpose of this study was to identify longitudinal heterogeneous trajectories of sleep status, adjusted for the effect of pain over time, among patients who had surgery for lung cancer and to quantify how disturbed sleep in the hospital affects functional recovery after discharge. METHODS We included patients from a surgical cohort (CN-PRO-Lung 1). All patients reported symptoms using the MD Anderson Symptom Inventory-Lung Cancer (MDASI-LC) daily during postoperative hospitalization. Group-based dual trajectory modeling was used to investigate trajectories of disturbed sleep and pain during the first 7 days of postoperative hospitalization. Cox regression was used to compare the recovery of walking ability between the different sleep trajectories. RESULTS Among 421 patients, disturbed sleep trajectories comprised low (31%), moderate (52%), and high (17%) groups. The surgical approach and number of chest tubes were associated with pain, and the number of chest tubes was also associated with sleep disturbances (OR = 1.99; 95% CI: 1.08-3.67). Recovery of walking ability after discharge was significantly slower in the high (median days = 16; 95% CI: 5-NA) and moderate disturbed sleep trajectory groups (median days = 5; 95%CI: 4-6) than in the low group (median days = 3; 95% CI: 3-4). CONCLUSION Changes in disturbed sleep among patients with lung cancer followed three distinct trajectories over the first 7 days of hospitalization after surgery. Dual trajectory analyses highlighted the high concordance between specific trajectories of disturbed sleep and pain. Patients at high sleep disturbance and high levels of pain may benefit from appropriate interventions for both symptoms in combination with the patient's surgical approach and the number of chest tubes.
Collapse
Affiliation(s)
- Yang Pu
- School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, No. 1, Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Wei Xu
- School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, No. 1, Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Wei Dai
- Department of Thoracic Surgery, Sichuan Cancer Center, Sichuan Cancer Hospital and Institute, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xing Wei
- Department of Thoracic Surgery, Sichuan Cancer Center, Sichuan Cancer Hospital and Institute, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Hongfan Yu
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Qingsong Yu
- Chengdu Center for Disease Control and Prevention, Chengdu, Sichuan, China
| | - Xueyao Su
- School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, No. 1, Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Ruoyan Gong
- School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, No. 1, Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Yubo Zhang
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
| | - Qiuling Shi
- School of Public Health, Research Center for Medicine and Social Development, Chongqing Medical University, No. 1, Yixueyuan Road, Yuzhong District, Chongqing, 400016, China.
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China.
- Center for Cancer Prevention Research, Sichuan Cancer Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
| |
Collapse
|
6
|
Bai P, Shao X, Ning X, Jiang X, Liu H, Lin Y, Hou F, Zhang Y, Zhou S, Yu P. Association between the trajectory of ideal cardiovascular health metrics and incident chronic kidney disease among 27,635 older adults in northern China-a prospective cohort study. BMC Geriatr 2024; 24:193. [PMID: 38408910 PMCID: PMC10898137 DOI: 10.1186/s12877-024-04760-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 01/30/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND There is a lack of relevant studies evaluating the long-term impact of cardiovascular health factor (CVH) metrics on chronic kidney disease (CKD). OBJECTIVE This study investigates the long-term change in CVH metrics in older people and explores the relationship between CVH metrics trajectory and CKD. METHODS In total, 27,635 older people aged over 60 from the community-based Tianjin Chronic Kidney Disease Cohort study were enrolled. The participants completed five annual physical examinations between January 01, 2014, and December 31, 2018, and a subsequent follow-up between January 01, 2019, and December 31, 2021. CVH metrics trajectories were established by the group-based trajectory model to predict CKD risk. The relationships between baseline CVH, CVH change (ΔCVH), and CKD risk were also explored by logistic regression and restricted cubic spline regression model. In addition, likelihood ratio tests were used to compare the goodness of fit of the different models. RESULTS Six distinct CVH metrics trajectories were identified among the participants: low-stable (11.19%), low-medium-stable (30.58%), medium-stable (30.54%), medium-high-decreased (5.46%), medium-high-stable (18.93%), and high-stable (3.25%). After adjustment for potential confounders, higher CVH metrics trajectory was associated with decreased risk of CKD (P for trend < 0.001). Comparing the high-stable with the low-stable group, the risk of CKD decreased by 46%. All sensitivity analyses, including adjusting for baseline CVH and removing each CVH component from the total CVH, produced consistent results. Furthermore, the likelihood ratio test revealed that the model established by the CVH trajectory fit better than the baseline CVH and Δ CVH. CONCLUSION The higher CVH metrics trajectory and improvement of CVH metrics were associated with decreased risk of CKD. This study emphasized the importance of improving CVH to achieve primary prevention of CKD in older people.
Collapse
Affiliation(s)
- Pufei Bai
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Institute of Endocrinology, Chu Hsien-I Memorial Hospital, Tianjin Medical University, Tianjin, 300134, China
| | - Xian Shao
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Institute of Endocrinology, Chu Hsien-I Memorial Hospital, Tianjin Medical University, Tianjin, 300134, China
| | - Xiaoqun Ning
- Special Medical Service Center, Zhujiang Hospital, Southern Medical University, No. 253, Middle Industrial Avenue, Haizhu District, Guangzhou, Guangdong, China
| | - Xi Jiang
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Institute of Endocrinology, Chu Hsien-I Memorial Hospital, Tianjin Medical University, Tianjin, 300134, China
| | - Hongyan Liu
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Institute of Endocrinology, Chu Hsien-I Memorial Hospital, Tianjin Medical University, Tianjin, 300134, China
| | - Yao Lin
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Institute of Endocrinology, Chu Hsien-I Memorial Hospital, Tianjin Medical University, Tianjin, 300134, China
| | - Fang Hou
- Community Health Service Center, Jiefang Road, Tanggu Street, Binhai New District, Tianjin, China
| | - Yourui Zhang
- Community Health Service Center, Jiefang Road, Tanggu Street, Binhai New District, Tianjin, China
| | - Saijun Zhou
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Institute of Endocrinology, Chu Hsien-I Memorial Hospital, Tianjin Medical University, Tianjin, 300134, China.
| | - Pei Yu
- NHC Key Laboratory of Hormones and Development, Tianjin Key Laboratory of Metabolic Diseases, Tianjin Institute of Endocrinology, Chu Hsien-I Memorial Hospital, Tianjin Medical University, Tianjin, 300134, China.
| |
Collapse
|
7
|
Zheng HL, Wang FH, Zhang LK, Li P, Zheng CH, Chen QY, Huang CM, Xie JW. Trajectories of neutrophil-to-lymphocyte ratios during neoadjuvant chemotherapy correlate with short- and long-term outcomes in gastric cancer: a group-based trajectory analysis. BMC Cancer 2024; 24:226. [PMID: 38365617 PMCID: PMC10873962 DOI: 10.1186/s12885-024-11950-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 02/04/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Systemic inflammatory factors can predict the survival prognosis of gastric cancer (GC) patients after neoadjuvant chemotherapy (NACT). However, whether longitudinal changes in systemic inflammatory factors are associated with short - and long-term outcomes has not been reported. METHODS This study is a retrospective analysis of 216 patients with advanced gastric cancer who received NACT between January 2011 and June 2019, comparing receiver operating characteristic (ROC) curves for screening suitable inflammatory markers. Group-based trajectory modeling (GBTM) was used to analyze longitudinal changes in inflammatory markers during NACT to identify different potential subgroups and to compare postoperative complications, recurrence-free survival (RFS), and overall survival (OS) among subgroups. RESULTS Ultimately, neutrophil-lymphocyte ratio (NLR) had the highest area under the curve (AUC) value in predicting prognosis was included in the GBTM analysis. Three trajectories of NLR were obtained: Stable group (SG) (n = 89), Ascent-descend group (ADG) (n = 80) and Continuous descend group (CDG) (n = 47). Compared with SG, ADG and CDG are associated with an increased risk of postoperative recurrence and death. The median time of RFS and OS of SG was longer than that of ADG and CDG (median RFS 81 vs. 44 and 22 months; median OS 69 vs. 41 and 30 months). In addition, CDG had significantly higher postoperative serious complications than SG and ADG (17 (36.2%) vs. 17 (19.1%) and 12 (15.0%); p = 0.005). CONCLUSION There were different trajectories of NLR during NACT, and these potential trajectories were significantly associated with severe postoperative complications, recurrence, and mortality in patients with GC.
Collapse
Affiliation(s)
- Hua-Long Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian Province, 350001, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Fu-Hai Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian Province, 350001, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ling-Kang Zhang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian Province, 350001, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian Province, 350001, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian Province, 350001, China
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian Province, 350001, China.
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian Province, 350001, China.
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou, Fujian Province, 350001, China.
- Fujian Provincial Minimally Invasive Medical Center, Fuzhou, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
| |
Collapse
|
8
|
Chen S, Zhu YY, Chu ZX, Zhou H, Liu M, Jiang YJ, Hu QH. Trajectories of anxiety and depression among Chinese men who have sex with men on pre-exposure prophylaxis: a group-based trajectory model approach. BMC Public Health 2024; 24:365. [PMID: 38310254 PMCID: PMC10837939 DOI: 10.1186/s12889-024-17854-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Anxiety and depression can influence adherence to Pre-exposure Prophylaxis (PrEP). However, there is limited research on the temporal dynamics of anxiety and depression among men who have sex with men (MSM) using PrEP. METHODS From December 2018 to November 2020, we administered the Hospital Anxiety and Depression Scale (HADS) to participants in the China Real-World Oral Intake of PrEP (CROPrEP) to measure their anxiety and depression levels. The group-based trajectory model (GBTM) depicted the dynamic changes of anxiety and depression scores over time. RESULTS A total of 1023 MSM were included, with 4523 follow-up assessments. The GBTM categorized the trajectories into three distinct patterns: consistently low (54.8% for anxiety, 60.7% for depression), consistently moderate (39.3% for anxiety, 31.4% for depression), and high but bell-shaped (5.9% for anxiety, 7.9% for depression). Higher anxiety levels were associated with being aged 18-30 years old, earning less than US$619 per month, female-identifying, adopting the bottom sexual role with men, and having two or more anal sex partners in the past three months; similarly, higher depression levels correlated with a monthly income under US$619, female-identifying, sexual behavior as bottom and a positive syphilis at baseline. PrEP adherence was notably lower in the high but bell-shaped anxiety and depression group compared to the other groups, particularly at the 12th-month follow-up. CONCLUSIONS Close monitoring of anxiety and depression levels in MSM on PrEP is crucial. Provision of targeted mental health support is essential to enhance PrEP effectiveness.
Collapse
Affiliation(s)
- Shuo Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yan-Yan Zhu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhen-Xing Chu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hui Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Miao Liu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Yong-Jun Jiang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Qing-Hai Hu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Centre for Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China.
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang, China.
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China.
- Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.
| |
Collapse
|
9
|
Lin J, Wang K, Zhang Y, Lu K, Xia H, Hua M, Zheng W, Chen R. Frailty index trajectories in Chinese older adults with diverse levels of social participation: findings from a national population-based longitudinal study. Aging Clin Exp Res 2023; 35:3105-3114. [PMID: 37948011 DOI: 10.1007/s40520-023-02617-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Aging and frailty pose significant challenges globally, placing a substantial burden on healthcare and social services due to their adverse consequences. AIM The primary objective of this study was to investigate the relationship between social participation and development of frailty transition and trajectory. METHODS This study utilized data from the CLHLS Cohort, a 10-year follow-up study involving 6713 participants, to investigate the association between social participation and development of frailty. Frailty reflects a comprehensive decline in various body functions. The study employed a group-based trajectory model to analyze the development trajectory of the frailty index and used logistic regression to assess the odds ratio (OR) of frailty risk. RESULTS We identified two distinct groups of frailty progression trajectories: the "stable development group" and the "rapid growth group." Individuals who engaged in social activities at least once a month, but not daily, exhibited a significant association with an increased risk of transitioning into the "rapid growth group" (OR 1.305, 95% CI 1.032-1.649). Those with social participation less than once a month had an even greater risk (OR 1.872, 95% CI 1.423-2.463). Moreover, low social participation frequency (occasionally/never) has a more pronounced impact on frailty progression in males. CONCLUSION A higher frequency of social participation is associated with a lower risk of being classified into the "rapid growth group" and a slower rate of frailty index progression. Preventing the progression of frailty can contribute to enhanced support for healthy aging among older adults.
Collapse
Affiliation(s)
- Junjie Lin
- School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
| | - Kunyi Wang
- School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
| | - Yu Zhang
- School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
| | - Kexin Lu
- School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
| | - Huilin Xia
- School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
| | - Minxia Hua
- School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China
| | - Weijun Zheng
- Department of Medical Statistics, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, 310053, China
| | - Rucheng Chen
- School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, 310053, Zhejiang Province, China.
| |
Collapse
|
10
|
You R, Li W, Ni L, Peng B. Study on the trajectory of depression among middle-aged and elderly disabled people in China: Based on group-based trajectory model. SSM Popul Health 2023; 24:101510. [PMID: 37736259 PMCID: PMC10509349 DOI: 10.1016/j.ssmph.2023.101510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/09/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023] Open
Abstract
Background Previous studies have shown that middle-aged and elderly adults with disabilities are at higher risk for depressive symptoms. However, there are few studies on the long-term trajectories of depressive symptoms in the Chinese middle-aged and elderly disabled population. Objective This study aimed to identify the different development trajectories of depressive symptoms and their influencing factors in middle-aged and elderly people with disabilities in China. Methods Using data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018, a longitudinal cohort was formed for the study. A total of 2053 participants underwent at least two measures of depressive symptoms, assessed using the Center for Epidemiological Studies Depression Scale (CES-D10), a depression symptom assessment scale. We constructed a Group-Based Trajectory Model (GBTM) to identify the development trajectory of depressive symptoms in 2053 middle-aged and elderly disabled individuals, screened the potential predictors using lasso regression, and analyzed the factors affecting the development trajectory of depression through multivariate logistic regression. Results We identified four depression symptom trajectories throughout the follow-up process: "low depressive symptom group", "worsening depressive symptom group", "relieved depressive symptom group", and "high depressive symptom group". We found that there were differences in basic characteristics among different subgroups of depression trajectory. However, middle-aged and elderly disabled women living in rural areas, with limited ADL or IADL, physical pain, poor self-reported health and self-reported memory, short sleep time, and no relatives and friends to take care of them were the key groups for the prevention and treatment of depressive symptoms. Conclusion There is heterogeneity in the trajectories of depressive symptoms in the Chinese middle-aged and elderly disabled population, it is necessary to focus on the characteristics of the trajectories of different subgroups.
Collapse
Affiliation(s)
| | | | - Linghao Ni
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| | - Bin Peng
- School of Public Health, Chongqing Medical University, Chongqing, 400016, China
| |
Collapse
|
11
|
Dai Y, Zhang J, Wang Z, Ding J, Xu S, Zhang B, Guo J, Qi X, Chang X, Wu C, Zhou Z. Per- and polyfluoroalkyl substances in umbilical cord serum and body mass index trajectories from birth to age 10 years: Findings from a longitudinal birth cohort (SMBCS). Environ Int 2023; 180:108238. [PMID: 37783122 DOI: 10.1016/j.envint.2023.108238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) has been linked to low birth weight but higher childhood weight and obesity. However, little is known regarding the associations between PFAS exposure and dynamic body mass index (BMI) trajectories, particularly from birth through preadolescence. OBJECTIVE To evaluate the associations of cord serum PFAS concentrations with BMI trajectories from birth to age 10 years and longitudinal BMI in different periods. METHODS Based on 887 mother-child pairs in the longitudinal prospective birth cohort, we measured 12 PFAS congeners in cord serum and calculated BMI with anthropometric indicators at 9 follow-up time points from birth to age 10 years. The BMI trajectories were identified using group-based trajectory model (GBTM). To estimate the associations of cord serum PFAS levels with BMI trajectories and longitudinal changes in BMI, logistic regression models, linear mixed models, Bayesian kernel machine regression, and quantile-based g-computation models (QGC) were used. RESULTS The median concentrations of 10 PFAS congeners included in statistical analysis ranged from 0.047 to 3.623 μg/L. Two BMI trajectory classes were identified by GBTM, characterized by high group and low group. In logistic regression models, five PFAS congeners (PFBA, PFHpA, PFHxS, PFHpS, and PFDoDA) were associated with the higher probability of being in high BMI trajectory group (odds ratio, OR: 1.21 to 1.74, p < 0.05). Meanwhile, higher PFAS mixture were related to elevated odds for the high group in both BKMR models and QGC models, with PFHpA and PFHpS being the two most important drivers jointly. In the sex-stratified analysis, the positive associations remained significant exclusively among males. In the longitudinal analysis, PFUnDA and PFDoDA were associated with increased BMI from birth to age 10 years. Furthermore, PFBS and PFHpA were negatively related to BMI throughout infancy and toddlerhood (from birth to age 3 years), whereas PFDoDA confirmed a positive association with mid-childhood (from age 6 to 10 years) BMI. CONCLUSIONS Prenatal PFAS exposure was positively associated with BMI trajectories from birth to preadolescence and longitudinal BMI in various periods. Future research could use better trajectory modeling strategies to shape more complete growth trajectories and explore the relationship between BMI trajectories and adulthood health.
Collapse
Affiliation(s)
- Yiming Dai
- Key Laboratory of Public Health Safety of Ministry of Education, Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, No.130 Dong'an Road, Shanghai 200032, China
| | - Jiming Zhang
- Key Laboratory of Public Health Safety of Ministry of Education, Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, No.130 Dong'an Road, Shanghai 200032, China.
| | - Zheng Wang
- Key Laboratory of Public Health Safety of Ministry of Education, Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, No.130 Dong'an Road, Shanghai 200032, China
| | - Jiayun Ding
- Key Laboratory of Public Health Safety of Ministry of Education, Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, No.130 Dong'an Road, Shanghai 200032, China
| | - Sinan Xu
- Key Laboratory of Public Health Safety of Ministry of Education, Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, No.130 Dong'an Road, Shanghai 200032, China
| | - Boya Zhang
- Key Laboratory of Public Health Safety of Ministry of Education, Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, No.130 Dong'an Road, Shanghai 200032, China
| | - Jianqiu Guo
- Key Laboratory of Public Health Safety of Ministry of Education, Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, No.130 Dong'an Road, Shanghai 200032, China
| | - Xiaojuan Qi
- Key Laboratory of Public Health Safety of Ministry of Education, Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, No.130 Dong'an Road, Shanghai 200032, China; Zhejiang Provincial Center for Disease Control and Prevention, No. 3399 Binsheng Road, Hangzhou 310051, China
| | - Xiuli Chang
- Key Laboratory of Public Health Safety of Ministry of Education, Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, No.130 Dong'an Road, Shanghai 200032, China
| | - Chunhua Wu
- Key Laboratory of Public Health Safety of Ministry of Education, Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, No.130 Dong'an Road, Shanghai 200032, China
| | - Zhijun Zhou
- Key Laboratory of Public Health Safety of Ministry of Education, Key Laboratory of Health Technology Assessment of National Health Commission, School of Public Health, Fudan University, No.130 Dong'an Road, Shanghai 200032, China.
| |
Collapse
|
12
|
Zhou X, Ma X, Gao S, Ma Y, Gao J, Jiang H, Zhu W, Hong N, Long Y, Su L. Measuring the worldwide spread of COVID-19 using a comprehensive modeling method. BMC Med Inform Decis Mak 2023; 21:384. [PMID: 37715170 PMCID: PMC10504693 DOI: 10.1186/s12911-023-02213-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/20/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND With the global spread of COVID-19, detecting high-risk countries/regions timely and dynamically is essential; therefore, we sought to develop automatic, quantitative and scalable analysis methods to observe and estimate COVID-19 spread worldwide and further generate reliable and timely decision-making support for public health management using a comprehensive modeling method based on multiple mathematical models. METHODS We collected global COVID-19 epidemic data reported from January 23 to September 30, 2020, to observe and estimate its possible spread trends. Countries were divided into three outbreak levels: high, middle, and low. Trends analysis was performed by calculating the growth rate, and then country grouping was implemented using group-based trajectory modeling on the three levels. Individual countries from each group were also chosen to further disclose the outbreak situations using two predicting models: the logistic growth model and the SEIR model. RESULTS All 187 observed countries' trajectory subgroups were identified using two grouping strategies: with and without population consideration. By measuring epidemic trends and predicting the epidemic size and peak of individual countries, our study found that the logistic growth model generally estimated a smaller epidemic size than the SEIR model. According to SEIR modeling, confirmed cases in each country would take an average of 9-12 months to reach the outbreak peak from the day the first case occurred. Additionally, the average number of cases at the peak time will reach approximately 10-20% of the countries' populations, and the countries with high trends and a high predicted size must pay special attention and implement public health interventions in a timely manner. CONCLUSIONS We demonstrated comprehensive observations and predictions of the COVID-19 outbreak in 187 countries using a comprehensive modeling method. The methods proposed in this study can measure COVID-19 development from multiple perspectives and are generalizable to other epidemic diseases. Furthermore, the methods also provide reliable and timely decision-making support for public health management.
Collapse
Affiliation(s)
- Xiang Zhou
- Department of Critical Care Medicine, State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xudong Ma
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Sifa Gao
- Department of Medical Administration, National Health Commission of the People's Republic of China, Beijing, 100044, China
| | - Yingying Ma
- Digital Health China Technologies Co. Ltd, Beijing, 100080, China
| | - Jianwei Gao
- Digital Health China Technologies Co. Ltd, Beijing, 100080, China
| | - Huizhen Jiang
- Department of Information Management, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Weiguo Zhu
- Department of Information Management, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Na Hong
- Digital Health China Technologies Co. Ltd, Beijing, 100080, China.
| | - Yun Long
- Department of Critical Care Medicine, State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Longxiang Su
- Department of Critical Care Medicine, State Key Laboratory for Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
| |
Collapse
|
13
|
Li W, Wen CP, Li W, Ying Z, Pan S, Li Y, Zhu Z, Yang M, Tu H, Guo Y, Song Z, Chu DTW, Wu X. 6-Year trajectory of fasting plasma glucose (FPG) and mortality risk among individuals with normal FPG at baseline: a prospective cohort study. Diabetol Metab Syndr 2023; 15:169. [PMID: 37574540 PMCID: PMC10424387 DOI: 10.1186/s13098-023-01146-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Higher fasting plasma glucose (FPG) levels were associated with an increased risk of all-cause mortality; however, the associations between long-term FPG trajectory groups and mortality were unclear, especially among individuals with a normal FPG level at the beginning. The aims of this study were to examine the associations of FPG trajectories with the risk of mortality and identify modifiable lifestyle factors related to these trajectories. METHODS We enrolled 50,919 individuals aged ≥ 20 years old, who were free of diabetes at baseline, in the prospective MJ cohort. All participants completed at least four FPG measurements within 6 years after enrollment and were followed until December 2011. FPG trajectories were identified by group-based trajectory modeling. We used Cox proportional hazards models to examine the associations of FPG trajectories with mortality, adjusting for age, sex, marital status, education level, occupation, smoking, drinking, physical activity, body mass index, baseline FPG, hypertension, dyslipidemia, cardiovascular disease or stroke, and cancer. Associations between baseline lifestyle factors and FPG trajectories were evaluated using multinomial logistic regression. RESULTS We identified three FPG trajectories as stable (n = 32,481), low-increasing (n = 17,164), and high-increasing (n = 1274). Compared to the stable group, both the low-increasing and high-increasing groups had higher risks of all-cause mortality (hazard ratio (HR) = 1.18 (95% CI 0.99-1.40) and 1.52 (95% CI 1.09-2.13), respectively), especially among those with hypertension. Compared to participants with 0 to 1 healthy lifestyle factor, those with 6 healthy lifestyle factors were more likely to be in the stable group (ORlow-increasing = 0.61, 95% CI 0.51-0.73; ORhigh-increasing = 0.20, 95% CI 0.13-0.32). CONCLUSIONS Individuals with longitudinally increasing FPG had a higher risk of mortality even if they had a normal FPG at baseline. Adopting healthy lifestyles may prevent individuals from transitioning into increasing trajectories.
Collapse
Affiliation(s)
- Wanlu Li
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chi Pang Wen
- National Institute for Data Science in Health and Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China
| | - Wenyuan Li
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhijun Ying
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Sai Pan
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yizhan Li
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zecheng Zhu
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Min Yang
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Nutrition and Food Hygiene School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Huakang Tu
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yi Guo
- Department of Health Management Center and Department of General Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Zhenya Song
- Department of Health Management Center and Department of General Medicine, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China
| | | | - Xifeng Wu
- Department of Big Data in Health Science School of Public Health, and Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
- National Institute for Data Science in Health and Medicine, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, China.
- The Key Laboratory of Intelligent Preventive Medicine of Zhejiang Province, Hangzhou, Zhejiang, China.
- Cancer Center, Zhejiang University, Hangzhou, Zhejiang, China.
- School of Medicine and Health Science, George Washington University, Washington, DC, USA.
| |
Collapse
|
14
|
Han S, Lee JY, Cho SI, Oh DJ, Yoon DH. Risk Factors for Various Cognitive Function Decline Trajectories in Adults Over 40 Years of Age: A Retrospective Cohort Study. Psychiatry Investig 2023; 20:293-300. [PMID: 37005386 PMCID: PMC10151656 DOI: 10.30773/pi.2022.0188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 09/18/2022] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE The aims of our study were to identify distinct trajectories of cognitive function using the group-based trajectory model. We also investigate which demographic factors act as risk factors for cognitive decline in each group. METHODS The data from the Seoul National University Hospital Healthcare System Gangnam Center, from 2005 to 2019. The number of study subjects was 637. We used a group-based model to identify cognitive function trajectories. Multinomial logistic regression was employed to define risk factors for cognitive function decline. RESULTS The cognitive function trajectories among adults over 40 years of age were heterogeneous. We identified four trajectories: high (27.3%), medium (41.0%), low (22.7%), and rapid decline (9.1%). Older age, male, low educational level, bad dietary habits, diabetes mellitus, technical worker, and lower income increased the likelihood of a cognitive function decline. CONCLUSION A younger age, a higher educational level, professional worker, good dietary habits, no diabetes mellitus, and no obesity improved cognitive function. A combination of these factors can improve "cognitive reserve" and delay cognitive decline. Interventions to prevent cognitive decline are needed after identification of high-risk groups for cognitive decline.
Collapse
Affiliation(s)
- Sujeong Han
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Medical Device Development, Seoul National University, Seoul, Republic of Korea
| | - Sung-Il Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Dae Jong Oh
- Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dae Hyun Yoon
- Department of Psychiatry, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
15
|
Wang X, Zhang T, Chang Q, Wang C, Wang K, Yu Z, Zhang H, Huang H, Song D, Peixoto E, Yang J, Li C, Cui Z, Liu Y, Ma J. The risk of acute and early HIV (AEH) infection among MSM with different behaviour trajectories: an open cohort study in Tianjin, China, 2011-2019. BMC Infect Dis 2023; 23:37. [PMID: 36670349 PMCID: PMC9862950 DOI: 10.1186/s12879-023-08001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 01/10/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Acute and early HIV (AEH) infection is characterized by a high viral load and infectivity. Approximately 50% of cases of HIV-1 transmission occur during AEH. Understanding sexual behaviour trajectories would be useful for predicting changes in the risk of HIV acquisition. However, few studies have investigated sexual behaviour trajectories and their association with AEH acquisition. This study identified behaviour trajectories among men who have sex with men (MSM), determined the risk of AEH infection, and compared risk factors between different behaviour trajectories. METHODS The study was based on an ongoing prospective open cohort of voluntary HIV counselling and testing (VHCT) among MSM in Tianjin, China. From 2011 to 2019, 1974 MSM were recruited. Group-based trajectory modelling (GBTM) was used to identify behaviour trajectories by constructing a sexual risk behaviour score. Logistic regression and generalized estimating equation (GEE) were used to compare the risk of AEH infection and risk factors for different behaviour trajectories. All data analyses were performed using SAS 9.4. RESULTS The incidence of AEH infection was 1.76/100 person-years, with 64 AEH infections documented in 3633 person-years of follow-up. Three sexual behaviour trajectories were identified: CL (consistently low risk, 35.46%), CH (consistently high risk, 42.71%) and HTL (high to low risk, 21.83%). MSM in the HTL and CH groups had higher AEH infection rates than MSM in the CL group (6.73%, 3.08% and 1.28%, respectively), with ORs of 5.54 (2.60, 11.82) and 2.44 (1.14, 5.25), respectively. MSM aged 30-50 years old and MSM who underwent HIV testing in the last year were more likely to be in the CH group and HTL group. In addition, the HTL group was characterized by a lower likelihood of local registration and a higher likelihood of working as a MSW. CONCLUSION MSM in the CH group and the HTL group had a higher risk of AEH infection. In the future, VHCT should be performed more often among younger MSM, and HIV counselling should be given the same priority as HIV testing. In addition, VHCT combined with PrEP may have a better preventive impact on MSM with a high risk of AEH infection.
Collapse
Affiliation(s)
- Xiaomeng Wang
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Tiantian Zhang
- grid.506261.60000 0001 0706 7839Medical Service Division, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Qinxue Chang
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Chun Wang
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Keyun Wang
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Zeyang Yu
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Honglu Zhang
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Huijie Huang
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Desheng Song
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Elissa Peixoto
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Jie Yang
- “Shenlan” Public Health Counseling Service Center, Tianjin, China
| | - Changping Li
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Zhuang Cui
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Yuanyuan Liu
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| | - Jun Ma
- grid.265021.20000 0000 9792 1228Department of Epidemiology and Biostatistics, Tianjin Medical University, 22, Qixiangtai Road, Heping District, Tianjin, 300070 China
| |
Collapse
|
16
|
Lin Z, Zheng J, Liu X, Hu X, Fuxian R, Gao D. Assessing potassium levels in critically ill patients with heart failure: application of a group-based trajectory model. ESC Heart Fail 2022; 10:57-65. [PMID: 36151847 PMCID: PMC9871702 DOI: 10.1002/ehf2.14161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/06/2022] [Accepted: 09/12/2022] [Indexed: 01/27/2023] Open
Abstract
AIMS Abnormalities in potassium homeostasis are frequently seen in hospitalized patients. A poor outcome in heart failure (HF) has been linked to both hypokalaemia and hyperkalaemia. The studies on the connection between variations in potassium levels and all-cause mortality remain scarce. We delineated trajectories of potassium levels and investigated the association of these trajectories with all-cause mortality of critically ill patients with HF. METHODS AND RESULTS A retrospective analysis of blood potassium levels (9 times) in patients with HF after being admitted to the intensive care unit (ICU). Potassium levels were divided into three groups according to the first serum potassium level in ICU and thereafter categorized as follows: hypokalaemia group (n = 336) (<3.5 mmol/L), normal blood potassium-level group (n = 3322) (3.5-5.0 mmol/L), and hyperkalaemia group (n = 395) (>5.0 mmol/L). According to the group-based trajectory modelling (GBTM), the hyperkalaemia group and the normal blood potassium-level group can be divided into three trajectory groups: the low-level stable group, the medium-level stable group, and the high-level decline group. The hypokalaemia group can be divided into two trajectory groups: the low-level rise group and the high-level rise group. A total of 4053 HF patients were included (mean age 71.81 ± 13.12 years, 54.90% males, 45.10% females). After adjusting for possible confounding variables, in the hyperkalaemia group, the low-level stable group had lower 28 day [high-level decline group vs. low-level stable group hazard ratio (HR), 95% confidence interval (CI): 2.917, 1.555-5.473; P < 0.05] and 365 day (high-level decline group vs. low-level stable group HR, 95% CI: 2.854, 1.820-4.475; P < 0.05) all-cause mortality. In the normal blood potassium-level group, the medium-level stable group had lower 28 day (medium-level stable group vs. low-level stable group HR, 95% CI: 0.776, 0.657-0.918; P < 0.05) and 365 day (medium-level stable group vs. low-level stable group HR, 95% CI: 0.827, 0.733-0.934; P < 0.05) all-cause mortality. In the hypokalaemia group, the cumulative survival of the high-level rise group and the low-level rise group did not differ significantly. CONCLUSIONS Critically ill patients with HF have blood potassium trajectories. And the trajectories are associated with all-cause mortality for hyperkalaemia and normal blood potassium-level patients. GBTM is a granular method to describe the evolution of blood potassium, which may increase the current knowledge of blood potassium-level adjustment.
Collapse
Affiliation(s)
- Zehao Lin
- Department of CardiologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityNo. 157, Xiwu RdXi'anChina
| | - Jiawei Zheng
- Department of CardiologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityNo. 157, Xiwu RdXi'anChina
| | - Xiaochun Liu
- Department of CardiologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityNo. 157, Xiwu RdXi'anChina
| | - Xiaojun Hu
- Department of CardiologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityNo. 157, Xiwu RdXi'anChina
| | - Ren Fuxian
- Department of Cardiology, Meishan Branch of the Third Affiliated HospitalYan'an University School of MedicineMeishanSichuanChina
| | - Dengfeng Gao
- Department of CardiologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityNo. 157, Xiwu RdXi'anChina
| |
Collapse
|
17
|
Tian F, Yang H, Pan J. Association between functional disability and long-term trajectories of depressive symptoms: Evidence from the China Health and Retirement Longitudinal Study. J Affect Disord 2022; 310:10-16. [PMID: 35525506 DOI: 10.1016/j.jad.2022.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/17/2022] [Accepted: 05/02/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Prior research has suggested that functional disability was associated with increased risk of incident depressive symptoms in the elderly. However, little is known about the potential role of functional disability on the long-term trajectories of depressive symptoms among middle-aged and older Chinese adults. METHODS Data were drawn from the China Health and Retirement Longitudinal Study. A total of 8415 participants with up to four measurements of depressive symptoms assessed by the Center for Epidemiologic Studies Depression Scale (CESD) were included. Functional disability was evaluated by activities of daily living (ADLs) and instrumental ADLs (IADLs) at baseline. We identified the trajectories of depressive symptoms over 7-year follow-up using group-based trajectory modelling, and examined the association between functional disability and depressive symptom trajectories using multinomial logistic regression. RESULTS We identified four trajectories of depressive symptoms throughout the follow-up, characterized by maintaining a low CES-D score (low symptoms); maintaining a moderate CES-D score (moderate symptoms); increasing progressively and reaching a high CES-D score at the end of follow-up (increasing symptom); and increasing quickly and maintaining a high CES-D score (high symptoms). We found that participants with severe functional disability were at increased likelihood of being in the moderate (odds ratio [OR] = 2.27, 95% confidence interval [CI] 1.68-3.07), increasing (OR = 2.31, 95% CI 1.49-3.59), and high (OR = 4.74, 95% CI 3.07-7.31) depressive symptom trajectories. LIMITATIONS Depressive symptoms and functional disability were evaluated based on self-reported scales. CONCLUSIONS Our findings suggest that functional disability was associated with unfavorable depressive symptom trajectories among middle-aged and older Chinese adults.
Collapse
Affiliation(s)
- Fan Tian
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huazhen Yang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China; Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China; Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
18
|
Yuan Y, Lapane KL, Tjia J, Baek J, Liu SH, Ulbricht CM. Trajectories of physical frailty and cognitive impairment in older adults in United States nursing homes. BMC Geriatr 2022; 22:339. [PMID: 35439970 PMCID: PMC9017032 DOI: 10.1186/s12877-022-03012-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/29/2022] [Indexed: 12/04/2022] Open
Abstract
Background U.S. nursing homes provide long-term care to over 1.2 million older adults, 60% of whom were physically frail and 68% had moderate or severe cognitive impairment. Limited research has examined the longitudinal experience of these two conditions in older nursing home residents. Methods This national longitudinal study included newly-admitted non-skilled nursing care older residents who had Minimum Data Set (MDS) 3.0 (2014–16) assessments at admission, 3 months, and 6 months (n = 266,001). Physical frailty was measured by FRAIL-NH and cognitive impairment by the Brief Interview for Mental Status. Separate sets of group-based trajectory models were fitted to identify the trajectories of physical frailty and trajectories of cognitive impairment, and to estimate the association between older residents’ characteristics at admission with each set of trajectories. A dual trajectory model was used to quantify the association between the physical frailty trajectories and cognitive impairment trajectories. Results Over the course of the first six months post-admission, five physical frailty trajectories [“Consistently Frail” (prevalence: 53.0%), “Consistently Pre-frail” (29.0%), “Worsening Frailty” (7.6%), “Improving Frailty” (5.5%), and “Consistently Robust” (4.8%)] and three cognitive impairment trajectories [“Consistently Severe Cognitive Impairment” (35.5%), “Consistently Moderate Cognitive Impairment” (31.8%), “Consistently Intact/Mild Cognitive Impairment” (32.7%)] were identified. One in five older residents simultaneously followed the trajectories of “Consistently Frail” and “Consistently Severe Cognitive Impairment”. Characteristics associated with higher odds of the “Improving Frailty”, “Worsening Frailty”, “Consistently Pre-frail” and “Consistently Frail” trajectories included greater at-admission cognitive impairment, age ≥ 85 years, admitted from acute hospitals, cardiovascular/metabolic diagnoses, neurological diagnoses, hip or other fractures, and presence of pain. Characteristics associated with higher odds of the “Consistently Moderate Cognitive Impairment” and “Consistently Severe Cognitive Impairment” included worse at-admission physical frailty, neurological diagnoses, hip fracture, and receipt of antipsychotics. Conclusions Findings provided information regarding the trajectories of physical frailty, the trajectories of cognitive impairment, the association between the two sets of trajectories, and their association with residents’ characteristics in older adults’ first six months post-admission to U.S. nursing homes. Understanding the trajectory that the residents would most likely follow may provide information to develop a comprehensive care approach tailored to their specific healthcare goals. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03012-8.
Collapse
Affiliation(s)
- Yiyang Yuan
- Clinical and Population Health Research PhD Program, Graduate School of Biomedical Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA. .,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | - Kate L Lapane
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jennifer Tjia
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jonggyu Baek
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Shao-Hsien Liu
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Christine M Ulbricht
- Formerly: Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.,Currently: National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
19
|
Yang R, Han D, Zhang L, Huang T, Xu F, Zheng S, Yin H, Lyu J. Analysis of the correlation between the longitudinal trajectory of SOFA scores and prognosis in patients with sepsis at 72 hour after admission based on group trajectory modeling. J Intensive Med 2022; 2:39-49. [PMID: 36789228 DOI: 10.1016/j.jointm.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/26/2021] [Accepted: 11/08/2021] [Indexed: 11/22/2022]
Abstract
Background To identify the distinct trajectories of the Sequential Organ Failure Assessment (SOFA) scores at 72 h for patients with sepsis in the Medical Information Mart for Intensive Care (MIMIC)-IV database and determine their effects on mortality and adverse clinical outcomes. Methods A retrospective cohort study was carried out involving patients with sepsis from the MIMIC-IV database. Group-based trajectory modeling (GBTM) was used to identify the distinct trajectory groups for the SOFA scores in patients with sepsis in the intensive care unit (ICU). The Cox proportional hazards regression model was used to investigate the relationship between the longitudinal change trajectory of the SOFA score and mortality and adverse clinical outcomes. Results A total of 16,743 patients with sepsis were included in the cohort. The median survival age was 66 years (interquartile range: 54-76 years). The 7-day and 28-day in-hospital mortality were 6.0% and 17.6%, respectively. Five different trajectories of SOFA scores according to the model fitting standard were determined: group 1 (32.8%), group 2 (30.0%), group 3 (17.6%), group 4 (14.0%) and group 5 (5.7%). Univariate and multivariate Cox regression analyses showed that, for different clinical outcomes, trajectory group 1 was used as the reference, while trajectory groups 2-5 were all risk factors associated with the outcome (P < 0.001). Subgroup analysis revealed an interaction between the two covariates of age and mechanical ventilation and the different trajectory groups of patients' SOFA scores (P < 0.05). Conclusion This approach may help identify various groups of patients with sepsis, who may be at different levels of risk for adverse health outcomes, and provide subgroups with clinical importance.
Collapse
|
20
|
DuPre NC, Karimi S, Zhang CH, Blair L, Gupta A, Alharbi LMA, Alluhibi M, Mitra R, McKinney WP, Little B. County-level demographic, social, economic, and lifestyle correlates of COVID-19 infection and death trajectories during the first wave of the pandemic in the United States. Sci Total Environ 2021; 786:147495. [PMID: 33971599 PMCID: PMC8091799 DOI: 10.1016/j.scitotenv.2021.147495] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND The US COVID-19 epidemic impacted counties differently across space and time, though large-scale transmission dynamics are unclear. The study's objective was to group counties with similar trajectories of COVID-19 cases and deaths and identify county-level correlates of the distinct trajectory groups. METHODS Daily COVID-19 cases and deaths were obtained from 3141 US counties from January through June 2020. Clusters of epidemic curve trajectories of COVID-19 cases and deaths per 100,000 people were identified with Proc Traj. We utilized polytomous logistic regression to estimate Odds Ratios for trajectory group membership in relation to county-level demographics, socioeconomic factors, school enrollment, employment and lifestyle data. RESULTS Six COVID-19 case trajectory groups and five death trajectory groups were identified. Younger counties, counties with a greater proportion of females, Black and Hispanic populations, and greater employment in private sectors had higher odds of being in worse case and death trajectories. Percentage of counties enrolled in grades 1-8 was associated with earlier-start case trajectories. Counties with more educated adult populations had lower odds of being in worse case trajectories but were generally not associated with worse death trajectories. Counties with higher poverty rates, higher uninsured, and more living in non-family households had lower odds of being in worse case and death trajectories. Counties with higher smoking rates had higher odds of being in worse death trajectory counties. DISCUSSION In the absence of clear guidelines and personal protection, smoking, racial and ethnic groups, younger populations, social, and economic factors were correlated with worse COVID-19 epidemics that may reflect population transmission dynamics during January-June 2020. After vaccination of high-risk individuals, communities with higher proportions of youth, communities of color, smokers, and workers in healthcare, service and goods industries can reduce viral spread by targeting vaccination programs to these populations and increasing access and education on non-pharmaceutical interventions.
Collapse
Affiliation(s)
- Natalie C DuPre
- University of Louisville School of Public Health and Information Sciences, Department of Epidemiology and Population Health, United States of America.
| | - Seyed Karimi
- University of Louisville School of Public Health and Information Sciences, Department of Health Management and System Sciences, United States of America; Louisville Metro Department of Public Health and Wellness, Center for Health Equity, United States of America
| | - Charlie H Zhang
- University of Louisville, College of Arts and Sciences, Department of Geography and Geosciences, United States of America
| | - Lyndsey Blair
- University of Louisville School of Public Health and Information Sciences, Department of Epidemiology and Population Health, United States of America
| | - Arushi Gupta
- University of Louisville, School of Public Health and Information Sciences, United States of America
| | - Lamyaa Mousa A Alharbi
- University of Louisville School of Public Health and Information Sciences, Department of Bioinformatics and Biostatistics, United States of America
| | - Mariyam Alluhibi
- University of Louisville School of Public Health and Information Sciences, Department of Bioinformatics and Biostatistics, United States of America
| | - Riten Mitra
- University of Louisville School of Public Health and Information Sciences, Department of Bioinformatics and Biostatistics, United States of America
| | - W Paul McKinney
- University of Louisville School of Public Health and Information Sciences, Department of Health Promotion and Behavioral Sciences, United States of America
| | - Bert Little
- University of Louisville School of Public Health and Information Sciences, Department of Health Management and System Sciences, United States of America
| |
Collapse
|
21
|
Wang MP, Jiang L, Zhu B, Du B, Li W, He Y, Xi XM. Association of fluid balance trajectories with clinical outcomes in patients with septic shock: a prospective multicenter cohort study. Mil Med Res 2021; 8:40. [PMID: 34225807 PMCID: PMC8258941 DOI: 10.1186/s40779-021-00328-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 05/25/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Septic shock has a high incidence and mortality rate in Intensive Care Units (ICUs). Earlier intravenous fluid resuscitation can significantly improve outcomes in septic patients but easily leads to fluid overload (FO), which is associated with poor clinical outcomes. A single point value of fluid cannot provide enough fluid information. The aim of this study was to investigate the impact of fluid balance (FB) latent trajectories on clinical outcomes in septic patients. METHODS Patients were diagnosed with septic shock during the first 48 h, and sequential fluid data for the first 3 days of ICU admission were included. A group-based trajectory model (GBTM) which is designed to identify groups of individuals following similar developmental trajectories was used to identify latent subgroups of individuals following a similar progression of FB. The primary outcomes were hospital mortality, organ dysfunction, major adverse kidney events (MAKE) and severe respiratory adverse events (SRAE). We used multivariable Cox or logistic regression analysis to assess the association between FB trajectories and clinical outcomes. RESULTS Nine hundred eighty-six patients met the inclusion criteria and were assigned to GBTM analysis, and three latent FB trajectories were detected. 64 (6.5%), 841 (85.3%), and 81 (8.2%) patients were identified to have decreased, low, and high FB, respectively. Compared with low FB, high FB was associated with increased hospital mortality [hazard ratio (HR) 1.63, 95% confidence interval (CI) 1.22-2.17], organ dysfunction [odds ratio (OR) 2.18, 95% CI 1.22-3.42], MAKE (OR 1.80, 95% CI 1.04-2.63) and SRAE (OR 2.33, 95% CI 1.46-3.71), and decreasing FB was significantly associated with decreased MAKE (OR 0.46, 95% CI 0.29-0.79) after adjustment for potential covariates. CONCLUSION Latent subgroups of septic patients followed a similar FB progression. These latent fluid trajectories were associated with clinical outcomes. The decreasing FB trajectory was associated with a decreased risk of hospital mortality and MAKE.
Collapse
Affiliation(s)
- Mei-Ping Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10, Xitoutiao, You'anmen, Beijing, Fengtai District, China.,Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, No. 20, Street Fuxingmenwai, Beijing, Xicheng District, China
| | - Li Jiang
- Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Bo Zhu
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, No. 20, Street Fuxingmenwai, Beijing, Xicheng District, China
| | - Bin Du
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Wen Li
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, No. 20, Street Fuxingmenwai, Beijing, Xicheng District, China
| | - Yan He
- Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10, Xitoutiao, You'anmen, Beijing, Fengtai District, China.
| | - Xiu-Ming Xi
- Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, No. 20, Street Fuxingmenwai, Beijing, Xicheng District, China.
| | | |
Collapse
|
22
|
Chen X, Wang YY, Sun XY, Hu XY, Zhu FF, Sun Y. [Pattern of sugar-sweetened beverages consumption-based on group-based trajectory modeling and its association with childhood periodontal health]. Zhonghua Liu Xing Bing Xue Za Zhi 2020; 41:1308-12. [PMID: 32867441 DOI: 10.3760/cma.j.cn112338-20190826-00627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the prospective association between consumption pattern of sugar-sweetened beverages and childhood periodontal health. Methods: This study was based on a 4-year longitudinal cohort of children from Bengbu, Anhui province. Pattern of sugar-sweetened beverages was determined by group-based trajectory modeling (GBTM) through annual child-reported questionnaire. Association between sugar-sweetened beverages pattern with plague index and gingivitis was explored through multivariate linear and logistic regression. Results: A total of 997 children including 418 boys and 579 girls were included in this study, with an average age of (11.00±0.70) years at the final wave. Four consumption patterns on sugar-sweetened beverages were identified by GBTM: persistent low group (80.70%), gradually decreasing group (12.40%), decreasing after increasing group (2.20%) and gradually increasing group (4.70%). Compared with the persistent low group (1.08±0.70), the Plague index among gradually increasing group (1.73±0.80) was significantly higher (t=4.00, P<0.001). The prevalence of gingivitis was significantly higher among children in the gradually increasing group (12.80%) than that in the persistent low group (3.00%) (χ(2)=12.40, P<0.001). After controlling for related confounders, results suggested that Plague index increased by 0.58 (95%CI: 0.27-0.89) and 0.38 (95%CI: 0.03-0.73) in the gradually increasing group and "decreasing follow the increase" group, respectively when compared with the persistent low group. The risk for gingivitis was 4.42 times (95%CI: 1.65-12.20, P=0.003) higher in the gradually increasing group. Conclusion: Our data suggested that children with higher sugar-sweetened beverages consumption during the transition period from childhood to adolescence were under higher risk for periodontal diseases.
Collapse
|
23
|
Pellowski JA, Bengtson AM, Barnett W, DiClemente K, Koen N, Zar HJ, Stein DJ. Perinatal depression among mothers in a South African birth cohort study: Trajectories from pregnancy to 18 months postpartum. J Affect Disord 2019; 259:279-287. [PMID: 31454590 PMCID: PMC6851529 DOI: 10.1016/j.jad.2019.08.052] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/24/2019] [Accepted: 08/17/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Perinatal depression affects 21-50% of women in South Africa and poses significant health risks to mothers and children. Trajectories of depressive symptoms change over time and have not been well characterized during the perinatal period in low and middle-income countries. METHODS Data from women enrolled in a population-based birth cohort study in Paarl, South Africa with at least 3 depression measures from pregnancy through 18 months postpartum (N = 831) were analyzed. Depressive symptoms were measured continuously using the Edinburgh Postnatal Depression Scale (EPDS). Group-based trajectory models were used to estimate trajectories of depressive symptoms during the perinatal period and multinomial multivariable models to identify predictors of trajectory group membership. RESULTS Five distinct trajectory patterns of depressive symptoms were identified: moderate levels of depressive symptoms during pregnancy but minimal postpartum (3.5%), minimal levels during pregnancy and increasing postpartum (3.7%), unstable levels peaking at 12 months postpartum (6.6%), mild levels with slight decrease postpartum (82.9%), and severe levels during pregnancy and postpartum (3.1%). Membership in the chronic severe symptom group was associated with stressful life events, sexual intimate partner violence and tobacco use. LIMITATIONS Modeling limitations prevented determining how changes in psychosocial predictors over time may influence depressive symptom trajectories. CONCLUSIONS Mild to severe depressive symptoms during pregnancy/postpartum were common among this South African cohort. Interventions to treat women with severe chronic depressive symptoms with co-occurring psychosocial issues are urgently needed.
Collapse
Affiliation(s)
- Jennifer A. Pellowski
- Department of Behavioral and Social Sciences, International Health Institute, Brown University School of Public Health, Providence, RI, USA,Corresponding author.
| | - Angela M. Bengtson
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South African Medical Research Council (SAMRC) Unit on Child & Adolescent Health, University of Cape Town, South Africa
| | - Kira DiClemente
- Department of Behavioral and Social Sciences, International Health Institute, Brown University School of Public Health, Providence, RI, USA
| | - Nastassja Koen
- Department of Psychiatry and Mental Health and South African Medical Research Council (SAMRC) Unit on Risk & Resilience in Mental Disorders, Neuroscience Institute, University of Cape Town, South Africa
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South African Medical Research Council (SAMRC) Unit on Child & Adolescent Health, University of Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health and South African Medical Research Council (SAMRC) Unit on Risk & Resilience in Mental Disorders, Neuroscience Institute, University of Cape Town, South Africa
| |
Collapse
|
24
|
Franchini M, Duku E, Armstrong V, Brian J, Bryson SE, Garon N, Roberts W, Roncadin C, Zwaigenbaum L, Smith IM. Variability in Verbal and Nonverbal Communication in Infants at Risk for Autism Spectrum Disorder: Predictors and Outcomes. J Autism Dev Disord 2018; 48:3417-31. [PMID: 29767824 DOI: 10.1007/s10803-018-3607-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Early communication impairment is among the most-reported first concerns in parents of young children with autism spectrum disorder (ASD). Using a parent-report questionnaire, we derived trajectory groups for early language and gesture acquisition in siblings at high risk for ASD and in children at low risk, during their first 2 years of life. Developmental skills at 6 months were associated with trajectory group membership representing growth in receptive language and gestures. Behavioral symptoms also predicted gesture development. All communication measures were strongly related to clinical and developmental outcomes. Trajectory groups further indicated slowest language/gesture acquisition in infants with later ASD diagnoses, in particular when associated with language delay. Overall, our results confirm considerable variability in communication development in high-risk infants.
Collapse
|
25
|
Hu X, Gu S, Sun X, Gu Y, Zhen X, Li Y, Huang M, Wei J, Dong H. Cognitive ageing trajectories and mortality of Chinese oldest-old. Arch Gerontol Geriatr 2019; 82:81-87. [PMID: 30716682 PMCID: PMC6451875 DOI: 10.1016/j.archger.2019.01.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/24/2019] [Accepted: 01/26/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aims to identify distinctive cognitive trajectories jointly with mortality probabilities and to explore factors related to the particular trajectories of cognitive ageing in China. METHOD 6842 individuals aged 80 years and above from 7 waves of the Chinese Longitudinal Healthy Longevity Survey were assessed with the Mini-Mental State Examination for up to 16 years. A group-based trajectory model was used to jointly estimate cognitive ageing and mortality trajectories; and to explore the factors related to membership of the trajectory groups. RESULTS A four-group model best fit the data. For all groups, the cognitive function declined with age according to different rates. Group 4, 3, 2, and 1 showed slow (prevalence 52.8%), moderate (31.1%), progressive (12.6%) and rapid (3.5%) cognitive decline, respectively. Mortality probability trajectories followed a hierarchy in consistence with cognitive trajectories approximately. Females, illiteracy, and those born in rural areas were less likely to belong to the most favorable trajectory group. CONCLUSIONS The heterogeneity of cognitive ageing was identified among Chinese oldest-old. Childhood socioeconomic status, especially education, was associated with the rate of cognitive decline.
Collapse
Affiliation(s)
- Xiaoqian Hu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
| | - Shuyan Gu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
| | - Xueshan Sun
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
| | - Yuxuan Gu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
| | - Xuemei Zhen
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
| | - Yuanyuan Li
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
| | - Minzhuo Huang
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
| | - Jingming Wei
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China.
| |
Collapse
|
26
|
Lee J, Jang SN, Cho SI. The Trajectories of the Number of Pain Sites and Their Associated Factors in Older Adults: Results from the Korean Longitudinal Study of Ageing. Gerontology 2018; 64:532-540. [PMID: 29969763 DOI: 10.1159/000490051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 05/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aging of the population will result in an increase in demand for pain management. Pain adversely affects physical and mental functioning in older adults and accounts for a considerable proportion of all medical expenses. OBJECTIVES This study was performed to investigate the patterns of changes in the trajectories of the number of pain sites in older adults and the factors that affect these patterns according to gender. METHODS Data were extracted for subjects that participated in the Korean Longitudinal Study of Ageing from 2006 to 2014. The study population consisted of 2,839 individuals (1,190 men and 1,649 women) ≥60 years old. A group-based trajectory model was used to determine the optimal number of subgroups and the trajectories of the number of pain sites according to gender. A multinomial regression analysis was conducted to identify factors that affect the probability of inclusion in each trajectory group. RESULTS The trajectories of the number of pain sites were consistent in both genders. Almost all women had one or more pain symptom, and a greater number of pain sites than men. Older age, longest-duration occupation requiring manual labor, lack of physical activity, depressive symptoms, and poor self-rated health were associated with a greater number of pain sites in both genders. A lower level of education, married status, and experience of injury were associated with the number of pain sites in men but not in women, while household income and chronic diseases were associated with the number of pain sites only in women. CONCLUSIONS The pain status at the early stage is predictive of future pain. In this study, we identified gender differences in the trends of the number of pain sites and associated factors. Further comprehensive studies on pain intensity and duration are required.
Collapse
Affiliation(s)
- Jiae Lee
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.,The Research Institute of Aging Society, Seoul National University, Seoul, Republic of Korea
| | - Soong-Nang Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Sung-Il Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.,Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| |
Collapse
|
27
|
Wei M, Li J, Wang H. Impact of the disability trajectory on the mortality risk of older adults in China. Arch Gerontol Geriatr 2018; 74:174-83. [PMID: 29126080 DOI: 10.1016/j.archger.2017.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 08/27/2017] [Accepted: 10/20/2017] [Indexed: 11/22/2022]
Abstract
Using data from the Chinese Longitudinal Health Longevity Survey of 2005, 2008 and 2011, the authors compared the difference in the disability trajectory (DT) of survivor, decedent and dropped-out survey respondents and examined gender differences in DT using a group-based trajectory model, gender differences in the impact of DT on mortality risk (MR) among older adults, and mediating effects of resources and health status during late life through survival analysis. This analysis shows that the DTs of the survivors, decedents and dropped-out respondents differ remarkably. The trajectories of the decedents generally begin higher and increase more rapidly. Three types of DT exist for both genders: Type 1, the "independent type"; Type 2, the "low start, rapidly increasing in late life type"; and Type 3, the "high start, rapid development type". Women are more likely to experience a DT of functional impairment. Men who experience the Type 3 trajectory suffer the highest MR, followed by those of the Type 1 and Type 2 trajectories. Women who experience the Type 3 trajectory suffer the highest MR, followed by those of the Type 2 and Type 1 trajectories. In addition, economic status, medical treatment, daily care by the family and chronic diseases mediate the impact of DT on MR for both genders, while the mediating effect of emotional support from children was only observed for women.
Collapse
|
28
|
Klijn SL, Weijenberg MP, Lemmens P, van den Brandt PA, Lima Passos V. Introducing the fit-criteria assessment plot - A visualisation tool to assist class enumeration in group-based trajectory modelling. Stat Methods Med Res 2015; 26:2424-2436. [PMID: 26265768 DOI: 10.1177/0962280215598665] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background and objective Group-based trajectory modelling is a model-based clustering technique applied for the identification of latent patterns of temporal changes. Despite its manifold applications in clinical and health sciences, potential problems of the model selection procedure are often overlooked. The choice of the number of latent trajectories (class-enumeration), for instance, is to a large degree based on statistical criteria that are not fail-safe. Moreover, the process as a whole is not transparent. To facilitate class enumeration, we introduce a graphical summary display of several fit and model adequacy criteria, the fit-criteria assessment plot. Methods An R-code that accepts universal data input is presented. The programme condenses relevant group-based trajectory modelling output information of model fit indices in automated graphical displays. Examples based on real and simulated data are provided to illustrate, assess and validate fit-criteria assessment plot's utility. Results Fit-criteria assessment plot provides an overview of fit criteria on a single page, placing users in an informed position to make a decision. Fit-criteria assessment plot does not automatically select the most appropriate model but eases the model assessment procedure. Conclusions Fit-criteria assessment plot is an exploratory, visualisation tool that can be employed to assist decisions in the initial and decisive phase of group-based trajectory modelling analysis. Considering group-based trajectory modelling's widespread resonance in medical and epidemiological sciences, a more comprehensive, easily interpretable and transparent display of the iterative process of class enumeration may foster group-based trajectory modelling's adequate use.
Collapse
Affiliation(s)
- Sven L Klijn
- 1 Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Matty P Weijenberg
- 2 Department of Epidemiology, GROW School for Oncology and Developmental Biology, Maastricht, the Netherlands
| | - Paul Lemmens
- 3 Department of Health Promotion, Maastricht, the Netherlands
| | - Piet A van den Brandt
- 4 Department of Epidemiology, GROW School for Oncology and Developmental Biology, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Valéria Lima Passos
- 1 Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|