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Tao MH, Gordon SC, Wu T, Trudeau S, Rupp LB, Gonzalez HC, Daida YG, Schmidt MA, Lu M. Antiviral Treatment and Response are Associated With Lower Risk of Dementia Among Hepatitis C Virus-Infected Patients. Am J Geriatr Psychiatry 2024; 32:611-621. [PMID: 38199936 DOI: 10.1016/j.jagp.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Eradication of hepatitis C virus (HCV) infection has been linked with improvement in neurocognitive function, but few studies have evaluated the effect of antiviral treatment/ response on risk of dementia. Using data from the Chronic Hepatitis Cohort Study (CHeCS), we investigated how antiviral therapy impacts the risk of developing dementia among patients with HCV. METHODS A total of 17,485 HCV patients were followed until incidence of dementia, death, or last follow-up. We used an extended landmark modeling approach, which included time-varying covariates and propensity score justification for treatment selection bias, as well as generalized estimating equations (GEE) with a link function as multinominal distribution for a discrete time-to-event data. Death was considered a competing risk. RESULTS After 15 years of follow-up, 342 patients were diagnosed with incident dementia. Patients who achieved sustained virological response (SVR) had significantly decreased risk of dementia compared to untreated patients, with hazard ratios (HRs) of 0.32 (95% CI 0.22-0.46) among patients who received direct-acting antiviral (DAA) treatment and 0.41 (95% CI 0.26-0.60) for interferon-based (IFN) treatment. Risk reduction remained even when patients failed antiviral treatment (HR 0.38, 95% CI 0.38-0.51). Patients with cirrhosis, Black/African American patients, and those without private insurance were at significantly higher risk of dementia. CONCLUSION Antiviral treatment independently reduced the risk of dementia among HCV patients, regardless of cirrhosis. Our findings support the importance of initiation antiviral therapy in chronic HCV-infected patients.
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Affiliation(s)
- Meng-Hua Tao
- Department of Public Health Sciences (M-HT, TW, ST, HCG, ML), Henry Ford Health, Detroit MI.
| | - Stuart C Gordon
- Department of Gastroenterology and Hepatology (SCG, HCG), Henry Ford Health, Detroit MI; School of Medicine (SCG, HCG), Wayne State University, Detroit MI
| | - Trueman Wu
- Department of Public Health Sciences (M-HT, TW, ST, HCG, ML), Henry Ford Health, Detroit MI
| | - Sheri Trudeau
- Department of Public Health Sciences (M-HT, TW, ST, HCG, ML), Henry Ford Health, Detroit MI
| | - Loralee B Rupp
- Department of Health Policy and Health Services Research (LBR), Henry Ford Health, Detroit MI
| | - Humberto C Gonzalez
- Department of Public Health Sciences (M-HT, TW, ST, HCG, ML), Henry Ford Health, Detroit MI; Department of Gastroenterology and Hepatology (SCG, HCG), Henry Ford Health, Detroit MI; School of Medicine (SCG, HCG), Wayne State University, Detroit MI
| | - Yihe G Daida
- Center for Integrated Health Care Research (YGD), Kaiser Permanente Hawaii, Honolulu, HI
| | - Mark A Schmidt
- Center for Health Research (MAS), Kaiser Permanente Northwest, Portland, OR
| | - Mei Lu
- Department of Public Health Sciences (M-HT, TW, ST, HCG, ML), Henry Ford Health, Detroit MI
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Geng C, Meng K, Tang Y. Identifying the mediating role of inflammation on the relationship between socioeconomic status and Alzheimer's disease: a Mendelian randomization analysis and mediation analysis. J Neurol 2024; 271:2484-2493. [PMID: 38253907 DOI: 10.1007/s00415-023-12176-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/25/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND AND OBJECTIVES Observational studies have demonstrated a significant association between socio-economic status (SES) and Alzheimer's disease (AD). Nonetheless, the precise biological mechanisms underlying this association remain unclear. Therefore, we adopted a Mendelian Randomization (MR) approach to investigate the causal relationship between SES and genetic susceptibility to AD, as well as to explore the potential mediation effects of inflammation. METHODS Large-scale cohorts based on publicly available genome-wide association study (GWAS) datasets from European populations were employed for conducting the MR study. The primary criterion utilized was the inverse-variance weighting (IVW) model. Heterogeneity and horizontal pleiotropy were assessed. In addition, multivariate MR (MVMR) was utilized to correct the confounders. Moreover, a two-step MR approach was used to evaluate the potential mediating effects of factors on the causal effects between SES and AD. RESULTS As indicated by the results of the IVW model, educational years (OR = 0.708, 95% CI 0.610-0.821, P < 0.001) and household income (OR = 0.746, 95% CI 0.566-0.982, P = 0.037) was associated with a decreased genetic susceptibility risk for AD. The univariable results showed that the causal effect of educational years on the lower risk of AD remained significant (OR = 0.643, 95% CI 0.467-0.886, P = 0.006). In addition, our findings indicated that C-reactive protein (CRP) played a role in the causal effect of educational years on AD. The proportions of mediation were - 50.08% (95% CI - 92.78; - 7.38%). DISCUSSION These findings provided evidence supporting the causal effect of educational attainment lower AD risk, with inflammation playing a mediating role. These findings may inform prevention strategies and interventions directed toward AD. Future studies should explore other plausible biological mechanisms.
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Affiliation(s)
- Chaofan Geng
- Department of Neurology and Innovation Center for Neurological Disorders, Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Ke Meng
- Department of Neurology and Innovation Center for Neurological Disorders, Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, 45 Changchun Street, Beijing, 100053, China
| | - Yi Tang
- Department of Neurology and Innovation Center for Neurological Disorders, Xuanwu Hospital, National Center for Neurological Disorders, Capital Medical University, 45 Changchun Street, Beijing, 100053, China.
- Neurodegenerative Laboratory of Ministry of Education of the People's Republic of China, Beijing, China.
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van der Heide FC, Valeri L, Dugravot A, Danilevicz I, Landre B, Kivimaki M, Sabia S, Singh-Manoux A. Role of cardiovascular health factors in mediating social inequalities in the incidence of dementia in the UK: two prospective, population-based cohort studies. EClinicalMedicine 2024; 70:102539. [PMID: 38516105 PMCID: PMC10955651 DOI: 10.1016/j.eclinm.2024.102539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
Background The contribution of modifiable risk factors to social inequalities in dementia, observed in longitudinal studies, remains unclear. We aimed to quantify the role of cardiovascular health factors, assessed using Life's Essential 8 (LE8) score, in mediating social inequalities in incidence of dementia and, for comparison, in incidence of stroke, coronary heart disease, and mortality. Methods In this prospective, population-based cohort study, we collected data from the UK Whitehall II Study and UK Biobank databases. Participants were included if data were available on SEP, outcomes and LE8 (smoking, physical activity, diet, body mass index, blood pressure, fasting blood glucose, lipid levels, sleep duration). The primary outcome was incident dementia and secondary outcomes were stroke, coronary heart disease, and mortality. Outcomes were derived from electronic healthcare records. Socioeconomic position (SEP) was measured by occupation in Whitehall II and education in UK Biobank. Counterfactual mediation analysis was used to quantify the extent to which LE8 score explained the associations of SEP with all outcomes. Analyses involved Cox regression, accelerated failure time models, and linear regression; and were adjusted for age, sex, and ethnicity. Findings Between 10.09.1985 and 29.03.1988, a total of 9688 participants (mean age ± SD 44.9 ± 6.0; 67% men) from the Whitehall II study, and between 19.12.2006 and 01.10.2010, 278,215 participants (mean age ± SD 56.0 ± 8.1; 47% men) from the UK Biobank were included. There were 606 and 4649 incident dementia cases over a median (interquartile range) follow-up of 31.7 (31.1-32.7) and 13.5 (12.7-14.1) years respectively in Whitehall II and UK Biobank. In Whitehall II, the hazard ratio was 1.85 [95% CI 1.42, 2.32] for the total effect of SEP on dementia and 1.20 [1.12, 1.28] for the indirect effect via the LE8, the proportion mediated being 36%. In UK Biobank, the total effect of SEP on dementia was 1.65 [1.54, 1.78]; the indirect effect was 1.11 [1.09, 1.12], and the proportion mediated was 24%. The proportions mediated for stroke, coronary heart disease, and mortality were higher, ranging between 34% and 63% in Whitehall II and between 36% and 50% in UK Biobank. Interpretation In two well-characterised cohort studies, up to one third of the social inequalities in incidence of dementia was attributable to cardiovascular health factors. Promotion of cardiovascular health in midlife may contribute to reducing social inequalities in risk of dementia, in addition to cardiovascular diseases and all-cause mortality. This study used adult measures of SEP, further research is warranted using lifecourse measures of SEP. Funding NIH (RF1AG062553).
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Affiliation(s)
- Frank C.T. van der Heide
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Linda Valeri
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Aline Dugravot
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Ian Danilevicz
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Benjamin Landre
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Mika Kivimaki
- Faculty of Brain Sciences, University College London, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Séverine Sabia
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Faculty of Brain Sciences, University College London, UK
| | - Archana Singh-Manoux
- Université Paris Cité, Inserm U1153, Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
- Faculty of Brain Sciences, University College London, UK
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Mavragani A, Ji L, Wang Q, Yang G, Xiu S, Cui T, Shi N, Zhu L, Xu X, Jin H, Zhen S. Understanding Drivers of Vaccine Hesitancy During the COVID-19 Pandemic Among Older Adults in Jiangsu Province, China: Cross-sectional Survey. JMIR Form Res 2023; 7:e39994. [PMID: 36693149 PMCID: PMC9907572 DOI: 10.2196/39994] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 12/17/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Older adults are particularly at risk from infectious diseases, including serve complications, hospitalization, and death. OBJECTIVE This study aimed to explore the drivers of vaccine hesitancy among older adults based on the "3Cs" (confidence, complacency, and convenience) framework, where socioeconomic status and vaccination history played the role of moderators. METHODS A cross-sectional questionnaire survey was conducted in Jiangsu Province, China, between June 1 and July 20, 2021. Older adults (aged ≥60 years) were recruited using a stratified sampling method. Vaccine hesitancy was influenced by the 3Cs in the model. Socioeconomic status and vaccination history processed through the item parceling method were used to moderate associations between the 3Cs and hesitancy. Hierarchical regression analyses and structural equation modeling were used to test the validity of the new framework. We performed 5000 trials of bootstrapping to calculate the 95% CI of the pathway's coefficients. RESULTS A total of 1341 older adults participated. The mean age was 71.3 (SD 5.4) years, and 44.7% (599/1341) of participants were men. Confidence (b=0.967; 95% CI 0.759-1.201; P=.002), convenience (b=0.458; 95% CI 0.333-0.590; P=.002), and less complacency (b=0.301; 95% CI 0.187-0.408; P=.002) were positively associated with less vaccine hesitancy. Socioeconomic status weakened the positive effect of low complacency (b=-0.065; P=.03) on low vaccine hesitancy. COVID-19 vaccination history negatively moderated the positive association between confidence (b=-0.071; P=.02) and lower vaccine hesitancy. CONCLUSIONS Our study identified that confidence was the more influential dimension in reducing vaccine hesitancy among older adults. COVID-19 vaccination history, as well as confidence, had a positive association with less vaccine hesitancy and could weaken the role of confidence in vaccine hesitancy. Socioeconomic status had a substitution relationship with less complacency, which suggested a competitive positive association between them on less vaccine hesitancy.
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Affiliation(s)
| | - Lili Ji
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Qiang Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Guoping Yang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Shixin Xiu
- Department of Immunization Planning, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Tingting Cui
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Naiyang Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Lin Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Xuepeng Xu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hui Jin
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China.,Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing, China
| | - Shiqi Zhen
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
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Contribution of smoking towards the association between socioeconomic position and dementia: 32-year follow-up of the Whitehall II prospective cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2022; 23:100516. [PMID: 36189426 PMCID: PMC9523395 DOI: 10.1016/j.lanepe.2022.100516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background There is consistent evidence of social inequalities in dementia but the mechanisms underlying this association remain unclear. We examined the role of smoking in midlife in socioeconomic differences in dementia at older ages. Methods Analyses were based on 9951 (67% men) participants, median age 44.3 [IQR=39.6, 50.3] years at baseline in 1985-1988, from the Whitehall II cohort study. Socioeconomic position (SEP) and smoking (smoking status (current, ex-, never-smoker), pack years of smoking, and smoking history score (combining status and pack-years)) were measured at baseline. Counterfactual mediation analysis was used to examine the contribution of smoking to the association between SEP and dementia. Findings During a median follow-up of 31.6 (IQR 31.1, 32.6) years, 628 participants were diagnosed with dementia and 2110 died. Analyses adjusted for age, sex, ethnicity, education, and SEP showed smokers (hazard ratio [HR] 1.36 [95% CI 1.10-1.68]) but not ex-smokers (HR 0.95 [95% CI 0.79-1.14]) to have a higher risk of dementia compared to never-smokers; similar results for smoking were obtained for pack-years of smoking and smoking history score. Mediation analysis showed low SEP to be associated with higher risk of dementia (HRs between 1.97 and 2.02, depending on the measure of smoking in the model); estimate for the mediation effect was 16% for smoking status (Indirect Effect HR 1.09 [95% CI 1.03-1.15]), 7% for pack-years of smoking (Indirect Effect HR 1.03 [95% CI 1.01-1.06]) and 11% for smoking history score (Indirect Effect HR 1.06 [95% CI 1.02-1.10]). Interpretation Our findings suggest that part of the social inequalities in dementia is mediated by smoking. Funding NIH.
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Korhonen K, Leinonen T, Tarkiainen L, Einiö E, Martikainen P. Childhood socio-economic circumstances and dementia: prospective register-based cohort study of adulthood socio-economic and cardiovascular health mediators. Int J Epidemiol 2022; 52:523-535. [PMID: 36343014 PMCID: PMC10114069 DOI: 10.1093/ije/dyac205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Background
This study analysed the association between childhood socio-economic circumstances and the risk of dementia, and investigated the mediating role of potentially modifiable risk factors including adulthood socio-economic position and cardiovascular health.
Methods
We used a 10% sample of the 1950 Finnish population census linked with subsequent population and health registers (n = 95 381). Information of socio-economic characteristics, family structure and housing conditions at the age of 0–15 years was obtained from the 1950 census. We identified cohort members who developed dementia in 2000–2018 using national hospital, medication and death registers. Discrete time survival analysis using logistic regression and mediation analysis applying the Karlson–Holm–Breen (KHB) method were employed.
Results
An excess risk of dementia was observed for household crowding [odds ratio (OR) = 1.10; 95% CI 1.02–1.18 for 3 to <4 persons per heated room; OR = 1.19; 95% CI 1.11–1.27 for ≥4 persons], single-father family (OR = 1.27; 95% CI 1.07–1.51) and eastern and northern region of residence (OR = 1.19; 95% CI 1.10–1.28). The effects of single-father family and region of residence were mostly direct with adulthood characteristics mediating 14% and 29% of the total effect, respectively. The largest indirect effect was observed for household crowding mediated through adulthood socio-economic position (47–65%).
Conclusions
The study shows that childhood socio-economic circumstances are associated with dementia, and that the underlying mechanisms only partly relate to adulthood socio-economic position and cardiovascular health. Socio-economic and health interventions targeted at families with children may carry long-term benefits by contributing to a lower dementia risk in later life.
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Affiliation(s)
- Kaarina Korhonen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
| | - Taina Leinonen
- Finnish Institute of Occupational Health , Helsinki, Finland
| | - Lasse Tarkiainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
- Helsinki Institute of Urban and Regional Studies (URBARIA), University of Helsinki , Helsinki, Finland
| | - Elina Einiö
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
| | - Pekka Martikainen
- Population Research Unit, Faculty of Social Sciences, University of Helsinki , Helsinki, Finland
- Max Planck Institute for Demographic Research , Rostock, Germany
- Department of Public Health Sciences, Stockholm University , Stockholm, Sweden
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Kreft D, Doblhammer G. Sex and Gender Differences in Environmental Influences on Dementia Incidence in Germany, 2014-2019: An Observational Cohort Study Based on Health Claims Data. J Alzheimers Dis 2022; 87:223-237. [PMID: 35275528 PMCID: PMC9198799 DOI: 10.3233/jad-215030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is an ongoing debate about whether environmental characteristics influence dementia risk like individual traits do, and whether these differ by sex and gender. OBJECTIVE This study examines the influence of regional characteristics on the incidence of dementia and explores sex and gender differences using individual-level health information and regional characteristics. METHODS Using a random sample of 250,000 people aged 70 + insured through Germany's largest German public health agency, we analyzed quarterly data about diagnoses and place of residence from 2014 to 2019. Using five-digit postal codes, we added data on various dimensions of regional characteristics offered by the INKAR database and the 2011 Census database. We used multilevel survival regressions to tease out regional incidence differences while accounting for spatial clustering. RESULTS After adjusting for multi-morbidity and relocation-related selection bias, we saw that people living in regions with the highest tertile of income (HR = 0.87, p < 0.001), and who had the highest tertile of remaining life expectancy at age 60 (HR = 0.93, p = 0.012) had lower dementia risks. There was no gender difference in the regional income effect, but the effect of education (HR = 0.91, p = 0.015) was significant only for men and remaining life-expectancy was significant only for women (HR = 0.93, p = 0.026). CONCLUSION Environmental characteristics related to wealth and health resources of a region influence the risk of dementia among the elderly in Germany. This effect is independent of the health profiles of the individuals and differs between the two genders. Health policies need to acknowledge these modifiable risk factors and consider how they affect men and women differently.
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Affiliation(s)
- Daniel Kreft
- Institute for Sociology and Demography, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Gabriele Doblhammer
- Institute for Sociology and Demography, University of Rostock, Rostock, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
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