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Association of Body Mass Index with Risk of Household Catastrophic Health Expenditure in China: A Population-Based Cohort Study. Nutrients 2022; 14:nu14194014. [PMID: 36235667 PMCID: PMC9571178 DOI: 10.3390/nu14194014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 09/18/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022] Open
Abstract
Catastrophic health expenditure (CHE) is a major obstacle to achieving universal health coverage, and body mass index (BMI) is linked to both health and economy. We aimed to explore the association of BMI with the risk of CHE to provide advice for reducing CHE. We used national cohort data from the China Family Panel Studies, which comprised 33,598 individuals (14,607 households) from 25 provinces between 2010 to 2018. We used multivariate Cox proportional hazard models to estimate adjusted hazard ratios (aHRs) and 95% confident interval (CI) for CHE in participants at underweight, overweight, and obesity, compared with those at normal weight. Restricted cubic splines were employed to model the association of continuous BMI scale with risk of CHE. We found that families with female household heads at underweight had a 42% higher risk of CHE (aHR = 1.42, 95%CI: 1.16–1.75), and those at overweight had a 26% increased risk of CHE (aHR = 1.26, 95%CI: 1.09–1.47), compared with those at normal weight. A weak U-shaped curve for the association of continuous BMI with risk of CHE in female-headed households (p for non-linear = 0.0008) was observed, which was not significant in male-headed households (p for non-linear = 0.8725). In female-headed households, underweight and overweight BMI are connected with a higher risk of CHE. Concerted efforts should be made to keep a normal BMI to prevent CHE.
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Yu X, Zhang W, Kobayashi LC. Duration of Poverty and Subsequent Cognitive Function and Decline Among Older Adults in China, 2005-2018. Neurology 2021; 97:e739-e746. [PMID: 34099525 DOI: 10.1212/wnl.0000000000012343] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/13/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the relationship between late-life duration of poverty exposure and cognitive function and decline among older adults in China. METHODS Data were from 3,209 participants ≥64 years of age in the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Duration of poverty, defined according to urban and rural regional standards from the China Statistical Yearbook, was assessed according to annual household income from 2005 to 2011 (never in poverty; one-third of the period in poverty; two-thirds or more of the period in poverty). Cognitive function was measured by the Chinese Mini-Mental State Examination (CMMSE) from 2011 to 2018. We used attrition-weighted, multivariable mixed-effects Tobit regression to examine the association of duration of poverty with cognitive function and rate of decline. RESULTS A total of 1,162 individuals (36.21%) were never in poverty over the period from 2005 to 2011; 1,172 (36.52%) were in poverty one-third of the period; and 875 (27.27%) were in poverty two-thirds or more of the period. A longer poverty duration was associated with lower subsequent CMMSE scores with a dose-response relationship (one-third vs never in poverty: β = -0.98; 95% confidence interval -1.61 to -0.35; two-thirds or more vs never in poverty: β = -1.55; 95% confidence interval -2.29 to -0.81). However, a longer duration of poverty was associated with a slower rate of CMMSE score decline over time from 2011 to 2018. CONCLUSION These findings provide valuable evidence for the role of cumulative late-life poverty in relation to cognitive health among older adults in a rapidly urbanizing and aging middle-income country. Our findings may support a compensation hypothesis for cognitive reserve in this setting.
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Affiliation(s)
- Xuexin Yu
- From the West China Biomedical Big Data Center (X.Y., W.Z.), West China Hospital, Sichuan University; and Department of Epidemiology (X.Y., L.C.K.), University of Michigan School of Public Health, Ann Arbor
| | - Wei Zhang
- From the West China Biomedical Big Data Center (X.Y., W.Z.), West China Hospital, Sichuan University; and Department of Epidemiology (X.Y., L.C.K.), University of Michigan School of Public Health, Ann Arbor
| | - Lindsay C Kobayashi
- From the West China Biomedical Big Data Center (X.Y., W.Z.), West China Hospital, Sichuan University; and Department of Epidemiology (X.Y., L.C.K.), University of Michigan School of Public Health, Ann Arbor.
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Abraham IE, Patel AA, Wang H, Galvin JP, Frankfurt O, Liu L, Khan I. Impact of race on outcomes in intermediate-risk acute myeloid leukemia. Cancer Causes Control 2021; 32:705-712. [PMID: 33837498 DOI: 10.1007/s10552-021-01422-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Racial disparities in acute myeloid leukemia (AML) have been reported but the relative contribution of disease versus patient-specific factors including comorbidities and access to care is unclear. METHODS We conducted a retrospective analysis of patient characteristics, treatment patterns and outcomes in a racially diverse patient cohort controlling for cytogenetic risk group. Patients were classified into four groups: non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic and Other. RESULTS We evaluated 106 patients from 84 zipcodes incorporating demographics, clinicopathologic features, treatment patterns and outcomes. We identified significant differences in BMI and geographic poverty based on ethnoracial group, while prognostic mutations in NPM1 and FLT3 did not differ significantly. Utilization of intensive chemotherapy and transplant rate did not differ by ethnoracial group. However, there was a significantly higher use of alternate donor transplants in minority populations. There was a notably increased rate of clinical trial enrollment in NHW patients compared to other groups. In log-rank analysis, NHW patients had increased overall survival (OS) compared to NHB, Hispanic and Other patients (31.6 months vs. 16.7 months vs. 14.3 months, vs 18.1 months, p = 0.021). In bivariate analysis, overall survival was negatively influenced by advanced age and race. Obesity and zip code poverty levels approached statistical significance in predicting OS. In multivariate analysis, the only factors independently influencing OS were race and allogeneic stem cell transplant. CONCLUSION These results suggest that race impacts survival in intermediate-risk AML, highlighting the need to dissect biologic and nonbiologic factors that contribute to this disparity.
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Affiliation(s)
- Ivy Elizabeth Abraham
- Division of Hematology and Oncology, Department of Internal Medicine, University of Illinois at Chicago, 840 South Wood Street, Ste 820 E-CSB, Chicago, IL, 60612, USA
| | - Anand Ashwin Patel
- University of Chicago Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Heidy Wang
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - John Patrick Galvin
- Division of Hematology and Oncology, Department of Internal Medicine, University of Illinois at Chicago, 840 South Wood Street, Ste 820 E-CSB, Chicago, IL, 60612, USA
| | - Olga Frankfurt
- Hematology and Oncology Division, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Li Liu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Irum Khan
- Division of Hematology and Oncology, Department of Internal Medicine, University of Illinois at Chicago, 840 South Wood Street, Ste 820 E-CSB, Chicago, IL, 60612, USA.
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Swift SL, Elfassy T, Bailey Z, Florez H, Feaster DJ, Calonico S, Sidney S, Kiefe CI, Zeki Al Hazzouri A. Association of negative financial shocks during the Great Recession with depressive symptoms and substance use in the USA: the CARDIA study. J Epidemiol Community Health 2020; 74:995-1001. [PMID: 32788306 DOI: 10.1136/jech-2020-213917] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/03/2020] [Accepted: 07/10/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND The Great Recession of 2008 was marked by large increases in unemployment and decreases in the household wealth of many Americans. In the 21st century, there have also been increases in depressive symptoms, alcohol use and drug use among some groups in the USA. The objective of this analysis is to evaluate the influence of negative financial shocks incurred during the Great Recession on depressive symptoms, alcohol and drug use. METHODS We employed a quasi-experimental fixed-effects design, using data from adults enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Our financial shock predictors were within-person change in employment status, income and debt to asset ratio between 2005 and 2010. Our outcomes were within-person change in depressive symptoms score, alcohol use and past 30-day drug use. RESULTS In adjusted models, we found that becoming unemployed and experiencing a drop in income and were associated with an increase in depressive symptoms. Incurring more debts than assets was also associated with an increase in depressive symptoms and a slight decrease in daily alcohol consumption (mL). CONCLUSION Our findings suggest that multiple types of financial shocks incurred during an economic recession negatively influence depressive symptoms among black and white adults in the USA, and highlight the need for future research on how economic recessions are associated with health.
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Affiliation(s)
- Samuel Longworth Swift
- Center for Healthcare Equity in Kidney Disease, University of New Mexico, New Mexico, Albuquerque, USA
| | - Tali Elfassy
- Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Zinzi Bailey
- Sylvester Cancer Center, University of Miami, Miami, Florida, USA
| | - Hermes Florez
- Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Daniel J Feaster
- Public Health Sciences, University of Miami, Miami, Florida, USA
| | | | - Steve Sidney
- Kaiser Permanente Norther California Division of Research, Oakland, California, USA
| | - Catarina I Kiefe
- Quantitative Health Sciences, UMass Medical School, Worcester, Massachusetts, USA
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Grasset L, Glymour MM, Elfassy T, Swift SL, Yaffe K, Singh-Manoux A, Zeki Al Hazzouri A. Relation between 20-year income volatility and brain health in midlife: The CARDIA study. Neurology 2019; 93:e1890-e1899. [PMID: 31578298 PMCID: PMC6946474 DOI: 10.1212/wnl.0000000000008463] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/24/2019] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Income volatility presents a growing public health threat. To our knowledge, no previous study examined the relationship among income volatility, cognitive function, and brain integrity. METHODS We studied 3,287 participants aged 23-35 years in 1990 from the Coronary Artery Risk Development in Young Adults prospective cohort study. Income volatility data were created using income data collected from 1990 to 2010 and defined as SD of percent change in income and number of income drops ≥25% (categorized as 0, 1, or 2+). In 2010, cognitive tests (n = 3,287) and brain scans (n = 716) were obtained. RESULTS After covariate adjustment, higher income volatility was associated with worse performance on processing speed (β = -1.09, 95% confidence interval [CI] -1.73 to -0.44) and executive functioning (β = 2.53, 95% CI 0.60-4.50) but not on verbal memory (β = -0.02, 95% CI -0.16 to 0.11). Similarly, additional income drops were associated with worse performance on processing speed and executive functioning. Higher income volatility and more income drops were also associated with worse microstructural integrity of total brain and total white matter. All findings were similar when restricted to those with high education, suggesting reverse causation may not explain these findings. CONCLUSION Income volatility over a 20-year period of formative earning years was associated with worse cognitive function and brain integrity in midlife.
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Affiliation(s)
- Leslie Grasset
- From Université de Bordeaux (L.G.), INSERM, Bordeaux Population Health Research Center, Team VINTAGE UMR1219; Inserm (L.G.), CIC1401-EC, Bordeaux, France; Departments of Epidemiology and Biostatistics (M.M.G., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; Division of Epidemiology, Department of Public Health Sciences (T.E., S.L.S.), University of Miami, FL; INSERM U1018 (A.S.-M.), Centre for Research in Epidemiology and Population Health, Paris, France; Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY.
| | - M Maria Glymour
- From Université de Bordeaux (L.G.), INSERM, Bordeaux Population Health Research Center, Team VINTAGE UMR1219; Inserm (L.G.), CIC1401-EC, Bordeaux, France; Departments of Epidemiology and Biostatistics (M.M.G., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; Division of Epidemiology, Department of Public Health Sciences (T.E., S.L.S.), University of Miami, FL; INSERM U1018 (A.S.-M.), Centre for Research in Epidemiology and Population Health, Paris, France; Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
| | - Tali Elfassy
- From Université de Bordeaux (L.G.), INSERM, Bordeaux Population Health Research Center, Team VINTAGE UMR1219; Inserm (L.G.), CIC1401-EC, Bordeaux, France; Departments of Epidemiology and Biostatistics (M.M.G., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; Division of Epidemiology, Department of Public Health Sciences (T.E., S.L.S.), University of Miami, FL; INSERM U1018 (A.S.-M.), Centre for Research in Epidemiology and Population Health, Paris, France; Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
| | - Samuel L Swift
- From Université de Bordeaux (L.G.), INSERM, Bordeaux Population Health Research Center, Team VINTAGE UMR1219; Inserm (L.G.), CIC1401-EC, Bordeaux, France; Departments of Epidemiology and Biostatistics (M.M.G., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; Division of Epidemiology, Department of Public Health Sciences (T.E., S.L.S.), University of Miami, FL; INSERM U1018 (A.S.-M.), Centre for Research in Epidemiology and Population Health, Paris, France; Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
| | - Kristine Yaffe
- From Université de Bordeaux (L.G.), INSERM, Bordeaux Population Health Research Center, Team VINTAGE UMR1219; Inserm (L.G.), CIC1401-EC, Bordeaux, France; Departments of Epidemiology and Biostatistics (M.M.G., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; Division of Epidemiology, Department of Public Health Sciences (T.E., S.L.S.), University of Miami, FL; INSERM U1018 (A.S.-M.), Centre for Research in Epidemiology and Population Health, Paris, France; Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
| | - Archana Singh-Manoux
- From Université de Bordeaux (L.G.), INSERM, Bordeaux Population Health Research Center, Team VINTAGE UMR1219; Inserm (L.G.), CIC1401-EC, Bordeaux, France; Departments of Epidemiology and Biostatistics (M.M.G., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; Division of Epidemiology, Department of Public Health Sciences (T.E., S.L.S.), University of Miami, FL; INSERM U1018 (A.S.-M.), Centre for Research in Epidemiology and Population Health, Paris, France; Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
| | - Adina Zeki Al Hazzouri
- From Université de Bordeaux (L.G.), INSERM, Bordeaux Population Health Research Center, Team VINTAGE UMR1219; Inserm (L.G.), CIC1401-EC, Bordeaux, France; Departments of Epidemiology and Biostatistics (M.M.G., K.Y.), Psychiatry (K.Y.), and Neurology (K.Y.), University of California San Francisco; Division of Epidemiology, Department of Public Health Sciences (T.E., S.L.S.), University of Miami, FL; INSERM U1018 (A.S.-M.), Centre for Research in Epidemiology and Population Health, Paris, France; Department of Epidemiology and Public Health (A.S.-M.), University College London, UK; and Department of Epidemiology (A.Z.A.H.), Mailman School of Public Health, Columbia University, New York, NY
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Jaramillo-Espinosa L, Vasquez-Trespalacios EM, Alfaro-Velásquez JM. Uso temprano de antibióticos en la infancia y obesidad pediátrica: revisión sistemática de la literatura. INFECTIO 2019. [DOI: 10.22354/in.v23i4.811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introducción: la prevalencia de obesidad en el mundo es creciente y específicamente la obesidad en niños se ha convertido en un problema de salud pública que preocupa a varios países. La evidencia ha señalado al uso de antibióticos en la infancia como un factor relacionado con la presencia de obesidad infantil.Objetivo: Analizar sistemáticamente la evidencia reciente acerca de la relación entre el uso temprano de antibióticos en la infancia y la presencia de obesidad infantil.Métodos: Se realizó una búsqueda bibliográfica en las bases de Pubmed, Ovid, EBSCO, Lilacs, JAMA pediatrics de estudios observacionales en los últimos diez años que abordaran la relación entre el uso de antibióticos antes de los 24 meses de edad y la obesidad infantil.Resultados: Luego de realizar el tamizaje de los artículos, se seleccionaron 9 para la síntesis cualitativa. Con dos excepciones, los estudios analizados muestran una relación estadísticamente significativa entre el uso temprano de antibióticos y la obesidad o sobrepeso infantil, medido como peso para la edad o mediante el índice de masa corporal y aún con el ajuste por las potenciales variables de confusión, esta asociación permanece siendo estadísticamente significativa, debido a algunos de los diseños epidemiológicos, no se puede verificar la relación de antecedencia temporal de la exposición.
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Elfassy T, Swift SL, Glymour MM, Calonico S, Jacobs DR, Mayeda ER, Kershaw KN, Kiefe C, Al Hazzouri AZ. Associations of Income Volatility With Incident Cardiovascular Disease and All-Cause Mortality in a US Cohort. Circulation 2019; 139:850-859. [PMID: 30612448 PMCID: PMC6370510 DOI: 10.1161/circulationaha.118.035521] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 09/11/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Income volatility is on the rise and presents a growing public health problem. Because in many epidemiological studies income is measured at a single point in time, the association of long-term income volatility with incident cardiovascular disease (CVD) and mortality has not been adequately explored. The goal of this study was to examine associations of income volatility from 1990 to 2005 with incident CVD and all-cause mortality in the subsequent 10 years. METHODS The Coronary Artery Risk Development in Young Adults Study is an ongoing prospective cohort study conducted within urban field centers in Birmingham, AL; Chicago, IL; Minneapolis, MN; and Oakland, CA. We studied 3937 black and white participants 23 to 35 years of age in 1990 (our study baseline). Income volatility was defined as the intraindividual SD of the percent change in income across 5 assessments from 1990 to 2005. An income drop was defined as a decrease of ≥25% from the previous visit and less than the participant's average income from 1990 to 2005. CVD events (fatal and nonfatal) and all-cause mortality between 2005 and 2015 were adjudicated with the use of medical records and death certificates. CVD included primarily acute events related to heart disease and stroke. RESULTS A total of 106 CVD events and 164 deaths occurred between 2005 and 2015 (incident rate, 2.76 and 3.66 per 1000 person-years, respectively). From Cox models adjusted for sociodemographic, behavioral, and CVD risk factors, higher income volatility and more income drops were associated with greater CVD risk (high versus low volatility: hazard ratio, 2.07; 95% CI, 1.10-3.90; ≥2 versus 0 income drops: hazard ratio, 2.54; 95% CI, 1.24-5.19) and all-cause mortality (high versus low volatility: hazard ratio, 1.78; 95% CI,1.03-3.09; ≥2 versus 0 income drops: hazard ratio, 1.92; 95% CI, 1.07-3.44). CONCLUSIONS In a cohort of relatively young adults, income volatility and drops during a 15-year period of formative earning years were independently associated with a nearly 2-fold risk of CVD and all-cause mortality.
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Affiliation(s)
- Tali Elfassy
- Department of Public Health Sciences, School of Medicine, University of Miami, Miami, FL
| | - Samuel L. Swift
- Department of Public Health Sciences, School of Medicine, University of Miami, Miami, FL
| | - M. Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Sebastian Calonico
- Department of Economics, School of Business, Department of Economics, University of Miami, Miami, FL
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Elizabeth R. Mayeda
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA
| | - Kiarri N. Kershaw
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL
| | - Catarina Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Adina Zeki Al Hazzouri
- Department of Public Health Sciences, School of Medicine, University of Miami, Miami, FL
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