Alcohol Consumption and Longitudinal Trajectories of Physical Functioning in Central and Eastern Europe: A 10-Year Follow-up of HAPIEE Study

The associations of physical incapacity and wealth with remaining in paid employment after age 60 in five middle-income and high-income countries

Previous studies on health and socioeconomic determinants of later-life labour force participation have mainly come from high-income European countries and the United States of America (USA). Findings vary between studies due to different measures of socioeconomic status and labour force outcomes. This study investigated longitudinal associations of physical incapacity and wealth with remaining in paid employment after age 60 in middle- and high-income countries. Using harmonised cohort data in the USA, England, Japan, Mexico and China (N=32,132), multilevel logistic regression was applied for main associations. The age-related probabilities of remaining in paid employment by physical incapacity and wealth were estimated using marginal effects. This study found that physical incapacity predicted lower odds of remaining in paid employment in each country. Wealth was associated with higher odds of remaining in paid employment in the USA, England, and Japan, but not in Mexico. Probabilities of remaining in paid employment were high in Mexico but low in China. The absolute difference in the probability of remaining in paid employment between the richest and the poorest groups was greater in the USA than that in any other country. In the USA, England and Japan, the inverse association between physical incapacity and remaining in paid employment could be partially compensated by wealth only when physical incapacity was not severe. National policies, including considering older adults' changing capacities for job placement and prioritising the provision of supportive services for socioeconomically disadvantaged older adults, developing pathways for informal workers to access social security and pension coverage, and encouraging employers to hire socioeconomically disadvantaged older workers and enhancing their employability, could be facilitated. Future studies, such as exploring health and socioeconomic determinants of remaining in part-time and full-time paid employment separately in more countries, and the moderating effects of relevant policies on these associations, are needed.

Trajectories in physical functioning at older age in relation to childhood and adulthood SES and social mobility: a population-based cohort study

Introduction

Older age is associated with the deterioration of physical functioning (PF), and low PF is strongly related to poor quality of life among older people. We conducted a study to examine the trajectories of PF between middle and old age, considering sex differences as well as the association between socioeconomic status (SES) at different life stages and changes in PF.

Methods

We analyzed data from the Polish arm of the HAPIEE (Health, Alcohol and Psychosocial factors In Eastern Europe) study, including 1,116 men and 1,178 women aged 45-64 years at baseline. Adult and childhood SES and social mobility were assessed using a retrospectively focused questionnaire. PF was assessed using the 10-question SF-36 scale at baseline examination, face-to-face re-examination, and three postal surveys, covering up to 20 years (on average, 18 years). We employed Generalized Estimating Equations models to assess changes in PF scores over time and compare PF trajectories across different SES categories.

Results

After adjusting for age and other covariates, we found that, in both sexes, participants with always middle or high SES, as well as those who reported upward mobility, had higher PF scores at baseline compared to those with always low SES. A decline in PF between middle and old age was observed in all SES groups; however, the decline was slower in participants with always middle or high SES compared to those with always low SES.

Conclusion

This cohort study revealed that lower SES and downward social mobility were cross-sectionally associated with poorer PF, while upward social mobility seemed to largely reverse the effect of low childhood SES. In addition to the cross-sectional associations observed at baseline, advantaged SES was also significantly associated with a slower decline in PF over an 18-year follow-up period.

Socioeconomic position in childhood and depressive symptoms in later adulthood in the Czech Republic

BACKGROUND

Depression risk may partly originate from socioeconomic hardship in childhood. We investigated the association of childhood socioeconomic position with depressive symptoms in later adulthood in a Central and Eastern European country.

METHODS

We analyzed data from the Czech arm of the Health, Alcohol and Psychosocial factors In Eastern Europe (HAPIEE) study. We estimated the associations of three indicators of childhood socioeconomic position (access to household amenities at age of 10 years, father´s education and mother´s education) with high depressive symptoms, operationalized as ≥16 points on the Center for Epidemiological Studies - Depression 20 scale, controlling for age and sex, current socioeconomic position and other social and health-related factors.

RESULTS

The analytical sample included 4,213 individuals (mean age 58 years, 54% women). All three indicators of childhood socioeconomic position were inversely associated with depressive symptoms in age-sex adjusted models (p for trends: access to household amenities p<0.001; mother´s education p<0.001; father´s education p=0.03). Adjustment for current socioeconomic position attenuated the associations of depressive symptoms with access to household amenities (p for trend 0.04) and mother´s education (p for trend 0.05) and virtually eliminated the association with father´s education (p for trend 0.82).

LIMITATIONS

Individuals with higher depressive symptoms and more adverse socioeconomic position are likely to be underrepresented in the study sample. Data on childhood socioeconomic position may be reported inaccurately.

CONCLUSIONS

Socioeconomic hardship in childhood may have long-lasting consequences on mental health in later adulthood.

Changes in disease burden in Poland between 1990-2017 in comparison with other Central European countries: A systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND

Systematic collection of mortality/morbidity data over time is crucial for monitoring trends in population health, developing health policies, assessing the impact of health programs. In Poland, a comprehensive analysis describing trends in disease burden for major conditions has never been published. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides data on the burden of over 300 diseases in 195 countries since 1990. We used the GBD database to undertake an assessment of disease burden in Poland, evaluate changes in population health between 1990-2017, and compare Poland with other Central European (CE) countries.

METHODS

The results of GBD 2017 for 1990 and 2017 for Poland and CE were used to assess rates and trends in years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs). Data came from cause-of-death registration systems, population health surveys, disease registries, hospitalization databases, and the scientific literature. Analytical approaches have been used to adjust for missing data, errors in cause-of-death certification, and differences in data collection methodology. Main estimation strategies were ensemble modelling for mortality and Bayesian meta-regression for disability.

RESULTS

Between 1990-2017, age-standardized YLL rates for all causes declined in Poland by 46.0% (95% UI: 43.7-48.2), YLD rates declined by 4.0% (4.2-4.9), DALY rates by 31.7% (29.2-34.4). For both YLLs and YLDs, greater relative declines were observed for females. There was a large decrease in communicable, maternal, neonatal, and nutritional disease DALYs (48.2%; 46.3-50.4). DALYs due to non-communicable diseases (NCDs) decreased slightly (2.0%; 0.1-4.6). In 2017, Poland performed better than CE as a whole (ranked fourth for YLLs, sixth for YLDs, and fifth for DALYs) and achieved greater reductions in YLLs and DALYs than most CE countries. In 2017 and 1990, the leading cause of YLLs and DALYs in Poland and CE was ischaemic heart disease (IHD), and the leading cause of YLDs was low back pain. In 2017, the top 20 causes of YLLs and YLDs in Poland and CE were the same, although in different order. In Poland, age-standardized DALYs from neonatal causes, other cardiovascular and circulatory diseases, and road injuries declined substantially between 1990-2017, while alcohol use disorders and chronic liver diseases increased. The highest observed-to-expected ratios were seen for alcohol use disorders for YLLs, neonatal sepsis for YLDs, and falls for DALYs (3.21, 2.65, and 2.03, respectively).

CONCLUSIONS

There was relatively little geographical variation in premature death and disability in CE in 2017, although some between-country differences existed. Health in Poland has been improving since 1990; in 2017 Poland outperformed CE as a whole for YLLs, YLDs, and DALYs. While the health gap between Poland and Western Europe has diminished, it remains substantial. The shift to NCDs and chronic disability, together with marked between-gender health inequalities, poses a challenge for the Polish health-care system. IHD is still the leading cause of disease burden in Poland, but DALYs from IHD are declining. To further reduce disease burden, an integrated response focused on NCDs and population groups with disproportionally high burden is needed.

The association between social characteristics, alcoholic beverage preferences, and binge drinking in a Serbian adult population

Aim

To determine the association of sociodemographic characteristics and type of alcoholic beverage consumed during binge drinking in Serbia.

Method

We conducted a secondary analysis of data from the 2014 national survey on Serbian lifestyles focusing on substance abuse and gambling. The sample consisted of 5385 individuals. The respondents were divided into non-binge drinkers and binge drinkers, according to the quantity of alcohol consumed during one occasion. Binge drinkers reported consuming more than 60 g of pure alcohol (7.5 units of alcohol) during one occasion at least once during the previous year.

Results

The prevalence of binge drinking in the past year among 2676 female and 2709 male participants aged 18-64 years was 28.4%. The multivariate logistic regression model showed that binge drinkers were more likely to be male (95% CI 3.58-4.94), single (95% CI 1.01-1.53), to be former (95% CI 1.06-1.62) or current smokers (95% CI 1.57-2.19), and to consume more than one type of alcoholic beverage (95% CI 2.04-3.44). There was a negative association of binge drinking with age (95% CI 0.98-0.99), living outside Northern Serbia-Vojvodina region, and drinking only spirits (95% CI 0.39-0.93).

Conclusion

Focusing on the positive association of sociodemographic factors and binge drinking could help policy makers create public health interventions against alcohol misuse. These interventions should be directed to males, smokers, and those who consume more than one type of alcoholic beverage.

Mediterranean diet and physical functioning trajectories in Eastern Europe: Findings from the HAPIEE study

Background

Unhealthy diet may increase the risk of impaired physical functioning in older age. Although poor diet and limited physical functioning both seem to be particularly common in Eastern Europe, no previous study has assessed the relationship between these two factors in this region. The current analysis examined the association between overall diet quality and physical functioning in Eastern European populations.

Methods

We used data on 25,504 persons (aged 45–69 years at baseline) who participated in the Health Alcohol and Psychosocial factors in Eastern Europe (HAPIEE) study. Dietary assessment at baseline used food frequency questionnaire, and the overall diet quality was evaluated by the Mediterranean diet score (MDS). Physical functioning (PF) was measured by the physical functioning subscale (PF-10) of the 36-item Short-Form Health Survey at baseline and three subsequent occasions over a 10-year period. The cross-sectional and longitudinal relationships between the MDS and PF were examined simultaneously using growth curve models.

Results

Men and women with higher adherence to the Mediterranean diet had significantly better PF at baseline; after multivariable adjustment, the regression coefficient per 1-unit increase in the MDS was 0.39 (95% CI: 0.25, 0.52) in men and 0.50 (0.36, 0.64) in women. However, we found no statistically significant link between baseline MDS and the subsequent slope of PF decline in neither gender; the coefficients were -0.02 (-0.04, 0.00) in men and -0.01 (-0.03, 0.02) in women.

Discussion

Our results do not support the hypothesis that the Mediterranean diet has a substantial impact on the trajectories of physical functioning, although the differences existing at baseline may be related to dietary habits in earlier life.