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Levinsky M. Can countries shape the association between cumulative adversity and old-age health? Front Public Health 2024; 12:1364868. [PMID: 38813420 PMCID: PMC11133626 DOI: 10.3389/fpubh.2024.1364868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 04/24/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction The present study examined the relationships of Lifetime Cumulative Adversity (LCA) and country inequalities, as well as the interactions between them, with the self-rated health (SRH) in old age. Methods Using data from the Survey of Health, Aging and Retirement in Europe (SHARE), the study regressed self-rated health on Lifetime Cumulative Adversity and country-level inequality indices across European countries in two points in time. The analysis also considered adversity-inequality interactions, controlling for confounders. The sample was comprised of 28,789 adults, aged 50 to 80, from 25 European countries and Israel. Results The findings pointed out that LCA is negatively associated with SRH, but democracy and welfare regimes modify the ill effects of LCA on health. These effects are reduced as the LCA level increases. The effects remained significant over two measurement time-points over three years, showing that life-course trajectories may be shaped by individual accumulated risk exposure to stress, along with inequalities at the society level. Discussion The study provides constructive and important guidance for decreasing the harmful effect of lifetime adversity in old age, by the modification of the country's welfare policies.
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Affiliation(s)
- Michal Levinsky
- The Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel
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2
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Cheval B, Maltagliati S, Saoudi I, Fessler L, Farajzadeh A, Sieber S, Cullati S, Boisgontier MP. Physical activity mediates the effect of education on mental health trajectories in older age. J Affect Disord 2023; 336:64-73. [PMID: 37217099 DOI: 10.1016/j.jad.2023.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Why people with lower levels of educational attainment have poorer mental health than people with higher levels can partly be explained by financial circumstances. However, whether behavioral factors can further explain this association remains unclear. Here, we examined the extent to which physical activity mediates the effect of education on mental health trajectories in later life. METHODS Data from 54,818 adults 50 years of age or older (55 % women) included in the Survey of Health, Aging and Retirement in Europe (SHARE) were analyzed using longitudinal mediation and growth curve models to estimate the mediating role of physical activity (baseline and change) in the association between education and mental health trajectories. Education and physical activity were self-reported. Mental health was derived from depressive symptoms and well-being, which were measured by validated scales. RESULTS Lower education was associated with lower levels and steeper declines in physical activity over time, which predicted greater increases in depressive symptoms and greater decreases in well-being. In other words, education affected mental health through both levels and trajectories of physical activity. Physical activity explained 26.8 % of the variance in depressive symptoms and 24.4 % in well-being, controlling for the socioeconomic path (i.e., wealth and occupation). CONCLUSIONS These results suggest that physical activity is an important factor in explaining the association between low educational attainment and poor mental health trajectories in adults aged 50 years and older.
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Affiliation(s)
- Boris Cheval
- Swiss Center for Affective Sciences, University of Geneva, Switzerland; Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Switzerland.
| | | | - Ilyes Saoudi
- Univ. Grenoble Alpes, SENS, F-38000 Grenoble, France
| | - Layan Fessler
- Univ. Grenoble Alpes, SENS, F-38000 Grenoble, France
| | - Ata Farajzadeh
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Canada; Bruyère Research Institute, Ottawa, Canada
| | - Stefan Sieber
- LIVES Centre, Swiss Centre of Expertise in Life Course Research, University of Lausanne, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory, University of Fribourg, Switzerland; Department of Readaptation and Geriatrics, University of Geneva, Switzerland
| | - Matthieu P Boisgontier
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Canada; Bruyère Research Institute, Ottawa, Canada
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3
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Andersson MA, Wilkinson LR, Schafer MH. The Long Arm of Childhood: Does It Vary According to Health Care System Quality? JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2023; 64:79-97. [PMID: 36062757 DOI: 10.1177/00221465221120099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Increasing evidence points to the salience of early life experiences in shaping health inequalities, but scant research has considered the role of institutional resources as buffers in this relationship. Health care systems in particular are an understudied yet important context for the generation of inequalities from childhood into adulthood. This research investigates associations between childhood disadvantage and adult morbidity and examines the role of health care system quality in this relationship. We also consider the role of adult socioeconomic status. We merge individual-level data on major disease (2014 European Social Survey) with nation-level health care indicators. Results across subjective and objective approaches to health care system quality are similar, indicating a reduced association between childhood socioeconomic status and adult disease in countries with higher quality health care. In total, our results reiterate the long-term influence of childhood disadvantage on health while suggesting health care's specific role as an institutional resource for ameliorating life course health inequalities.
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Baumann I, Froidevaux A, Cabib I. Health among workers retiring after the state pension age: a longitudinal and comparative study. BMC Geriatr 2022; 22:984. [PMID: 36539688 PMCID: PMC9764581 DOI: 10.1186/s12877-022-03690-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In recent decades, many countries have observed increasing labor force participation beyond the state pension age (SPA). However, there is a lack of research on employment beyond SPA and how it relates to older workers' health. Moreover, there is a need to better understand how institutional factors affect the relationship between older workers' employment and health. In this study, we examine simultaneous employment and health trajectories over 11 years in 12 countries from Europe and the Americas, and study how these trajectories differ by welfare state regime and level of old-age pension redistribution. METHODS We used a harmonized pooled-country dataset of 3699 older workers based on four representative panel surveys: the Survey of Health, Ageing and Retirement in Europe (SHARE), the English Longitudinal Study of Ageing (ELSA), the Health and Retirement Survey (HRS), and the Chilean Social Protection Survey (EPS). We conducted multichannel sequence analysis to estimate the types of simultaneous employment-health trajectories, and multinomial regression analysis to examine the relationship between trajectory types and institutional factors. RESULTS We found that late retirement was equally associated with poor and good health. There is also a higher prevalence of late retirement trajectories in combination with poor health in liberal welfare regimes and in countries with lower levels of old-age pension redistribution. CONCLUSION Our study indicates that nonliberal welfare regimes and redistributive old-age pension policies may be better suited to protect vulnerable workers while providing those in good health with the opportunity to work beyond the SPA.
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Affiliation(s)
- Isabel Baumann
- grid.19739.350000000122291644Institute of Public Health, School of Health Sciences, Zurich University of Applied Sciences; National Centre of Competence in Research “Overcoming Vulnerability: Life Course Perspectives”, Gertrudstrasse 15, 8400 Winterthur, Switzerland ,grid.8591.50000 0001 2322 4988Centre for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Katharina-Sulzer-Platz 9, 8400 Winterthur, Switzerland
| | - Ariane Froidevaux
- grid.267315.40000 0001 2181 9515Department of Management, College of Business, University of Texas at Arlington, 701 S W St Arlington, Arlington, TX 76010 USA
| | - Ignacio Cabib
- grid.7870.80000 0001 2157 0406Instituto de Sociología & Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile ,grid.7870.80000 0001 2157 0406Centro UC Estudios de Vejez y Envejecimiento, Pontificia Universidad Católica de Chile, Santiago, Chile
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5
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Cheval B, Maltagliati S, Sieber S, Cullati S, Zou L, Ihle A, Kramer AF, Yu Q, Sander D, Boisgontier MP. Better Subjective Sleep Quality Partly Explains the Association Between Self-Reported Physical Activity and Better Cognitive Function. J Alzheimers Dis 2022; 87:919-931. [DOI: 10.3233/jad-215484] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Physical activity has been associated with better cognitive function and better sleep quality. Yet, whether the beneficial effect of physical activity on cognitive function can be explained by an indirect pathway involving better sleep quality is unclear. Objective: To investigate whether sleep quality mediates the association between physical activity and cognitive function in adults 50 years of age or older. Methods: 86,541 community-dwelling European adults were included in the study. Physical activity and sleep quality were self-reported. Indicators of cognitive function (immediate recall, delayed recall, verbal fluency) were assessed using objective tests. All measures were collected six times between 2004 and 2017. The mediation was tested using multilevel mediation analyses. Results: Results showed that self-reported physical activity was associated with better self-reported sleep quality, which was associated with better performance in all three indicators of cognitive function, demonstrating an indirect effect of physical activity on cognitive function through sleep quality. The mediating effect of sleep quality accounted for 0.41%, 1.46%, and 8.88% of the total association of physical activity with verbal fluency, immediate recall, and delayed recall, respectively. Conclusion: These findings suggest that self-reported sleep quality partly mediates the association between self-reported physical activity and cognitive function. These results need to be confirmed by device-based data of physical activity and sleep quality.
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Affiliation(s)
- Boris Cheval
- Swiss Center for Affective Sciences, University of Geneva, Switzerland
- Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Switzerland
| | | | - Stefan Sieber
- Swiss NCCR “LIVES – Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory, University of Fribourg, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Switzerland
| | - Liye Zou
- Institute of KEEP Collaborative Innovation, Shenzhen University, China
- Exercise Psychophysiology Laboratory, School of Psychology, Shenzhen University, China
| | - Andreas Ihle
- Swiss NCCR “LIVES – Overcoming Vulnerability: Life Course Perspectives”, University of Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland
- Cognitive Aging Lab, Department of Psychology, University of Geneva, Geneva, Switzerland
| | - Arthur F. Kramer
- Center for Cognitive and Brain Health, Department of Psychology, Northeastern University, Boston, MA, USA
- Beckman Institute, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Qian Yu
- Institute of KEEP Collaborative Innovation, Shenzhen University, China
- Exercise Psychophysiology Laboratory, School of Psychology, Shenzhen University, China
| | - David Sander
- Swiss Center for Affective Sciences, University of Geneva, Switzerland
- Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Switzerland
| | - Matthieu P. Boisgontier
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Canada
- Bruyère Research Institute, Ottawa, Canada
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Chalabaev A, Sieber S, Sander D, Cullati S, Maltagliati S, Sarrazin P, Boisgontier MP, Cheval B. Early-Life Socioeconomic Circumstances and Physical Activity in Older Age: Women Pay the Price. Psychol Sci 2022; 33:212-223. [PMID: 35112576 PMCID: PMC9096459 DOI: 10.1177/09567976211036061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Health in older age is shaped by early-life socioeconomic circumstances (SECs) and sex. However, whether and why these factors interact is unclear. We examined a cultural explanation of this interaction by distinguishing cultural and material aspects of SECs in the context of physical activity-a major determinant of health. We used data from 56,331 adults between 50 and 96 years old from the Survey of Health, Ageing and Retirement in Europe (SHARE), a 13-year, large-scale, population-based cohort. Confounder-adjusted logistic linear mixed-effects models showed an association between the cultural aspects of early-life SEC disadvantage and physical activity among women, but it was not consistently observed in men. Furthermore, these associations were compensated for only partially by adult-life socioeconomic trajectories. The material aspects of early-life SECs were not associated with adult-life physical activity. These findings highlight the need to distinguish different aspects of SECs because they may relate to health behaviors in diverse ways.
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Affiliation(s)
- Aïna Chalabaev
- Laboratoire Sport et Environnement
Social (SENS), Université Grenoble Alpes,Aïna Chalabaev, Université Grenoble Alpes,
Laboratoire Sport et Environnement Social (SENS)
| | - Stefan Sieber
- Swiss National Centre of Competence in
Research “LIVES - Overcoming Vulnerability: Life Course Perspectives,” University of
Geneva
| | - David Sander
- Swiss Center for Affective Sciences,
University of Geneva,Laboratory for the Study of Emotion
Elicitation and Expression, Department of Psychology, University of Geneva
| | | | - Silvio Maltagliati
- Laboratoire Sport et Environnement
Social (SENS), Université Grenoble Alpes
| | - Philippe Sarrazin
- Laboratoire Sport et Environnement
Social (SENS), Université Grenoble Alpes
| | - Matthieu P. Boisgontier
- School of Rehabilitation Sciences,
Faculty of Health Sciences, University of Ottawa,Bruyère Research Institute, Ottawa,
Canada
| | - Boris Cheval
- Swiss Center for Affective Sciences,
University of Geneva,Laboratory for the Study of Emotion
Elicitation and Expression, Department of Psychology, University of Geneva
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Sieber S, Orsholits D, Cheval B, Ihle A, Kelly-Irving M, Delpierre C, Burton-Jeangros C, Cullati S. Social protection expenditure on health in later life in 20 European countries: Spending more to reduce health inequalities. Soc Sci Med 2021; 292:114569. [PMID: 34801334 DOI: 10.1016/j.socscimed.2021.114569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/25/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study aims to examine whether higher social protection expenditure reduces the negative association of life-course socioeconomic disadvantages with subjective and objective health status and trajectories in later life. METHODS We used SHARE data from participants living in 20 European countries aged 50 to 96. Seven waves allowed to examine the trajectories of health inequalities in later life. We used linear mixed-effects models stratified by sex to examine the association between life-course socioeconomic disadvantage and subjective (self-rated health, SRH, N = 55,443) and objective (grip strength, N = 54,718) health. Cross-level interactions between net social protection expenditure as percentage of gross domestic product and life-course socioeconomic disadvantage tested for the moderating effect of social expenditures on the association of disadvantage with SRH and grip strength in later life. FINDINGS Higher social protection expenditure reduced socioeconomic health inequalities in both men and women for grip strength, and in women but not men for SRH. For SRH, the health-inequality-reducing effect of social protection expenditure became weaker with increasing age. This was not observed in grip strength. Some separate expenditure functions (disability, family and children) were found to have inequality-widening effects in men's and women's SRH, which were either offset or overcompensated by the other functions. No inequality-widening effects were observed in grip strength. INTERPRETATION Higher social spending reduces life-course socioeconomic inequalities in women's subjective health and in men's and women's objective health. However, some specific social protection policies may have the unintentional effect of increasing inequalities in people's evaluation of their own health.
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Affiliation(s)
- Stefan Sieber
- LIVES Centre, Swiss Centre of Expertise in Life Course Research, University of Lausanne, Switzerland.
| | - Dan Orsholits
- LIVES Centre, Swiss Centre of Expertise in Life Course Research, University of Geneva, Switzerland; Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland
| | - Boris Cheval
- Swiss Center for Affective Sciences, University of Geneva, Switzerland; Laboratory for the Study of Emotion Elicitation and Expression (E3Lab), Department of Psychology, University of Geneva, Switzerland
| | - Andreas Ihle
- LIVES Centre, Swiss Centre of Expertise in Life Course Research, University of Geneva, Switzerland; Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Switzerland; Department of Psychology, University of Geneva, Switzerland
| | | | - Cyrille Delpierre
- Institute of Sociological Research, University of Geneva, Switzerland
| | - Claudine Burton-Jeangros
- LIVES Centre, Swiss Centre of Expertise in Life Course Research, University of Geneva, Switzerland; Institute of Sociological Research, University of Geneva, Switzerland
| | - Stéphane Cullati
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Switzerland; Department of Readaptation and Geriatrics, University of Geneva, Switzerland
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8
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Gugushvili A, Reeves A. How democracy alters our view of inequality - and what it means for our health. Soc Sci Med 2021; 283:114190. [PMID: 34242889 DOI: 10.1016/j.socscimed.2021.114190] [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: 09/14/2020] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Income inequality is associated with poor health when economic disparities are especially salient. Yet, political institutions may alter this relationship because democracies (as opposed to autocracies) may be more inclined to frame inequalities in negative rather than positive ways. Living in a particular political system potentially alters the messages individuals receive about whether inequality is large or small, good or bad, and this, in turn, might affect whether beliefs about inequality influence health. Further, media coverage of economic inequality may negatively affect health if it contributes toward the general perception that the gap between rich and poor has gone up, even if there has been no change in income differentials. METHODS In this study, we explore the relationship between democracy, perceptions of inequality, and self-rated health across 28 post-communist countries using survey and macro-level data, multilevel regression models, and inverse probability weighting to estimate the average treatment effect on the treated. RESULTS We find that self-rated health is higher in more democratic countries and lower among people who believe that inequality has risen in the last few years. Moreover, we observe that people in democracies are more likely to learn about rising inequality through watching television and that when they do it has a more harmful effect on their health than when people in autocracies learn about rising inequality through the same channel, suggesting that in countries where there is less trust in the television media learning about rising inequality is not as harmful for health. CONCLUSIONS Our results indicate that while democracies are generally good for well-being, they may not be unambiguously positive for health. This does not mean, of course, that inequality is good for health nor that, on average, autocracies have better health than democracies; but rather that being more aware of inequality can negatively affect self-rated health.
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Affiliation(s)
- Alexi Gugushvili
- Department of Sociology and Human Geography, University of Oslo, Postboks 1096 Blindern, 0317, Oslo, Norway.
| | - Aaron Reeves
- Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, OX1 2ER, Oxford, United Kingdom.
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Iudici M, Jarlborg M, Lauper K, Müller-Ladner U, Smith V, Allanore Y, Balbir-Gurman A, Doria A, Airò P, Walker UA, Riccieri V, Vonk MC, Gabrielli A, Hoffmann-Vold AM, Szücs G, Martin T, Distler O, Courvoisier DS. Representativeness of Systemic Sclerosis Patients in Interventional Randomized Trials: an analysis of the EUSTAR database. Rheumatology (Oxford) 2021; 61:743-755. [PMID: 33989387 DOI: 10.1093/rheumatology/keab437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/10/2021] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To estimate the extent of and the reasons for ineligibility in randomized controlled trials (RCTs) of systemic sclerosis (SSc) patients included in the EUSTAR database, and to determine the association between patient's features and generalizability of study results. METHODS We searched Clinicaltrials.gov for all records on interventional SSc-RCTs registered from January 2013 to January 2018. Two reviewers selected studies, and information on the main trial features were retrieved. Data from 8046 patients having a visit in the EUSTAR database since 2013 were used to check patient's eligibility. The proportion of potentially eligible patients per trial, and the risk factors for ineligibility were analyzed. Complete-, worst- and best-case analyses were performed. RESULTS Of the 37 RCTs included, 43% were conducted in Europe, 35% were industry-funded, and 87% investigated pharmacological treatments. Ninety-one percent of 8046 patients included could have participated in at least one RCT. In complete-case analysis, the median [range] proportion of eligible patients having the main organ complication targeted by each study was 60% [10-100] in the overall sample of trials, ranging from 50% [32-79] for trials on skin fibrosis to 90% [34-77] for those targeting Raynaud's phenomenon. Among the criteria checked, treatment- and safety-related but not demographic were the main barriers to patient's recruitment. Older age, absence of Raynaud's phenomenon, and lower mRSS were independently associated with the failure to fulfill criteria for any of the included studies. CONCLUSIONS Patient's representativeness in SSc-RCTs is highly variable and is driven more by treatment- and safety-related rather than demographic criteria.
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Affiliation(s)
- Michele Iudici
- Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Matthias Jarlborg
- Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Kim Lauper
- Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Ulf Müller-Ladner
- Justus-Liebig-University of Giessen, Campus Kerckhoff, Bad Nauheim, Germany
| | - Vanessa Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium.,Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Ghent, Belgium
| | - Yannick Allanore
- Service de Rhumatologie, Cochin Hospital, APHP, Paris Descartes University, Paris, France
| | | | - Andrea Doria
- Department of Rheumatology, University of Padova, Padova, Italy
| | - Paolo Airò
- Rheumatology and Clinical Immunology, Spedali Civili, Brescia, Italy
| | - Ulrich A Walker
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Valeria Riccieri
- Dipartimento di Scienze Cliniche Internistiche Anestesiologiche e Cardiovascolari, Sapienza University of Rome, Rome, Italy
| | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Gabriella Szücs
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Thierry Martin
- Clinical immunology department, Hôpitaux Universitaires de Strasbourg, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Strasbourg, France
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Delphine S Courvoisier
- Rheumatology Unit, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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10
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Widding-Havneraas T, Pedersen SH. The role of welfare regimes in the relationship between childhood economic stress and adult health: a multilevel study of 20 European countries. SSM Popul Health 2020; 12:100674. [PMID: 33083511 PMCID: PMC7552090 DOI: 10.1016/j.ssmph.2020.100674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 08/22/2020] [Accepted: 09/26/2020] [Indexed: 11/18/2022] Open
Abstract
Childhood economic conditions are important for adult health, and welfare regimes may modify this relationship by altering exposure to social determinants of health. We examine the association between childhood economic stress (CES) and self-rated health (SRH) and cancer (any type), and how welfare regimes may influence these associations. We used data from European Social Survey round 7. Our study is based on 30 024 individuals between 25 to 75 years from 20 European countries grouped into five welfare regimes (Scandinavian, Anglo-Saxon, Bismarckian, Southern and Eastern). Multilevel models were used to assess the association between CES and SRH/cancer, and interactions between CES and welfare regimes. CES increased the risk of poor SRH (RR 1.41, 95% CI 1.29–1.54) and cancer (RR 1.19, 95% CI 1.02–1.37). Controlling for adult socioeconomic status slightly reduced risk for poor SRH, but not cancer. CES increased the probability of poor SRH in the Southern and Eastern regime, and the probability of cancer in the Anglo-Saxon regime, relative to the Scandinavian regime. Childhood economic stress increases the risk of poor self-rated health and cancer. More comprehensive welfare states mitigate these associations, which emphasizes the impact of welfare policies on long-term health outcomes of childhood economic conditions. The association between childhood economic stress and adult self-rated health and cancer was examined. The interaction of childhood economic stress and welfare regimes was tested on a large data set with 20 European countries. The article draws on welfare regime and life course theory. Childhood economic stress increased risk of poor self-rated health and cancer in adulthood. Welfare regimes affected the association between childhood economic stress and adult poor self-rated health and cancer.
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Affiliation(s)
- Tarjei Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Norway
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11
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Emerson E, Milner A, Aitken Z, Vaughan C, Llewellyn G, Kavanagh AM. Exposure to discrimination and subsequent changes in self-rated health: prospective evidence from the UK's Life Opportunities Survey. Public Health 2020; 185:176-181. [PMID: 32640384 DOI: 10.1016/j.puhe.2020.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 02/10/2020] [Accepted: 04/30/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES We sought to estimate risk of poor self-rated health (SRH) following exposure to disability-related and other forms of overt discrimination in a cohort of working age adults. STUDY DESIGN The study design is a population-based cohort survey. METHODS Secondary analysis of data collected in Waves 1 and 2 of the UK's Life Opportunities Survey which at Wave 2 involved the participation of 12,789 working age adults. Adjusted prevalence rate ratios were used to estimate the impact of exposure to disability and non-disability discrimination on two measures of SRH at Wave 2, controlling for SRH status at Wave 1. RESULTS Exposure to disability discrimination in the previous year was reported by 3.9% of working age British adults. Other forms of discrimination were reported less frequently (age: 3.7%, ethnicity: 2.5%, gender: 1.6%, religion: 0.8%, sexual orientation: 0.4%). In all analyses, there were stronger associations between exposure to disability discrimination and poor SRH at Wave 2 when compared with exposure to other forms of discrimination. CONCLUSIONS Disability discrimination represents a violation of human rights. It is also likely to be a major contributor to the health inequities experienced by working age adults with disability.
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Affiliation(s)
- E Emerson
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Australia; Centre for Disability Research, Faculty of Health and Medicine, Lancaster University, UK.
| | - A Milner
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - Z Aitken
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - C Vaughan
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Australia.
| | - G Llewellyn
- Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney, Australia.
| | - A M Kavanagh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Australia.
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Sieber S, Cheval B, Orsholits D, van der Linden BWA, Guessous I, Gabriel R, Kliegel M, von Arx M, Kelly-Irving M, Aartsen MJ, Boisgontier MP, Courvoisier D, Burton-Jeangros C, Cullati S. Do Welfare Regimes Moderate Cumulative Dis/advantages Over the Life Course? Cross-National Evidence from Longitudinal SHARE Data. J Gerontol B Psychol Sci Soc Sci 2020; 75:1312-1325. [PMID: 32206791 PMCID: PMC8456519 DOI: 10.1093/geronb/gbaa036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES This study aimed to examine the cumulative disadvantage of different forms of childhood misfortune and adult-life socioeconomic conditions (SEC) with regard to trajectories and levels of self-rated health in old age and whether these associations differed between welfare regimes (Scandinavian, Bismarckian, Southern European, and Eastern European). METHOD The study included 24,004 respondents aged 50-96 from the longitudinal SHARE survey. Childhood misfortune included childhood SEC, adverse childhood experiences, and adverse childhood health experiences. Adult-life SEC consisted of education, main occupational position, and financial strain. We analyzed associations with poor self-rated health using confounder-adjusted mixed-effects logistic regression models for the complete sample and stratified by welfare regime. RESULTS Disadvantaged respondents in terms of childhood misfortune and adult-life SEC had a higher risk of poor self-rated health at age 50. However, differences narrowed with aging between adverse-childhood-health-experiences categories (driven by Southern and Eastern European welfare regimes), categories of education (driven by Bismarckian welfare regime), and main occupational position (driven by Scandinavian welfare regime). DISCUSSION Our research did not find evidence of cumulative disadvantage with aging in the studied life-course characteristics and age range. Instead, trajectories showed narrowing differences with differing patterns across welfare regimes.
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Affiliation(s)
- Stefan Sieber
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives,”
University of Geneva, Switzerland
| | - Boris Cheval
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives,”
University of Geneva, Switzerland
| | - Dan Orsholits
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives,”
University of Geneva, Switzerland
| | - Bernadette W A van der Linden
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives,”
University of Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability,
University of Geneva, Switzerland
| | - Idris Guessous
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva
University Hospitals, Switzerland
| | - Rainer Gabriel
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives,”
University of Geneva, Switzerland
- ZHAW School of Social Work, Institute of Diversity and Social
Integration, Zurich, Switzerland
| | - Matthias Kliegel
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives,”
University of Geneva, Switzerland
- Center for the Interdisciplinary Study of Gerontology and Vulnerability,
University of Geneva, Switzerland
| | - Martina von Arx
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives,”
University of Geneva, Switzerland
| | | | - Marja J Aartsen
- NOVA - Norwegian Social Research, Centre for Welfare and Labour Research,
OsloMet - Oslo Metropolitan University, Norway
| | - Matthieu P Boisgontier
- School of Rehabilitation Sciences, University of Ottawa, Ontario, Canada.
Department of Readaptation and Geriatrics, University of
Geneva, Switzerland
| | - Delphine Courvoisier
- School of Rehabilitation Sciences, University of Ottawa, Ontario, Canada.
Department of Readaptation and Geriatrics, University of
Geneva, Switzerland
| | - Claudine Burton-Jeangros
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives,”
University of Geneva, Switzerland
- Institute of Sociological Research, University of Geneva,
Switzerland
| | - Stéphane Cullati
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives,”
University of Geneva, Switzerland
- School of Rehabilitation Sciences, University of Ottawa, Ontario, Canada.
Department of Readaptation and Geriatrics, University of
Geneva, Switzerland
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13
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Van Der Linden BWA, Sieber S, Cheval B, Orsholits D, Guessous I, Gabriel R, Von Arx M, Kelly-Irving M, Aartsen M, Blane D, Boisgontier MP, Courvoisier D, Oris M, Kliegel M, Cullati S. Life-Course Circumstances and Frailty in Old Age Within Different European Welfare Regimes: A Longitudinal Study With SHARE. J Gerontol B Psychol Sci Soc Sci 2020; 75:1326-1335. [PMID: 31665484 PMCID: PMC7265805 DOI: 10.1093/geronb/gbz140] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study aimed to assess whether cumulative disadvantage in childhood misfortune and adult-life socioeconomic conditions influence the risk of frailty in old age and whether welfare regimes influence these associations. METHOD Data from 23,358 participants aged 50 years and older included in the longitudinal SHARE survey were used. Frailty was operationalized according to Fried's phenotype as presenting either weakness, shrinking, exhaustion, slowness, or low activity. Confounder-adjusted mixed-effects logistic regression models were used to analyze associations of childhood misfortune and life-course socioeconomic conditions with frailty. RESULTS Childhood misfortune and poor adult-life socioeconomic conditions increased the odds of (pre-)frailty at older age. With aging, differences narrowed between categories of adverse childhood experiences (driven by Scandinavian welfare regime) and adverse childhood health experiences (driven by Eastern European welfare regime), but increased between categories of occupational position (driven by Bismarckian welfare regime). DISCUSSION These findings suggest that childhood misfortune is linked to frailty in old age. Such a disadvantaged start in life does not seem to be compensated by a person's life-course socioeconomic trajectory, though certain types of welfare regimes affected this relationship. Apart from main occupational position, our findings do not support the cumulative dis/advantage theory, but rather show narrowing differences.
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Affiliation(s)
| | - Stefan Sieber
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives”
| | - Boris Cheval
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives”
- Department of Readaptation and Geriatrics, University of Geneva, Switzerland
| | - Dan Orsholits
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives”
| | - Idris Guessous
- Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, Switzerland
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - Rainer Gabriel
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives”
- ZHAW, Zurich University of Applied Sciences, Switzerland
| | - Martina Von Arx
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives”
| | - Michelle Kelly-Irving
- INSERM, UMR1027, Toulouse, France
- Université Toulouse III Paul-Sabatier, UMR1027, Toulouse, France
| | - Marja Aartsen
- NOVA - Norwegian Social Research, Center for Welfare and Labor Research, Oslo, Norway
| | - David Blane
- International Centre for Life Course Studies in Society and Health, Department of Epidemiology and Public Health, University College London, UK
| | | | | | - Michel Oris
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives”
- Center for the Interdisciplinary Study of Gerontology and Vulnerability
| | - Matthias Kliegel
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives”
- Center for the Interdisciplinary Study of Gerontology and Vulnerability
| | - Stéphane Cullati
- Swiss NCCR “LIVES - Overcoming Vulnerability: Life Course Perspectives”
- Department of Readaptation and Geriatrics, University of Geneva, Switzerland
- Institute of Sociological Research, University of Geneva, Switzerland
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14
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Shahidi FV, Muntaner C, Shankardass K, Quiñonez C, Siddiqi A. The effect of welfare reform on the health of the unemployed: evidence from a natural experiment in Germany. J Epidemiol Community Health 2020; 74:211-218. [PMID: 31915239 DOI: 10.1136/jech-2019-213151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/18/2019] [Accepted: 12/21/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Over the past several decades, governments have enacted far-reaching reforms aimed at reducing the generosity and coverage of welfare benefits. Prior literature suggests that these policy measures may have deleterious effects on the health of populations. In this study, we evaluate the impact of one of the largest welfare reforms in recent history-the 2005 Hartz IV reform in Germany-with a focus on estimating its effect on the health of the unemployed. METHODS We employed a quasi-experimental difference-in-differences (DID) design using population-based data from the German Socio-Economic Panel Study, covering the period between 1994 and 2016. We applied DID linear probability modelling to examine the association between the Hartz IV reform and poor self-rated health, adjusting for a range of demographic and socioeconomic confounders. RESULTS The Hartz IV reform was associated with a 3.6 (95% CI 0.9 to 6.2) percentage point increase in the prevalence of poor self-rated health among unemployed persons affected by the reform relative to similar but unaffected controls. This negative association appeared immediately following the implementation of the reform and has persisted over time. CONCLUSION Governments in numerous European and North American jurisdictions have introduced measures to further diminish the generosity and coverage of welfare benefits. In line with growing concerns over the potential consequences of austerity and associated policy measures, our findings suggest that these reform efforts pose a threat to the health of socioeconomically disadvantaged populations.
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Affiliation(s)
- Faraz V Shahidi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada .,Institute for Work and Health, Toronto, Ontario, Canada
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Ketan Shankardass
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Carlos Quiñonez
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
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Childhood and adulthood circumstances predicting affective suffering and motivation among older adults: a comparative study of European welfare systems. Eur J Ageing 2019; 16:425-438. [PMID: 31798368 DOI: 10.1007/s10433-019-00518-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The aims of the study are, first, to examine the effect of childhood and adulthood predictors on affective suffering and motivational symptoms among older adults in Europe and, second, to assess differentials across European welfare systems. The mediating role of adulthood circumstances is also explored. Data are derived from the Survey of Health, Ageing and Retirement in Europe (SHARE) waves 2 (cross-sectional material) and 3 (retrospective information). The sample includes 23,050 respondents aged 50 +. The EUROD subscales were obtained using factor analysis; scores were transformed to binary constructs; logistic regression models were used to identify predictors; mediation was assessed employing a decomposition technique. Prevalence of both subscales is higher in Southern and Central/Eastern Europe and lower in Nordic countries, which are characterised by more equitable and generous welfare provisions. Though health, childhood socioeconomic status and childhood adversity are significant for both subscales, there are also differences; female gender, adulthood socioeconomic status and stress are associated with affective suffering, whereas age and educational attainment are of greater consequence for motivational symptoms. These findings are quite consistent across regions, indicating that the subscales represent different aspects of depression. By contrast, childhood circumstances are attenuated differentially by adulthood factors across Europe. Nevertheless, important mediating circumstances are stress for affective suffering and poor health for motivational symptoms. The importance of childhood circumstances in all aspects of later life mental health highlights the need for policy interventions across welfare systems, which should target vulnerable groups early in life.
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Cheval B, Orsholits D, Sieber S, Stringhini S, Courvoisier D, Kliegel M, Boisgontier MP, Cullati S. Early-life socioeconomic circumstances explain health differences in old age, but not their evolution over time. J Epidemiol Community Health 2019; 73:703-711. [PMID: 30967487 DOI: 10.1136/jech-2019-212110] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/14/2019] [Accepted: 03/19/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Early-life socioeconomic circumstances (SEC) are associated with health in old age. However, epidemiological evidences on the influence of these early-life risk factors on trajectories of healthy ageing are inconsistent, preventing drawing solid conclusion about their potential influence. Here, to fill this knowledge gap, we used a statistical approach adapted to estimating change over time and an outcome-wide epidemiology approach to investigate whether early-life SEC were associated with the level of and rate of decline of physical, cognitive and emotional functioning over time. METHODS We used data on more than 23 000 adults in older age from the Survey of Health, Ageing and Retirement in Europe, a 12-year large-scale longitudinal study with repeated measurements of multiple health indicators of the same participants over time (2004 -2015, assessments every 2 years). Confounder-adjusted linear growth curve models were used to examine the associations of early-life SEC with the evolution of muscle strength, lung function, cognitive function, depressive symptoms and well-being over time. RESULTS We consistently found an association between early-life SEC and the mean levels of all health indicators at age 63.5, with a critical role played by the cultural aspect of disadvantage. These associations were only partly explained by adult-life SEC factors. By contrast, evidences supporting an association between early-life SEC and the rate of change in health indicators were weak and inconsistent. CONCLUSIONS Early-life SEC are associated with health in old age, but not with trajectories of healthy ageing. Conceptual models in life course research should consider the possibility of a limited influence of early-life SEC on healthy ageing trajectories.
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Affiliation(s)
- Boris Cheval
- Swiss NCCR 'LIVES - Overcoming Vulnerability: Life Course Perspectives', University of Geneva, Geneva, Switzerland .,Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Dan Orsholits
- Swiss NCCR 'LIVES - Overcoming Vulnerability: Life Course Perspectives', University of Geneva, Geneva, Switzerland
| | - Stefan Sieber
- Swiss NCCR 'LIVES - Overcoming Vulnerability: Life Course Perspectives', University of Geneva, Geneva, Switzerland
| | - Silvia Stringhini
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | - Delphine Courvoisier
- Swiss NCCR 'LIVES - Overcoming Vulnerability: Life Course Perspectives', University of Geneva, Geneva, Switzerland.,Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
| | - Matthias Kliegel
- Swiss NCCR 'LIVES - Overcoming Vulnerability: Life Course Perspectives', University of Geneva, Geneva, Switzerland.,Center for the Interdisciplinary Study of Gerontology and Vulnerability, University of Geneva, Geneva, Switzerland
| | | | - Stephane Cullati
- Swiss NCCR 'LIVES - Overcoming Vulnerability: Life Course Perspectives', University of Geneva, Geneva, Switzerland.,Department of General Internal Medicine, Rehabilitation and Geriatrics, University of Geneva, Geneva, Switzerland
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