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Zhu R, Wang R, He J, Wang L, Chen H, Wang Y, An P, Li K, Ren F, Xu W, Martinez JA, Raben A, Guo J. Associations of cardiovascular-kidney-metabolic syndrome stages with premature mortality and the role of social determinants of health. J Nutr Health Aging 2025; 29:100504. [PMID: 39952015 DOI: 10.1016/j.jnha.2025.100504] [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: 12/27/2024] [Revised: 01/26/2025] [Accepted: 02/02/2025] [Indexed: 02/17/2025]
Abstract
OBJECTIVES The American Heart Association defined cardiovascular-kidney-metabolic (CKM) syndrome as a novel multi-stage disorder. We examined the associations of CKM stages with premature mortality and the role of social determinants of health (SDOHs). DESIGN A prospective cohort study. SETTING AND PARTICIPANTS A nationally representative sample of US adults from NHANES 1999-2018. MEASUREMENTS CKM included 5 stages (stages 0-4), reflecting progressive pathophysiology. Premature mortality (deaths before 75 years) were ascertained via linkage to the National Death Index with follow-up until 2019. Cox proportional-hazards models adjusted for age, sex, race/ethnicity, medical history, and other confounding factors were used to calculate the hazard ratios (HR) and 95% CIs for CKM-mortality associations. RESULTS Among 27,909 participants (mean age 49.7 years, 49.0% females), 1762 premature deaths occurred over a median follow-up of 8.3 years. Compared with stage 0, the adjusted HRs for all-cause premature mortality at CKM stages 1-4 were 0.88 (95% CI 0.66-1.17), 1.31 (0.99-1.73), 1.94 (1.31-2.87), and 2.19 (1.61-2.98), respectively. For CVD premature mortality, the adjusted HRs for CKM stages 1-4 were 1.12 (0.46-2.72), 1.74 (0.71-4.28), 3.93 (1.53-10.12), and 6.48 (2.95-14.20), respectively. Among adults at CKM stages 3-4, unfavorable SDOHs, particularly not living with a partner, low family income, lack of private health insurance, unemployment, or ≥2 cumulative SDOHs (4.16, 95% CI 3.35-5.18) were associated with increased all-cause premature mortality. Among those at CKM stages 0-2, unfavorable SDOHs were also related to increased premature mortality. CONCLUSION CKM stages 3-4, but not stages 1-2, were associated with increased risks of premature mortality compared with stage 0. The risks were increased by unfavorable SDOHs across CKM stages.
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Affiliation(s)
- Ruixin Zhu
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Ran Wang
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Jingjing He
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Langrun Wang
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Huiyu Chen
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Yifan Wang
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Peng An
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Keji Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Fazheng Ren
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China
| | - Weili Xu
- Department of Neurobiology, Care Sciences & Society, Karolinska Institutet, Solna, Sweden
| | - J Alfredo Martinez
- Centro de Investigacion Biomedica en Red Area de Fisiologia de la Obesidad y la Nutricion (CIBEROBN), Madrid, Spain; Precision Nutrition and Cardiometabolic Health Program, IMDEA-Food Institute (Madrid Institute for Advanced Studies), CEI UAM + CSIC, Madrid, Spain; Department of Medicine and Endocrinology, University of Valladolid, Valladolid, Spain
| | - Anne Raben
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark; Department for Clinical and Translational Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Jie Guo
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing, China; Department of Neurobiology, Care Sciences & Society, Karolinska Institutet, Solna, Sweden.
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Makiuchi T, Kakizaki M, Sobue T, Kitamura T, Yatsuya H, Yamaji T, Iwasaki M, Inoue M, Tsugane S, Sawada N. Mortality After Partner's Cancer Diagnosis or Death: A Population-based Prospective Cohort Study in Japan. J Epidemiol 2025; 35:118-128. [PMID: 39183033 PMCID: PMC11821380 DOI: 10.2188/jea.je20240114] [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: 10/03/2023] [Accepted: 07/23/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND The health statuses of closely connected individuals are interdependent. Little is known about mortality risk associated with partner's cancer diagnosis and cause-specific mortality risk associated with partner's death. METHODS Relative risks for all-cause and cause-specific mortality following a partner's cancer diagnosis or death compared to the period when the partner is cancer-free and alive were investigated in the population-based prospective cohort study that enrolled 140,420 people at the age between 40-69 years in 1990-1994. RESULTS 55,050 participants (27,665 men and 27,385 women) who were identified as married couples were followed-up for 1,073,746.1 (518,368.5 in men and 555,377.6 in women) person-years, during which 9,816 deaths were observed (7,217 in men and 2,599 in women). After a partner's cancer diagnosis, the mortality rate ratio (MRR) of all-cause mortality was not increased among both men and women, while an increase of externally-caused MRR was observed. The suicide MRR significantly increased among men (MRR 2.90; 95% confidence interval, 1.70-4.93), and it persisted for more than 5 years. After a partner's death, the MRRs of all-cause, cardiovascular disease (CVD), respiratory disease (RD), and externally-caused mortality significantly increased only among men. Stratified analysis by smoking status among men showed significantly increased MRRs of CVD and RD mortality among former/current smokers, but not among never-smokers. CONCLUSION Partner's cancer diagnosis did not increase all-cause mortality risk, but increased externally-caused mortality risk, especially suicide among men. The impact of partner's death on mortality risk differed by the mortality causes and sex, and smoking affected some of cause-specific mortality risk.
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Affiliation(s)
- Takeshi Makiuchi
- Division of Environmental Medicine and Population Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masako Kakizaki
- Department of Medical Education, Nagoya City University School of Medicine, Aichi, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Taiki Yamaji
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Motoki Iwasaki
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Manami Inoue
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- International University of Health and Welfare Graduate School of Public Health, Tokyo, Japan
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
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Alabdulkareem KB, Alshammari GM, Alyousef AA, Mohammed MA, Fattiny SZ, Alqahtani IZ, Yahya MA. Factors Associated with the Prevalence of Psychiatric Disorders Among Saudi Adults in the Eastern Region and Their Health Implications. Healthcare (Basel) 2024; 12:2419. [PMID: 39685040 DOI: 10.3390/healthcare12232419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2024] [Revised: 11/12/2024] [Accepted: 11/29/2024] [Indexed: 12/18/2024] Open
Abstract
BACKGROUND/OBJECTIVES The present study examined the link between sociodemographic variables, anthropometric indices, and psychiatric disorders among patients in Saudi Arabia's Eastern Region (Al-Hassa), as well as health outcomes, including basic hematological and biochemical markers. METHODS The patients included 89 females and 79 males with psychiatric disorders, with ages ranging from 19 to 59. Sociodemographic characteristics, anthropometric proxies, and fundamental hematological and biochemical markers were assessed. RESULTS The sociodemographic characteristics of the patients were poor and varied within and between sexes. This study observed that male psychiatric patients had greater anthropometric proxies, particularly those who were overweight or obese, than females. Most of the patients' hematological and biochemical parameters were below the normal level, with some higher than normal. Moreover, anemia was identified in 40.51% of the male participants in the study, with a higher percentage among those diagnosed with depressive disorders (Dep-d, 57.14%) and schizophrenia spectrum and other psychotic disorders (SsP-d, 32.43%), and 49.44% of the female participants, with a higher percentage among those diagnosed with depressive disorders (52.50%) and other psychotic disorders (46.15%). Furthermore, to confirm the link between sociodemographic variables, anthropometric indices, and psychiatric disorders among patients, the Spearman correlation coefficient and simple regression analysis of such variables was carried out. The results revealed that the majority of sociodemographic characteristics were either favorably or adversely correlated with patients' anthropometrics and type of depression in both sexes. CONCLUSION Low sociodemographic characteristics and high anthropometric variables may be risk factors for people with psychotic disorders, which have been linked to negative health consequences.
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Affiliation(s)
- Kholoud B Alabdulkareem
- Department of Social Studies, College of Arts, King Saud University, Riyadh 11495, Saudi Arabia
| | - Ghedeir M Alshammari
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ali Abdullah Alyousef
- Department of Clinical Nutrition, Mental Health Hospital Al-Ahsa, Minister of Health, Hofuf 13791, Saudi Arabia
| | - Mohammed A Mohammed
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Sndos Z Fattiny
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
| | - Ismail Zayed Alqahtani
- Department of Clinical Nutrition, Mental Health Hospital Al-Ahsa, Minister of Health, Hofuf 13791, Saudi Arabia
| | - Mohammed Abdo Yahya
- Department of Food Science and Nutrition, College of Food and Agricultural Sciences, King Saud University, Riyadh 11451, Saudi Arabia
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Zawada SJ, Ganjizadeh A, Conte GM, Demaerschalk BM, Erickson BJ. Accelerometer-Measured Behavior Patterns in Incident Cerebrovascular Disease: Insights for Preventative Monitoring From the UK Biobank. J Am Heart Assoc 2024; 13:e032965. [PMID: 38818948 PMCID: PMC11255632 DOI: 10.1161/jaha.123.032965] [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: 10/03/2023] [Accepted: 04/03/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The goal was to compare patterns of physical activity (PA) behaviors (sedentary behavior [SB], light PA, moderate-to-vigorous PA [MVPA], and sleep) measured via accelerometers for 7 days between patients with incident cerebrovascular disease (CeVD) (n=2141) and controls (n=73 938). METHODS AND RESULTS In multivariate models, cases spent 3.7% less time in MVPA (incidence rate ratio [IRR], 0.963 [95% CI, 0.929-0.998]) and 1.0% more time in SB (IRR, 1.010 [95% CI, 1.001-1.018]). Between 12 and 24 months before diagnosis, cases spent more time in SB (IRR, 1.028 [95% CI, 1.001-1.057]). Within the year before diagnosis, cases spent less time in MVPA (IRR, 0.861 [95% CI, 0.771-0.964]). Although SB time was not associated with CeVD risk, MVPA time, both total min/d (hazard ratio [HR], 0.998 [95% CI, 0.997-0.999]) and guideline threshold adherence (≥150 min/wk) (HR, 0.909 [95% CI, 0.827-0.998]), was associated with decreased CeVD risk. Comorbid burden had a significant partial mediation effect on the relationship between MVPA and CeVD. Cases slept more during 12:00 to 17:59 hours (IRR, 1.091 [95% CI, 1.002-1.191]) but less during 0:00 to 5:59 hours (IRR, 0.984 [95% CI, 0.977-0.992]). No between-group differences were significant at subgroup analysis. CONCLUSIONS Daily behavior patterns were significantly different in patients before CeVD. Although SB was not associated with CeVD risk, the association between MVPA and CeVD risk is partially mediated by comorbid burden. This study has implications for understanding observable behavior patterns in cerebrovascular dysfunction and may help in developing remote monitoring strategies to prevent or reduce cerebrovascular decline.
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Affiliation(s)
| | - Ali Ganjizadeh
- Mayo Clinic Artificial Intelligence LaboratoryRochesterMN
| | | | - Bart M. Demaerschalk
- Mayo Clinic College of Medicine and SciencePhoenixAZ
- Mayo Clinic Division of Stroke and Cerebrovascular DiseasesDepartment of NeurologyPhoenixAZ
- Mayo Clinic Center for Digital HealthPhoenixAZ
| | - Bradley J. Erickson
- Mayo Clinic College of Medicine and SciencePhoenixAZ
- Mayo Clinic Artificial Intelligence LaboratoryRochesterMN
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Pasokh Z, Seif M, Ghaem H, Rezaianzadeh A, Johari MG. Age at natural menopause and development of chronic diseases in the female population of Kharameh, Iran: A historical cohort study. Health Sci Rep 2024; 7:e2042. [PMID: 38650726 PMCID: PMC11033488 DOI: 10.1002/hsr2.2042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
Background and Aims Declines in estradiol levels after menopause have been reported to be associated with several health outcomes. This study aimed to determine the effect of age at natural menopause (ANM) on some of the most common chronic diseases. Methods This historical cohort study was performed on 2636 postmenopausal women aged 40-70 years participating in phase one of the PERSIAN cohort study in Kharameh, Iran, during 2015-2017. The effect of early (<45 years), intermediate (45-53 years), and late menopause (>53 years) on chronic diseases such as hypertension, diabetes, ischemic heart diseases, stroke, thyroid diseases, and depression was assessed using classic logistic regression for diseases with an incidence rate of more than 10% and Firth's logistic regression for diseases with an incidence of less than this amount. Results The mean age of women was 53.48 ± 8.59. Respectively, early and intermediate menopause was associated with ischemic heart disease (odds ratio [OR = 1.61, 95% confidence interval [CI]: 1.08-2.42; p = 0.020), (OR = 1.57, 95% CI: 1.13-2.21; p = 0.008) and thyroid diseases (OR = 3.10, 95% CI: 1.64-6.24; p < 0.001), (OR = 1.83, 95% CI: 1.02-3.57; p = 0.042). furthermore, early menopause was a risk factor for diabetes (OR = 1.46, 95% CI: 1.07-2.00; p = 0.018), depression (OR = 4.79, 95% CI: 2.20-11.79; p = <0.001) and stroke (OR = 3.00, 95% CI: 1.08-9.32; p = 0.034). Conclusions In this study, women with diabetes, ischemic heart diseases, stroke, thyroid disorders, and depression had a younger ANM compared to their healthy counterparts. Therefore, applying appropriate strategies to postpone the age of menopause, can reduce the incidence of these types of chronic diseases.
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Affiliation(s)
- Zahra Pasokh
- Student Research Committee, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Mozhgan Seif
- Non‐Communicable Diseases Research Center, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Haleh Ghaem
- Non‐Communicable Diseases Research Center, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Abbas Rezaianzadeh
- Colorectal Research Center, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Masoumeh Ghoddusi Johari
- Breast Diseases Research Center, Community Medicine DepartmentShiraz University of Medical SciencesShirazIran
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Cai A, Chen C, Wang J, Ou Y, Nie Z, Feng Y. Social Determinants of Health, Cardiovascular Health, and Outcomes in Community-Dwelling Adults Without Cardiovascular Disease. JACC. ASIA 2024; 4:44-54. [PMID: 38222255 PMCID: PMC10782398 DOI: 10.1016/j.jacasi.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/07/2023] [Accepted: 09/04/2023] [Indexed: 01/16/2024]
Abstract
Background Limited data exist regarding the prognostic implications of social determinants of health (SDOH) and cardiovascular health (CVH) in Chinese community populations. Objectives The aim of this study was to evaluate the associations of SDOH and CVH with major adverse cardiovascular events (MACE) and all-cause death. Methods Individuals without cardiovascular disease were obtained from the China Patient-Centered Evaluative Assessment of Cardiac Events Million Persons Project. SDOH (educational attainment, economic stability, health care access, social support, and neighborhood) and CVH components were extracted. Participants were divided into groups with low and high burden of unfavorable SDOH and groups with poor, intermediate, and ideal CVH. MACE (a composite of coronary heart disease or myocardial infarction, stroke, heart failure, and cardiovascular death) and all-cause death were identified by linking hospital records with resident identity card number. Results Among the cohort (n = 38,571, median age 54 years, 60.5% women), the proportion of individuals with a high burden of unfavorable SDOH was 68.9%, and that with poor CVH was 30.7%. In reference to the group with a low burden of unfavorable SDOH, the adjusted HRs for MACE and all-cause death in the high burden group were 1.18 (95% CI: 1.08-1.30) and 1.35 (95% CI: 1.09-1.68), respectively. In reference to the group with ideal CVH, poor CVH was associated with higher risks for MACE and all-cause death. A high burden of unfavorable SDOH and poor CVH exerted joint effects on all-cause death (HR: 2.20; 95% CI: 1.08-4.48). Conclusions A high burden of unfavorable SDOH and poor CVH were associated with increased risks for MACE and mortality. Dedicated efforts are needed to address these health disparities.
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Affiliation(s)
- Anping Cai
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Chaolei Chen
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jiabin Wang
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Epidemiology, Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Sothern Medical University, Guangzhou, China
| | - Yanqiu Ou
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Zhiqiang Nie
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Epidemiology, Global Health Research Center, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Sothern Medical University, Guangzhou, China
| | - Yingqing Feng
- Department of Cardiology, Hypertension Research Laboratory, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
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Hong J, Dembo RS, DaWalt LS, Baker MW, Berry-Kravis E, Mailick MR. Mortality in Women across the FMR1 CGG Repeat Range: The Neuroprotective Effect of Higher Education. Cells 2023; 12:2137. [PMID: 37681869 PMCID: PMC10486613 DOI: 10.3390/cells12172137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/09/2023] Open
Abstract
Higher education has been shown to have neuroprotective effects, reducing the risk of Alzheimer's and Parkinson's diseases, slowing the rate of age-related cognitive decline, and is associated with lower rates of early mortality. In the present study, the association between higher education, fragile X messenger ribonucleoprotein 1 (FMR1) cytosine-guanine-guanine (CGG) repeat number, and mortality before life expectancy was investigated in a population cohort of women born in 1939. The findings revealed a significant interaction between years of higher education and CGG repeat number. Counter to the study's hypothesis, the effects of higher education became more pronounced as the number of CGG repeats increased. There was no effect of years of higher education on early mortality for women who had 25 repeats, while each year of higher education decreased the hazard of early mortality by 8% for women who had 30 repeats. For women with 41 repeats, the hazard was decreased by 14% for each additional year of higher education. The interaction remained significant after controlling for IQ and family socioeconomic status (SES) measured during high school, as well as factors measured during adulthood (family, psychosocial, health, and financial factors). The results are interpreted in the context of differential sensitivity to the environment, a conceptualization that posits that some people are more reactive to both negative and positive environmental conditions. Expansions in CGG repeats have been shown in previous FMR1 research to manifest such a differential sensitivity pattern.
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Affiliation(s)
- Jinkuk Hong
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.S.D.); (L.S.D.); (M.R.M.)
| | - Robert S. Dembo
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.S.D.); (L.S.D.); (M.R.M.)
- NORC at the University of Chicago, Chicago, IL 60603, USA
| | - Leann Smith DaWalt
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.S.D.); (L.S.D.); (M.R.M.)
| | - Mei Wang Baker
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA;
- Wisconsin State Laboratory of Hygiene, Madison, WI 53706, USA
| | - Elizabeth Berry-Kravis
- Department of Pediatrics, Rush University Medical Center, Chicago, IL 60612, USA;
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL 60612, USA
- Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Marsha R. Mailick
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA; (R.S.D.); (L.S.D.); (M.R.M.)
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Lopez-Espejo M, Poblete R, Bastias G. Social and health determinants related to adverse short-term outcomes after a first-ever stroke in adults younger than 65 years. J Stroke Cerebrovasc Dis 2023; 32:107153. [PMID: 37172471 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107153] [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: 01/21/2023] [Revised: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Stroke-related mortality and disability-adjusted life years in adults younger than 65 have increased over the last decade. However, geographical differences in distributing these outcomes could reflect dissimilarity in determinants. Therefore, this cross-sectional study of secondary data from Chilean hospitals aims to analyze the association of sociodemographic and clinical factors with in-hospital case-fatality risk or acquired neurologic deficits (adverse outcomes) in inpatients aged 18 to 64 who experienced their first-ever stroke. METHODOLOGY Adjusted multivariable logistic regression models and interaction analysis using multiple imputation for missing data (4.99%) for 1,043 hospital discharge records from the UC-CHRISTUS Health Network International Refined Diagnosis Related Groups (IR-DRG) system database (2010-2021) were conducted. RESULTS Mean age: 51.47 years (SD, 10.79); female: 39.60%. Stroke types: subarachnoid hemorrhage (SAH): 5.66%, intracerebral hemorrhage (ICH): 11.98%, and ischemic: 82.45%. Adverse outcomes: 25.22% (neurological deficit: 23.59%; in-hospital case-fatality risk: 1.63%). After adjusting for confounders, adverse outcomes were associated with stroke type (patients with ICH and ischemic stroke had higher odds than those with SAH), sociodemographic characteristics (age ≥ 40 years, residence in an area of the capital city other than the center-east, and coverage by public health insurance), and discharge diagnoses (obesity, coronary artery and chronic kidney diseases, and mood and anxiety disorders). For hypertension, women had higher odds of adverse outcomes. CONCLUSIONS In this predominantly Hispanic sample, modifiable social and health determinants are related to adverse short-term outcomes after a first-ever stroke. Longitudinal studies are needed to investigate the causal role of these factors.
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Affiliation(s)
- Mauricio Lopez-Espejo
- Unit of Neurology, Division of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, Diagonal Paraguay 362, (postal: 8330077) Santiago, Chile.
| | - Rodrigo Poblete
- Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, Diagonal Paraguay 362, (postal: 8330077) Santiago, Chile.
| | - Gabriel Bastias
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile, Diagonal Paraguay 362, (postal: 8330077) Santiago, Chile.
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Yang JM, Kim JH. Effect of trajectory of employment status on all-cause mortality in the late middle-aged and older population: results of the Korea Longitudinal Study of Aging (2006-2020). Epidemiol Health 2023; 45:e2023056. [PMID: 37309113 PMCID: PMC10482569 DOI: 10.4178/epih.e2023056] [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: 03/23/2023] [Accepted: 05/20/2023] [Indexed: 06/14/2023] Open
Abstract
OBJECTIVES This study conducted a longitudinal analysis of the effect of trajectory of employment status (TES) on all-cause mortality in late middle-aged and older Koreans based on the Korean Longitudinal Study of Aging (KLoSA). METHODS After excluding missing values, data on 2,774 participants were analyzed using the chi-square test and the group-based trajectory model (GBTM) for data from the first to fifth KLoSA and the chi-square test, log-rank test, and Cox proportional hazard regression for data from the fifth to eighth KLoSA. RESULTS The GBTM analysis identified 5 TES groups: sustained white collar (WC; 18.1%), sustained standard blue collar (BC; 10.8%), sustained self-employed BC (41.1%), WC to job loss (9.9%), and BC to job loss (20.1%). Compared to the sustained WC group, the WC to job loss group had higher mortality at 3 years (hazard ratio [HR], 4.04, p=0.044), 5 years (HR, 3.21, p=0.005), and 8 years (HR, 3.18, p<0.001). The BC to job loss group had higher mortality at 5 years (HR, 2.57, p=0.016) and 8 years (HR, 2.20, p=0.012). Those aged 65 years and older and males in the WC to job loss and BC to job loss groups had an increased risk of death at 5 years and 8 years. CONCLUSIONS There was a close association between TES and all-cause mortality. This finding highlights the need for policies and institutional measures to reduce mortality within vulnerable groups with an increased risk of death due to a change in employment status.
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Affiliation(s)
- Jeong Min Yang
- Institute for Digital Life Convergence, Dankook University, Cheonan, Korea
- Department of Public Health, General Graduate School of Dankook University, Cheonan, Korea
| | - Jae Hyun Kim
- Institute for Digital Life Convergence, Dankook University, Cheonan, Korea
- Department of Health Administration, Dankook University College of Health Science, Cheonan, Korea
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Tian DS, Liu CC, Wang CL, Qin C, Wang MH, Liu WH, Liu J, Zhang HW, Zhang RG, Wang SK, Zhang XX, Wang L, Pan DJ, Hu JP, Luo X, Xu SB, Wang W. Prevalence and risk factors of stroke in China: a national serial cross-sectional study from 2003 to 2018. Stroke Vasc Neurol 2023; 8:238-248. [PMID: 36418056 PMCID: PMC10359805 DOI: 10.1136/svn-2022-001598] [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: 03/21/2022] [Accepted: 11/02/2022] [Indexed: 11/24/2022] Open
Abstract
Stroke imposes a substantial burden worldwide. With the rapid economic and lifestyle transition in China, trends of the prevalence of stroke across different geographic regions in China remain largely unknown. Capitalizing on the data in the National Health Services Surveys (NHSS), we assessed the prevalence and risk factors of stroke in China from 2003 to 2018. In this study, data from 2003, 2008, 2013, and 2018 NHSS were collected. Stroke cases were based on participants' self-report of a previous diagnosis by clinicians. We estimated the trends of stroke prevalence for the overall population and subgroups by age, sex, and socioeconomic factors, then compared across different geographic regions. We applied multivariable logistic regression to assess associations between stroke and risk factors. The number of participants aged 15 years or older were 154,077, 146,231, 230,067, and 212,318 in 2003, 2008, 2013, and 2018, respectively, among whom, 1435, 1996, 3781, and 6069 were stroke patients. The age and sex standardized prevalence per 100,000 individuals was 879 in 2003, 1100 in 2008, 1098 in 2013, and 1613 in 2018. Prevalence per 100,000 individuals in rural areas increased from 669 in 2003 to 1898 in 2018, while urban areas had a stable trend from 1261 in 2003 to 1365 in 2018. Across geographic regions, the central region consistently had the highest prevalence, but the western region has an alarmingly increasing trend from 623/100,000 in 2003 to 1898/100,000 in 2018 (P trend<0.001), surpassing the eastern region in 2013. Advanced age, male sex, rural area, central region, hypertension, diabetes, depression, low education and income level, retirement or unemployment, excessive physical activity, and unimproved sanitation facilities were significantly associated with stroke. In conclusion, the increasing prevalence of stroke in China was primarily driven by economically underdeveloped regions. It is important to develop targeted prevention programs in underdeveloped regions. Besides traditional risk factors, more attention should be paid to nontraditional risk factors to improve the prevention of stroke.
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Affiliation(s)
- Dai-Shi Tian
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chen-Chen Liu
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chao-Long Wang
- Department of Epidemiology and Biostatistics, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chuan Qin
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ming-Huan Wang
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wen-Hua Liu
- Department of Scientific Research Management, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jian Liu
- Department of Scientific Research Management, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Han-Wen Zhang
- Infervision Medical Technology Co., Ltd, Beijing, China
| | | | | | - Xiao-Xiang Zhang
- Department of Computer Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Liang Wang
- Department of Computer Center, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Deng-Ji Pan
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jian-Ping Hu
- Centre for Health Statistics Information, National Health Commission of the People's Republic of China, Beijing, China
| | - Xiang Luo
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Sha-Bei Xu
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wei Wang
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 2277] [Impact Index Per Article: 1138.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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12
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Huynh TB, McClure LA, Howard VJ, Stafford MM, Judd SE, Burstyn I. Duration of employment within occupations and incident stroke in a US general population cohort 45 years of age or older (REGARDS study). Am J Ind Med 2023; 66:142-154. [PMID: 36440885 DOI: 10.1002/ajim.23446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The work environment can contribute to the risk of cardiovascular diseases (CVD) including stroke. Our objective was to identify occupations with elevated risk of stroke within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. METHODS We analyzed incident stroke outcomes (ischemic and hemorrhagic strokes) from 2003 to 2020 and employment characteristics of 13,659 adults aged ≥45 years enrolled in a national population-based cohort study. Using a modified Poisson regression approach, we estimated the relative risks (RRs) and the associated 95% confidence intervals (CI) of stroke in relation to years of employment within each occupation coded using the US Census two-digit Standard Occupation Code. Models were adjusted for Framingham Stroke Risk Score, region, race, age, and body mass index. We conducted stratified analysis by sex, employment time period (pre-1975 vs. post-1975), and region. RESULTS Workers in the following occupations had a greater risk of stroke with longer duration of employment (per decade): protective service (RR: 2.35, 95% CI: 1.11, 4.97), food preparation and service (RR: 1.51, 95% CI: 1.05, 2.19), and transportation and material moving (RR: 1.30, 95% CI: 1.00, 1.69). The stroke risk in these occupations was disproportionately elevated in men, and differed by region and employment time period. CONCLUSIONS Longer employment in protective service, food preparation and serving, and transportation and materials moving occupations may increase the risk of stroke. Surveillance may uncover specific work-related risk factors in these occupations, leading to interventions to reduce the burden of stroke among US workers.
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Affiliation(s)
- Tran B Huynh
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Leslie A McClure
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Virginia J Howard
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monika M Stafford
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Suzanne E Judd
- Graduate School of Medical Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Igor Burstyn
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Serrano-Castro ML, Garro-Zúñiga M, Simon E, Tamayo A, Siepmann T. Clinical and Imaging Phenotypes and Outcomes in a Costa Rican Cohort of Acute Ischemic Stroke Survivors: A Retrospective Study. J Clin Med 2023; 12:1080. [PMID: 36769728 PMCID: PMC9917829 DOI: 10.3390/jcm12031080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND We characterized clinical and imaging phenotypes and their association with clinical outcomes in acute ischemic stroke (AIS) survivors in the understudied region of Costa Rica. METHODS We conducted a retrospective cohort study in AIS patients treated at a tertiary stroke center in Costa Rica from 2011-2015. Participants underwent detailed phenotyping for cardiovascular risk factors and stroke etiology. We assessed the association of ischemic brain lesion features and clinical outcomes using the Oxfordshire Community Stroke Project (OCSP) classification. RESULTS We included 684 AIS survivors (60.2% males, aged 68.1 ± 13.6 years, mean ± SD). While the cardiovascular risk profiles and mortality rates of our patients were similar to populations in European and North American countries, only 20.2% of patients with atrial fibrillation (AF) received anticoagulation. On multivariable analysis, patients with total anterior circulation infarct (TACI) displayed an increased risk of complications (OR: 4.2; 95% CI: 2.2-7.8; p < 0.001), higher mortality (OR: 6.9; 95% CI: 2.9-16.1; p < 0.001) and lower chance of functional independence at discharge (OR: 8.9; 95% CI: 4.1-19; p < 0.001) compared to non-TACI. The comorbidity of bronchopneumonia increased the probability of death by 14.5 times. CONCLUSIONS Our observations in a Costa Rican cohort of AIS survivors might help improve local measures for preventing and managing AIS.
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Affiliation(s)
- María Lorena Serrano-Castro
- Department of Internal Medicine, Hospital Chacón Paut, Caja Costarricense de Seguro Social, San José 10101, Costa Rica
- Division of Health Care Sciences, Dresden International University, 01067 Dresden, Germany
| | - Mónica Garro-Zúñiga
- Department of Neurology, Hospital San Juan de Dios, Caja Costarricense del Seguro Social, San José 94088, Costa Rica
| | - Erik Simon
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01069 Dresden, Germany
| | - Arturo Tamayo
- Division of Health Care Sciences, Dresden International University, 01067 Dresden, Germany
- Winnipeg Regional Health Authority (WRHA), Section of Neurology, Department of Medicine, The Max Rady Faculty of Health Sciences, Brandon Regional Health Centre, University of Manitoba, Winnipeg, MB R3T 2N2, Canada
| | - Timo Siepmann
- Division of Health Care Sciences, Dresden International University, 01067 Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01069 Dresden, Germany
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Dev R, Adams AM, Raparelli V, Norris CM, Pilote L. Sex and Gender Determinants of Vascular Disease in the Global Context. Can J Cardiol 2022; 38:1799-1811. [PMID: 35667597 DOI: 10.1016/j.cjca.2022.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/17/2022] [Accepted: 05/29/2022] [Indexed: 12/14/2022] Open
Abstract
Globally, vascular diseases are a leading cause of morbidity and mortality. Many of the most significant risk factors for vascular disease have a gendered dimension, and sex differences in vascular diseases incidence are apparent, worldwide. In this narrative review, we provide a contemporary picture of sex- and gender-related determinants of vascular disease. We illustrate key factors underlying sex-specific risk stratification, consider similarities and sex differences in vascular disease risk and outcomes with comparisons of data from the global North (ie, developed high-income countries in the Northern hemisphere and Australia) and the global South (ie, regions outside Europe and North America), and explore the relationship between country-level gendered inequities in vascular disease risk and the United Nation's gender inequality index. Review findings suggest that the rising incidence of vascular disease in women is partly explained by an increase in the prevalence of traditional risk factors linked to gender-related determinants such as shifting roles and relations related to the double burden of employment and caregiving responsibilities, lower educational attainment, lower socioeconomic status, and higher psychosocial stress. Social isolation partly explained the higher incidence of vascular disease in men. These patterns were apparent across the global North and South. Study findings emphasize the necessity of taking into account sex differences and gender-related factors in the determination of the vascular disease risk profiles and management strategies. As we move toward the era of precision medicine, future research is needed that identifies, validates, and measures gender-related determinants and risk factors in the global South.
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Affiliation(s)
- Rubee Dev
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Faculty of Applied Science, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alayne M Adams
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Valeria Raparelli
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy; University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Colleen M Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine and School of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada; Cardiovascular and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Louise Pilote
- Divisions of General Internal Medicine and Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Quebec, Canada; Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, Quebec, Canada.
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Voluntary Unemployment Is Associated With Increased Prevalence of Stroke and its Risk Factors in Middle-Aged Adults. J Occup Environ Med 2022; 64:e672-e676. [PMID: 35941742 DOI: 10.1097/jom.0000000000002662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The aim of the study is to investigate the association between the prevalence of stroke, its risk factors, and occupational status, with a differentiation between voluntary and involuntary unemployment. METHODS This is a cross-sectional study, which included 3013 individuals aged 40 to 65 years. We compared the prevalence of stroke, comorbidities, self-reported stroke-like symptoms, healthy behaviors, and knowledge about stroke among the voluntarily and involuntarily unemployed versus the employed. RESULTS Voluntary unemployment was associated with increased chances of stroke (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.05-3.57), hypertension (OR, 1.18; 95% CI, 1.06-1.32), diabetes (OR, 1.16; 95% CI, 1.01-1.35), and obesity (OR, 1.16; 95% CI, 1.05-1.29). Involuntary job loss was associated with increased odds of hypertension (OR, 1.69; 95% CI, 1.16-2.50) and more frequent self-reported stroke-like symptoms. CONCLUSIONS We found higher chances of stroke among the voluntarily unemployed middle-aged adults, presumably because of increased prevalence of hypertension, diabetes, and obesity.
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Thomas RD, Davis JW, Cuccaro PM, Gemeinhardt GL. Assessing associations between insecure income and US workers’ health: An IPUMS-MEPS analysis. Soc Sci Med 2022; 309:115240. [DOI: 10.1016/j.socscimed.2022.115240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/01/2022] [Accepted: 07/23/2022] [Indexed: 10/15/2022]
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Kragelund K, Tolstrup JS, Lau CJ, Christensen AI, Jørgensen MB. Smoking and labour market participation: a 5-year prospective cohort study of transitions between work, unemployment and sickness absence. Scand J Public Health 2022:14034948221081289. [PMID: 35484856 DOI: 10.1177/14034948221081289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To examine whether smokers are at higher risk of unemployment and sickness absence and have a lower chance of getting employed compared to never smokers. METHODS The study sample in this prospective register-based cohort study consisted of 87,830 men and women between 18 and 60 years of age from the Danish National Health Survey 2010. Assessment of smoking status was obtained at baseline and the participants were followed in the Danish register-based evaluation of marginalisation database from 2010 to 2015. Data were analysed by Cox proportional hazards. RESULTS The median age was 44.5 years and 47.3% were men. At baseline, 88.8% were categorised as working, 7.7% as unemployed and 3.5% as being on sickness absence. At the 5-year follow-up, hazard ratios for transitions from work to unemployment were 1.31 (95% confidence interval (CI) 1.22-1.40; P<0.001) for current smokers (<15/day) and 1.52 (95% CI 1.43-1.62; P<0.001) for current heavy smokers (⩾15/day), compared to never smokers. Hazard ratios for transitions from work to sickness absence were 1.31 (95% CI 1.24-1.38; P<0.001) for current smokers (<15/day) and 1.64 (95% CI 1.56-1.71; P<0.001) for current heavy smokers (⩾15/day). Current heavy smokers (⩾15/day) also had a lower chance of becoming re-employed with a hazard ratio of 0.81 (95% CI 0.75-0.88; P<0.001) compared to never smokers. Smoking was associated with a higher risk of unemployment and sickness absence, and a lower chance of becoming employed. More focus on smoking prevention and smoking cessation could therefore be implemented in relation to job seeking and sickness absence.
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Affiliation(s)
- Kamilla Kragelund
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Cathrine J Lau
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Anne I Christensen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Maja B Jørgensen
- National Institute of Public Health, University of Southern Denmark, Denmark
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 3152] [Impact Index Per Article: 1050.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Li F, Zhong J, He F, Wang H, Lin J, Yu M. Stock market fluctuation and stroke incidence: A time series study in Eastern China. Soc Sci Med 2022; 296:114757. [DOI: 10.1016/j.socscimed.2022.114757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/21/2022] [Accepted: 01/26/2022] [Indexed: 01/22/2023]
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Rakhmatullin A, Kutlubaev M, Kutlubaeva R, Ozerova A. Socioeconomic factors and stroke. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:45-51. [DOI: 10.17116/jnevro202212203245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Social Determinants of Health and Cardiovascular Disease: Current State and Future Directions Towards Healthcare Equity. Curr Atheroscler Rep 2021; 23:55. [PMID: 34308497 DOI: 10.1007/s11883-021-00949-w] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW We sought to examine the role of social and environmental conditions that determine an individual's behaviors and risk of disease-collectively known as social determinants of health (SDOH)-in shaping cardiovascular (CV) health of the population and giving rise to disparities in risk factors, outcomes, and clinical care for cardiovascular disease (CVD), the leading cause of death in the United States (US). RECENT FINDINGS Traditional CV risk factors have been extensively targeted in existing CVD prevention and management paradigms, often with little attention to SDOH. Limited evidence suggests an association between individual SDOH (e.g., income, education) and CVD. However, inequities in CVD care, risk factors, and outcomes have not been studied using a broad SDOH framework. We examined existing evidence of the association between SDOH-organized into 6 domains, including economic stability, education, food, neighborhood and physical environment, healthcare system, and community and social context-and CVD. Greater social adversity, defined by adverse SDOH, was linked to higher burden of CVD risk factors and poor outcomes, such as stroke, myocardial infarction (MI), coronary heart disease, heart failure, and mortality. Conversely, favorable social conditions had protective effects on CVD. Upstream SDOH interact across domains to produce cumulative downstream effects on CV health, via multiple physiologic and behavioral pathways. SDOH are major drivers of sociodemographic disparities in CVD, with a disproportionate impact on socially disadvantaged populations. Efforts to achieve health equity should take into account the structural, institutional, and environmental barriers to optimum CV health in marginalized populations. In this review, we highlight major knowledge gaps for each SDOH domain and propose a set of actionable recommendations to inform CVD care, ensure equitable distribution of healthcare resources, and reduce observed disparities.
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22
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 3525] [Impact Index Per Article: 881.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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23
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Ying Y, Lin S, Kong F, Li Y, Xu S, Liang X, Wang C, Han L. Ideal Cardiovascular Health Metrics and Incidence of Ischemic Stroke Among Hypertensive Patients: A Prospective Cohort Study. Front Cardiovasc Med 2020; 7:590809. [PMID: 33330652 PMCID: PMC7719670 DOI: 10.3389/fcvm.2020.590809] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 09/29/2020] [Indexed: 12/16/2022] Open
Abstract
Background: This study aimed to assess the relationship between ideal cardiovascular health (CVH) metrics and incident ischemic stroke (IS) in hypertensive patients, especially those with hyperhomocysteinemia (HHcy). Methods: A prospective cohort study enrolled 5,488 hypertensive patients in Nanshan District of Shenzhen City in southern China from September 2011 to December 2017. CVH metrics were defined according to the American Heart Association. Cox proportional hazards models were used to examine the associations between the number of ideal CVH metrics and the incidence of IS by calculating multivariable-adjusted hazard ratios (HRs) and 95% CI. Results: During an average follow-up of 5.7 years, 340 IS patients were identified. Compared with those having 0 ideal CVH metrics, the HRs (95% CIs) for IS among those with 1, 2, 3, 4, and 5–6 ideal CVH metrics were 0.62 (0.31–1.25), 0.37 (0.19–0.74), 0.37 (0.18–0.74), 0.34 (0.16–0.71), and 0.28 (0.12–0.63), respectively (P < 0.001). An ideal healthy diet score and ideal fasting blood glucose level were independently associated with IS among participants, with HRs (95% CIs) of 0.53 (0.33–0.86) and 0.32 (0.17–0.66), respectively. Additionally, compared with those with normal total homocysteine (tHcy) levels (<15 μmol/L), the HR (95% CI) for IS among participants with HHcy and who had 5–6 ideal CVH metrics was 0.50 (0.27–0.92). Conclusion: An increased number of ideal CVH metrics was inversely associated with the incidence of IS in hypertensive patients. The participants with HHcy who had 5–6 ideal CVH metrics exhibited a lower IS risk than those with normal tHcy levels.
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Affiliation(s)
- Yuchen Ying
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | - Shaoyi Lin
- Cardiology Department, Ningbo First Hospital, Ningbo, China
| | - Fanqian Kong
- Department of Medical Record and Statistics, Ningbo Medical Center Lihuili Hospital, Ningbo, China
| | - Yuying Li
- Shenzhen Polytechnic, Shenzhen, China
| | - Shujun Xu
- Zhejiang Provincial Key Laboratory of Pathophysiology, School of Medicine, Ningbo University, Ningbo, China
| | | | - Changyi Wang
- Department of Chronic Disease Prevention and Control, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Liyuan Han
- Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.,Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
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Working status is related to post stroke/TIA cognitive decline: data from the TABASCO study. J Stroke Cerebrovasc Dis 2020; 29:105019. [PMID: 32807434 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105019] [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] [Received: 04/10/2020] [Revised: 05/26/2020] [Accepted: 06/01/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND AIMS Occupational status may influence physical and mental post-stroke outcomes. We aimed to evaluate the association between occupational status and type, or engagement in social and family activities, neuroimaging measures and cognitive decline (CD) in a prospective cohort of stroke patients. METHODS We included 273 first-ever stroke survivors at working age. All patients underwent 3T MRI at admission, as well as clinical and cognitive assessments at admission, 6, 12 and 24 months thereafter. RESULTS Ninty nine (36.3%) of the participants were unemployed prior to the stroke. Age, sex, work type, other comorbidities, stroke severity or location were not associated with return to work. Patients who returned to work (87.4%) had better cognitive results and less depressive symptoms than those who retired after the event. Pre-stroke unemployment was associated with diabetes mellitus, hypertension, dyslipidemia, depression, poorer cognitive scores and brain atrophy. During the follow-up, 11% developed CD. CD was more common among previously unemployed than employed participants (19.2% vs. 6.3%, p = 0.001). Multiple regression adjusted for risk factors, revealed that pre-stroke unemployment was an independent predictor of CD (HR, 3.0; 95% CI: 1.06-8.44). Furthermore, engagement in mentally stimulating jobs decreased the risk for CD. CONCLUSIONS Pre-stroke unemployment and post-stroke work disruption were each associated with depression and poorer cognitive performance up to two years post-stroke, as well as with brain atrophy at admission. Retirement after the stroke may increase the risk of developing CD. These results highlight the importance of continued employment in preserving cognitive abilities among stroke survivors.
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Egan KK, Jørgensen MB, Christensen AI, Bramming M, Lau CJ, Becker U, Tolstrup JS. Association between alcohol, socioeconomic position and labour market participation: A prospective cohort study of transitions between work and unemployment. Scand J Public Health 2020; 49:197-205. [PMID: 32667258 DOI: 10.1177/1403494820911802] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: This study aimed to test the hypothesis that heavy alcohol consumption and problem drinking is associated with a higher risk of becoming unemployed and a lower chance of entering the job market across socioeconomic positions. Methods: A sample of 84,474 men and women aged 18-60 years from the Danish National Health Survey 2010 participated in the study. Information on alcohol consumption and problem drinking was obtained by questionnaire. The primary outcomes were becoming unemployed and entering the job market. The follow-up period was five years. Information on labour market transitions and socioeconomic position (educational level) was obtained through nationwide registers. Multiplicative analyses were performed. Results: Heavy alcohol consumption and problem drinking were associated with a higher risk of unemployment among low-educated (hazard ratio (HR)=1.5; 95% confidence interval (CI) 1.3-1.9) and medium-educated (HR=1.3; 95% CI 1.1-1.5) individuals in comparison to individuals with a similar educational level drinking one to seven drinks per week. Excessive alcohol consumption and problem drinking were associated with a lower chance of entering the job market for individuals with a medium or high level of education: medium-educated individuals drinking >28 drinks per week had a HR of 0.82 (95% CI 0.69-0.98) when compared to medium-educated individuals drinking one to seven drinks per week. The corresponding HR among high-educated individuals was 0.71 (95% CI 0.49-1.0). Conclusions: Heavy alcohol consumption and problem drinking are associated with a higher risk of unemployment in some social strata, whereas excessive alcohol consumption and problem drinking are associated with a lower chance of entering the job market in other social strata.
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Affiliation(s)
- Kia K Egan
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Maja B Jørgensen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Anne I Christensen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Maja Bramming
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Cathrine J Lau
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Denmark
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Denmark.,Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Denmark
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 5379] [Impact Index Per Article: 1075.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5803] [Impact Index Per Article: 967.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Bramming M, Jørgensen MB, Christensen AI, Lau CJ, Egan KK, Tolstrup JS. BMI and Labor Market Participation: A Cohort Study of Transitions Between Work, Unemployment, and Sickness Absence. Obesity (Silver Spring) 2019; 27:1703-1710. [PMID: 31544342 DOI: 10.1002/oby.22578] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/11/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVE This study aimed to test the hypotheses that individuals with obesity are at higher risk of unemployment and sickness absence and have a lower chance of getting employed compared with individuals with normal weight. METHODS Data on weight and height were collected at baseline from 87,796 participants in the Danish National Health Survey 2010. Participants were then followed in national registers for 5 years. Outcome measures were transitions from employment to unemployment and sickness absence and the transitions from unemployment or sickness absence to employment. Data were analyzed by Cox proportional hazards models adjusted for potential confounders. RESULTS Hazard ratios for unemployment were 1.18 (95% CI: 1.10-1.26) for individuals with obesity and 1.27 (95% CI: 1.14-1.41) for individuals with severe obesity compared with individuals with normal weight. Participants with obesity also had a higher risk of sickness absence. Additionally, participants with obesity who were unemployed at baseline had a lower chance of becoming employed compared with participants with normal weight. CONCLUSIONS Obesity was associated with a higher risk of unemployment and sickness absence compared with individuals with normal weight. Additionally, obesity was associated with a lower chance of employment.
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Affiliation(s)
- Maja Bramming
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Maja B Jørgensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Anne I Christensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Cathrine J Lau
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Kia K Egan
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Janne S Tolstrup
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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The Factors Associated with the Fatal Outcome of Stroke. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2019. [DOI: 10.2478/sjecr-2019-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of this study is to determine the risk factors associated with the fatal outcome of stroke. The research was designed as observational, non-interventional study, conducted by the type of case series, and it included 290 patients hospitalized with a diagnosis of stroke at Neurology Clinic of the Clinical Center Kragujevac during the observed period from 01/02/2013 to 31/01/2014. The data used for the research were: documentation of Neurology Clinic of the Clinical Center Kragujevac, documentation of the Institute of Public Health Kragujevac and patients’ questionnaires. The results of univariate binary logistic regression pointed out a relevant connection between the fatal outcome of stroke and age (p˂ 0.0001), gender (p˂ 0.0001), the severity of the disease (p = 0.002), smoking (p = 0.021), care for the parents’ health (p = 0.018), the concern about business problems (p = 0.018), while the influence of antidepressants was indicative (p = 0.066), whereas using the multivariate binary logistic regression, it was concluded that age (OR=1.096; 95% CI=1.059-1.134; p<0.001), the severity of the disease (OR=4.324; 95% CI=1.256-14.885; p=0.020) and the use of antidepressants (OR=5.578; 95% CI=1.178-26.423; p=0.030) were factors independently associated with the mortality rate. These findings suggest that it would be useful to carry out additional comprehensive research about all potential risk factors for the occurrence of stroke, and also to establish all the steps that can be taken in order to identify and detect risk factors, their elimination or reduction, and, accordingly, to take aggressive measures of primary and secondary prevention.
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Han J, Lee HI, Shin YI, Son JH, Kim SY, Kim DY, Sohn MK, Lee J, Lee SG, Oh GJ, Lee YS, Joo MC, Han EY, Chang WH, Kim YH. Factors influencing return to work after stroke: the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study. BMJ Open 2019; 9:e028673. [PMID: 31300502 PMCID: PMC6629413 DOI: 10.1136/bmjopen-2018-028673] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate the rate of return to work and identify key factors associated with return to work between 3 months and 2 years after stroke. DESIGN Prospective cohort study. SETTING The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) in Korea. PARTICIPANTS A total of 193 persons with first-ever stroke who reported working status at 3 months after stroke. OUTCOME MEASURES Data on baseline characteristics were collected from medical records. Functional assessments were performed using the National Institutes of Health Stroke Scale, the modified Rankin Scale, the Fugl-Meyer Assessment, the Functional Ambulatory Category, the Korean Mini-Mental State Examination, the Korean version of the Frenchay Aphasia Screening Test, the American Speech-Language-Hearing Association National Outcomes Measurement System, the Korean-Modified Barthel Index, the Geriatric Depression Scale-Short Form and the EuroQol-5 dimensions. An enumeration survey included the Reintegration to Normal Living Index, the Psychosocial Well-being Index-Short Form (, the Family Support Index and the Caregivers Burden Index. RESULTS Overall, 145 (75.1%) patients who had a stroke in the "Continuously-Employed" group and 48 (24.9%) in the "Employed-Unemployed" group returned to work between 3 months and 2 years after stroke. Multivariate logistic analysis demonstrated that in patients who had a stroke, characteristics such as age, PWI-SF Score, and caregiver characteristics, including age, sex (female) and living arrangements, were significantly associated with return to work between 3 months and 2 years after stroke. CONCLUSION Age and PWI-SF Score of patients who had a stroke, as well as the age, sex and living arrangements of caregivers, are key factors influencing the return to work after stroke. TRIAL REGISTRATION NUMBER NCT03402451.
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Affiliation(s)
- Junhee Han
- Department of Statistics and Institute of Statistics, Hallym University, Chuncheon, The Republic of Korea
| | - Hae In Lee
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Yong-Il Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Ju Hyun Son
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Soo-Yeon Kim
- Department of Rehabilitation Medicine, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, The Republic of Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, The Republic of Korea
| | - Min Kyun Sohn
- School of Medicine, Department of Rehabilitation Medicine, Chungnam National University, Daejeon, The Republic of Korea
| | - Jongmin Lee
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Seoul, The Republic of Korea
| | - Sam-Gyu Lee
- Department of Physical and Rehabilitation Medicine, Chonnam National University Medical School, Gwangju, The Republic of Korea
| | - Gyung-Jae Oh
- Department of Preventive Medicine, School of Medicine, Wonkwang University, Iksan, The Republic of Korea
| | - Yang-Soo Lee
- Department of Rehabilitation Medicine, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Daegu, The Republic of Korea
| | - Min Cheol Joo
- Department of Rehabilitation Medicine, School of Medicine, Wonkwang University, Iksan, The Republic of Korea
| | - Eun Young Han
- Department of Rehabilitation Medicine, School of Medicine, Jeju National University, Jeju, The Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
| | - Yun-Hee Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
- Department of Health Sciences and Technology,Department of Medical Device Management & Research, Department of DigitalHealth, SAIHST, Sungkyunkwan University, Seoul, The Republic of Korea
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Schnitzler A, Jourdan C, Josseran L, Azouvi P, Jacob L, Genêt F. Participation in work and leisure activities after stroke: A national study. Ann Phys Rehabil Med 2019; 62:351-355. [PMID: 31096014 DOI: 10.1016/j.rehab.2019.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/13/2019] [Accepted: 04/06/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Stroke is a common and debilitating neurological disorder having a negative impact on quality of life. OBJECTIVES We aimed to compare differences in participation in work and leisure activities between patients with and without a self-reported stroke at the national level in France. METHODS This study used cross-sectional data from the Disability Health Survey that was administered in people's homes (DHH) in 2008 and in institutions (DHI) in 2009. Stroke history and levels of participation in work and leisure activities were collected by interviews. The levels of participation in these activities were compared between participants with and without a history of stroke. RESULTS Among the 33,785 interviewed participants, 1725 reported a history of stroke. After weighting, this represented a mean (SD) of 766,641 (36,650) people among 49 million adults living in France. After adjustment, as compared with people without stroke, those with stroke were less likely to work (odds ratio 0.19 [95% confidence interval 0.13-0.27]), use the telephone (0.21 [0.17-0.25]) and drive (0.25 [0.21-0.32]). In the age group 19-59 years, as compared with people without stroke, those with stroke less frequently worked (35.9% vs. 72.2%), drove (54.3% vs. 81.3%) and participated in sports (26.6% vs. 55.8%). CONCLUSIONS Overall, our study indicates that people with a history of stroke report more difficulties in participating in work and leisure activities than those without a history of stroke.
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Affiliation(s)
- Alexis Schnitzler
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, AP-HP, CIC-IT 1429, 104, boulevard Raymond-Poincaré, 92380 Garches, France; EA4047, UFR des Sciences de la SantéUniversity Versailles Saint Quentin en Yvelines, "Handi-Resp", Simone Veil, 78180, France.
| | - Claire Jourdan
- EA4047, UFR des Sciences de la SantéUniversity Versailles Saint Quentin en Yvelines, "Handi-Resp", Simone Veil, 78180, France; Physical Medicine and Rehabilitation Department, 34000 Montpellier, France
| | - Loic Josseran
- EA4047, UFR des Sciences de la SantéUniversity Versailles Saint Quentin en Yvelines, "Handi-Resp", Simone Veil, 78180, France; Department of epidemiology, Raymond Poincaré Hospital, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - Philippe Azouvi
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, AP-HP, CIC-IT 1429, 104, boulevard Raymond-Poincaré, 92380 Garches, France; EA4047, UFR des Sciences de la SantéUniversity Versailles Saint Quentin en Yvelines, "Handi-Resp", Simone Veil, 78180, France
| | - Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France
| | - François Genêt
- Department of Physical Medicine and Rehabilitation, Raymond Poincaré Hospital, AP-HP, CIC-IT 1429, 104, boulevard Raymond-Poincaré, 92380 Garches, France; "End-icap" U1179 Inserm, UFR des Sciences de la Santé, University Versailles Saint Quentin en Yvelines, Simone Veil, 78180, France
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Jørgensen MB, Pedersen J, Thygesen LC, Lau CJ, Christensen AI, Becker U, Tolstrup JS. Alcohol consumption and labour market participation: a prospective cohort study of transitions between work, unemployment, sickness absence, and social benefits. Eur J Epidemiol 2019; 34:397-407. [PMID: 30627937 PMCID: PMC6451700 DOI: 10.1007/s10654-018-0476-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/15/2018] [Indexed: 12/18/2022]
Abstract
The aim of this study was to investigate the association of alcohol consumption and problem drinking on transitions between work, unemployment, sickness absence and social benefits. Participants were 86,417 men and women aged 18-60 years who participated in the Danish National Health Survey in 2010. Information on alcohol consumption (units per week) and problem drinking (CAGE-C score of 4-6) was obtained by questionnaire. The primary outcome was labour market attachment. Information on labour market attachment was obtained from the national administrative registers during a 5-year follow-up period. Using Cox proportional hazards models, we estimated hazard ratios (HR) for transitions between work, unemployment, sickness absence and social benefits. Analyses were adjusted for potential confounders associated with demography, health, and socio-economy. High alcohol consumption and problem drinking was associated with higher probability of unemployment, sickness absence and social benefits among participants employed at baseline compared with participants who consumed 1-6 drinks/week. High alcohol consumption and problem drinking was associated with lower probability of returning to work among participants receiving sickness absence at baseline compared with participants who consumed 1-6 drinks/week and with non-problem drinkers: HRs were 0.75 (0.58-0.98) for 35+ drinks per week and 0.81 (0.65-1.00) for problem drinking (CAGE-C score of 4-6). Similar trends for weekly alcohol consumption and problem drinking were observed among participants who were unemployed at baseline. In summary, problem drinking has adverse consequences for labour market participation and is associated with higher probability of losing a job and a lower chance of becoming employed again.
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Affiliation(s)
- Maja Bæksgaard Jørgensen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
| | - Jacob Pedersen
- The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100 Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
| | - Cathrine Juel Lau
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Anne Illemann Christensen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
| | - Ulrik Becker
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, 2650 Hvidovre, Denmark
| | - Janne S. Tolstrup
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
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Arpino B, Gumà J, Julià A. Early-life conditions and health at older ages: The mediating role of educational attainment, family and employment trajectories. PLoS One 2018; 13:e0195320. [PMID: 29621290 PMCID: PMC5886483 DOI: 10.1371/journal.pone.0195320] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/20/2018] [Indexed: 11/19/2022] Open
Abstract
Objectives We examine to what extent the effect of early-life conditions (health and socioeconomic status) on health in later life is mediated by educational attainment and life-course trajectories (fertility, partnership, employment). Methods Using data from the Survey of Health, Ageing and Retirement in Europe (N = 12,034), we apply, separately by gender, multichannel sequence analysis and cluster analysis to obtain groups of similar family and employment histories. The KHB method is used to disentangle direct and indirect effects of early-life conditions on health. Results Early-life-conditions indirectly impact on health in later life as result of their influence on education and family and employment trajectories. For example, between 22% and 42% of the effect of low parental socio-economic status at childhood on the three considered health outcomes at older age is explained by educational attainment for women. Even higher percentages are found for men (35% - 57%). On the contrary, the positive effect of poor health at childhood on poor health at older ages is not significantly mediated by education and life-course trajectories. Education captures most of the mediating effect of parental socio-economic status. More specifically, between 66% and 75% of the indirect effect of low parental socio-economic status at childhood on the three considered health outcomes at older age is explained by educational attainment for women. Again, higher percentages are found for men (86% - 93%). Early-life conditions, especially socioeconomic status, influence family and employment trajectories indirectly through their impact on education. We also find a persistent direct impact of early-life conditions on health at older ages. Conclusions Our findings demonstrate that early-life experiences influence education and life-course trajectories and health in later life, suggesting that public investments in children are expected to produce long lasting effects on people’s lives throughout the different phases of their life-course.
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Affiliation(s)
- Bruno Arpino
- Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- * E-mail:
| | - Jordi Gumà
- Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Albert Julià
- Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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