Sex-specific effects of social networks on the prevalence, awareness, and control of hypertension among older Korean adults

Role of Perceived Social Support in Adherence to Antihypertensives and Controlled Hypertension: Findings of a Community Survey from Urban Nepal

Introduction

Social support is considered vital for effective management of chronic conditions, but its role in improving adherence to antihypertensive medication and control of hypertension in urban Nepal is unknown. We examined the role of social support in adherence to antihypertensives and controlled blood pressure to inform future interventions for hypertension management.

Methods

We analyzed cross-sectional data collected at baseline of a cluster randomized trial of hypertension patients (n=1252) in the community between May and November 2022. Multidimensional scale of perceived social support was used to measure social support, adherence to antihypertensives was measured using the Morisky medication adherence scale -8, and individuals with systolic- and diastolic- blood pressure less than 140 and 90 mmHg respectively were considered to have controlled hypertension. Modified Poisson regression models were used to estimate the prevalence ratios and corresponding 95% confidence intervals.

Results

We found that 914 (73%) individuals received moderate to high social support. Participants receiving high social support had a numerically lower proportion of controlled hypertension (51%) however not statistically significant. The proportion of good adherence to antihypertensives did not differ between the social support categories. There was no association in overall, family, friends, and significant other sub-scales of social support with controlled hypertension and adherence to antihypertensives.

Discussion

Further studies to understand the quality and mechanisms through which social support contributes to blood pressure control are needed for the health system to include social support in designing and implementing community-based interventions for hypertension management.

Sex differences in the association between socioeconomic status and untreated hypertension among residents with hypertension in rural Khánh Hòa, Vietnam: a post-hoc analysis

BACKGROUND

Several studies have examined the association between socioeconomic status (SES) and the proportion of untreated hypertension, but have produced conflicting findings. In addition, no study has been conducted to determine sex differences in the association between SES and untreated hypertension. Thus, the aim of this study was to examine whether the associations between SES and the proportion of untreated hypertension differed by sex in Vietnam.

METHODS

This study was conducted using the data of 1189 individuals (558 males and 631 females) who were judged to have hypertension during the baseline survey of a prospective cohort study of 3000 residents aged 40-60 years in the Khánh Hòa Province. A multilevel Poisson regression model with a robust variance estimator was used to examine whether sex and SES indicators (household income and educational attainment) interacted in relation to untreated hypertension.

RESULTS

The proportion of untreated hypertension among individuals identified as hypertensive was 69.1%. We found significant interaction between sex and SES indicators in relation to untreated hypertension (education: p < 0.001; household income: p < 0.001). Specifically, the association between SES and untreated hypertension was inverse among males while it was rather positive among females.

CONCLUSIONS

Our finding suggests that the role of SES in the proportion of untreated hypertension might differ by sex.

Psychosocial profiles and longitudinal achievement of optimal cardiovascular risk factor levels: the Coronary Artery Risk Development in Young Adults (CARDIA) study

Psychosocial factors are associated with the achievement of optimal cardiovascular disease risk factor (CVDRF) levels. To date, little research has examined multiple psychosocial factors simultaneously to identify distinguishing psychosocial profiles among individuals with CVDRF. Further, it is unknown whether profiles are associated with achievement of CVDRF levels longitudinally. Therefore, we characterized psychosocial profiles of individuals with CVDRF and assessed whether they are associated with achievement of optimal CVDRF levels over 15 years. We included 1148 CARDIA participants with prevalent hypertension, hypercholesterolemia and/or diabetes mellitus in 2000-2001. Eleven psychosocial variables reflecting psychological health, personality traits, and social factors were included. Optimal levels were deemed achieved if: Hemoglobin A1c (HbA1c) < 7.0%, low-density lipoprotein (LDL) cholesterol < 100 mg/dl, and systolic blood pressure (SBP) < 140 mm Hg. Latent profile analysis revealed three psychosocial profile groups "Healthy", "Distressed and Disadvantaged" and "Discriminated Against". There were no significant differences in achievement of CVDRF levels of the 3 targets combined across profiles. Participants in the "Distressed and Disadvantaged" profile were less likely to meet optimal HbA1c levels compared to individuals in the "Healthy" profile after demographic adjustment. Associations were attenuated after full covariate adjustment. Distinct psychosocial profiles exist among individuals with CVDRF, representing meaningful differences. Implications for CVDRF management are discussed.

Gender differences in the longitudinal association between husbands' and wives' depressive symptoms among Korean older adults: the moderating effects of the spousal relationship

PURPOSE

The mutual effects of depressive symptoms between couples have long been reported; however, it remains unknown whether the spousal concordance in depressive symptoms differs depending on spousal relationships.

METHOD

Data on 291 married couples from the Korean Social Life, Health, and Aging Project (KSHAP) were examined. The KSHAP collected global network data from the target population living in one Korean village over eight years and across five waves. A seemingly unrelated regression (SUR) model in the panel data was employed to address correlations and heterogeneity.

RESULTS

If one spouse (husband or wife) had depressive symptoms, the other spouse tended to have depressive symptoms. However, the effect of marital relations on spousal concordance in depressive symptoms was different among husbands and wives. This study demonstrated both spousal support and spousal network aspects of spousal relationships. Depression concordance was stronger for couples with more negative marital relationship. A supportive marital relationship was associated with less concordance between spouses' depressive symptoms for wives but not for husbands. Spousal network overlap was associated with less depression concordance for husbands; however, for wives, spousal network overlap was directly associated with more depressive symptoms and did not mediate the association with depression concordance.

CONCLUSION

Our findings suggest that approaches to supporting older adults dealing with mental health disorders may involve support at both the individual and couple levels. Gender-specific strategies could also be devised to improve the mental well-being of the older population.

Gender role stereotypes, patriarchal attitudes, and cognitive function in the elderly rural Korean population: a cross-sectional study

OBJECTIVES

We analyzed whether gender role stereotypes (GRS) and patriarchal attitudes are associated with cognitive function in an elderly community.

METHODS

We analyzed data from 580 people enrolled in the Korean Social Life, Health, and Aging Project. The degrees to which respondents held stereotypical beliefs about gender roles and had patriarchal mindsets were measured using a questionnaire. Based on participants' responses, we divided respondents into 2 groups-those with conservative mindsets and those with open mindsets-according to the median score for each of the 2 variables. Cognitive function was assessed using the Mini-Mental State Examination, Korean version (MMSE-K). Cognitive impairment was defined as an MMSE-K score ≤21 points. Multivariable logistic regression was performed, adjusting for gender, age, socio-demographic and lifestyle factors, and social network size. Age and lifestyle factors were stratified.

RESULTS

Compared to those with open mindsets, those with conservative mindsets regarding gender roles and patriarchal norms had adjusted odds ratios of 1.88 (95% confidence interval [CI], 1.11 to 3.19) and 1.67 (95% CI, 1.00 to 2.79) for cognitive impairment, respectively. In the stratified analysis, subgroups with younger age and a good lifestyle maintained a protective association with cognitive impairment.

CONCLUSIONS

GRS and a patriarchal mindset were marginally significantly associated with cognitive impairment among women later in life.

Blood Pressure Control and Associations with Social Support among Hypertensive Outpatients in a Developing Country

Relationships between social support characteristics with blood pressure control and recommended behaviors in Vietnamese hypertensive patients have not been investigated. This study is aimed at examining the role of social support characteristics in hypertension control and behaviors. Patients with hypertension (n = 220) in Hanoi, Vietnam, were recruited into a cross-sectional study. Both functional and structural characteristics of social support and network were examined. Results showed that increasing total network size was related to 52% higher odds of uncontrolled hypertension (adjusted OR = 1.52, 95%CI = 1.22 - 1.89). Higher network sizes on the provision of information support related to advice, emotional support related to decisions, and practical support related to sickness were associated with lower odds of uncontrolled hypertension. Every additional 1% of the percentage of network members having hypertension decreased 2% the odds of uncontrolled hypertension (adjusted OR = 0.98, 95%CI = 0.96 - 1.00). A 1% additional network members who were living in the same household was associated with a decrease of 0.08 point of behavioral adherence score (coef. = -0.08; 95%CI = -0.12 - 0.03). Meanwhile, a 1% increase of network members who were friends on the provision of practical support related to sickness and jobs was related to an increase of 0.10 point and 0.19 point of behavioral adherence score (coef. = 0.10; 95%CI = 0.04 - 0.17 and coef. = 0.19; 95%CI = 0.06 - 0.32, respectively). The current study suggested that further interventions to improve hypertension management should address the potential effects of social network characteristics.

Sex differences in the association between social relationships and insomnia symptoms

STUDY OBJECTIVES

Social relationships are an understudied factor affecting insomnia. In particular, these effects have not been evaluated in the context of sex differences. In this study, we investigated differences between sexes with regard to the association between insomnia symptoms and social relationships.

METHODS

We used data from 2681 middle-aged adults (aged 40-64 years; females, 68.8%) from the Cardiovascular and Metabolic Diseases Etiology Research Center project. Insomnia symptoms were defined as difficulty with sleep induction or maintenance ≥3 nights per week. We assessed social network size and bridging potentials as indicators of social relationships. Social network size is a quantitative measure of the size of social relationships, and bridging potential is a qualitative indicator of the diversity and independence of these relationships. Multivariate regression analysis controlling for confounding factors was performed to evaluate associations between social relationships and insomnia symptoms.

RESULTS

Smaller social network size was significantly associated with sleep induction (adjusted odds ratio = 0.866, P = .015) and sleep maintenance (adjusted odds ratio = 0.862, P = .015) difficulties, but only in men. Poor bridging potential was also associated with sleep induction (adjusted odds ratio = 0.321, P = .024) and maintenance (adjusted odds ratio = 0.305, P = .031) difficulties only in men. For women, social relationship variables were not significantly associated with insomnia symptoms.

CONCLUSIONS

The association between insomnia symptoms and social relationships varied by sex, as noted by statistical analyses accounting for covariates affecting insomnia symptoms. These results suggest that qualitative assessments of social relationship variables should be considered in clinical practice, since these variables can be interpreted differently for men and women.

Social Activities and Health-Related Quality of Life in Rural Older Adults in South Korea: A 4-Year Longitudinal Analysis

During later life, inadequate social interactions may be associated with worse quality of life in older adults. Rural older adults are prone to developing unhealthy lifestyles related to social activities, which can lead to a poorer quality of life than that enjoyed by older adults living in urban areas. This study aimed to describe longitudinal changes in social activity participation and health-related quality of life among rural older adults, exploring potential associations with changes to in-person social activity over four years. We used prospective community-based cohort data from the Korean Social Life, Health, and Aging Project (KSHAP) collected between December 2011 and January 2016. The sample included 525 older adults who completed the measure of health-related quality of life. Our results showed a significant change in health-related quality of life according to changes in participation in meeting with friends. Even though an individual's participation in other social activities did not show significant differences in health-related quality of life, our findings imply that in-person social activities may be an important resource to encourage participation in physical activities and to develop other positive outcomes, such as a sense of belonging or satisfaction with later life, among rural older adults.

Egocentric Health Networks and Cardiovascular Risk Factors in the ECHORN Cohort Study

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the Caribbean region.

OBJECTIVE

This study explored the concept of a health network, relationships focused on health-related matters, and examined associations with CVD risk factors in the Eastern Caribbean.

DESIGN

The Eastern Caribbean Health Outcomes Research Network Cohort Study is an ongoing longitudinal cohort being conducted in the US Virgin Islands, Puerto Rico, Trinidad and Tobago, and Barbados.

PARTICIPANTS

Participants (n = 1989) were English or Spanish-speaking adults 40 years and older, who were residents of the island for at least 10 years, and who intended to live on-island for the next 5 years.

MAIN MEASURES

Logistic regression was used to examine associations between health network characteristics and CVD risk factors: physical activity, hypertension, and smoking. A baseline survey asked questions about health networks using name generator questions that assessed who participants spoke to about health matters, whose opinions on healthcare mattered, and who they would trust to make healthcare decisions on their behalf.

KEY RESULTS

Health networks were mainly comprised of family members and friends. Healthcare professionals comprised 7% of networks, mean network size was four, and 74% of health network contacts were perceived to be in "good" to "excellent" health. Persons with larger health networks had greater odds of being physically active compared with those with smaller networks (OR = 1.07, CI = 1.01-1.14).

CONCLUSIONS

Health networks may be useful to intervention efforts for CVD risk factor reduction. More studies are needed to examine health networks in Caribbean contexts and explore associations with other CVD risk factors.

Cohort profile: Korean Urban Rural Elderly (KURE) study, a prospective cohort on ageing and health in Korea

PURPOSE

The Korean Urban Rural Elderly (KURE) cohort was initiated to study the epidemiologic characteristics, physical performance, laboratory and imaging biomarkers and incidence of age-related diseases in an elderly population with respect to both clinical and social aspects to develop preventive and therapeutic strategies for combatting age-related diseases.

PARTICIPANTS

A total of 3517 adults aged 65 or older participated in the cohort at baseline from 2012 to 2015, recruited from three urban districts and one rural district in Korea. The second-wave follow-up survey is now being conducted at a 4-year interval from baseline (2016-2019; follow-up rate 71.5%). The data set included detailed information on anthropometric and socioeconomic factors, functional assessments, image scans (plain radiography, dual-energy X-ray absorptiometry and CT), biospecimens (ie, serum, urine and DNA) and social support networks along with the feasibility of linkage to a national claims database.

FINDINGS TO DATE

Mean age of participants at entry was 71.9±4.6 years and 67% were women. From the KURE participants enrolled in baseline recruitment, several studies were published in the fields of cardiometabolic diseases, musculoskeletal health and the association between social support network and diseases in ageing.

FUTURE PLANS

Participants will be observed actively and passively every 4-5 years and the first follow-up will be completed in 2020. The KURE data set has strength in comprehensive physical function assessments, quantifiable imaging data sets using CT and detailed information regarding the social support networks of participants from a large community-based elderly Korean population.

Social Network Position Moderates the Relationship between Late-life Depressive Symptoms and Memory Differently in Men and Women

Late-life depression has been considered to be associated with memory deficits and hippocampal volume reduction. Considering that not all depression patients undergo the same amount of cognitive impairment or regional brain volume loss, moderating factors such as complex mental activity and social activity have been examined to assess whether these factors attenuate the detrimental impact of depressive symptoms on cognitive function and regional brain volume. However, the premise that a cognitively stimulating experience may modify the association between depressive symptoms and memory or hippocampal volume has not been investigated using social network data, which would reflect individuals' concrete characteristic of everyday social activity. In a social network, a brokerage position which connects two otherwise unconnected others demands mental and physical efforts. Using complete social network data in an entire village in South Korea, we examined whether opportunities for brokerage in social networks alter the negative association between depressive symptoms and episodic memory function or hippocampal volume in older adults. Initially, 125 participants were included in the analysis involving episodic memory function. Then, of which 65 participants completed the MRI scan, and were included in the subsequent analysis containing the hippocampal volume. Furthermore, we investigated the gender-specific effect of brokerage based on the previously reported gender difference in the effect of social networks. We found a gender-specific moderating effect of brokerage. For men, a large opportunity for brokerage weakened the negative association between depressive symptoms and memory performance and left hippocampal volume. In contrast, women showed that a large opportunity for brokerage was not beneficial for assuaging the impact of depressive symptoms on memory performance and hippocampal volume. In women, the opportunity for brokerage was positively associated with the detrimental impact of depressive symptoms on memory performance and hippocampal volume. Our findings suggest that occupying a bridging position in a social network may minimize the impact of depressive symptoms on memory function and hippocampal volume among older men, whereas the opposite holds true for older women.

The differential effects of type and frequency of social participation on IADL declines of older people

BACKGROUND

Although social participation (SP) is valid in active aging, it is vague which types and the frequency of SP are effective in maintaining instrumental activities of daily living (IADL). We conducted a community-based prospective cohort study and investigated the association of the types and frequency for SP with IADL decline in community-dwelling older adults.

METHODS

The target population were all individuals aged ≥65 living in a commuter town in Nara, Japan. A total of 6,013 participants with independent IADL at baseline were analyzed. IADL was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Six SP types were assessed: volunteer groups, sports groups, hobby clubs, senior citizens' clubs, neighborhood community associations, and cultural clubs. The frequency of SP was categorized into frequent (i.e., weekly or more), moderate (i.e., monthly or yearly), and non-participation. Using multiple logistic regression models, the odds ratio (OR) and a 95% confidence interval (CI) for IADL decline were calculated. Covariates included age, marital status, education, subjective economic status, work status, body mass index, chronic medical conditions (i.e., hypertension, diabetes mellitus, heart disease, and cerebrovascular disease), lifestyle factors (i.e., alcohol, smoking, and exercise), self-rated health, depression, and cognitive functioning. To examine gender differences, stratified analyses by gender were performed.

RESULTS

During the 33-month follow-up, 16.4% of men and 8.7% of women exhibited IADL decline. After adjustment for all covariates, compared to those who never participated, women with moderate participation had significantly lower odds of IADL decline in volunteer groups (OR = 0.53, 95% CI = 0.31-0.88), hobby clubs (OR = 0.55, 95% CI = 0.38-0.79), neighborhood community associations (OR = 0.58, 95% CI = 0.42-0.81), and cultural clubs (OR = 0.51, 95% CI = 0.31-0.82), and women with frequent participation had lower odds of IADL decline in hobby clubs (OR = 0.63, 95% CI = 0.43-0.93). In contrast, among men, the significant association between SP and less risk of IADL decline was limited to moderate participation in neighborhood community associations (OR = 0.79, 95% CI = 0.63-0.99), and there were no differences between frequent participation and non-participation in all types of SP. Regarding volunteer groups, compared to women with frequent participation, women with moderate participation had a significantly lower risk of IADL decline (OR = 0.37, 95% CI = 0.18-0.77). The results of additional stratified analyses by self-rated health, depression, and cognitive functioning showed that the associations of the type and frequency of SP with IADL decline varied according to physical and mental functioning.

CONCLUSIONS

Several types of SP have a favorable effect on IADL through moderate participation rather than frequent participation, and women with moderate participation in volunteer groups have a more beneficial effect on IADL than women with frequent participation. When advising community-dwelling older adults on SP for IADL maintenance, health professionals may need to take into account plateau effects, gender differences, and physical and mental functioning.

Is the Relationship between Depression and C Reactive Protein Level Moderated by Social Support in Elderly?-Korean Social Life, Health, and Aging Project (KSHAP)

OBJECTIVE

To investigate the buffering effects of social support as an effects modifier in the association between depression and inflammation in the elderly.

METHODS

We analyzed the Korean Social Life, Health, and Aging Project (KSHAP) for questionnaire, clinical, and laboratory data of 530 older adults living in a rural community. Multivariate regression models were used to investigate the association between depressive symptoms and C-reactive protein level (CRP), a marker of inflammation, at varying levels of social support.

RESULTS

Social support affected the association between depressive symptoms and CRP level in both sexes. However, the direction of effects modification was different for men and women. In men, a higher CRP level was significantly associated with depressive symptoms only among those with lower support from a spouse or family members. By contrast, in women, the association was significant only among subgroups with higher spousal or family support. Social support from neighbors or friends did not affect the depression-inflammation relationship in men but modestly affected the relationship in women.

CONCLUSION

Our findings suggest that social support may have a buffering effect in the relationship between depression and inflammation in elderly Koreans. But the influence of social support may run in different directions for men and women.

Contingent association between the size of the social support network and osteoporosis among Korean elderly women

OBJECTIVE

To investigate the association between the number of personal ties (or the size of the social support network) and the incidence of osteoporosis among older women in Korea.

METHODS

Data from the Korean Urban Rural Elderly Study were used. Bone density was measured by dual-energy X-ray absorptiometry at the lumbar spine (L1-L4) and femur neck. T-score, the standardized bone density compared with what is normally expected in a healthy young adult, was measured and the presence of osteoporosis was determined, if the T-score was < -2.5. The social support network size was measured by self-responses (number of confidants and spouse).

RESULTS

Of the 1,846 participants, 44.9% were diagnosed with osteoporosis. The association between the social support network size and the incidence of osteoporosis was curvilinear in both bivariate and multivariate analyses. Having more people in one's social support network size was associated with lower risk of osteoporosis until it reached around four. Increasing the social support network size beyond four, in contrast, was associated with a higher risk of osteoporosis. This association was contingent on the average intimacy level of the social network. At the highest average intimacy level ("extremely close"), increasing the number of social support network members from one to six was associated with linear decrease in the predicted probability of osteoporosis from 45% to 30%. However, at the lowest average intimacy level ("not very close"), the predicted probability of osteoporosis dramatically increased from 48% to 80% as the size of the social network increased from one to six.

CONCLUSION

Our results show that maintaining a large and intimate social support network is associated with a lower risk of osteoporosis among elderly Korean women, while a large but less-intimate social relationship is associated with a higher risk.