Relationship of self-rated health with fatal and non-fatal outcomes in cardiovascular disease: a systematic review and meta-analysis

Adverse effects of obesity on overall health, quality of life, and related physical health metrics: A cross-sectional and longitudinal study from the All of Us Research Program

BACKGROUND

Population-level adverse effects of obesity beyond commonly considered chronic conditions need to be characterized to understand its overall burden.

OBJECTIVE

To assess the cross-sectional associations between obesity and self-reported status of overall health, quality of life, pain, fatigue, ability of physical activity, and the risks of developing chronic pain syndrome, chronic fatigue syndrome, fibromyalgia, and insomnia.

METHODS

Using data from the All of Us Research Program (the United States), we included participants with a body mass index (BMI) ≥18.5 kg/m2 and available Overall Health Survey or electronic health records. Cross-sectional analyses of self-reported variables were conducted using multivariable logistic and linear regression models. Cox proportional-hazard models were used to assess risks for incident outcomes.

RESULTS

Among 323,640 participants (60.3% were female, mean age: 51.3 years), 20.7%, 11.0%, and 9.5% were with Classes I, II, and III obesity, respectively. Higher BMI categories were correlated with worse health metrics, with Class III obesity exhibiting the greatest disparities. Among those with Class III obesity, 9.6% (vs. 3.2% for normal weight) reported poor overall health, 28.3% (vs. 13.2%) reported severe pain, and 11.8% (vs. 8.4%) had prevalent insomnia. Graded associations were observed across high BMI categories, with Class III obesity showing the strongest effects. Compared with normal weight, in Class III obesity, the odds ratio (95% CI) was 3.82 (3.69-3.96) for fair/poor overall health, 3.93 (3.71-4.17) for severe pain, and 3.13 (2.98-3.29) for severely limited physical activity; the hazard ratio (95% CI) was 2.83 (2.36-3.40) for fibromyalgia and 1.53 (1.41-1.65) for insomnia.

CONCLUSION

Obesity imposes a substantial burden on broad aspects of well-being in the US population.

The mediating effect of psychosocial work factors in the prospective associations between organisational changes and self-rated health: Results from the national French working conditions survey

OBJECTIVES

Organisational changes have been found to be associated with health outcomes but the underlying mechanisms remain understudied. The study aimed at exploring the prospective associations of organisational changes with self-rated health and the mediating effect of psychosocial work factors in these associations.

STUDY DESIGN

The study had a prospective design.

METHODS

The study was based on a nationally representative sample of 14,989 employees surveyed in 2013, 2016, and 2019 (national French working conditions survey). The associations between seven organisational changes, a large set of psychosocial work factors, and the incidence of poor self-rated health were studied using weighted robust Poisson regression models and the Karlson, Holm and Breen (KHB) method. Covariates included gender, age, marital status, stressful life events, social support outside work, occupation, and economic activity of the company.

RESULTS

The exposure to any organisational change predicted the incidence of poor self-rated health (covariate-adjusted incidence rate ratio: 1.30, 95 % CI: 1.16-1.46). All types of organisational changes were predictors of the incidence of poor self-rated health. There was a linear trend between the number of changes and the incidence of poor self-rated health. Mismanagement of changes increased the incidence still further. Psychosocial work factors had a mediating effect of 18.4-51.8 % in the associations between organisational changes and the incidence of poor self-rated health. The most contributing factors were those related to quantitative demands, role stressors, job insecurity, and internal violence.

CONCLUSIONS

Prevention oriented towards organisational changes may be useful to improve psychosocial working conditions and health among working populations.

Cannabis and mental health in adolescents: changes in associations over 15 years

PURPOSE

Recent changes in the cannabis market, including decreased adolescence usage, increased Δ9-tetrahydrocannabinol levels and rising mental disorders over the last decade raises questions about the changing profile of cannabis consumers.

METHODS

This study explores the trends of associations between regular cannabis use and mental health in five waves of a national representative survey of 17-year-old French adolescents, including more than 150,000 participants. Multivariable models, adjusted for gender and socioeconomic variables, were used.

RESULTS

Cannabis use and mental health indicators showed some variations over time, with increasing divergence between 2017 and 2022. Regular use of cannabis decreased from 7.4% in 2008 to 3.8% in 2022 (p < 0.001). In contrast, suicidal ideation in the past year increased from 16% in 2008 to 18% in 2022 (p = 0.009), although it followed a U-shaped trend. The association between regular cannabis use and suicidal ideation in the past year increased from 1.44 (CI: 1.29-1.61) in 2008 to 2.52 (CI: 2.05-3.10) in 2022. Similarly, the association between cannabis use and antidepressant use in the past year increased from 2.57 (CI: 2.18-3.03) in 2008 to 4.47 (CI: 3.35-5.97) in 2022.

CONCLUSION

These results suggest that cannabis users are now more prone to mental health disorders compared to 15 years ago. Several mechanisms might explain these findings, including the self-selection of a population with both vulnerabilities, changes in the effects of cannabis, or the use of cannabis as a self-medication strategy.

Self-rated health in preadolescent children as a predictor for hospital contacts and redeemed prescriptions: the Danish National Birth Cohort 1996-2002

AIM

The decline in self-rated health among young people raises concerns for future health outcomes. We examined whether self-rated health in preadolescence predicts hospital contacts and prescription redemption in later adolescence.

METHODS

This longitudinal study uses the Danish National Birth Cohort on children born 1996-2002. A questionnaire was distributed to 96,382 11-year-old preadolescents followed from 2010 to 2018. Number of hospital contacts and prescriptions were obtained from Danish registers. Incidence rate ratios (IRRs) were estimated, comparing preadolescents with poor ('Not So Good'/'Poor') and 'Good' self-rated health to those with 'Excellent' self-rated health.

RESULTS

Among the 47,365 (49.1%) 11-year-old participants, 5.3% reported poor self-rated health and 38.3% reported good health. Analyses revealed that children with good self-rated health had higher rates of somatic (IRR, 1.17 [1.14-1.21]) and psychiatric (IRR, 1.63 [1.47-1.81]) hospital contacts. Children with poor self-rated health showed even higher rates, with IRRs of 1.73 [1.62-1.85] for somatic and 3.54 [3.03-4.15] for psychiatric contacts. Additionally, those with good self-rated health had more somatic and psychiatric prescriptions (IRR, 1.25 [1.21-1.30] and 1.75 [1.55-1.97], respectively), whereas children with poor self-rated health had IRRs of 1.67 [1.56-1.80] for somatic and 4.03 [3.39-4.82] for psychiatric prescriptions.

CONCLUSION

Preadolescents with both good and poor self-rated health show higher rates of hospital contacts and prescription redemption in adolescence, especially pronounced in children with poor self-rated health. This indicates that early-life health perceptions impact long-term wellbeing, particularly psychiatric health. This simple self-rated health measure provides valuable insights for healthcare professionals by aiding in identifying children in need of support and early intervention.

Health, Disability, and Economic Inactivity Following a Diagnosis of a Severe Mental Illness: Cohort Study of Electronic Health Records Linked at the Individual-Level, to Census from England

BACKGROUND

The association of social and clinical indicators with employment, disability, and health outcomes among individuals with severe mental illnesses (SMI) remains unclear. Existing evidence primarily comes from smaller cohort studies limited by shorter follow-up and high attrition, or registry-based research, which lacks information on important social determinants.

STUDY DESIGN

We utilized a novel data linkage consisting of clinical records of individuals diagnosed with schizophrenia-spectrum or bipolar disorders from the South London and Maudsley Mental Health Trust, linked at the individual-level to the 2011 UK Census, a rich source for sociodemographic information. Using logistic regression, we estimated adjusted odds ratios (aORs) and 95% confidence intervals to determine associations between socioeconomic and clinical indicators and economic inactivity, self-rated health, and disability outcomes.

RESULTS

The sample comprised 8249 people with SMI diagnoses. Economic inactivity (77.3%), disability (68.3%) and poor health (61.1%) were highly prevalent. Longer duration of illness and comorbid substance misuse were associated with economic inactivity, poorer self-rated health, and disability, with associations noted between living alone and all outcomes (aORs and 95% CI: Economic inactivity: 1.72, 1.45-2.03; disability: 1.48, 1.31-1.68; poor health: 1.32, 1.18-1.49). Relative to the White British group, Black African, South Asian, and Other Black groups were more likely to be economically inactive. Black Caribbean and other groups were less likely to report poorer self-rated health or disability.

CONCLUSIONS

Our findings highlight considerable disability, poorer health, and economic inactivity experienced by people with SMI. Addressing comorbid substance misuse and social isolation could play a role in improving outcomes.

Educated but Unhealthy? Examining Minorities' Diminished Returns

Background

Educational attainment is known to improve self-rated health; however, research suggests that these benefits may be less pronounced for racial and ethnic minority groups. The Minorities' Diminished Returns (MDRs) theory posits that the protective effects of resources such as education are weaker for marginalized populations, such as Black and Latino individuals, compared to their White counterparts.

Objective

This study aims to investigate racial and ethnic disparities in the association between years of schooling and self-rated health among U.S. adults, with a focus on understanding the reduced health benefits of education for Black and Latino individuals.

Methods

Using data from the Understanding America Study (UAS; 2014), we conducted a cross-sectional analysis of adults aged 18 and older (N = 6,785). Self-rated health was the outcome, and years of schooling was the primary independent variable. We controlled for sociodemographic factors including age, gender, employment status, immigration status, and marital status. Stratified analyses were conducted by race/ethnicity (Non-Latino White, Non-Latino Black, and Latino). Linear regression models were used to examine the association between years of schooling and self-rated health, and interaction terms were included to assess variation in this relationship across racial/ethnic groups.

Results

While years of schooling was positively associated with better self-rated health overall, the magnitude of this effect was weaker for Black and Latino individuals compared to White individuals. After adjusting for sociodemographic factors, Black and Latino adults reported worse self-rated health for each additional year of schooling, compared to their White counterparts, supporting the MDRs hypothesis.

Conclusion

The findings suggest that while higher educational attainment is protective against worse self-rated health, this protection is not equally distributed across racial and ethnic groups. Black and Latino individuals experience diminished returns from their years of schooling in terms of self-rated health, likely due to structural barriers and social inequalities. Policies addressing health disparities must consider these diminished returns and aim to reduce structural racism and discrimination that undermine the benefits of education for minoritized populations.

Self-rated health and the risk of incident atrial fibrillation in general population

The association between self-rated health (SRH) and the development of atrial fibrillation (AF) in the general population remains underexplored. We reviewed the data of 9,895 participants in the Ansung-Ansan cohort study, a community-based Korean study. SRH was categorised as 'poor', 'fair', or 'good'. A newly developed AF was identified through biennial electrocardiography examinations and/or a self-reported history of physician-determined diagnoses. Over a median follow-up of 11 years, 149 patients (1.5%) developed AF. Compared with the 'good' group, the 'poor' group exhibited a higher risk of incident AF (adjusted hazard ratio, 1.85; 95% confidence interval, 1.19-2.87). Old age, female sex, lower educational level, smoking, cardiovascular diseases (hypertension, diabetes mellitus, and coronary artery disease), and inflammation were associated with 'poor' SRH. Along with SRH, age, male sex, urban residence, hypertension, and myocardial infarction were also associated with a higher risk of incidental AF. The combined model, which included conventional risk factors and SRH, demonstrated a marginally improved performance in predicting incident AF (concordance index: 0.704 vs. 0.714, P = 0.058). Poor SRH is independently associated with the development of AF in Korean adults. However, it plays a limited role in AF surveillance when combined with conventional AF risk factors.

Self-rated health and risk of incident cardiovascular events among individuals with hypertension

BACKGROUND

The relationship between self-rated health (SRH) and cardiovascular events in individuals with hypertension, but without diabetes mellitus, is understudied.

METHODS

We performed a post hoc analysis of data from SPRINT (Systolic Blood Pressure Intervention Trial). SRH was categorized into excellent, very good, good and fair/poor. Using multivariable Cox regression, we estimated hazard ratios and 95% confidence intervals (CIs) for the association of SRH with both all-cause mortality and a composite of cardiovascular events (the primary outcome), which was defined to include myocardial infarction (MI), other acute coronary syndromes, stroke, acute decompensated heart failure, and cardiovascular death.

RESULTS

We included 9319 SPRINT participants (aged 67.9 ± 9 years, 35.6% women) with a median follow-up of 3.8 years. Compared with SRH of excellent, the risk [hazard ratio (95% CI)] of the primary outcome associated with very good, good, and fair/poor SRH was 1.11(0.78-1.56), 1.45 (1.03-2.05), and 1.87(1.28-2.75), respectively. Similarly, compared with SRH of excellent, the risk of all-cause mortality [hazard ratio (95% CI)] associated with very good, good, and fair/poor SRH was 1.13 (0.73-1.76), 1.72 (1.12-2.64), and 2.11 (1.32-3.38), respectively. Less favorable SRH (LF-SRH) was also associated with a higher risk of each component of the primary outcome and serious adverse events (SAE).

CONCLUSION

Among individuals with hypertension, SRH is independently associated with the risk of incident cardiovascular events, all-cause mortality, and SAE. Our study suggest that guidelines should consider the potential significance of including SRH in the clinical history of patients with hypertension.

Change of self-rated physical health predicts mortality in aging individuals: results of a population-based cohort study

BACKGROUND

Self-rated physical health (SRPH) is known as an important predictor of mortality. Previous studies mostly used baseline values of self-rated health to predict long-term mortality. The effect of change in self-rated physical health on mortality during the course of aging has rarely been researched. The present study aimed to determine SRPH over time in women and men of an aging population, assess whether and how change in SRPH affects mortality while adjusting for known determinants of mortality, and test effect modification by sex on the relation between course of SRPH and mortality.

METHODS

Data of N = 12,423 respondents of the 5-year follow-up of the Gutenberg Health Study (GHS) with participation at the baseline assessment were analysed. All-cause mortality from 5-year follow-up onwards was defined as the primary outcome. SRPH was assessed by a single item. Cox proportional hazards models with adjustment for age, sex, socio-economic status and physical diseases were fitted to assess the predictive power of baseline score and course of SRPH. Additionally, effect modification by sex was assessed.

RESULTS

During a median follow-up period of 7.3 years (quartiles 6.0-8.5 years), 618 (5%) participants died. Overall, 70.9% of the participants indicated good or very good SRPH at baseline (T1) and follow-up (T2), 6.9% rated their SRPH as not so good at T1 and T2, and 0.6% reported bad SRPH at T1 and T2. An improvement of SRPH was indicated by 9.6% and 12.0% indicated deterioration of their SRPH. Change in SRPH added substantial predictive information to the Cox proportional hazards models, when adjusting for relevant covariates. In men, deterioration and constantly bad SRPH were associated with the strongest increase in risk of mortality by 87%, resp. 228%. While improvements increased mortality risk in men (67%), women with an improved SRPH had a lower risk (57%).

CONCLUSION

A sizeable subgroup of aging participants reported deterioration of SRPH over five years. The association between change of SRPH and mortality is modified by sex. Deterioration of SRPH predicts mortality over baseline-assessment even when adjusted for relevant covariates. SRPH should be assessed regularly as part of an older individual's health evaluation. Deterioration, constantly bad and improved SRPH should be taken seriously as unfavorable prognostic indicators, the latter only in men.

Changes in Accelerometer-Measured Physical Activity and Sedentary Time Across Retirement Transition as a Predictor of Self-Rated Health

BACKGROUND

Retirement transition has been shown to associate with changes in physical activity (PA) and self-rated health (SRH), but their interrelationship is less studied. The aim was to investigate changes in accelerometer-measured total PA, moderate to vigorous PA (MVPA), and sedentary time across retirement transition as a predictor of SRH.

METHODS

Data from the Swedish Retirement Study and the Finnish Retirement and Aging study were harmonized and pooled. Data from 3 waves (about 12 mo apart) were included: 1 preretirement (wave 1) and 2 postretirement follow-ups (wave 2-3). A totally of 245 participants (27% men) were included. Thigh-worn accelerometers were used to collect data for PA variables (wave 1-2), and SRH was obtained from the questionnaire (wave 1-3).

RESULTS

Between wave 1 and 2, total PA decreased with 11 (CI, -22 to -1) minutes per day, MVPA was stable (0 [CI, -3 to 3] min), and sedentary time decreased nonsignificantly with 9 (CI, -20 to 1) minutes. SRH changed between all 3 waves (all P < .001). At preretirement, 10 more minutes of MVPA was associated with greater odds of better SRH when adjusting for accelerometer wear-time, cohort, sex, age, and occupational status (odds ratio: 1.11 [95% CI, 1.02-1.22]). This association was no longer statistically significant when additionally adjusting for marital status, body mass index, and smoking. No significant associations were observed between changes in the PA variables during retirement transition and SRH at postretirement follow-ups.

CONCLUSIONS

This study showed a cross-sectional association between MVPA and greater odds of reporting better SRH before retirement. No longitudinal associations were observed between changes in the PA variables from before to after retirement and later changes in SRH.

Impact of Chronic Disease Self-Management Program on the Self-Perceived Health of People in Areas of Social Vulnerability in Asturias, Spain

The Chronic Disease Self-Management Program (CDSMP) focuses on a health promotion perspective with a salutogenic approach, reinforcing the pillars of self-efficacy. The aim of this study was to assess the impact of the CDSMP on Self-perceived Health (SPH) in disadvantaged areas of Asturias, España. The study included vulnerable adults with experience of chronic diseases for over six months, along with their caregivers. The intervention consisted of a six-session workshop led by two trained peers. SPH was evaluated by administering the initial item of the SF-12 questionnaire at both baseline and six months post-intervention. To evaluate the variable "Change in SPH" [improvement; remained well; worsening/no improvement (reference category)], global and disaggregated by sex multivariate multinomial logistic regression models were applied. There were 332 participants (mean = 60.5 years; 33.6% were at risk of social vulnerability; 66.8% had low incomes). Among the participants, 22.9% reported an improvement in their SPH, without statistically significant sex-based differences, while 38.9% remained in good health. The global model showed age was linked to decreased "improvement" probability (RRRa = 0.96), and the "remaining well" likelihood drops with social risk (RRRa = 0.42). In men, the probability of "remaining well" decreased by having secondary/higher education (RRRa = 0.25) and increased by cohabitation (RRRa = 5.11). Women at social risk were less likely to report "remaining well" (RRRa = 0.36). In conclusion, six months after the intervention, 22.9% of the participants had improved SPH. Age consistently decreased the improvement in the different models.

Health Perceptions, Multimorbidity, and New Fractures and Mortality Among Patients With a Fracture

Importance

A high proportion of patients who sustain a fracture have multimorbidity. However, the association of multimorbidity with postfracture adverse outcomes, such as subsequent fractures and premature mortality, has not been widely explored.

Objective

To examine the association of multimorbidity and self-rated health with subsequent fractures and mortality after fracture.

Design, Setting, and Participants

This prospective cohort study included participants from New South Wales, Australia, in the Sax Institute's 45 and Up Study (n = 267 357). Participants were recruited from July 2005 to December 2009 and followed up from the date of the incident fracture until subsequent fracture, death, or the end of the study (April 2017), whichever occurred first, with questionnaire data linked to hospital admission and medication records. Data analysis was reported between March and September 2023.

Exposures

Charlson Comorbidity Index (CCI) score and self-rated health (SRH).

Main Outcomes and Measures

The main outcomes were subsequent fracture or mortality after an incident fracture. Associations between SRH measures and subsequent fracture and mortality were also assessed. All analyses were stratified by sex given the different fracture and mortality risk profiles of females and males.

Results

Of 25 280 adults who sustained incident fractures, 16 191 (64%) were female (mean [SD] age, 74 [12] years) and 9089 (36%) were male (mean [SD] age, 74 [13] years). During a median follow-up time of 2.8 years (IQR, 1.1-5.2 years), 2540 females (16%) and 1135 males (12%) sustained a subsequent fracture and 2281 females (14%) and 2140 males (24%) died without a subsequent fracture. Compared with a CCI score of less than 2, those with a CCI score of 2 to 3 had an increased risk of subsequent fracture (females: hazard ratio [HR], 1.16 [95% CI, 1.05-1.27]; males: HR, 1.25 [95% CI, 1.09-1.43]) and mortality (females: HR, 2.19 [95% CI, 1.99-2.40]; males: HR, 1.89 [95% CI, 1.71-2.09]). Those with a CCI score of 4 or greater had greater risks of subsequent fracture (females: HR, 1.33 [95% CI, 1.12-1.58]; males: HR, 1.48 [95% CI, 1.21-1.81]) and mortality (females: HR, 4.48 [95% CI, 3.97-5.06]; males: HR, 3.82 [95% CI 3.41-4.29]). Self-rated health was also significantly associated with subsequent fracture and mortality. Those reporting the poorest health and quality of life had the highest subsequent fracture risks, and their mortality risks were even higher.

Conclusions and Relevance

In this cohort study, both CCI and SRH measures were associated with increased risk of subsequent fractures and mortality after fracture, underscoring the importance of managing the care of patients with comorbidities who sustain a fracture.

Life's Essential 8 in relation to self-rated health and health-related quality of life in a large population-based sample: the SCAPIS project

PURPOSE

To monitor cardiovascular health, in 2022, the American Heart Association (AHA) updated the construct "Life's Simple 7" (LS7) to "Life's Essential 8" (LE8). This study aims to analyze the associations and capacity of discrimination of LE8 and LS7 in relation to self-rated health (SRH) and health-related quality of life (HRQoL).

METHODS

This study from the Swedish CArdioPulmonary bioImage Study (SCAPIS) included 28 731 Swedish participants, aged 50-64 years. Three different scores were derived from the SF-12 questionnaire: 1-item question SRH ("In general, would you say your health is …?"), mental-HRQoL and physical-HRQoL. Logistic regression, restricted cubic splines, and ROC analysis were used to study the associations between the AHA scores in relation to SRH and HRQoL.

RESULTS

Compared to those with a LE8 score of 80, participants with a LE8 score of 40 were 14.8 times more likely to report poor SRH (OR: 14.8, 95% CI: 13.0-17.0), after adjustments. Moreover, they were more likely to report a poor mental-HRQoL (OR: 4.9, 95% CI: 4.2-5.6) and a poor physical-HRQoL (OR: 8.0, 95% CI: 7.0-9.3). Area under curves for discriminating poor SRH were 0.696 (95% CI: 0.687-0.704), 0.666 (95% CI: 0.657-0.674), and 0.643 (95% CI: 0.634-0.651) for LE8, LS7 (0-14), and LS7 (0-7), respectively, all p values < 0.001 in the DeLong's tests.

CONCLUSION

LE8 and LS7 had strong and inverse associations with SRH, mental-HRQoL, and physical-HRQoL, though LE8 had a somewhat higher capacity of discrimination than LS7. The novel LE8, a construct initially conceived to monitor cardiovascular health, also conveys SRH and HRQoL.

Association between changed self-rated health and the risk of venous thromboembolism in Malmö Preventive Program: a cohort study

Poor self-rated health (SRH) is associated with incident arterial cardiovascular disease in both sexes. Studies on the association between SRH and incident venous thromboembolism (VTE) show divergent results in women and no association in men. This study focuses on the association between change in SRH and incident VTE in a cohort of 11,558 men and 6682 women who underwent a baseline examination and assessment of SRH between 1974 and 1992 and a re-examination in 2002-2006. To investigate if changes in SRH over time affect the risk of incident VTE in men and women. During a follow-up time from the re-examination of more than 16 years, there was a lower risk for incident VTE among women if SRH changed from poor at baseline to very good/excellent (HR 0.46, 95% CI 0.28; 0.74) at the re-examination. Stable good SRH (good to very good/excellent at the re-examination, HR 0.60, 95% CI 0.42; 0.89), or change from good SRH at baseline into poor/fair at the re-examination (HR 0.68, 95% CI 0.51; 0.90) were all significantly associated with a reduced risk for VTE. All comparisons were done with the group with stable poor SRH. This pattern was not found among men. Regardless of a decreased or increased SRH during life, having an SRH of very good/excellent at any time point seems to be associated with a decreased risk of VTE among women.

Insufficient Workplace Infection Control and Unhealthy Lifestyle Behaviors Are Related to Poor Self-Rated Health During the COVID-19 Pandemic

OBJECTIVE

This study investigated whether workers who practiced unhealthy lifestyles but worked under organizations with insufficient control against coronavirus disease 2019 (COVID-19) would pose a synergistic risk of poor self-rated health (SRH).

METHODS

A total of 22,637 workers (men, 48.5%) were extracted from an online survey during the COVID-19 pandemic in Japan (December 2020). Multiple logistic regression analyses were performed to estimate adjusted odds ratio (AOR) against poor (poor, fair) SRH.

RESULTS

Accumulation of unhealthy lifestyle behaviors (AOR, 1.49 to 4.40; P < 0.05) and insufficient infection control (AOR, 1.80; P < 0.05) were independently related to poor SRH; however, when these factors were combined, SRH was additively worsened (AOR, 2.14 to 7.72; P < 0.05).

CONCLUSIONS

This study highlights that not only unhealthy lifestyle practices but also poor organizational management against infection would worsen workers' SRH during the COVID-19 pandemic.

A perinatal coparenting intervention: Effects of a randomized trial on parent cardiometabolic risk and self-reported health

BACKGROUND

The transition to parenthood is a common yet stressful experience faced by many young and midlife adults, and the risk of cardiometabolic conditions also begins to rise at this time. Consequently, parenthood represents an opportune time to intervene with adults to support their psychological and physical health.

PURPOSE

We examined whether the benefits of the Family Foundations program, a perinatal preventative intervention promoting positive coparenting, extend beyond documented mental health and family relationship outcomes to better cardiometabolic risk factors among parents.

METHODS

We analyzed data from 183 couples (n = 366 participants) who, eight years prior, were randomly assigned to the 9-session perinatal preventative intervention program or a control condition. We collected dried blood spots to measure C-reactive protein (CRP), interleukin-6 (IL-6), and cholesterol; parents also reported on their self-rated health.

RESULTS

Randomization to the intervention condition was associated with lower cholesterol (B=-.081, p = .049). Among parents who demonstrated more negative communication styles at pretest (during pregnancy), the intervention was further associated with better self-rated health (B=.181, p = .018). Participation in the intervention program was also marginally associated with lower CRP (B=-.261, p = .077), particularly among mothers (B=-.428, p = .076).

CONCLUSIONS

These findings indicate that coparenting-focused interventions, such as Family Foundations, can lead to benefits beyond psychosocial and behavioral outcomes, and suggest that Family Foundations may improve parents' longer-term physical health, with potentially more benefits among couples who demonstrated more negative communication styles during pregnancy.

Associations of health-related quality of life with major adverse cardiovascular and cerebrovascular events for individuals with ischaemic heart disease: systematic review, meta-analysis and evidence mapping

OBJECTIVE

To investigate the association between health-related quality of life (HRQoL) and major adverse cardiovascular and cerebrovascular events (MACCE) in individuals with ischaemic heart disease (IHD).

METHODS

Medline(R), Embase, APA PsycINFO and CINAHL (EBSCO) from inception to 3 April 2023 were searched. Studies reporting association of HRQoL, using a generic or cardiac-specific tool, with MACCE or components of MACCE for individuals with IHD were eligible for inclusion. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale to assess the quality of the studies. Descriptive synthesis, evidence mapping and random-effects meta-analysis were performed stratified by HRQoL measures and effect estimates. Between-study heterogeneity was assessed using the Higgins I2 statistic.

RESULTS

Fifty-one articles were included with a total of 134 740 participants from 53 countries. Meta-analysis of 23 studies found that the risk of MACCE increased with lower baseline HeartQoL score (HR 1.49, 95% CI 1.16 to 1.93) and Short Form Survey (SF-12) physical component score (PCS) (HR 1.39, 95% CI 1.28 to 1.51). Risk of all-cause mortality increased with a lower HeartQoL (HR 1.64, 95% CI 1.34 to 2.01), EuroQol 5-dimension (HR 1.17, 95% CI 1.12 to 1.22), SF-36 PCS (HR 1.29, 95% CI 1.19 to 1.41), SF-36 mental component score (HR 1.18, 95% CI 1.08 to 1.30).

CONCLUSIONS

This study found an inverse association between baseline values or change in HRQoL and MACCE or components of MACCE in individuals with IHD, albeit with between-study heterogeneity. Standardisation and routine assessment of HRQoL in clinical practice may help risk stratify individuals with IHD for tailored interventions.

PROSPERO REGISTRATION NUMBER

CRD42021234638.

The Effects of Subjective Wellbeing and Self-Rated Health on Lifetime Risk of Cardiovascular Conditions in Women

Subjective wellbeing may predict future health conditions, and lower self-rated physical health (SRH) is associated with the presence of chronic conditions, such as cardiovascular disease (CVD). This study examines whether subjective wellbeing and SRH predict long-term CVD conditions for women using the Midlife in the United States study. The study cohort includes 1716 women participants who completed waves 1 (1995-1996), 2 (2004-2006), and 3 (2013-2014). Data on demographics, chronic conditions of diabetes and CVD, subjective wellbeing (life satisfaction, positive affect, and negative affect), and SRH were collected repeatedly at each wave. Multiple logistic regressions were conducted to test whether subjective wellbeing was associated with a lifetime CVD risk. Greater life satisfaction was significantly associated with a lower risk of CVD at 10 years (odds ratio (OR): 0.83; 95% confidence interval (CI): 0.74-0.95) and 19 years (OR: 0.83; 95% CI: 0.74-0.93), while positive and negative affects were not significantly associated. Additionally, better physical SRH significantly lowered odds of having cardiovascular conditions at both 10 years (OR: 0.79; 95% CI 0.68-0.92) and 19 years (OR 0.74; 95% CI: 0.64-0.86). Measures of life satisfaction and SRH can be used as additional CVD screening tools.

Sleep Duration, Sleep Quality, and Insomnia in Association With Self-Rated Health: A Systematic Review and Meta-Analysis

Background and Objective This study undertook a systematic review and meta-analysis of the relationship between sleep duration, sleep quality, and insomnia in association with self-rated health.Methods Studies that had examined the relationship between sleep duration, sleep quality, and insomnia with self-rated health were eligible. PubMed and Scopus were the two main databases for searching for studies related to this meta-analysis. The Google Scholar database as a source of gray literature was also searched by hand. This search was from the beginning of the formation of databases until the end of January 2022, and the search language was limited to articles published in English. The Effective Public Health Practice Project Quality Assessment Tool was used to assess the quality of studies. For this meta-analysis, odds ratio and 95% confidence interval were extracted or calculated. The pool of studies was processed by the random effects method.Results Twenty-six studies were included in this meta-analysis. Sleep duration of ≤ 8 hours per day (h/d) (odds ratio = 1.58 and 95% confidence interval = [1.41–1.77]) and sleep duration of > 8 h/d (odds ratio = 1.32 and 95% confidence interval = [1.17–1.50]) are associated with poor self-rated health. Poor sleep quality and insomnia are associated with poor self-rated health. Conclusions Sleep problems have a negative effect on self-rated health, and therefore, effective interventions can help improve sleep.

Personality Traits Predict Self-Rated Health (SRH) in Coronary Heart Disease (CHD) Patients and Healthy Controls

OBJECTIVE

The objective of the present study is to examine the association between Big Five personality traits and self-rated health (SRH) among individuals with coronary heart disease (CHD), and to compare this relationship with that of healthy control participants, which is of importance as SRH can be a determinant of outcomes.

METHODS

The current study used data from 566 participants with CHD with a mean age of 63.00 (S.D. = 15.23) years old (61.13% males) and 8608 age- and sex-matched healthy controls with a mean age of 63.87 (S.D.= 9.60) years old (61.93% males) from the UKHLS. The current study used predictive normative modelling approaches, one-sample t tests, a hierarchical regression, and two multiple regressions.

RESULTS

The current study found that CHD patients have significantly lower Conscientiousness (t(565) = -3.84, p < 0.001, 95% C.I. [-0.28, -0.09], Cohen's d = -0.16) and SRH (t(565) = -13.83, p < 0.001, 95% C.I. [-0.68, -0.51], and Cohen's d = -0.58) scores compared to age and sex-matched healthy controls. Moreover, health status (controls vs. CHD patients) moderated the links between Neuroticism, Extraversion and SRH. Specifically, Neuroticism (b = -0.03, p < 0.01, 95% C.I. [-0.04, -0.01]), Openness (b = 0.04, p < 0.001, 95% C.I. [0.02, 0.06]), and Conscientiousness (b = 0.08, p < 0.001, 95% C.I. [0.06, 0.10]) were significant predictors of SRH in healthy controls, whereas Conscientiousness (b = 0.08, p < 0.05, 95% C.I. [0.01, 0.16]) and Extraversion (b = -0.09, p < 0.01, 95% C.I. [-0.15, -0.02]) were significant predictors of SRH in CHD patients.

CONCLUSION

Based on the close associations between personality traits and SRH, and the subsequent impact on patient outcomes, the results of this study should be taken into consideration by clinicians and health professionals when developing tailored treatment and intervention programs for their patients.

Cognitive Behavioral Therapy Enhances Survival in Cardiac Patients Aged Under 60: 14-YEAR OUTCOMES OF THE BEATING HEART PROBLEMS PROGRAM TRIAL

PURPOSE

To optimize recovery and improve prognosis, people who have had an acute cardiac event (ACE) need support to manage their cardiac risk. In 2008, we conducted a randomized controlled trial (RCT) of Beating Heart Problems (BHP) , an 8-wk group program based on cognitive behavioral therapy (CBT) and motivational interviewing (MI), designed to improve behavioral and mental health. This study investigated 14-yr mortality status for RCT participants in order to evaluate the survival impact of the BHP program.

METHODS

In 2021, mortality data on 275 participants from the earlier RCT were obtained from the Australian National Death Index. Survival analysis was undertaken to investigate differences in survival for participants in the treatment and control groups.

RESULTS

Over the 14-yr follow-up period, there were 52 deaths (18.9%). For those aged <60 yr, there was a significant survival benefit to program participation, with 3% deaths in the treatment group and 13% deaths in the control group ( P = .022). For those aged ≥60 yr, the death rate was identical in both groups (30%). Other significant predictors of mortality included older age, higher 2-yr risk score, lower functional capacity, lower self-rated health, and having no private health insurance.

CONCLUSIONS

Participation in the BHP conferred a survival benefit for patients aged <60 yr but not for participants overall. The findings highlight the long-term benefit of behavioral and psychosocial management of cardiac risk through CBT and MI for those who are younger at the time of their first ACE.

Mechanism of the association between sleep quality and mortality in middle-aged and older adults: A prospective study analysis of the UK Biobank

BACKGROUND

Although sleep quality is known to be associated with mortality, how poor sleep quality contributes to an increased risk of mortality is still unknown. We aimed to examine whether lifestyle, psychosocial and biological factors mediate the association.

METHODS

205,654 participants from UK Biobank were used for the analysis. The outcome was all-cause, cardiovascular disease (CVD) and cancer mortality by February 2022. Exposure was assessed by a sleep score consisting of five sleep behaviors at baseline. Lifestyle, psychosocial, and biological factors are regarded as potential mediators. Mediation analysis based on Cox proportional hazards models was performed.

RESULTS

Poor sleep quality was associated with a higher risk of all-cause (Hazard Ratio [HR] = 1.098; 95% CI: 1.058-1.140), CVD (HR = 1.139; 95% CI: 1.045-1.243) and cancer mortality (HR = 1.095; 95% CI: 1.040-1.152). Lifestyle mediators (smoking, physical activity, sedentary, BMI and diet) could explain between 2.6% and 34.0% of the increased risk of all-cause mortality in individuals with poor sleep quality. Self-reported health, frailty, depression, and loneliness were significant psychosocial mediators of this association pathway. About one-fifth of the association can be explained by the biological role of CRP. Similar mediating patterns were observed for CVD and cancer mortality.

LIMITATIONS

Both exposure and mediators were measured at baseline, so the possibility of reverse causality cannot be ruled out.

CONCLUSIONS

Poor sleep quality is associated with an increased risk of death through a combination of lifestyle, psychosocial and biological pathways. Adopting healthy lifestyles and staying psychosocial well-being are cost-effective interventions to lower the risk of death.

Self-rated health status and associated factors in rural workers

BACKGROUND

Self-rated health status can be considered a good predictor of morbidity and mortality and has been used due to its easy assessment and applicability. The instrument is efficient for understanding sociodemographic, environmental and clinical conditions that may be related to the self-rated health status. Thus, this study aims to analyze the self-assessment of health status in rural workers and its association with socioeconomic characteristics, lifestyle, clinical condition and work characteristics.

METHODS

This is a cross-sectional study carried out with 787 male and female rural reporting agriculture as their main source of income in the municipality of Santa Maria de Jetibá. A simple and direct question was used "In general, compared to people your age, how do you rate your own state of health?" to see how rural workers rate their current health status. The independent variables analyzed were socioeconomic, clinical, health and work conditions. The magnitude of the associations was evaluated by means of hierarchical logistic regression.

RESULTS

It was found that 42.1% of rural workers self-rated their health status as regular or poor. Belonging to socioeconomic classes C (OR = 1.937; 95% CI = 1.009-3.720) or D/E (OR = 2.280; 95% CI = 1.178-4.415), being overweight (or having excess weight) (OR = 1.477; 95% CI = 1.086-2.008), multimorbidity (OR = 1.715; 95% CI = 1.201-2.447) and complex multimorbidity (OR = 1.738; 95% CI = 1.097-2.751) were risk factors for worse self-rated health.

CONCLUSION

It was concluded that chronic diseases, socioeconomic status and overweight are risk factors for negative self-rated health. The identification of these determinants through self-rated status can support the planning of actions aimed at improving the health of the rural population.

TRIAL REGISTRATION

This study was approved by the Research Ethics Committee of the Health Sciences Center of the Federal University of Espírito Santo (Protocol No. 2091172; CAAE No. 52839116.3.0000.5060). All research participants gave their informed consent.

Investigating the Physical and Mental Health Nexus: a Network Analysis of Depression, Cardiometabolic Health, Bone Mass, and Perceived Health Status Among Filipino Domestic Workers

BACKGROUND

Migrant domestic workers are vulnerable to physical and mental health problems given the many challenges they experience while working abroad. Using network analysis, this study examined the structure of depression, cardiometabolic health indicators (BMI, waist-hip ratio (WHR), blood pressure, and heart rate), bone mass, and perceived health status in this population. The network model allowed for an examination of central symptoms or symptoms with the most direct connections with other symptoms; bridge symptoms, or symptoms that link two or more communities; and edges, or relationships among symptoms.

METHOD

Cross-sectional data were gathered from 1375 Filipino domestic workers in Macao (SAR), China. Data from a subsample of 510 participants who met a cutoff indicating depression were analyzed. Anthropometric measurements and surveys were used to collect data, which was analyzed using R statistical software.

RESULTS

Results showed four community clusters: three communities consisted of at least two depression symptoms each and the fourth community included physical health indicators. Strong edges were formed between BMI-bone mass, psychomotor-concentration, BMI-WHR, and sad mood-anhedonia. The node with the highest expected influence was BMI. There were three bridges: worthlessness, psychomotor difficulties, and concentration difficulties.

CONCLUSION

The link between depression, cardiometabolic indicators, bone mass, and poor perceived health reinforces the need to address multimorbidity within migrant populations. Health promotion interventions that address mental and physical health may improve the health of this population.

Impact of hematopoietic cell transplant frailty scale on transplant outcome in adults

This prospective study designs an HCT Frailty Scale to classify alloHCT candidates into groups of frail, pre-frail, and fit, and to be implemented in the first consultation at no additional cost. The present scale is composed of the following eight variables: Clinical Frailty Scale, Instrumental Activities of Daily Living, Timed Up and Go Test, Grip Strength, Self-Health Rated, Falls, Albumin, and C-Reactive Protein. The Frailty score of a patient is the weighted sum of scores for each item, with weights assigned according to the hazard ratios of a multivariable Cox proportional hazards model estimated and validated with data on OS as the dependent variable, and the scores of the eight variables as explanatory ones, from 298 adults split into training (n = 200) and validation (n = 98) sets. For clinical use, the scale scores were transformed into three categories: scale score ≤1: fit; 1<scale score ≤5.5: pre-frail; scale score >5.5 frail. The estimated probabilities of 1-year OS in each group of frailty, were, respectively: 83.7%, 48.5%, and 16.5% (p < 0.001). In the validation cohort, the respective values were 90.3%, 69.5%, and 46.2% (p < 0.001). Pending further external validations, the HCT Frailty Scale is a low cost-highly informative prognostic signal of outcomes at the pre-transplant stage.

Multi-dimensional Profiles of Risk and Their Association with Obesity-Severity in Low-Income Black Women

Multi-level risk factors underlie disproportionate obesity rates among Black women. Latent class analysis of multi-level risk and protective factors among low-income Black women (n = 917) in 2011 (Pittsburgh, PA). Data were collected via in-person survey, interviewer-assisted online dietary recalls, and from 2011 crime records. Multinomial logistic regression estimated cross-sectional associations between latent classes and obesity severity derived from measured anthropometry. Latent class analysis identified four groups of women according to their motivations and intentions to be healthy, socioeconomic and health burden, and neighborhood risk: Class 1 = Very high burden (n = 283), Class 2 = Health motivated, low burden, low neighborhood risk (n = 231), Class 3 = High burden and high neighborhood risk (n = 106), and Class 4 = Low burden and low neighborhood risk (n = 297). Class 3 = High burden and high neighborhood risk women had the highest severe obesity risk. Multi-level strategies may support low-income Black women women's resilience to obesity who face neighborhood-level and socioeconomic stressors.

Predictive factors on caregiver burden in caregivers of individuals with cognitive impairment

Introduction

Informal caregivers, mostly family members or friends, have often been required to engage in medical/nursing tasks and to navigate complex healthcare systems. It is unclear whether those activities impact caregiver burden. Therefore, the purpose of this study was to examine predictive factors of caregiver burden in consideration of healthcare-related factors (caregivers’ perception of performing medical/nursing tasks, care coordination, and number of hospitalizations).

Methods

Secondary analysis of cross-sectional survey data taken from the Caregiving in the U.S. 2015 was conducted. Data were collected by the National Alliance for Caregiving and the American Association of Retired Persons (AARP). Self-identified caregivers (n = 304) who provided care for individuals with cognitive impairment (ICI), and who were living in the community were participants in the study.

Results

The overall model explained 38.4% of the variance in caregiver burden (F = 20.48, p < 0.001). When examining each factor, perceived difficulty in medical/nursing tasks (β = 0.38, p < 0.001) was the most influential factor, followed by caregivers’ physical health (β = −0.27, p < 0.001), income (β = −0.13, p = 0.01), and level of the care coordination (β = 0.12, p = 0.02).

Discussion

Although caregivers’ involvement in healthcare-related activities for ICI is necessary, this involvement has a considerable impact on caregiver burden. Healthcare providers should be cognizant of caregiver burden related to healthcare-related activities. Moreover, researchers should develop interventions and community services to decrease caregivers’ difficulty in performing their roles.

Prospective associations between psychosocial work factors and self-reported health: study of effect modification by gender, age, and occupation using the national French working conditions survey data

Background

Prospective studies exploring the effects of psychosocial work factors on self-reported health (SRH) are lacking, especially those studying effect modifications. The objectives were to examine the prospective associations of these factors, and multiple exposures to these factors, with SRH in a national representative sample, and effect modifications by gender, age, and occupation.

Methods

The prospective study relied on the three data collection waves (2013, 2016, and 2019) of the national French Working Conditions survey and was based on a sample of 15,971 employees, in good SRH at the beginning of the follow-up period. The occupational exposures were time-varying variables measured in 2013 and 2016, and included: 20 psychosocial work factors grouped into 5 broad domains, 4 exposures related to working time/hours and 4 physical-biomechanical-chemical exposures. The incidence of poor SRH three years later was the outcome. Discrete time Poisson regression models were performed using weighted data and with adjustment for gender, age, marital status, life events, and occupation.

Results

Almost all the studied psychosocial work factors were predictive of poor SRH. Some physical-biomechanical-chemical exposures were found to predict poor SRH. Only rare effect modifications were observed according to gender, age, and occupation. Dose-response associations between multiple exposures and the incidence of poor SRH were observed for 4 among 5 domains of psychosocial work factors.

Conclusions

Our study underlined the effects of psychosocial work factors, as well as multiple exposure effects, on the incidence of poor SRH. However, most of these effects were the same across population groups related to gender, age, and occupation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13773-x.

[The importance of health-related quality of life at baseline in predicting event-free survival in patients with a cardiovascular risk profile]

The importance of health-related quality of life at baseline in predicting event-free survival in patients with a cardiovascular risk profile Background: Manifest heart failure impairs all dimensions of health-related quality of life (HRQOL). However, the role of HRQOL in patients with risk factors for the development of heart failure with preserved ejection fraction (HFpEF) is only poorly understood. Objective: In this post-hoc analysis of the DIAST-CHF observational study, we tested the hypothesis whether a lower HRQOL at baseline is prognostically associated with an increase in cardiovascular events during follow-up in elderly patients with a cardiovascular risk profile. Methods: The DIAST-CHF observational study enrolled 1.937 patients aged 50 to 85 years with at least one risk factor for the development of HFpEF. HRQOL was assessed using the German version of the Short-Form-36 (SF-36) Health Survey. Results: Patients with comorbid chronic diseases, including manifest heart failure, coronary artery disease, atrial fibrillation, diabetes mellitus and depression, rated their health status (Self-rated health, SRH) significantly worse than those without comorbidities. Older age, higher body-mass index and elevated serum amino-terminal pro-brain natriuretic peptide (NTproBNP) concentration as well as lower left ventricular ejection fraction (LVEF) and impaired 6-minute walk test showed significant relationships to SRH. Kaplan-Meier analyses and Cox regression models using quartiles of either SF-36 subscales "Physical Component Summary" (PCS) or SRH groups demonstrated significant differences in event-free survival (all-cause death or cardiovascular hospitalization), whereas no difference in event-free survival was observed among the quartiles of the SF-36 subscale "Mental Component Summary" (MCS). Conclusion: In patients with risk factors for the development of HFpEF, HRQOL questionnaires are suitable instruments for risk stratification if they capture physical impairments, rather than psychological limitations of quality of life.

Negative aging perceptions and cognitive and functional decline: Are you as old as you feel?

BACKGROUND

Research has shown the associations between negative aging perceptions and cognitive and physical decline may be mediated through behavioral and psychological pathways, but they are rarely examined simultaneously. We aimed at assessing the difference in the probability of following a high-, mid-, or low-performing cognitive trajectory, and a high- or low-performing physical function trajectory by negative aging perceptions. We sought to test two competing pathway mechanisms for the associations.

METHODS

This longitudinal study used data from the Irish Longitudinal Study on Ageing (TILDA), a nationally representative study of community-dwelling adults in Ireland. Adults aged ≥50 years who participated in two or more waves of TILDA (n = 6121) were included. An analysis of the population aged 65 years and above was also conducted (n = 2359). We identified latent class trajectories of Mini-Mental State Examination (MMSE), Instrumental Activities of Daily Living (IADL), ADL, and Timed-Up-and-Go (TUG) performance using Latent Growth Class Analysis (LGCA) on data collected every 2 years over 5 waves. Multinomial logistic regression was used to estimate the likelihood of membership to each trajectory class by negative aging perceptions (APQ). Finally, we tested possible behavioral, psychological, and social mechanisms.

RESULTS

LCGA identified three trajectory classes in cognitive and two in each physical function measure. People with the highest tertile of negative APQ were more likely to be in the declining MMSE class and the increasing IADL, ADL, and TUG classes. These associations for cognitive function were partially mediated by psychosocial pathways and for physical function were fully mediated by both psychosocial and health behavior pathways.

CONCLUSIONS

Negative aging perceptions were associated with cognitive and physical function declines. Poor self-rated health, depressive symptoms, loneliness, and low exercise seem to explain the relationships; however, the possibility of reverse causation remains.

Alcohol abstinence and mortality in a general population sample of adults in Germany: A cohort study

BACKGROUND

Evidence suggests that people who abstain from alcohol have a higher mortality rate than those who drink low to moderate amounts. However, little is known about factors that might be causal for this finding. The objective was to analyze former alcohol or drug use disorders, risky drinking, tobacco smoking, and fair to poor health among persons who reported abstinence from alcohol drinking in the last 12 months before baseline in relation to total, cardiovascular, and cancer mortality 20 years later.

METHODS AND FINDINGS

A sample of residents aged 18 to 64 years had been drawn at random among the general population in northern Germany and a standardized interview conducted in the years 1996 to 1997. The baseline assessment included 4,093 persons (70.2% of those who had been eligible). Vital status and death certificate data were retrieved in the years 2017 and 2018. We found that among the alcohol-abstinent study participants at baseline (447), there were 405 (90.60%) former alcohol consumers. Of the abstainers, 322 (72.04%) had met one or more criteria for former alcohol or drug dependence or abuse, alcohol risky drinking, or had tried to cut down or to stop drinking, were daily smokers, or self-rated their health as fair to poor. Among the abstainers with one or more of these risk factors, 114 (35.40%) had an alcohol use disorder or risky alcohol consumption in their history. Another 161 (50.00%) did not have such an alcohol-related risk but were daily smokers. The 322 alcohol-abstinent study participants with one or more of the risk factors had a shorter time to death than those with low to moderate alcohol consumption. The Cox proportional hazard ratio (HR) was 2.44 (95% confidence interval (CI), 1.68 to 3.56) for persons who had one or more criteria for an alcohol or drug use disorder fulfilled in their history and after adjustment for age and sex. The 125 alcohol-abstinent persons without these risk factors (27.96% of the abstainers) did not show a statistically significant difference from low to moderate alcohol consumers in total, cardiovascular, and cancer mortality. Those who had stayed alcohol abstinent throughout their life before (42; 9.40% of the alcohol-abstinent study participants at baseline) had an HR 1.64 (CI 0.72 to 3.77) compared to low to moderate alcohol consumers after adjustment for age, sex, and tobacco smoking. Main limitations of this study include its reliance on self-reported data at baseline and the fact that only tobacco smoking was analyzed as a risky behavior alongside alcohol consumption.

CONCLUSIONS

The majority of the alcohol abstainers at baseline were former alcohol consumers and had risk factors that increased the likelihood of early death. Former alcohol use disorders, risky alcohol drinking, ever having smoked tobacco daily, and fair to poor health were associated with early death among alcohol abstainers. Those without an obvious history of these risk factors had a life expectancy similar to that of low to moderate alcohol consumers. The findings speak against recommendations to drink alcohol for health reasons.

Self-Rated Diet Quality and Cardiometabolic Health Among U.S. Adults, 2011-2018

INTRODUCTION

Self-rated health has been extensively studied, but the utility of a similarly structured question to rate diet quality is not well characterized. This study aims to assess the relative validity of self-rated diet quality, compared with that of a validated diet quality measure (Healthy Eating Index-2015) and to examine the associations with cardiometabolic risk factors.

METHODS

Analyses were conducted in 2020-2021 using cross-sectional data from the National Health and Nutrition Examination Survey, 2011-2018. Nonpregnant adults who responded to the question: How healthy is your overall diet? and provided 2 dietary recalls were eligible (n=16,913). Associations between self-rated diet quality (modeled as a 5-point continuous variable, poor=1 to excellent=5) and Healthy Eating Index-2015 scores and cardiometabolic risk factors were assessed by linear regression, accounting for the complex survey design and adjusting for demographic and lifestyle characteristics.

RESULTS

Self-rated diet quality was positively associated with total Healthy Eating Index-2015 scores (p < 0.001) and with all components except with Dairy (p=0.94) and Sodium (p=0.66). Higher self-rated diet quality was associated with lower BMI, waist circumference, glucose, insulin, triglycerides, and HbA1c and with higher high-density lipoprotein cholesterol (all p<0.01). Positive associations with total diet quality persisted across all racial/ethnic groups, although the associations with individual dietary components varied. Higher self-ratings were most consistently associated with better-scored diet quality among individuals with BMI <30 kg/m².

CONCLUSIONS

Self-rated diet quality was associated with Healthy Eating Index-2015 scores and cardiometabolic disease risk factors. This single-item assessment may be useful in time-limited settings to quickly and easily identify patients in need of dietary counseling to improve cardiometabolic health.

Preparedness for Serious Illnesses: Impact of Ethnicity, Mistrust, Perceived Discrimination, and Health Communication

BACKGROUND

Increasing severity of serious illness requires individuals to prepare and make decisions to mitigate adverse consequences of their illness. In a racial and ethnically diverse sample, the current study examined preparedness for serious illness among adults in California.

METHODS

This cross-sectional study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. Participants included 542 non-Hispanic White (52%), non-Hispanic Black (28%), and Hispanic (20%) adults who reported at least one chronic medical condition that they perceived to be a serious illness. Race/ethnicity, socio-demographic factors, health status, discrimination, mistrust, and communication with provider were measured. To perform data analysis, we used logistic regression models.

RESULTS

Our findings revealed that 19%, 24%, and 34% of non-Hispanic White, non-Hispanic Blacks, and Hispanic believed they were not prepared if their medical condition gets worse, respectively. Over 60% indicated that their healthcare providers never engaged them in discussions of their feelings of fear, stress, or sadness related to their illnesses. Results of bivariate analyses showed that race/ethnicity was associated with serious illness preparedness. However, multivariate analysis uncovered that serious illness preparedness was only lower in the presence of medical mistrust in healthcare providers, perceived discrimination, less communication with providers, and poorer quality of self-rated health.

CONCLUSION

This study draws attention to the need for healthcare systems and primary care providers to engage in effective discussions and education regarding serious illness preparedness with their patients, which can be beneficial for both individuals and family members and increase quality of care.

Self-rated health trajectories: A dynamic time warp analysis

Self-rated health (SRH), individuals’ overall perception of their health, is a key predictor of health events. To target disease prevention efforts, it is important to understand how SRH develops over time. The goal of this short communication is to find prototypic SRH trajectories by applying dynamic time warping, a time series comparison technique initially developed for speech recognition. Revealing prototypic SRH trajectories can help direct disease prevention efforts towards trajectories that are more likely to result in adverse health events. Based on data from a Dutch representative sample of 2,154 individuals, our dynamic time warp analysis suggests that Dutch individuals do not typically show a steady growth or decline in SRH. Instead, we identified four relatively stable SRH trajectories that differed in average SRH. One of these trajectories is a path of consistent low SRH.

Association of fish consumption with risk of all-cause and cardiovascular disease mortality: an 11-year follow-up of the Guangzhou Biobank Cohort Study

BACKGROUND

Whether fish consumption is associated with all-cause, cardiovascular (CVD), ischemic heart disease (IHD) and stroke mortality remains inconclusive. We examined the association of fish consumption with all-cause, cardiovascular (CVD), ischemic heart disease (IHD) and stroke mortality in older men and women in south China.

METHODS

A total of 18,215 participants including men and women without CVD at baseline (2003-2006) from Guangzhou Biobank Cohort Study (GBCS) were included and followed up till December 2017. Deaths were identified through record linkage with the Death Registry. Information on fish consumption was obtained using a food frequency questionnaire.

RESULTS

During an average follow-up of 11.4 (standard deviation = 2.1) years, 2,697 deaths occurred, including 917 total CVD, 397 IHD and 374 stroke deaths. After adjusting for potential confounders, compared with fish consumption of 0-3 servings/week (i.e., 0-21 g/day, one serving = 50 g), consumption of 4-6 servings/week (29-43 g/day) showed significantly lower risks of all-cause and CVD mortality (hazards ratio (HR) and 95% confidence interval (CI): 0.85 (0.76, 0.95) and 0.77 (0.64, 0.93), respectively), but the reduced risk of IHD mortality (HR (95% CI): 0.80 (0.60, 1.07)) was not significant. Consumption of 7-10 servings/week or higher showed no association with all-cause, CVD, IHD, and stroke mortality.

CONCLUSIONS

Moderate fish consumption of 4-6 servings/week (29-43 g/day) was associated with lower all-cause and CVD mortality risk. Our findings support the current general advice on regular fish consumption also in middle-aged and older adults.

The predictive ability of EQ-5D-3L compared to the LACE index and its association with 30-day post-hospitalization outcomes

PURPOSE

To examine whether the EQ-5D-3L at the time of discharge from hospital provides additional prognostic information above the LACE index for 30-day post-discharge hospital readmission and to explore the association of EQ-5D-3L with readmissions, emergency department (ED) visits, and death within the same period.

METHODS

Using data (n = 495; mean age 62.9 years (SD 18.6), 50.5% female) from a prospective cohort study of patients discharged from medical wards at two university hospitals, the prognostic ability of EQ-5D-3L was examined using C-statistic, Integrated Discrimination Improvement (IDI) Index, and Akaike's Information Criterion (AIC). The associations between EQ-5D-3L dimensions, total sum, index and VAS scores at the time of discharge and 30-day post-discharge ED visits, readmission, and readmission/death were examined using multivariate logistic regression.

RESULTS

At the time of discharge, 58.6% of participants reported problems in mobility, 28.3% in self-care, 62.1% in usual activities, 62.7% in pain/discomfort, and 42.4% in anxiety/depression. Mean (SD) total sum score was 7.9 (2.0), index score was 0.69 (0.21), and VAS score was 63.7 (18.4). In adjusted analyses, mobility, self-care, usual activities, and the total sum score were significantly associated with 30-day readmission and readmission/death. Differences in C-statistic for LACE readmission prediction models with and without EQ-5D-3L were small. AIC analysis suggests that readmission prediction models containing EQ-5D-3L dimensions or scores were more often preferred to those with the LACE index only. IDI analysis indicates that the discrimination slope of readmission prediction models is significantly improved with the addition of mobility, self-care, or the total sum score of the EQ-5D-3L.

CONCLUSION

The EQ-5D-3L, especially the mobility and self-care dimensions as well as the total sum score, improves 30-day readmission prediction of the LACE index and is associated with 30-day readmissions or readmissions/death.

Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults

PURPOSE

Although we know that racial and ethnic minorities are more likely to have mistrust in the health care system, very limited knowledge exists on correlates of such medical mistrust among this population. In this study, we explored correlates of medical mistrust in a representative sample of adults.

METHODS

We analyzed cross-sectional study data from the Survey of California Adults on Serious Illness and End-of-Life 2019. We ascertained race/ethnicity, health status, perceived discrimination, demographics, socioeconomic factors, and medical mistrust. For data analysis, we used multinomial logistic regression models.

RESULTS

Analyses were based on 704 non-Hispanic Black adults, 711 Hispanic adults, and 913 non-Hispanic White adults. Racial/ethnic background was significantly associated with the level of medical mistrust. Adjusting for all covariates, odds of reporting medical mistrust were 73% higher (adjusted odds ratio [aOR] = 1.73; 95% CI, 1.15-2.61, P <.01) and 49% higher (aOR = 1.49; 95% CI, 1.02-2.17, P <.05) for non-Hispanic Black and Hispanic adults when compared with non-Hispanic White adults, respectively. Perceived discrimination was also associated with higher odds of medical mistrust. Indicating perceived discrimination due to income and insurance was associated with 98% higher odds of medical mistrust (aOR = 1.98; 95% CI, 1.71-2.29, P <.001). Similarly, the experience of discrimination due to racial/ethnic background and language was associated with a 25% increase in the odds of medical mistrust (aOR = 1.25; 95% CI, 1.10-1.43; P <.001).

CONCLUSIONS

Perceived discrimination is correlated with medical mistrust. If this association is causal, that is, if perceived discrimination causes medical mistrust, then decreasing such discrimination may improve trust in medical clinicians and reduce disparities in health outcomes. Addressing discrimination in health care settings is appropriate for many reasons related to social justice. More longitudinal research is needed to understand how complex societal, economic, psychological, and historical factors contribute to medical mistrust. This type of research may in turn inform the design of multilevel community- and theory-based training models to increase the structural competency of health care clinicians so as to reduce medical mistrust.

Unmet Need for Medical Care: The Role of Mental Health Status

Mental health status is an important factor to consider when exploring correlates of unmet need for medical care and prescription drugs. This paper explores whether self-rated mental health status is associated with unmet need and delays in obtaining medical care and prescription drugs. Descriptive statistics and multivariable logistic regression with 27,305 non-institutionalized adults aged 18 and older from the 2012 Medical Expenditure Panel Survey explore factors associated with self-reported unmet need for medical care and prescriptions, as well as access delays. Patients with lower physical and mental health status had the highest odds of experiencing unmet need for medical care and prescriptions, as well as access delays. These findings highlight the importance of increasing access to a usual source of care among individuals with lower self-rated mental health status as a strategy for addressing unmet need.

Statin Use for Atherosclerotic Cardiovascular Disease Prevention Among Sexual Minority Adults

Background

Sexual minority, or lesbian, gay, and bisexual (LGB), individuals are at increased risk for cardiovascular disease attributable to elevated rates of health risk factors. However, although there is clear evidence that statin use can prevent cardiovscular disease in certain adult populations, no studies have examined how statins are being used among the LGB population. This study aimed to examine the prevalence and predictors of statin use among LGB and non‐LGB individuals using Facebook‐delivered online surveys.

Methods and Results

We conducted a cross‐sectional online survey about statin use in adults ≥40 years of age between September and December 2019 using Facebook advertising (n=1531). We calculated the prevalence of statin use by age, sexual orientation, and statin benefit populations. We used multivariable logistic regression to examine whether statin use differed by sexual orientation, adjusting for covariates. We observed a significantly lower rate of statin use in the LGB versus non‐LGB respondents (20.8% versus 43.8%; P<0.001) in the primary prevention population. However, the prevalence of statin use was not statistically different in the LGB versus non‐LGB respondents in the secondary prevention population. Adjusting for the covariates, the LGB participants were less likely to use statins than the non‐LGB respondents in the primary prevention population (odds ratio, 0.37; 95% CI, 0.19–0.70).

Conclusions

Our results are the first to emphasize the urgent need for tailored, evidence‐based cardiovascular disease prevention programs that aim to promote statin use, and thus healthy aging, in the LGB population.

The association between subjective health perception and lifestyle factors in Shiga prefecture, Japan: a cross-sectional study

Background

The Ministry of Health has reported that in Japan, the Shiga prefecture has the highest life expectancy. Subjective health perception is a predictive indicator of mortality. For this study, we examined the association between subjective health perception and multiple lifestyle factors.

Methods

Data were obtained from the 2015 Health and Nutrition Survey in Shiga prefecture. The analytic sample comprised 6057 adults aged 20 or older. Information on subjective health perception and lifestyle behaviors was obtained from a self-administered questionnaire. As for subjective health perception, participants were divided into 2 groups: (1) Excellent or Good and (2) Average, Poor, or Very Poor. A 1-day dietary survey was also administered. The health behaviors score (HBS) was calculated based on 5 factors: consuming a healthy diet, never smoking, low-risk alcohol drinking, regular exercise, and moderate sleep duration. HBS scores ranged from 0 to 5. Multiple logistic regression was used to calculate the sex-, age- BMI- and energy intake-adjusted odds ratios (ORs) of poor subjective health across HBS, with 0 points as the reference.

Results

Among all participants, 2397 (39.6%) individuals were classified into the good subjective health group. Participants with an HBS of 3 (OR 0.59, 95% CI 0.37–0.96), 4 (OR 0.40, 95% CI 0.24–0.65) or 5 (OR 0.33, 95% CI 0.19–0.59) had a lower OR of rating themselves as being average/poor health compared with those having zero. The association with a higher HBS was remarkable (p for trend: < 0.001). Additional analyses revealed that the combinations including regular exercise were particularly associated with a lower risk of subjective average/poor health.

Conclusions

This study showed that the higher the number of healthy lifestyle factors, the lower risk of subjective average/poor health. Combinations of healthy lifestyle factors, especially those involving exercise, suggest good subjective health for individuals living in the Shiga prefecture.

Relationship between patient activation measurement and self-rated health in patients with chronic diseases

Background

In the aging population, chronic diseases and multimorbidity are common. Therefore, it is important to engage patients in their self-care. The aim of this study was to analyze the relationship between activity in self-care and self-rated health among primary care patients with chronic diseases.

Methods

The data of the present study were derived from a research project on the Participatory Patient Care Planning in Primary Care (4PHC). A total of 605 patients were recruited in the Siilinjärvi Health Center from those patients who were being monitored due to the treatment of hypertension, ischemic heart disease or diabetes.

We evaluated the level of patient’s activity in self-care with the Patient Activation Measurement (PAM). Self-rated health (SRH) was measured with the 5-item Likert scale. An adjusted hypothesis of linearity across categories of PAM and self-rated health was estimated using analysis of covariance (ANCOVA).

Results

It was found that 76 patients had low activity, 185 had moderate while 336 patients had high activity as measured with PAM. Patients with the highest activity were younger, less depressed, had a lower body mass index and a higher level of physical activity than those with the lower activity. Correspondingly, good SRH was perceived by 29, 45 and 67% of the patients in these three PAM groups adjusted with sex, age, depressive symptoms (BDI) and number of diseases. There was a significant linear trend (adjusted with age, number of diseases and depressive symptoms) between SRH and PAM, p < 0.001.

Conclusions

Activity in self-care had an independent, linear relationship with the self-rated health. The present findings suggest that Patient Activation Measurement has the potential to categorize the patients according to their perceived health and their needs related to their disease management and self-care. The present results warrant longitudinal studies on the impact of promoting patient activation levels.

Trial registration

ClinicalTrials.gov Identifier: NCT02992431. Registered 14 December 2016 https://clinicaltrials.gov/ct2/show/NCT02992431

The Impact of Performing Medical/Nursing Tasks at Home Among Caregivers of Individuals With Cognitive Impairment

Caregiving for older adults with cognitive impairment can be more difficult as caregivers are required to perform medical/nursing tasks at home. Little is known about medical/nursing tasks and their relationship to caregivers’ characteristics and their effects on caregiver burden. Secondary data analyses were conducted with 423 caregivers of individuals with cognitive impairment from the 2015 National Alliance for Caregiving (NAC) and American Association of Retired Persons (AARP) data. In terms of the caregiving context, caregivers who performed medical/nursing tasks lived with the care recipients and provided longer hours of care than caregivers who did not perform medical/nursing tasks. When caregivers delivered medical/nursing tasks, they were 2 times more likely to experience higher levels of caregiver burden. Medical/nursing tasks can exacerbate caregiver burden. Health care providers’ explanations of the needs and the benefits of performing medical/nursing tasks, as well as education and training for the tasks, are needed to reduce caregiver burden.

End-of-Life Wishes Among Non-Hispanic Black and White Middle-Aged and Older Adults

PURPOSE

Although some research has been done on end-of-life (EOL) preferences and wishes, our knowledge of racial differences in the EOL wishes of non-Hispanic White and non-Hispanic Black middle-aged and older adults is limited. Previous studies exploring such racial differences have focused mainly on EOL decision-making as reflected in advance healthcare directives concerning life-sustaining medical treatment. In need of examination are aspects of EOL care that are not decision-based and therefore not normally covered by written advance healthcare directives. This study focuses on racial differences in non-decision-based aspects of EOL care, that is, EOL care that incorporates patients' beliefs, culture, or religion.

AIM

To test the combined effects of race, socioeconomic status, health status, spirituality, perceived discrimination and medical mistrust on the EOL non-decision-based desires and wishes of a representative sample of non-Hispanic White and non-Hispanic Black older California adults.

METHODS

This cross-sectional study used data from the Survey of California Adults on Serious Illness and End-of-Life 2019. To perform data analysis, we used multiple logistic regression models.

RESULTS

Non-Hispanic Blacks reported more EOL non-decision-based desires and wishes than non-Hispanic Whites. In addition to gender, age, and education other determinants of EOL non-decision-based medical desires and wishes included perceived and objective health status, spirituality, and medical trust. Poverty level, perceived discrimination did not correlate with EOL medical wishes.

CONCLUSION

Non-Hispanic Blacks desired a closer relationship with their providers as well as a higher level of respect for their cultural beliefs and values from their providers compared with their White counterparts. Awareness, understanding, and respecting the cultural beliefs and values of older non-Hispanic Black patients, that usually are seen by non-Hispanic Black providers, is the first step for meaningful relationship between non-Hispanic Black patients and their providers that directly improve the end-of-life quality of life for this segment of our population.

Cautionary tails of grip strength in health inequality studies: An analysis from the Canadian longitudinal study on aging

Self-rated health is widely used in studies of the socioeconomic gradient of health in community-based populations. Its subjectivity may lead to under- or over-estimation of a true underlying socioeconomic gradient and has increased interest in searching for alternative, objective measures of health. Grip strength has emerged as one such alternative for community-based older populations, yet no study has directly assessed the relationship between these two measures and compared their associations with socioeconomic status and health behaviours. Using 26,754 participants aged 45-85 years in the baseline data of the Canadian Longitudinal Study on Aging Comprehensive Cohort, we estimated adjusted-grip strength through indirect standardization using age, sex, height, weight, and their square terms and used ANOVA to assess the variance of adjusted-grip strength within and between each self-rated health category. We ran four separate logistic regression models, examining unhealthy tails (those reporting poor health vs. not and those at the bottom 8th percentile of adjusted-grip strength vs. above) and healthy tails (those reporting excellent health vs. not and those at the top 20th percentile of adjusted-grip strength vs. below). Stronger adjusted-grip strength correlated with better self-rated health, but only 2% of the total variance of adjusted-grip strength was explained by variance between the self-rated health categories. While self-rated health largely showed the expected socioeconomic gradients and positive relationships with health enhancing behaviours, adjusted-grip strength showed no clear, consistent associations with either socioeconomic or health behaviour variables. The results give caution about using grip strength as an objective alternative to self-rated health in studies of social inequalities in health. Empirical approaches demand careful considerations as to which dimensions of health and corresponding measures of health are most relevant to the context being studied.

A comparison of the four healthy days measures (HRQOL-4) with a single measure of self-rated general health in a population-based health survey in New York City

Background

Data on health-related quality of life (HRQOL) can be used to track health disparities, assess the impact of chronic diseases, and predict mortality. The Centers for Disease Control and Prevention’s “Healthy Days Measures” (HRQOL-4) assesses four key domains: self-rated general health, physical health, mental health, and activity limitations. The domains are not easily combined to summarize overall HRQOL, and some evidence suggests that self-rated general health may be an adequate proxy indicator for overall HRQOL. This study compares self-rated general health as a solitary measure of HRQOL with two summary indices of the HRQOL-4 as a predictor of adverse health conditions in a representative sample of adult New York City residents.

Methods

The 2017 NYC Social Determinants of Health survey implemented by the New York City Department of Health and Mental Hygiene collected data from a representative sample of New Yorkers (n = 2335) via phone, mail, and web. We compared the information criteria and predictive power of self-rated general health with two alternative summary indices of the HRQOL-4 in predicting self-reported health conditions (hypertension, diabetes, obesity, non-specific psychological distress, and a summary indicator for at least one those four morbidities).

Results

Overall, 19.1% (95% CI: 16.9, 21.5) of respondents reported that they had fair or poor general health. Self-rated general health was significantly associated with days of poor physical health, poor mental health, and activity limitations (p < 0.001 for each). While the Akaike and Bayesian information criteria suggested that the summary indices of the HRQOL-4 produced marginally better models for predicting adverse health conditions, self-rated general health had slightly higher predictive power than did the summary indices in all models of physical health outcomes as measured by Tjur’s pseudo-R² and the area under the curve.

Conclusion

We found very small differences between self-rated general health and the summary indices of the HRQOL-4 in predicting health conditions, suggesting self-rated general health is an appropriate proxy measure of overall HRQOL. Because it can be measured with a single question rather than four, it might be the most simple, efficient, and cost-effective method of summarizing HRQOL in large population-based surveys.

Text message-based lifestyle intervention in primary care patients with hypertension: a randomized controlled pilot trial

OBJECTIVE

To evaluate the feasibility of a randomized controlled pilot study with lifestyle-promoting text messages as a treatment for hypertension in primary care.

DESIGN

Randomized controlled pilot trial.

SETTING

Three primary health care centers in southern Sweden.

SUBJECTS

Sixty patients aged 40-80 years with hypertension were included.

MAIN OUTCOME MEASURES

Feasibility of the pilot study, i.e. recruitment rate, dropout rate and eligibility criteria. Secondary outcomes were change in blood pressure and other cardiovascular risk factors.

METHODS

Thirty participants were randomized to the intervention group with four lifestyle-promoting text messages sent every week for six months. The control group received usual care. The baseline and follow-up visits for all 60 patients included measurements of blood pressure, anthropometrics, blood tests and a self-reported questionnaire.

RESULTS

All feasibility criteria (recruitment rate (≥55%), dropout rate (≤15%) and eligibility (60 eligible patients during the four-month inclusion period) for the pilot study were fulfilled. This means that a larger study with a similar design may be conducted. After six months, there were no significant improvements in cardiovascular risk factors. However, we found favorable trends for all secondary outcomes in the intervention group as compared to the control group.

CONCLUSION

Lifestyle modification in patients with hypertension is important to reduce cardiovascular risk. However, primary healthcare has limited resources to work with modifying lifestyle habits. This is the first pilot study to test the feasibility of text message-based lifestyle intervention in patients with hypertension in Swedish primary healthcare. Whether significant improvement in cardiovascular risk factors may be achieved in a larger study population remains to be evaluated. Key points This pilot randomized controlled trial (RCT) is the first study to evaluate the feasibility of text message-based lifestyle advice to patients with hypertension in Swedish primary healthcare. •All feasibility criteria for the pilot study were fulfilled. This outcome means that a larger study with a similar design may be conducted. •The study was not powered to find significant changes in cardiovascular risk factors. Nevertheless, after six months we found favorable trends for all secondary outcomes in the intervention group compared to control. •If a future larger study can show significant results, this intervention could serve as a useful tool in everyday primary healthcare.