Pulmonary function and trajectories of cognitive decline in aging population

BACKGROUND

The number of older people with cognitive impairment is increasing worldwide. Impaired lung function might be associated with cognitive decline in older age; however, results from large longitudinal studies are lacking. In this study, we examined the longitudinal associations between pulmonary function and the trajectories of cognitive decline using prospective population-based SHARE data from 14 countries.

METHODS

The analytic sample included N = 32,049 older adults (Mean age at baseline = 64.76 years). The dependent variable was cognitive performance, measured repeatedly across six waves in three domains: verbal fluency, memory, and numeracy. The main predictor of interest was peak expiratory flow (PEF). The data were analyzed in a multilevel accelerated longitudinal design, with models adjusted for a variety of covariates.

RESULTS

A lower PEF score was associated with lower cognitive performance for each domain as well as a lower global cognitive score. These associations remained statistically significant after adjusting for all covariates Q4 vs Q1 verbal fluency: unstandardized coefficient B = -3.15; numeracy: B = -0.52; memory: B = -0.64; global cognitive score B = -2.65, all p < .001). However, the PEF score was not found to be associated with the rate of decline for either of the cognitive outcomes.

CONCLUSIONS

In this large multi-national longitudinal study, the PEF score was independently associated with lower levels of cognitive functions, but it did not predict a future decline. The results suggest that pre-existing differences in lung functions are responsible for variability in cognitive functions and that these differences remained stable across aging.

Early-Life Temperamental Differences as Longitudinal Predictors of Unintentional Injuries

OBJECTIVE

Unintentional injuries are the leading cause of hospitalization and death among children. Compared to environmental factors, less attention in injury preventive efforts has been paid to how individual characteristics relate to the risk of injury. Using a large prospective cohort, the current study assessed the longitudinal impact of early-life temperament on the cumulative number of injuries until mid-adolescence.

METHODS

The data came from the European Longitudinal Study of Pregnancy and Childhood (ELSPAC-CZ). Temperament was evaluated by mothers when children were 3 years old (N = 3,545). The main outcome was the pediatrician-reported sum of child's injuries from age 3 to 15 (seven timepoints). Latent profile analysis (LPA) was used to determine classes based on temperamental dimensions and then extended to a mixture model with a distal count outcome. The covariates included maternal conflict and attachment, sex, family structure, and maternal education.

RESULTS

The LPA determined the existence of three classes: shy children (8.1% of the sample; lowest activity/highest shyness), outgoing children (50.8%; highest activity/lowest shyness), and average: children (41.1%; middle values). Results from a mixture model showed that the outgoing temperament was associated with the highest longitudinal risk for injuries, as both average children (IRR = 0.89 [0.80, 0.99]), and the shy children (IRR = 0.80 [0.68, 0.95]) had lower risk.

CONCLUSIONS

Early childhood temperamental differences can have long-term effects on injury risk. Highly active children showed the highest risk for future injuries, suggesting that these characteristics make them more likely to be involved in novel and potentially dangerous situations.

Current-use pesticide exposure pathways in Czech adults and children from the CELSPAC-SPECIMEn cohort

INTRODUCTION

In this study, we aimed to characterise exposure to pyrethroids, organophosphates, and tebuconazole through multiple pathways in 110 parent-child pairs participating in the CELSPAC-SPECIMEn study.

METHODS

First, we estimated the daily intake (EDI) of pesticides based on measured urinary metabolites. Second, we compared EDI with estimated pesticide intake from food. We used multiple linear regression to identify the main predictors of urinary pesticide concentrations. We also assessed the relationship between urinary pesticide concentrations and organic and non-organic food consumption while controlling for a range of factors. Finally, we employed a model to estimate inhalation and dermal exposure due to spray drift and volatilization after assuming pesticide application in crop fields.

RESULTS

EDI was often higher in children in comparison to adults, especially in the winter season. A comparison of food intake estimates and EDI suggested diet as a critical pathway of tebuconazole exposure, less so in the case of organophosphates. Regression models showed that consumption per g of peaches/apricots was associated with an increase of 0.37% CI [0.23% to 0.51%] in urinary tebuconazole metabolite concentrations. Consumption of white bread was associated with an increase of 0.21% CI [0.08% to 0.35%], and consumption of organic strawberries was inversely associated (-61.52% CI [-79.34% to -28.32%]), with urinary pyrethroid metabolite concentrations. Inhalation and dermal exposure seemed to represent a relatively small contribution to pesticide exposure as compared to dietary intake.

CONCLUSION

In our study population, findings indicate diet plays a significant role in exposure to the analysed pesticides. We found an influence of potential exposure due to spray drift and volatilization among the subpopulation residing near presumably sprayed crop fields to be minimal in comparison. However, the lack of data indicating actual spraying occurred during the critical 24-hour period prior to urine sample collection could be a significant contributing factor.

Determinants of depressive symptoms increase in older persons during the COVID-19 pandemic: evidence from Czech cohort study using repeated assessments

BACKGROUND

Numerous studies reported higher levels of mental health issues during the COVID-19 pandemic but only a minority used repeated measurements. We investigated change in depressive symptoms in the Czech ageing cohort and the impact of pre-existing and COVID-19-related stressors.

METHODS

We used data on 2853 participants (mean age 73.4 years) from the Czech part of the prospective Health, Alcohol and Psychosocial factors In Eastern Europe cohort that participated in postal questionnaire surveys before (September 2017-June 2018) and during the pandemic (October 2020-April 2021). Participants reported their depressive symptoms using the Centre for Epidemiological Studies-Depression Scale including 10 (CESD-10) tool. A principal component analysis (PCA) was used to create representative components of the pandemic-related stressors. The impact of the stressors on change in depressive symptoms was tested using multivariable linear regression, after adjustment for age and potential confounders.

RESULTS

Three patterns of the pandemic-related stressors ('financial stressors', 'social and perception stressors' and 'death and hospitalisation stressors') were extracted from the PCA. The mean CESD-10 score increased from 4.90 to 5.37 (p<0.001). In fully adjusted models, significantly larger increases in depression score were reported by older people (β=0.052; p=0.006), those with poor self-rated health (β=0.170; p<0.001), those who experienced death or hospitalisation of a close person (β=0.064; p<0.001), social deprivation (β=0.057; p<0.001), delays in healthcare (β=0.048; p=0.005) and those who suffered from COVID-19 (β=0.045; p=0.008).

CONCLUSION

This study confirms an increase in depressive symptoms in older persons during the pandemic and identified several pandemic-related risk factors suggesting that public health policies should address this vulnerable group by adopting the preventing strategies.

Pandemic-related determinants of depression in Czech older persons: Evidence from the HAPIEE cohort

Background

A number of studies reported higher levels of mental health issues during the COVID-19 pandemic but only minority of studies focused to assess changes in mental health against measurements taken before the pandemics. We investigated a change in depressive symptoms using repeated measurements and the impact of the pre-existing and COVID-19-related stressors in an ageing cohort in the Czech Republic.

Methods

We used data on 2853 subjects (mean age 73 years) from the Czech part of the prospective HAPIEE cohort that participated on postal questionnaire surveys before (2017) and during the pandemic (autumn 2020 to early 2021). Participants reported their depressive symptoms using validated CESD-10 report tool. The impact of pre-existing stressors (age, sex, education, living alone, self-rated health, employment status, depression before pandemic), as well as pandemic-related stressors on change in depressive symptoms were tested using multivariable linear regression, after adjustment for age and potential confounders.

Results

Compared with pre-pandemic period, there was a significant increase in depression score during the COVID-19 pandemic. The mean CESD-10 score increased from 4.92 to 5.37 (p < 0.001). Significantly larger increases in depressive score reported older persons (β = 0.073; p < 0.001) and those with poor self-rated health (β = 0.170; p < 0.001) in the fully adjusted model. Moreover, those who experienced social deprivation (β = 0.057; p < 0.001), death or hospitalization of a close person (β = 0.064; p < 0.001), delays in healthcare (β = 0.048; p = 0.005) and those who suffered from COVID-19 (β = 0.045; p = 0.008) also reported worsened depressive symptoms.

Conclusions

This longitudinal study confirms important increase in depressive symptoms during the COVID-19 pandemic and contributes to identify pandemic-related risk factors. Interventions and future public health policies should address vulnerable individuals and population groups.

Key messages

• Mental health worsened during the COVID-19 pandemic compared to previous years.

• Social deprivation, delays in healthcare and experiencing COVID-19 infection affected mental health of older people.

Educational gradients in all-cause mortality in two cohorts in the Czech Republic during the early stage of the postcommunist transition

Objectives

We investigated whether social gradient in all-cause mortality in the Czech Republic changed during the postcommunist transition by comparing two cohorts, recruited before and after the political changes in 1989.

Methods

Participants (aged 25–64 years) in two population surveys (n=2530 in 1985, n=2294 in 1992) were followed up for mortality for 15 years (291 and 281 deaths, respectively). Education was classified into attainment categories and years of schooling (both continuous and in tertiles). Cox regression was used to estimate HR of death by educational indices in each cohort over a 15-year follow-up.

Results

All three educational variables were significantly associated with reduced risk of death in both cohorts when men and women were combined; for example, the adjusted HRs of death in the highest versus lowest tertile of years of schooling were 0.65 (95% CI 0.47 to 0.89) in 1985 and 0.67 (95% CI 0.48 to 0.93) in 1992. Adjustment for covariates attenuated the gradients. In sex-specific analysis, the gradient was more pronounced and statistically significant in men. There were no significant interactions between cohort and educational indices.

Conclusions

The educational gradient in mortality did not differ between the two cohorts (1985 vs 1992), suggesting no major increase in educational inequality during the early stage of postcommunist transition. Further research is needed to understand trends in health inequalities during socioeconomic transitions.

Self-Reported Mental Health and Lifestyle Behaviour During the COVID-19 Pandemic in the Czech Population: Evidence From Two Cross-Sectional Surveys

Objectives: Evidence of the impact of COVID-19 pandemic on mental and physical health behaviours is limited. This study presents results of two cross-sectional surveys on mental health changes and its consequences on healthy and unhealthy lifestyle behaviours.

Methods: An online survey was distributed during Spring 2020 (N = 9,168) and Autumn 2020 (N = 1,042) in the Czech Republic. Differences in mental health observed in both surveys were evaluated using Mann-Whitney test and logistic regressions were used to examine demographic and socio-economic determinants of COVID-19-related mental health issues and resulting healthy and unhealthy lifestyle behaviours.

Results: In multivariable models, the youngest individuals, females, people with increased work demands and participants with a reduced personal income due to the COVID-19 pandemic were all negatively associated with self-reported mental health issues (p < 0.05). A worsened quality of sleep, dietary habits, physical activity and unhealthy behaviours were highly associated with affected mental health in the models adjusted for potential covariates (p < 0.05).

Conclusion: Taken together, these findings suggest that health promotion strategies directed to individuals who are at risk should be encouraged to adopt and/or maintain positive health-related behaviours.

Lifetime Carcinogenic Risk Proportions from Inhalation Exposures in Industrial and Non-Industrial Regions

The aim of this work was to estimate the share of selected significant risk factors for respiratory cancer in the overall incidence of this disease and their comparison in two environmentally different burdened regions. A combination of a longitudinal cross-sectional population study with a US EPA health risk assessment methodology was used. The result of this procedure is the expression of lifelong carcinogenic risks and their contribution in the overall incidence of the disease. Compared to exposures to benzo[a]pyrene in the air and fibrogenic dust in the working air, several orders of magnitude higher share of the total incidence of respiratory cancer was found in radon exposures, for women 60% in the industrial area, respectively 100% in the non-industrial area, for men 24%, respectively 15%. The share of risks in workers exposed to fibrogenic dust was found to be 0.35% in the industrial area. For benzo[a]pyrene, the share of risks was below 1% and the share of other risk factors was in the monitored areas was up to 85%. The most significant share in the development of respiratory cancer in both monitored areas is represented by radon for women and other risk factors for men.

Risk of chronic diseases limiting longevity and healthy aging by lifestyle and socio-economic factors during the life-course - a narrative review

The review provides a comprehensive summary of existing literature focusing on the most serious risk factors of non-communicable diseases and collects current knowledge on their distribution, determinants, clusters, psychological and socio-economic consequences. Especially, the life-course approach is stressed, early life consequences of the later onset of chronic diseases, the risk behavior and its social, socio-economic and psychosocial determination is reviewed. Potential of preventing these harmful consequences has a lifelong approach. The aim is to demonstrate the opportunity for future health system transformation in terms of public health prevention regarding the non-communicable diseases. It is concluded that personalized lifestyle medicine should address a patient's health by empowering them with the information they need to regain control of their health. Preventive methods should be tailored for each patient, considering such patient's specific genes, environment, lifestyle, early life factors and social patterns of risk factors to avoid burden of health in later age. Intervention and preventive measures should target not only to individual factors but should reflect wider social, psychosocial and socio-economic consequences. It is also crucial from the point of view of public health to consider data on exposome, which are not included in epidemiological studies as well as its impact on health in the context of non-communicable diseases. Med Pr. 2021;72(5):535-48.

Changes of perceived risk and mental well-being during two waves of COVID-19 pandemic in Czechia

Background

The COVID-19 pandemic has been negatively affecting many people's daily life. The strict preventive measures might have contributed to psychological distress, fear and fatigue. Therefore, it is crucial to build trust and ensure effective communication from the government to maintain public awareness. This study focuses on the comparative analysis of public health risk perception of COVID-19 during the pandemic.

Methods

The questionnaire surveys were conducted online during the first (April 2020) and second (November-December 2020) waves of the pandemics. The health risk concerns, perceived mental well-being and compliance with the adopted measures of the population were evaluate for potential development in time. The impact of age, gender and socio-demographic factors were tested. The average values of the 5-point Likert scale were tested for differences by Mann-Whitney and Kruskal-Wallis tests on the significance level 5% and analyzed using the SW STATA v.15.

Results

From a sample of 9,168 (1st survey) and 1,042 (2nd survey) Czech respondents aged 40 years, respectively 45 years in average, the present results showed that individual health concerns increased with age, while descending trend toward younger age was observed in terms of mental health. The perceived risk of COVID-19 substantially elevated over the observed period (p &lt; 0.001) as well as compliance with the measures (p &lt; 0.001). Further, 27% of the respondents self-evaluated their mental health as bad or very bad that was analysed as a significantly worsening (p &lt; 0.001). Moreover, 66% of respondents evaluated communication of the government as unsatisfactory that was in relation with a low compliance with measures.

Conclusions

This study contributes to understanding the development of the risk perception as a public response to COVID-19 pandemic. A divergence among the generation was observed. More focused communication of government might be required to enhance public trust.

Key messages

Compliance with the measures substantially elevated over the pandemics that is in relation with low government trust. Mental well-being has been significantly worsened over the COVID-19 pandemics.

Perception of health risk and compliance with preventive measures related to COVID-19 in the Czech population: preliminary results of a rapid questionnaire survey

OBJECTIVES

In the Czech Republic, an outbreak of the coronavirus disease (COVID‑19) has been decelerated by quickly adopting strict and strongly limiting government measures. In this study, the authors present the preliminary results (April 1-5, 2020) of a public risk perception study of COVID‑19.

MATERIAL AND METHODS

The online questionnaire survey was announced in the national TV and radio stations with the nationwide coverage. Respondents were recruited through the website of the University of Ostrava during the first 5 days of the survey (N = 7966). The data covered risk perception with a focus on physical and psychological aspects, the current socio-economic situation and adaptation to the lockdown. The authors used Mann-Whitney and Kruskal-Wallis tests, as well as ordered logistic regression, with a significance level of 5% using STATA version 15.

RESULTS

From the total sample of the respondents aged 40 years on average (a range of 15-87 years), the present study shows that women (p < 0.001) and elderly people (p < 0.001) perceived the health risk related to COVID‑19 as significantly worse than others. Older people (>60 years) perceived their mental health as significantly better than younger participants (p < 0.001). Most of the respondents assessed the adopted measures as adequate (71%) and believed in their effectiveness (69.7%).

CONCLUSIONS

This study contributes to understanding the risk perception as a public response to the COVID‑19 pandemic. Int J Occup Med Environ Health. 2021;34(2):165-76.

The mediating role of lung function on air pollution-induced cardiopulmonary mortality in elderly women: The SALIA cohort study with 22-year mortality follow-up

BACKGROUND

Air pollution exposure is associated with reduced lung function and increased cardio-pulmonary mortality (CPM).

OBJECTIVES

We analyzed the potential mediating effect of reduced lung function on the association between air pollution exposure and CPM.

METHODS

We used data from the German SALIA cohort including 2527 elderly women (aged 51-56 years at baseline 1985-1994) with 22-year follow-up to CPM. Exposures to PM₁₀, PM_2.5, PM_2.5 absorbance, NO₂ and NO_x were assessed by land-use regression modelling and back-extrapolated to estimate exposures at baseline. Lung function (FVC, FEV₁) was measured by spirometry and transformed to GLI z-scores. Adjusted Cox proportional hazards and causal proportional hazards mediation analysis models were fitted.

RESULTS

The survival analysis showed that reduced lung function (z-scores of FVC or FEV₁ below 5% predicted) reflected significantly lower survival probability from CPM (p < 0.0001). Longterm exposures to NO_x and NO₂ were associated with increased risks of CPM (eg. HR = 1.215; 95%CI: 1.017-1.452 for IQR increase in NO_x and HR = 1.209; 95%CI: 1.011-1.445 for IQR increase in NO₂) after adjusting for reduced lung function and additional covariates. The associations of PM_2.5 absorbance and CPM remained significant in models adjusted for FEV₁/FVC, but the associations with PM₁₀ and PM_2.5 were not significant. The mediation analysis showed significant indirect effects of NO₂ and NO_x on CPM mediated through reduced FEV₁ and FVC. The largest indirect effects were found for exposures to NO₂ (HR = 1.037; 95%CI: 1.005-1.070) and NO_x (HR = 1.028; 95%CI: 1.004-1.052) mediated through reduced FVC. The mediated proportion effect ranged from 13.9% to 19.6% in fully adjusted models.

DISCUSSION

This study provides insights into the mechanism of reduced lung function in association between long-term air pollution exposure and CPM. The mediated effect was substantial for exposure to nitrogen oxides (NO_x and NO₂), but less pronounced for PM₁₀ and PM_2.5.

How serious are health impacts in one of the most polluted regions of Central Europe?

BACKGROUND

The long-term exposure to pollutants in ambient air is associated with higher mortality and occurrence of respiratory and cardiopulmonary diseases. The longitudinal cross-section study focuses on the associations between long-term exposures to carcinogenic and non-carcinogenic pollutants and the prevalence and incidence of such specific diseases including immunodeficiencies.

METHODS

The data on health status from industrial and non-industrial regions were obtained from health documentation for a 5-year period from 2007 to 2011 and represent the whole population living in polluted (1,249,323 inhabitants) and unpolluted (631,387 inhabitants) regions. The data on concentrations of PM10, PM2,5, NO2, SO2, benzene and benzo[a]pyrene were collected. The concentrations of pollutants were estimated from measured data by using dispersion models. The average population-weighted concentration of pollutants, which is representative for a defined geographic area and time period from 2007 to 2011, was calculated from the obtained data. The logistic regression and the Mantel-Haenszel χ2 test were used to determine the odds ratios (OR) and p-values for a linear trend. Moreover, the relative risks of mortality and morbidity to specific diseases were calculated according to theoretical dose-response association published by World Health Organization (WHO).

RESULTS

The probability of incidence of chronic obstructive pulmonary disease and bronchial asthma is statistically significantly higher in the population living in the polluted region compared to the population living in the unpolluted region. The association between long-term exposure to pollutants and the prevalence of immunodeficiency with predominantly antibody defects (D80) was confirmed. The strongest association was found for exposures to particulate matter (PM2,5). The prevalence of immunodeficiency with predominantly antibody defects was also observed in both regions depending on the age of the population and statistically significant difference was only found in the group of adults (20 and over).

CONCLUSION

These associations encourage the hypothesis, that the long-term exposure to PM2.5 might cause the activation of cellular immune response. Further research is needed to explore the correlative immunoregulatory mechanism linking PM2.5 (or other pollutants - SO2) and immune cells. Nowadays, it is also believed that these associations are important in the increase of incidence of immune inflammatory response which is proven risk factor for cardiovascular disease (atherosclerotic disease, coronary heart disease and sudden cardiac death). Positive association between long-term exposure and prevalence of bronchial asthma and chronic obstructive pulmonary disease might be skewed due to important socio-economic factors (especially smoking).