Adjustment For Health Behaviors Research Articles

Posttraumatic Stress Disorder, Depression, and Accelerated Aging: Leukocyte Telomere Length in the Nurses’ Health Study II

BackgroundExposure to trauma, posttraumatic stress disorder (PTSD), and depression have been independently associated with leukocyte telomere length (LTL), a cellular marker of aging associated with mortality and age-related diseases. However, the joint contributions of trauma and its psychological sequelae on LTL have not been examined. MethodsWe conducted an analysis of LTL in a subset of women from the Nurses’ Health Study II (N = 1868). Lifetime exposure to traumatic events, PTSD, and depression was assessed with validated measures. DNA was extracted from peripheral blood leukocytes and telomere repeat copy number to single gene copy number was determined by quantitative real-time polymerase chain reaction telomere assay. Linear regression models assessed the association of trauma, PTSD, and depression with LTL after adjustment for health behaviors and medical conditions. ResultsTrauma, PTSD, and depression were not independently associated with LTL in mutually adjusted models. However, individuals with severe psychological distress—characterized by comorbid PTSD and depression—had shorter LTL equivalent to being 7.62 years older (95% CI, 0.02 to 17.97) than participants who had never experienced a traumatic event and were not depressed. Further examination found only an association among individuals with the highest number of PTSD symptoms and comorbid depression equivalent to 9.71 additional years of aging (95% CI, 1.36 to 20.49). No effect was found among individuals meeting the minimum threshold for probable PTSD with comorbid depression. ConclusionsSevere psychological distress, as indicated by the presence of comorbid PTSD and depression, may be associated with shorter LTL.

Work stress and loss of years lived without chronic disease: an 18-year follow-up of 1.5 million employees in Denmark

We aimed to examine the association between exposure to work stress and chronic disease incidence and loss of chronic disease-free life years in the Danish workforce. The study population included 1,592,491 employees, aged 30–59 in 2000 and without prevalent chronic diseases. We assessed work stress as the combination of job strain and effort-reward imbalance using job exposure matrices. We used Cox regressions to estimate risk of incident hospital-diagnoses or death of chronic diseases (i.e., type 2 diabetes, coronary heart disease, stroke, cancer, asthma, chronic obstructive pulmonary disease, heart failure, and dementia) during 18 years of follow-up and calculated corresponding chronic disease-free life expectancy from age 30 to age 75. Individuals working in occupations with high prevalence of work stress had a higher risk of incident chronic disease compared to those in occupations with low prevalence of work stress (women: HR 1.04 (95% CI 1.02–1.05), men: HR 1.12 (95% CI 1.11–1.14)). The corresponding loss in chronic disease-free life expectancy was 0.25 (95% CI − 0.10 to 0.60) and 0.84 (95% CI 0.56–1.11) years in women and men, respectively. Additional adjustment for health behaviours attenuated these associations among men. We conclude that men working in high-stress occupations have a small loss of years lived without chronic disease compared to men working in low-stress occupations. This finding appeared to be partially attributable to harmful health behaviours. In women, high work stress indicated a very small and statistically non-significant loss of years lived without chronic disease.

Abstract WP212: Racial Disparities In Perioperative Stroke And Mortality Following Stroke In Adult Cardiac Transplant Recipients

Introduction: In the general US population, Black adults have a higher stroke incidence and mortality rate after stroke compared to white adults. Among heart transplant recipients, Black adults also have a higher mortality rate beginning 6-12 months post-transplant. Whether there are racial disparities in perioperative stroke incidence and all-cause mortality following perioperative stroke among cardiac transplant recipients is unknown. Methods: Using the Scientific Registry of Transplant Recipients, we examined all adults in the United States who received their first heart transplant between January 2008 - December 2018. We used multivariable conditional logistic regression to assess the association between race and perioperative stroke. We used multivariable Cox proportional hazard regression to examine the association between race and mortality among adults who survived a perioperative stroke. In both models, we included age, sex, hospitalization status, prior ventricular assist device (VAD) implantation, extracorporeal membrane oxygenation (ECMO), calendar year, etiology of heart disease, bilirubin, and functional status as covariates. Results: Among 20,912 adults, 428 (2.7%) white recipients and 126 (2.4%) Black recipients had a perioperative stroke. In a multivariable model, there was 11% lower odds of perioperative stroke in Black recipients compared to white recipients (OR = 0.89, 95% CI: 0.71, 1.12). Among perioperative stroke survivors, mortality rates were similar between Black and white recipients within 6 months (HR = 1.02, 95% CI: 0.70, 1.49) and in long-term follow up (HR = 0.95, 95% CI: 0.52, 1.73). However, our regression results were imprecise. Further adjustment for health behaviors and socioeconomic position did not alter the results. Conclusion: Black recipients experienced a lower incidence of perioperative stroke; however, mortality rates were similar between Black and white recipients following perioperative stroke. These unexpected findings warrant further research.

Abstract 16105: Depression Modulates Polygenic Risk of Cardiovascular and Cardiometabolic Disease

Introduction: Depression is associated with an increased risk of coronary artery disease (CAD). Whether depression modifies genetic risk of cardiovascular and cardiometabolic disease is unknown. Methods: We included genotyped, unrelated European ancestry individuals in the UK Biobank. Using genome-wide significant single nucleotide polymorphisms (SNPs) from studies external to the UK Biobank, we generated polygenic risk scores (PRS) for coronary artery disease (CAD, 74 SNPs), hypertension (75 SNPs), type 2 diabetes (T2D, 64 SNPs), atrial fibrillation (25 SNPs), and ischemic stroke (11 SNPs). Participants were stratified by PRS for each condition as low (quintile 1), intermediate (quintiles 2-4), and high (quintile 5) genetic risk. Cox models tested the association of depression frequency with each incident condition among individuals with high PRS, with adjustment for age, sex, the first 20 principal components, genotyping array, and Townsend deprivation index. Additional models further adjusted for health behaviors (exercise, tobacco and alcohol use, vegetable and fresh fruit intake) and tested associations across the PRS spectrum. Results: Among 348,083 individuals, 78,664 (22.6%) reported depression in the past 2 weeks, including 14,776 (4.2%) with depression more than half of days. Depression burden modified the risk of incident CAD across the spectrum of CAD polygenic risk (Figure 1A). Among individuals with high PRS, lack of depression was associated with lower risk of incident CAD (HR 0.70, 95% 0.58-0.86), hypertension (HR 0.58, 95% CI 0.50-0.67), T2D (HR 0.48, 95% CI 0.41-0.55), and atrial fibrillation (HR 0.74, 95% CI 0.62-0.89) compared to those with a high burden of depression. These risk reductions were minimally attenuated after further adjustment for health behaviors (Figure 1B). Conclusions: Lower burden of depression was associated was decreased risks of cardiovascular disease among individuals at high genetic cardiovascular risk.

Social inequality in obesity in an Eastern Mediterranean population: a national health survey

Abstract Background This study aimed to explore socioeconomic factors associated with obesity in the Republic of Cyprus. Methods We interviewed 3021 Greek-Cypriots aged 25-64 years through a multistage survey. We collected self-reported information on demographics, health behaviours (physical activity, smoking, alcohol consumption and dietary intake), socio-economic characteristics (educational attainment, household income and occupational social class) and anthropometric measurements. Obesity was defined as body mass index ≥30 kg/m2. For the association between obesity and each socio-economic indicator, we conducted sex-specific Poisson's regression with robust variance, adjusting for all demographics and health-related behaviours, reporting adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results The prevalence of obesity was 22% and 17% among men and women, respectively. There was a significant trend of higher obesity prevalence with increasing age as well as with being widowed in both genders and being a refugee in men. Obesity prevalence decreased with increasing educational attainment (postgraduate vs. none/gymnasium: a PRmen=0.45; 95%CI=0.25-0.82; a PRwomen=0.41; 95%CI=0.18-0.95; p-trends<0.005), and household income (>€4000/month vs. ≤€1000/month: a PRmen=0.45; 95%CI=0.26-0.81; a PRwomen=0.45; 95%CI=0.22-0.92; p-trends<0.005). Occupational social class did not show any clear association with obesity. After adjustment for health-behaviours as mediators the association between income and obesity in women was attenuated. Conclusions The current study highlights striking social inequalities in obesity among Cypriot men and women, characterised by a linear decrease in obesity prevalence each step up the socioeconomic hierarchy. We recommend that comprehensive and multifaceted public health interventions are considered to address income and education-related barriers resulting in higher obesity rates among specific population sub-groups. Key messages Among Greek Cypriot adults, obesity affects almost one in five whilst obesity prevalence shows gender-specific social inequalities. When investigating social inequalities in health, the choice of socioeconomic indicators should reflect the context of the population and gender-specific differences.

Socio-economic position across the lifecourse and risk of breast cancer: findings from EPIC-Italy

Abstract Backgrounds Socio-economic position (SEP) is linked to many health outcomes but the link between SEP and breast cancer (BC) is complex. This study explores the relationship between SEP from early life and future risk of BC. Methods We used data from the Italian component of the European prospective investigation into cancer and nutrition: EPIC-Italy (up to 26,391 women). Cox proportional hazard models were used to estimate the association between measures of life course SEP (father’s occupation, educational level, highest household occupation) with risk of BC, adjusting for health behaviours (smoking, alcohol, physical activity, Mediterranean diet), height, weight and reproductive factors (postmenopausal status, age at first full term pregnancy). To mimic life course experiences, we analysed the relationship between father’s occupation and risk of BC, sequentially adjusting for SEP in young adulthood and adulthood, as well as the impact of social mobility. Results We observed a significant association between father’s occupation and risk of BC, where participant with low SEP had lower risk to develop BC (HR[95%CI] = 0.88[0.78; 0.99]). This association was borderline significant when we analysed educational level and highest household occupation. These associations were only slightly modified after adjustment for health behaviours, height and weight but more strongly affected by reproductive factors. However, the association between father’s occupation and BC remained borderline significant in the fully adjusted model (HR[95%CI] = 0.91[0.80; 1.03]). Stable low trajectory showed a lower risk of BC (HR[95%CI] = 0.82[0.71; 0.96]) slightly attenuated after adjusted for reproductive factors (HR[95%CI] = 0.88 [0.75; 1.03]). Conclusions Our findings suggest that low early-life SEP and stable low trajectory are associated with a lower risk of BC, which is partly explained by reproductive factors. Key messages Low early life socioeconomic position and stable low trajectory are associated with a lower risk of BC. Reproductive factors, especially age at the first full term pregnancy, explain part of these associations.

Optimism and Healthy Aging in Women and Men.

Mounting evidence indicates that there are specific associations between higher levels of optimism and healthier behaviors, reduced risk of chronic diseases, and lower mortality. Yet, for public health purposes, it is critical to consider how optimism might be related to a full scope of health conditions in aging-from cognitive to physical health. Using prospective data from the Health and Retirement Study (n = 5,698), we examined whether higher baseline optimism was associated with subsequent increased likelihood of maintaining healthy aging over 6-8 years of follow-up. Optimism was assessed at study baseline (2006 or 2008), and components of healthy aging were assessed every 2 years, defined as: 1) remaining free of major chronic diseases; 2) having no cognitive impairment; and 3) good physical functioning. Hazard ratios were obtained using Cox proportional hazards models, and a range of relevant covariates were considered (sociodemographic factors, depressive symptoms, and health behaviors). After adjusting for sociodemographic factors and depression, the most (top quartile) versus least (bottom quartile) optimistic participants had a 24% increased likelihood of maintaining healthy aging (95% CI: 1.11, 1.38). Further adjustment for health behaviors did not meaningfully change the findings. Optimism, a potentially modifiable health asset, merits further research for its potential to improve likelihood of health in aging.

Two theoretical strands of social capital, and total, cardiovascular, cancer and other mortality: A population-based prospective cohort study

The aim is to prospectively investigate both the “cohesion” and “network” perspectives of social capital in relation to total, cardiovascular (CVD), cancer and all other causes mortality. The 2008 public health survey in Scania was a postal questionnaire with three letters of reminder, and it was answered in the Autumn by 28,198 respondents (55% participation) aged 18–80 from a stratified random sample of the population register. This baseline was connected with the national causes of death registry (Dödsorsaksregistret) with a more than five-year follow-up August 27- November 14 (depending on individual response) to December 31, 2013 (946 deaths). The analyses were performed in multiple adjusted survival (Cox-) regression models. Results show that low social participation, common to both theoretical perspectives, had consistently high hazard rate ratios (HRRs) of total, CVD, cancer and other morality, and that HRRs of total and CVD mortality remained statistically significant even after adjustments for all covariates including health behaviors, BMI, unmet healthcare needs and self-rated health, HRR 1.28 (1.08–1.52) and HRR 1.79 (1.28–2.50), respectively. In contrast, low social support, specific to the “network” perspective, showed no significant associations with mortality, except for low emotional and instrumental support and other causes mortality for which HRRs remained significant adjusted for demographics and socioeconomic status (SES). Generalized trust in other people, specific to the “cohesion” perspective, showed statistically significant HRRs for total and other causes mortality until adjustments for health-related behaviours and BMI, although not after complete adjustments, and significant HRRs for CVD and cancer mortality before adjustment for health behaviours. In conclusion, low social participation is consistently associated with all forms of mortality, and particularly total and CVD mortality. Social participation represents a strong core of social capital theory, and items should measure both variety of social contact surfaces and intensity.

Impairments in Hemodynamic Responses to Orthostasis Associated with Frailty: Results from The Irish Longitudinal Study on Ageing (TILDA).

To characterize the relationships between orthostatic blood pressure (BP) and heart rate recovery and frailty in an older population. Cross-sectional study. Two health centers in the Republic of Ireland. The Irish Longitudinal Study on Ageing participants aged 50 and older (N=4,334). Continuous noninvasive BP responses during active standing were captured using digital photoplethysmography. Frailty was assessed using the Cardiovascular Health Study criteria. Linear mixed models (random intercept) with piecewise splines were used to model differences in rate of BP and heart rate recovery. Ninety-three (2.2%) participants were frail, and 1,366 (31.5%) were prefrail. Adjusting for age and sex, frailty was associated with a slower rate of systolic BP recovery 10 to 20 seconds after standing (frailty by time = -4.12, 95% confidence interval=-5.53 to -2.72) and with subsequent deficits in BP 20 to 50 seconds after standing. Similar results were seen for diastolic BP and heart rate. Further adjustment for health behaviors, morbidities, and medications reduced, but did not attenuate, these associations. Of the 5 frailty criteria, only slow gait speed was consistently related to impaired BP and heart rate responses in the full model. Frailty, particularly slow gait speed, was associated with slower rate of BP and heart rate recovery after active standing. Impaired BP recovery may be a marker of physiological frailty.

The relation between obesity and depressed mood in a multi-ethnic population. The HELIUS study

PurposeTo examine the association between obesity and depressed mood in a large multi-ethnic population and check for consistency in this association across six ethnic groups.MethodsData of 21,030 persons (18–70 years) were sourced from the HELIUS study. Cross-sectional relationships between obesity measures [body mass index (kg/m2) and waist circumference (cm)] and depressed mood (PHQ-9 score ≥ 10) were analysed. Consistency of associations was investigated across ethnic groups by interaction terms (ethnicity*obesity measures) in basic (age, sex, education) and fully (health behaviours and somatic health) adjusted models.ResultsObesity was prevalent in all ethnic groups, but varied substantially. After sociodemographic adjustment, obesity measures were associated with increased odds of depressed mood but this was inconsistent across ethnic groups. Obesity (BMI ≥ 30 or highest waist circumference quartile) was strongly and significantly associated with depressed mood in the Dutch [Odds Ratio (OR) = 1.72; 95% Confidence intervals (CI) 1.24–2.40, and OR = 1.86; 95% CI 1.38–2.50], respectively, and African Surinamese (OR = 1.60; 95% CI 1.29–1.98 and OR = 1.59; 95% CI 1.27–2.00, respectively) but had a weaker, non-significant association in other ethnic groups (South-Asian Surinamese, Ghanaian, Moroccan, Turkish groups). Adjustment for health behaviours and somatic health had limited effect on this pattern.ConclusionObesity was associated with a higher risk of depressed mood. However, ethnic differences were found: the obesity-depressed mood association was strong in the Dutch and African Surinamese populations, but not in other ethnic groups. Future studies should explore whether differential normative values or pathophysiology across ethnic groups explain why the obesity-depression association is inconsistent across ethnic groups.

Socioeconomic differences among community-dwelling diabetic adults screened for diabetic retinopathy and nephropathy: The 2015 Korean Community Health Survey.

We investigated the association between socioeconomic status (SES) and screening for diabetic retinopathy (DR) and diabetic nephropathy (DN) in community-dwelling diabetics. We analyzed data from 22,134 people with diabetes aged ≥19 years at the time of the nationwide 2015 Korean Community Health Survey. Multiple logistic regression analysis was used to explore the relationship between SES and screening for DR and DN both before and after adjustment for health behaviors, comorbidities, and educational level. Of all diabetic subjects, 33.9% and 38.1% underwent DR and DN screening, respectively. In the fully adjusted model, the extent of the DR and DN screening trended significantly lower as the educational level fell. Monthly household income was positively associated with DR screening, but a lower odds ratio (OR) for DN screening was evident only when the lowest and highest income groups were compared. Compared with managers/professionals, agricultural/forestry/fishery workers (OR 0.81, 95% confidence interval [CI] 0.69–0.96) and mechanical/manual laborers (OR 0.83, 95% CI 0.71–0.97) had lower ORs for DN screening. Residents in rural (compared with urban) areas and widows/widowers (compared with members of couples) were significantly less likely to undergo screening for DR and DN. Similar findings were obtained when the analysis was limited to those who had been educated about diabetes. In conclusion, socioeconomic inequalities were evident in terms of screening for DR and DN in community-dwelling Korean diabetics, regardless of whether they had reported receiving diabetes education. Tailored public health policies (and societal attention) are required to aid the socioeconomically disadvantaged.

Cross-sectional association between medical expenses and intellectual activity in community-dwelling older adults

BackgroundLittle is known concerning the lifestyle habits and health conditions in community-dwelling elderly who do not get medical care. We investigated the cross-sectional association between medical expenses (ME) and intellectual activity (IA) in community-dwelling older Japanese.MethodsSelf-administered questionnaires were mailed to all residents born between 1945 and 1949 and covered by A City’s medical insurance system (n = 19,354). Independent variables including health behaviors, oral health, social capital, neighborhood environment, and physical and mental functioning were included in the questionnaires. Medical fee receipts were used to evaluate ME for fiscal 2014, and respondents were classified into no, low, medium, and high ME groups. Higher-level functional capacity was evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence, which is comprised of three subscales: instrumental activities of daily living, IA, and social role. Poisson regression models were used to examine the association of ME with IA, with the low ME group as reference.ResultsQuestionnaires were returned by 12,747 individuals (response rate 65.9%). The no ME group had the lowest response rate, the worst lifestyle behaviors, and the lowest social capital, but no problems with neighborhood environment. Higher-level functional capacity, especially IA, was reduced in both the high ME and no ME groups. After adjustments for age, gender, health insurance, accessibility to public facilities in their residential area, family size, body mass index, and physical and mental functioning, the prevalence ratio (PR) for impaired IA lost its significance in the high ME group (PR 0.97, 95% confidence interval 0.90–1.05), but remained significant in the no ME group (1.19, 1.08–1.31). After additional adjustments for health behaviors (i.e., health checks, smoking, fitness, and dietary variety), the PR of the no ME group was attenuated towards the null (1.08, 0.98–1.20).ConclusionsCommunity-dwelling elderly who did not seek medical treatment were indifferent to health surveys and health-promoting behaviors, and undesirable health behaviors were a possible determinant of their impaired IA. Further longitudinal research is needed to confirm the causal associations.

Posttraumatic stress disorder and accelerated aging: PTSD and leukocyte telomere length in a sample of civilian women.

Studies in male combat veterans have suggested posttraumatic stress disorder (PTSD) is associated with shorter telomere length (TL). We examined the cross-sectional association of PTSD with TL in women exposed to traumas common in civilian life. Data are from a substudy of the Nurses' Health Study II (N = 116). PTSD and subclinical PTSD were assessed in trauma-exposed women using diagnostic interviews. An array of health behaviors and conditions were assessed. DNA was extracted from peripheral blood leukocytes (collected 1996-1999). Telomere repeat copy number to single gene copy number (T/S) was determined by quantitative real-time PCR telomere assay. We used linear regression models to assess associations and examine whether a range of important health behaviors (e.g., cigarette smoking) and medical conditions (e.g., hypertension) previously associated with TL might explain a PTSD-TL association. We further examined whether type of trauma exposure (e.g., interpersonal violence) was associated with TL and whether trauma type might explain a PTSD-TL association. Relative to not having PTSD, women with a PTSD diagnosis had shorter log-transformed TL (β = -.112, 95% confidence interval (CI) = -0.196, -0.028). Adjustment for health behaviors and medical conditions did not attenuate this association. Trauma type was not associated with TL and did not account for the association of PTSD with TL. Our results add to growing evidence that PTSD may be associated with more rapid cellular aging as measured by telomere erosion. Moreover, the association could not be explained by health behaviors and medical conditions assessed in this study, nor by type of trauma exposure.

Life Course Socioeconomic Position and Subclinical Disease: The Jackson Heart Study.

African Americans experience higher rates of cardiovascular disease (CVD) and lower childhood and adult socioeconomic position (SEP). Research that examines the associations of multiple measures of SEP with subclinical CVD markers among African Americans is limited. Data from the Jackson Heart Study (JHS) were used to examine cross-sectional associations of childhood SEP and adult SEP with subclinical markers among 4,756 African American participants (mean age 54, 64% female), adjusting for age, health behaviors and CVD risk factors. Subclinical markers included prevalent left ventricular hypertrophy (LVH), peripheral artery disease (PAD), coronary artery calcification (CAC), and carotid intima-media thickness (CIMT). The prevalence of LVH, PAD and CAC was 7%, 6% and 45%, respectively. The mean CIMT was .72 ± .17 mm. In fully-adjusted models, having a college education was inversely associated with PAD (OR, .27; 95% CI .13,.56) and CIMT (β=-29.7, P<.01). Income was inversely associated with LVH after adjustment for health behaviors (OR, .49 95% CI .25,.96), though associations attenuated in the fully-adjusted model. Measures of childhood SEP (material resources and mother's education) were not consistently associated with subclinical disease measures other than a positive association between material resources and CIMT. Subclinical disease markers were patterned by adult SEP measures among African Americans.

Association Between Psychological Distress and Liver Disease Mortality: A Meta-analysis of Individual Study Participants

Risk factors for cardiovascular disease, such as obesity and hypertension, have been associated with nonalcoholic fatty liver disease. Psychological distress (symptoms of anxiety and depression) is a risk factor for cardiovascular disease, so it might also be associated, directly or indirectly, with liver disease. We investigated the relationship between psychological distress (measured by the 12-item General Health Questionnaire [GHQ]) and liver disease mortality. We performed a meta-analysis of data from individual participants in 16 prospective studies of the general population in the United Kingdom, initiated from 1994 through 2008. Subjects were assigned to groups based on GHQ score: 0 (no distress), 1-3, 4-6, or 7-12. We analyzed data from 166,631 individuals (55% women; mean ± SD age, 46.6 ± 18.4 years; range, 16-102 years). During a mean follow-up period of 9.5 years, 17,368 participants died (457 with liver disease). We found a significant increase in liver disease mortality with increase in GHQ score (Ptrend < .001). The age- and sex-adjusted hazard ratio for the highest GHQ score category (ie, 7-12), compared with the 0 score category, was 3.48 (95% confidence interval: 2.68-4.52). After adjustment for health behaviors, socioeconomic status, body mass index, and diabetes, this hazard ratio decreased to 2.59 (95% confidence interval: 1.82-3.68). Based on a meta-analysis, psychological distress is associated with liver disease mortality, although this finding requires additional analysis. Although one is not likely to cause the other, we provide additional evidence for the deleterious effects of psychological problems on physical health.

Explanatory factors for health inequalities across different ethnic and gender groups: data from a national survey in England

BackgroundThe objective of this study was to examine the relative contribution of factors explaining ethnic health inequalities (EHI) in poor self-reported health (pSRH) and limiting long-standing illness (LLI) between Health...

The Red Cell Distribution Width and Anemia in Association With Prevalent Dementia

The red cell distribution width (RDW), a measure of anisocytosis, independently predicts cardiovascular disease outcomes and chronic disease mortality. Little is known about the RDW, or the interplay between RDW and anemia, in relation to dementia risk. We evaluated the association between the RDW and prevalent dementia, overall and by anemia status, among 2556 community-dwelling older adults participating in the Chicago Health and Aging Project. RDW measurements came from complete blood counts, and participants underwent diagnosis for dementia according to standard clinical criteria. Five hundred twenty-five participants were diagnosed with dementia. Elevated RDW was associated with increased odds of having dementia: after adjusting for age, sex, race, and education, the odds of prevalent dementia increased progressively over increasing quartile of RDW (Ptrend=0.02), and persons in the highest RDW quartile (≥14.8%) had 42% greater odds of having dementia than those in the lowest quartile [odds ratio (OR), 1.42; 95% confidence interval (CI), 1.05-1.92)]. Per unit (%) increment in RDW, the odds of dementia were higher by 6% (OR, 1.06; 95% CI, 1.00-1.13). Findings were similar upon further adjustment for health behaviors and diabetes. In analyses adjusted for hemoglobin concentration, the RDW-dementia association was attenuated, whereas the inverse association between hemoglobin and dementia remained significant. However, RDW was associated with dementia more strongly among participants without anemia (OR, 1.09; 95% CI, 1.00-1.43) than among those with anemia (OR, 0.99; 95% CI, 0.86-1.18), although this difference was not statistically significant. The RDW, a readily available and inexpensive hematologic measure, may offer novel information about dementia risk, particularly among persons without anemia. Future studies should establish the RDW's ability to predict risk prospectively.

Personality and All-Cause Mortality: Individual-Participant Meta-Analysis of 3,947 Deaths in 76,150 Adults

Personality may influence the risk of death, but the evidence remains inconsistent. We examined associations between personality traits of the five-factor model (extraversion, neuroticism, agreeableness, conscientiousness, and openness to experience) and the risk of death from all causes through individual-participant meta-analysis of 76,150 participants from 7 cohorts (the British Household Panel Survey, 2006-2009; the German Socio-Economic Panel Study, 2005-2010; the Household, Income and Labour Dynamics in Australia Survey, 2006-2010; the US Health and Retirement Study, 2006-2010; the Midlife in the United States Study, 1995-2004; and the Wisconsin Longitudinal Study's graduate and sibling samples, 1993-2009). During 444,770 person-years at risk, 3,947 participants (54.4% women) died (mean age at baseline = 50.9 years; mean follow-up = 5.9 years). Only low conscientiousness-reflecting low persistence, poor self-control, and lack of long-term planning-was associated with elevated mortality risk when taking into account age, sex, ethnicity/nationality, and all 5 personality traits. Individuals in the lowest tertile of conscientiousness had a 1.4 times higher risk of death (hazard ratio = 1.37, 95% confidence interval: 1.18, 1.58) compared with individuals in the top 2 tertiles. This association remained after further adjustment for health behaviors, marital status, and education. In conclusion, of the higher-order personality traits measured by the five-factor model, only conscientiousness appears to be related to mortality risk across populations.

Neighborhood disadvantage, neighborhood safety and cardiometabolic risk factors in African Americans: biosocial associations in the Jackson Heart study.

ObjectiveWe examined associations between neighborhood socioeconomic disadvantage, perceived neighborhood safety and cardiometabolic risk factors, adjusting for health behaviors and socioeconomic status (SES) among African Americans.MethodsStudy participants were non-diabetic African Americans (n = 3,909) in the baseline examination (2000–2004) of the Jackson Heart Study. We measured eight risk factors: the metabolic syndrome, its five components, insulin resistance and cardiovascular inflammation. We assessed neighborhood socioeconomic disadvantage with US Census 2000 data. We assessed perceived neighborhood safety, health behaviors and SES via survey. We used generalized estimating equations to estimate associations with a random intercept model for neighborhood effects.ResultsAfter adjustment for health behaviors and SES, neighborhood socioeconomic disadvantage was associated with the metabolic syndrome in women (PR 1.13, 95% CI 1.01, 1.27). Lack of perceived safety was associated with elevated glucose (OR 1.36, 95% CI 1.03, 1.80) and waist circumference (PR 1.06, 95% CI 1.02, 1.11) among women, and with elevated glucose (PR 1.30, 95% CI 1.02, 1.66) and insulin resistance (PR 1.25, 95% CI 1.08, 1.46) among men.ConclusionsNeighborhood socioeconomic disadvantage and perceived safety should be considered as targets for intervention to reduce cardiometabolic risks among African Americans.

Why do those out of work because of sickness or disability have a high mortality risk? Evidence from a Scottish cohort

Background: Existing evidence on the association between being out of work because of sickness or disability and high mortality risk suggests that most of the association cannot be explained by controlling for health, health behaviour or socio-economic position. However, studies are often based on administrative data that lack explanatory factors. Here, we investigate this high mortality risk using detailed information from a cohort study. Methods: Data from the West of Scotland Twenty-07 prospective cohort study were used to follow those (average age 56 years) employed, unemployed and out of work in 1988 to death or end of follow-up in 2011. Using a parametric survival model, mean survival was calculated for each employment group after adjustment for health behaviours, health and socio-economic position. Results: The difference in survival between those sick or disabled (30% survival at end of follow-up), and those unemployed (49%) or employed (61%) was mostly accounted for by adjusting for the higher levels of poor heath at baseline in the former group (49, 46 and 56%, respectively, after adjustment). After controlling for all variables, the difference between those sick or disabled (51%) and those employed (56%) was further attenuated slightly. Conclusion: Our results suggest that the present health of those out of work and sick or disabled should be taken seriously, as their long-term survival prospects are considerably poorer than other employment groups.