Adverse Socioeconomic Circumstances Research Articles

Cardiovascular disease in South Asian immigrants facing adverse socioeconomic circumstances: challenges and opportunities for enhanced management.

To describe the challenges that health professionals often face when attempting to provide optimal primary and secondary prevention care of atherosclerotic cardiovascular disease (ASCVD) to South Asian immigrant patients who face adverse socioeconomic factors, such as many of the South Asian men and women who live in Catalonia, and to present a number of constructive approaches that can help minimize those barriers. The challenges include limited health literacy, frequent language barriers, cultural factors that limit the relevance of standard lifestyle advice, financial barriers, limited access to preventive care, racism, and other barriers. Approaches that can help minimize them and enhance the quality of secondary cardiovascular preventive care in this group include empathy, using support from cultural mediators, enhanced proficiency using readily available translation programs, approaches that minimize financial barriers and simplify treatment regimes, and provision of more culturally competent lifestyle advice, among others. We hope that the notions included in this review will help physicians and healthcare system managers around the world become more aware and culturally competent when treating South Asian patients with ASCVD. The ongoing Pul-Cat and other studies will illuminate the most effective steps moving forward.

Psychosocial disorder or rational action? Contrasting professional and pupil narratives of school exclusion

ABSTRACT Over the last five years, the Excluded Lives team has been examining the patterns and processes of school exclusions across the UK in order to identify those factors which may exacerbate or reduce exclusions. One of most the striking aspects is the contrasting accounts of the causes of exclusion provided by professionals and pupils. Drawing on interview data from 29 school-based professionals and 16 excluded pupils in Wales, the paper analyses the different discourses which underpin their respective narratives. Professional accounts draw on discourses of vulnerability – seeing their pupils’ behaviour as symptomatic of some underlying malaise, typically as victims of adverse socio-economic and familial circumstances. Pupils’ accounts, on the other hand, are not about underlying ‘causes’, but about the specific circumstances of the ‘offence’. In their accounts, they are neither vulnerable nor victims. Indeed, they present their actions as rational – sometimes even heroic – responses to their situation. In drawing out this contrast, the paper does not seek to privilege one type of narrative over another – for both contain ‘truths’. However, it concludes that the hierarchy of credibility might need to be rebalanced in favour of the pupil if pupil-professional dialogue is to progress and trust be fostered.

Profile and healthcare utilisation patterns of adolescent frequent attenders in Singapore primary care: a retrospective study

ObjectivesFrequent attenders (FAs) visit healthcare settings at higher rates compared with the general population and use disproportionate amounts of healthcare resources. Frequent attendance (FA) has also been associated with greater...

Family economic status and vulnerability to suicidal ideation among adolescents: A re-examination of recent findings

BackgroundAccording to the “differential vulnerability hypothesis,” individuals in adverse socioeconomic circumstances as less mentally resilient to stressful events. However, several recent papers radically challenged this hypothesis based on the accumulated literature on stress inoculation and presented cases in which lower-SES adolescents appear to be less vulnerable to suicidal ideation in the face of interpersonal aggression. ObjectiveWe re-examine the link between psychological vulnerability to acute stressors and SES using yearly longitudinal public survey data from South Korea. Participants and settingThis is a secondary data analysis of a multi-year public health panel dataset on South Korean adolescents. MethodsLogistic regression is used to examine the association between suicidal ideation and a range of predictor variables, with a particular focus on the interaction between bullying victimhood and log family income. These variables and the sample were chosen for consistency with recent revisionist research. ResultsWe reaffirm the well-established finding that bullying victimhood strongly and consistently increases the odds of suicidal ideation (OR = 1.859, p < 0.01). However, we find no evidence in favor of the traditional “differential vulnerability hypothesis” or the recently proposed counterhypothesis. A subsample analysis from the latest wave (W4–W5) did produce results that are consistent with recent revisionist findings, but we suggest this is likely a false positive. ConclusionsThere appears to be no systematic association between SES and vulnerability to suicidal ideation in the face of peer aggression among South Korean adolescents. The claim that lower-SES adolescents may be more resilient to stressful events stands on limited empirical support.

Life-course socioeconomic factors are associated with markers of epigenetic aging in a population-based study

Adverse socioeconomic circumstances negatively affect the functioning of biological systems, but the underlying mechanisms remain only partially understood. Here, we explore the associations between life-course socioeconomic factors and four markers of epigenetic aging in a population-based setting.We included 684 participants (52 % women, mean age 52.6 ± 15.5 years) from a population and family-based Swiss study. We used nine life-course socioeconomic indicators as the main exposure variables, and four blood-derived, second generation markers of epigenetic aging as the outcome variables (Levine’s DNAmPhenoAge, DunedinPoAm38, GrimAge epigenetic age acceleration (EAA), and the mortality risk score (MS)). First, we investigated the associations between socioeconomic indicators and markers of epigenetic aging via mixed-effect linear regression models, adjusting for age, sex, participant’s recruitment center, familial structure (random-effect covariate), seasonality of blood sampling, and technical covariates. Second, we implemented counterfactual mediation analysis to investigate life-course and intermediate mechanisms underlying the socioeconomic gradient in epigenetic aging. Effect-size estimates were assessed using regression coefficients and counterfactual mediation parameters, along with their respective 95 % confidence intervals.Individuals reporting a low father’s occupation, adverse financial conditions in childhood, a low income, having financial difficulties, or experiencing unfavorable socioeconomic trajectories were epigenetically older and had a higher mortality risk score than their more advantaged counterparts. Specifically, this corresponded to an average increase of 1.1–1.5 years for Levine’s epigenetic age (β and 95 %CI range, β (minimum and maximum): 1.1–1.5 95 %CI[0.0–0.2; 2.3–3.0]), 1.1–1.5 additional years for GrimAge (β: 1.1–1.5 95 %CI[0.2–0.6; 1.9–3.0]), a 1–3 % higher DunedinPoAm38 age acceleration (β: 0.01–0.03 95 %CI[0.00; 0.03–0.04]), and a 10–50 % higher MS score (β: 0.1–0.4 95 %CI[0.0–0.2; 0.3–0.4]) for the aforementioned socioeconomic indicators. By exploring the life-course mechanisms underlying the socioeconomic gradient in epigenetic aging, we found that both childhood and adulthood socioeconomic factors contributed to epigenetic aging, and that detrimental lifestyle factors mediated the relation between socioeconomic circumstances in adulthood and EAA (31–89 % mediated proportion).This study provides emerging evidence for an association between disadvantaged life-course socioeconomic circumstances and detrimental epigenetic aging patterns, supporting the “sensitive-period” life-course model. Counterfactual mediation analyses further indicated that the effect of socioeconomic factors in adulthood operates through detrimental lifestyle factors, whereas associations involving early-life socioeconomic factors were less clear.

Differential fetal growth rates mediated by sociodemographic factors in Yucatan, Mexico: an epidemiological study

Background Fetal growth restriction (FGR) may be related to ethnicity. Additionally, ethnic groups experience adverse socioeconomic circumstances that increase FGR risk. However, the dearth of evidence of the interaction between socioeconomic factors and FGR highlights the need for additional research. Objective To analyze the association between socioeconomic factors and FGR in Maya and non-Maya populations in Yucatan, Mexico. Methods A total of 21,320 singleton births in 2017 in Yucatan were analyzed. The student’s t-test and the chi-square test were used to compare the means and proportions of maternal and perinatal variables between the FGR group and the birthweight appropriate for gestational age (AGA) group. Path analysis was performed to identify the direct and indirect effects of socioeconomic factors on FGR and mediators between predictors and FGR. Results The prevalence of FGR at birth was 9.06%; this rate was higher in the Maya population (12.4, 95% CI 11.3–13.5), without differences between socioeconomic levels. Path analysis revealed sociostructural variables (ethnicity and poverty) are reliable predictors of FGR at birth mediated by maternal education (β = −.152, p < .001) and teenage pregnancy (β = .065, p = .037). The proposal path model had a good fit index CFI = .968, TLI = .920, RMSEA = .046. Conclusion The prevalence of FGR was higher among Maya women than non-Maya women The socioeconomic conditions associated with FGR at birth were ethnicity, poverty, maternal education, and teenage pregnancy. Maternal education and teenage pregnancy act as mediators between sociostructural variables and FGR at birth.

Factors Associated With Early Elementary Child Health-Related Quality of Life: The Generation R Study.

AimTo identify the factors associated with health-related quality of life (HRQOL) among early elementary age children (5–6 years) from a general population sample.MethodsWe analyzed data of 4,202 children from the Generation R Study, a population-based cohort study in the Netherlands. Children's physical and psychosocial HRQOL were measured using the Child Health Questionnaire Parent Form 28 (CHQ-PF28). Associations between socio-demographic characteristics (child age, sex, ethnic background, family situation, parental educational level, parental employment status, and net household income), health-related lifestyle behaviors (physical activity and screen time), health conditions (number of chronic conditions, emotional and behavioral problems, and family functioning) and children's physical and psychosocial HRQOL were assessed using multivariate regression analyses.ResultsMean child age was 6.0 years (SD: 0.43); 63.6% had a majority (Dutch) ethnic background. Children with a non-western ethnic background, and children of unemployed mothers had a lower physical HRQOL (all p < 0.05). Older children, boys, and children from single-parent or low educated families had a lower psychosocial HRQOL (all p < 0.05). Children from a low income household family, children having chronic conditions or emotional and behavioral problems, or from families with relatively high “pathological family functioning” reported both lower physical and psychosocial HRQOL (all p < 0.05).ConclusionIndicators of adverse socioeconomic and family circumstances and indicators of child health problems were associated with lower HRQOL. Public health initiatives to improve HRQOL of children should prioritize children from a low socioeconomic status or with less favorable health conditions from early age onwards.

Significant Reduction in Pediatric, Population-Based Hospital Admissions Due To COVID-19 in Malta

Objective:This population-based, retrospective study aimed to determine whether there was a drop in pediatric admissions during the first year of COVID-19 in Malta, as reported in other centers worldwide, as well as to determine any differences in patient characteristics when compared to the previous year.Materials and Methods:All unplanned pediatric medical admissions to Mater Dei Hospital from March 1, 2020 (a few days before the first case of COVID-19 in Malta) till February 28, 2021 (study period) and the corresponding period in 2019/20 (control period) and characteristics of patients admitted during the first 10 weeks (first wave of COVID-19) were analyzed.Results:Pediatric admissions dropped by 57.7% during the first year of COVID-19 (1601 vs. 3789 in 2019). During the first wave of COVID-19, a higher percentage of neonates were admitted in 2020 when compared to all other ages. There was a lower prevalence of respiratory illnesses during the first wave of COVID-19 (31.6% vs. 47.5% in 2019, P < .001), with a higher prevalence of cases related to child abuse or adverse socio-economic circumstances (2020, 9 [3.4%] vs 1 [0.1%] in 2019, P < .001). Following school closures, a drop in communicable disease admissions was recorded (68 [42.2%] vs. 421 [70.3%] in 2019, P < .001). A negative correlation between daily pediatric admissions and active COVID-19 cases in Malta was noted (r (68) = −0.33, P = .005).Conclusion:The drop in admissions likely represents fear of contracting COVID-19 in hospital environments, together with a decline in communicable diseases due to school closures. Guardians’ concerns must be alleviated as best as possible by effective public health measures.

Significant Reduction in Pediatric, Population-Based Hospital Admissions Due To COVID-19 in Malta.

This population-based, retrospective study aimed to determine whether there was a drop in pediatric admissions during the first year of COVID-19 in Malta, as reported in other centers worldwide, as well as to determine any differences in patient characteristics when compared to the previous year. All unplanned pediatric medical admissions to Mater Dei Hospital from March 1, 2020 (a few days before the first case of COVID-19 in Malta) till February 28, 2021 (study period) and the corresponding period in 2019/20 (control period) and characteristics of patients admitted during the first 10 weeks (first wave of COVID-19) were analyzed. Pediatric admissions dropped by 57.7% during the first year of COVID-19 (1601 vs. 3789 in 2019). During the first wave of COVID-19, a higher percentage of neonates were admitted in 2020 when compared to all other ages. There was a lower prevalence of respiratory illnesses during the first wave of COVID-19 (31.6% vs. 47.5% in 2019, P < .001), with a higher prevalence of cases related to child abuse or adverse socio-economic circumstances (2020, 9 [3.4%] vs 1 [0.1%] in 2019, P < .001). Following school closures, a drop in communicable disease admissions was recorded (68 [42.2%] vs. 421 [70.3%] in 2019, P < .001). A negative correlation between daily pediatric admissions and active COVID-19 cases in Malta was noted (r (68) = -0.33, P = .005). The drop in admissions likely represents fear of contracting COVID-19 in hospital environments, together with a decline in communicable diseases due to school closures. Guardians' concerns must be alleviated as best as possible by effective public health measures.

Linking widowhood and later-life depressive symptoms: Do childhood socioeconomic circumstances matter?

Objectives: Widowhood and adverse childhood socioeconomic circumstances (CSC) have both been linked to increased levels of depressive symptoms in old age. Beyond their independent impact on depressive symptoms, experiencing adverse CSC may also trigger a cascade of cumulative adversity and secondary stressors across the life course that shapes how individuals weather stressful life events later on. Method: We examine whether exposure to adverse CSC moderates the relationship between later-life widowhood and depressive symptoms using data from the Survey of Health, Ageing and Retirement in Europe (2004-2017). Results: Mixed-effects models revealed that both widowhood and adverse CSC were associated with increased levels of depressive symptoms among men and women. Associations between widowhood and depressive symptoms, however, were not moderated by CSC for both genders. Conclusion: Persisting differences in the levels of mental health in response to later-life widowhood did not further widen in the presence of disparities experienced early in the life course. This may reflect the life-altering impact of this age-normative, yet stressful life event across the social strata.

Wages of politics or last-mile welfare? The case of the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA)

ABSTRACT Using official statistics, bureaucratic registers and ethnographic material collected from the implementation of the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) from six districts across six Indian states, the article explains under what conditions the capacity of last-mile bureaucracy matters for the performance of pro-poor welfare programmes in the Indian federal polity. In seeking to address the presence of heterogenous welfare outcomes in the districts of India, the article underscores the salience of last-mile bureaucrats and the extent to which the politicization of redistributive struggles might contribute to local state capacity to deliver welfare services, a hitherto under-researched aspect in comparative social development research. Challenging the conventional thesis that only a strong autonomous state succeeds in implementing welfare programmes, the article further argues that effective policy implementation can occur within the peculiar environment of relatively low-capacity last-mile bureaucracies even in the face of adverse socioeconomic circumstances. In short, the article shifts attention to the understudied relationship between the capacity of last-mile bureaucracy and welfare outcomes in India.

Exploring the relation between socioeconomic position and DNA methylation in a European population

Abstract Background Previous investigations have reported that adverse socioeconomic circumstances across the life-course lead to the alteration of major biological processes, eventually resulting in a higher disease risk and premature death. In particular, a low life-course socioeconomic position (SEP) has been associated with a modified epigenetic signature of loci involved in inflammation, the physiological response to stress, and other regulatory processes. Methods In this study, we investigated the association between nine indicators of SEP across the life-course and the differential methylation of 451'000 genome-wide CpG markers, using data from 690 adults included in a Swiss population-based study. We further examined the interrelations between the SEP-related CpGs, and the biological pathways in which the identified markers are involved. Results Three SEP indicators in adulthood were associated the differential methylation of 161 genome-wide CpG markers, whereby 156 CpGs were less methylated in people with low versus high SEP. Among the identified CpGs, a substantial proportion of markers were no longer associated with SEP upon accounting for health behaviors and cardiometabolic disorders. In addition, the identified CpGs were found to be involved in immune, inflammatory, and cancer-related processes. Conclusions Our results support the hypothesis that adverse socioeconomic circumstances may lead to the dysregulation of inflammatory processes, eventually resulting in the occurrence of serious chronic conditions such as atherosclerosis, diabetes, or cancer. Key messages Socioeconomic position is a major determinant of health-related outcomes. Epigenetic modifications may constitute a biological mechanism through which socioeconomic circumstances affect health.

The determinants and consequences of forgoing healthcare

Abstract Background Forgoing healthcare is associated with unfavorable health-related outcomes, a higher risk of hospitalization, and a decreased quality of life. Relatively to its neighboring countries, forgoing healthcare for economic reasons is high in Switzerland, primarily because of the high out of pocket expenditures that characterize the Swiss healthcare system. The purpose of this study was to investigate the determinants of forgoing healthcare, and to examine the long term health-related consequences of unmet medical needs. Methods We used data from “Bus Santé”, a cross-sectional study conducted in the city of Geneva (CH). Socioeconomic factors were self-reported by participants at baseline (N = 5032, 2007-2011), including income, education, receiving subsidies, and insurance deductibles (mandatory out of pocket expenditures). Forgoing healthcare for economic reasons was self-reported by study participants, including details about the frequency and the type of forgone care. Prospectively, a subset of participants came for a follow-up visit (2014-2015) in order to assess objective (glycemia, blood pressure, plasma lipids) and subjective health-outcomes (self-reported physical and mental health) resulting from forgone healthcare at baseline. Results At baseline, adverse socioeconomic circumstances (lower income, education, receiving subsidies, and high deductibles) were associated with a higher risk of forgoing healthcare (OR range 1.51-5.49, p &amp;lt; 0.015). Four years later, participants who reported forgoing healthcare at baseline were at a higher risk of having lower HDL-cholesterol (β=-0.08 [-0.14;-0.03]), and adverse physical and mental self-reported health outcomes when compared to controls (p &amp;lt; 0.017). Conclusions Forgoing healthcare is driven by adverse socioeconomic circumstances, subsequently leading to adverse lipid profiles and poor self-reported health outcomes. Unmet medical needs may constitute a pathway through which socioeconomic status affects health. Key messages Adverse socioeconomic circumstances lead to unmet medical needs, even in wealthy countries. Unmet medical needs lead to poor objective and subjective health-related outcomes.

Historical Antecedents of Breastfeeding for African American Women: from the Pre-Colonial Period to the Mid-Twentieth Century.

African American women have much lower breastfeeding rates than other racial and ethnic groups in the USA. While researchers are beginning to explore contemporary factors contributing to this inequality, much less research has been devoted to the historical conditions that have contributed to these disparities. The aim of this paper was to describe the social, economic, and political factors that have influenced African American breastfeeding behavior in the USA from the colonial era through the mid-twentieth century. A thematic analysis was conducted across multiple databases and sources. A social history framework, which focuses on the experiences of ordinary people and events, was used to identify and integrate themes found within the reviewed literature. Three themes emerged: (1) Labor forces and other socio-cultural factors affected feeding practices and communal caregiving; (2) history of supplementation; and (3) influence of medicalization of birth and mobility on infant feeding in the twentieth century. These themes illustrate how African American women's ability to breastfeed has been significantly constrained throughout the U.S. Supplementation with non-human milk substitutes and communal caregiving helped African American women navigate infant rearing under adverse socioeconomic circumstances. Social, political, and economic factors have contributed significantly to African American women's ability to breastfeed throughout the U.S. Understanding the influences of historical antecedents on breastfeeding decisions over time may be key to finding effective interventions that might increase breastfeeding rates within this population.

Pregnant women at increased risk of adverse perinatal outcomes: A combination of less healthy behaviors and adverse psychosocial and socio-economic circumstances

Smoking during pregnancy is associated with a multitude of health behaviors and with the psychosocial and socio-economic circumstances of pregnant women. Limited research has so far been conducted on the clustering of these characteristics and on their effect on pregnancy outcomes. This study aimed to identify different groups of pregnant women based on their behavioral, psychosocial and socio-economic characteristics and their pregnancy outcomes.In total, 2455 women who were 12 weeks pregnant completed a questionnaire on smoking behavior, health behaviors and psychosocial and socio-economic characteristics. Neonatal and maternal outcomes were extracted from the Dutch perinatal registration. Subgroups were identified with latent class analysis and adverse pregnancy outcomes were compared between subgroups with logistic regression.Women were classified into four latent classes. Two classes represented the healthy higher-educated pregnant women who did not smoke: one group of multigravida women and one of primigravida women, also characterized by less pregnancy-specific knowledge and more pregnancy-related stress. The remaining women were grouped into two less healthy groups. One group frequently quit smoking, reported less healthy eating, less physical activity and comparable stress levels as the healthy higher-educated groups. The last group contained the most smokers, had the highest scores on psychosocial and pregnancy-related stress and the most adverse socio-economic circumstances. This group had an increased risk of adverse maternal outcomes, in particular developing diabetes during pregnancy.A comprehensive and integrated approach is needed to improve outcomes in pregnancies with a combination of adverse health, psychosocial, and socio-economic conditions.

Social inequalities in sleep-disordered breathing: Evidence from the CoLaus|HypnoLaus study.

Sleep-disordered breathing is a common condition, related to a higher cardiometabolic and neurocognitive risk. The main risk factors for sleep-disordered breathing include obesity, craniofacial characteristics, male sex and age. However, some studies have suggested that adverse socioeconomic circumstances and lifestyle-related behaviours such as smoking and alcohol use, may also be risk factors for sleep-disordered breathing. Here, we investigate the associations between socioeconomic status and sleep-disordered breathing, as measured by sleep apnea-hypopnea and oxygen desaturation indexes. Furthermore, we assess whether these associations are explained by lifestyle-related factors (smoking, sedentary behaviour, alcohol use and body mass index [BMI]). We used data from the CoLaus|HypnoLaus study, a population-based study including 2162 participants from Lausanne (Switzerland). Socioeconomic status was measured through occupation and education. Sleep-disordered breathing was assessed through polysomnography and measured using the apnea-hypopnea index (AHI: number of apnea/hypopnea events/hr: ≥15/≥30 events), and the ≥3% oxygen desaturation index (ODI: number of oxygen desaturation events/hr: ≥15/≥30 events). Lower occupation and education were associated with higher AHI and ODI (occupation: AHI30, odds ratio (OR)=1.88, 95% confidence interval (CI) [1.07; 3.31]; ODI30, OR=2.29, 95% CI [1.19; 4.39]; education: AHI30, OR=1.21, 95% CI [0.85; 1.72]; ODI30, OR=1.26, 95% CI [0.83; 1.91]). BMI was associated with socioeconomic status and AHI/ODI, and contributed to the socioeconomic gradient in SDB, with mediation estimates ranging between 43% and 78%. In this Swiss population-based study, we found that low socioeconomic status is a risk factor for sleep-disordered breathing, and that these associations are partly explained by BMI. These findings provide a better understanding of the mechanisms underlying social differences in sleep-disordered breathing and may help implement policies for identifying high-risk profiles for this disorder.

Socioeconomic Context as a Moderator in the Relationship between Body Mass Index and Depression in Europe.

Obesity and depression are two major health issues in contemporary societies. This study aims to address two fundamental questions: (1) what is the impact of macro-level adverse socioeconomic circumstances on depression? and (2) how do macro-level variations in the socioeconomic context affect the relationship between body mass index (BMI) and depression? Data from the 7th round of the European Social Survey were used, collected from a sample size of 37,623 participants and aggregated around a total of 20 countries. A random intercept multilevel model was constructed to study the variations in the relationship between depression and BMI. The contextual effect of risk of poverty, unemployment rate, and gross domestic product per capita were studied at the country level. First, both unemployment and poverty risk were found to be positively associated with depressive disorders. Second, the results show that a higher risk of poverty at the macro level may increase the effect of BMI on depression in European countries. The present study provides new evidence suggesting that the obesity-depression relationship will be, on average, stronger in countries with poor socioeconomic conditions. Therefore, adverse socioeconomic contextual conditions may increase depression associated with obesity.

Co-occurrence and clustering of health conditions at age 11: cross-sectional findings from the Millennium Cohort Study

ObjectivesTo identify patterns of co-occurrence and clustering of 6 common adverse health conditions in 11-year-old children and explore differences by sociodemographic factors.DesignNationally representative prospective cohort study.SettingChildren born in the UK...

The demographic ageing of population in Bosnia and Herzegovina: causes and consequences

In this paper the age structure and the ageing population process in Bosnia and Herzegovina in the second half of the 20th century and the beginning of the 21st century is analyzed. The main reasons that caused changes in the age composition of the population and the population ageing in Bosnia and Herzegovina have been researched. The main causes of the population ageing in Bosnia and Herzegovina in the second half of the 20th century were primarily trends in fertility rates and secondarily trends in mortality rates. The economic growth of Bosnia and Herzegovina after World War II conditioned changes in the economic and educational structure of the population and with that the changes in the natural increase rates and migration balance. The war was the main cause of negative demographic changes in Bosnia and Herzegovina in the period from 1992 to 1995, and the post-war adverse socioeconomic, political and other circumstances have been the cause of negative demographic trends after 1995. The aim of this paper is to determine the level of population ageing in Bosnia and Herzegovina and the consequences this process could have on the demographic future of this country.

Insulin-like growth factor 1 and risk of later depression in older people: prospective evidence from the English Longitudinal Study of Ageing

BackgroundDepressive disorders are a leading cause of mortality and morbidity. Whereas the role of psychosocial and behavioural predictors has been well examined, little is known about the biological origins of depression. In mice in which insulin-like growth factor 1 (IGF-1) was knocked out with viral vectors, there was evidence of increased signs of depression. In other studies, IGF-1 infusions in rodents had antidepressant properties. We tested the association of depression with IGF-1 in a large population-based study. MethodsIGF-1 concentrations were measured from serum taken at a nurse visit in 2008 from adults participating in the English Longitudinal Study of Ageing. Symptoms of depression were assessed in 2008 and 2012 with the eight item Center for Epidemiological Studies Depression Scale (CES-D) and diagnosis was based on self-report. Cross-sectional analyses were carried out on measures collected at baseline, in 2008. Outcome measures in longitudinal analyses were new reports of depression symptoms and physician-diagnosed depression in 2012. We used logistic regression to test both the cross-sectional and longitudinal associations, adjusted in a stepwise manner for age, anthropometric measures, comorbidities, psychosocial factors, and health behaviours. FindingsSamples from 6017 adults were included (mean age 65·7 years [SD 9·3], range 50–99; mean IGF-1 15·9 nmol/L [SD 5·7]). Mean CES-D score at baseline was 1·2 (SD 1·8). In cross-sectional and longitudinal analyses, the association between IGF-1 and symptoms of depression followed a U-shaped pattern—ie, lower and higher concentrations of IGF-1 were associated with an increased risk of depression, whereas the lowest risk was seen around median concentrations. In women, with the lowest quintile of IGF-1 as the referent, the age-adjusted odds ratios for increasing quintiles of IGF-1 in longitudinal analysis were 0·88 (95% CI 0·60–1·29), 0·77 (0·51–1·16), 0·84 (0·53–1·35), and 0·95 (0·60–1·50) (p for curve=0·027). Corresponding results in men were 0·51 (0·28–0·91), 0·50 (0·27–0·92), 0·63 (0·35–1·15), and 0·63 (0·35–1·13) (p for curve=0·002). These associations were partly attributable to comorbidities, adverse socioeconomic circumstances, and psychosocial and behavioural factors. Similar results were observed for the association between IGF-1 and physician-diagnosed depression. InterpretationIn the present study, which is the first to our knowledge to use validated measures of depression, there was some evidence that low and high concentrations of IGF-1 were associated with a slightly elevated risk of diagnosed depression and symptoms of depression. Further studies are needed to examine whether the observed association is causal and whether normalising IGF-1 concentrations with drugs or IGF-1 infusions could be useful and safe in the treatment of depression in older people. FundingThis work was supported by an Economic and Social Research Council–Medical Research Council studentship (awarded to SC).