GAZEL Cohort Research Articles

The Effect of Urinary Incontinence on Health-related Quality of Life: Is It Similar in Men and Women?

To compare the association between self-reported urinary incontinence (UI) and health-related quality of life (HRQoL) in men and women while taking chronic comorbidities into account, on the hypothesis that UI might negatively affect HRQoL differently in each sex. In 2006, a total of 10,723 men (aged 57-67 years) and 3777 women (aged 52-67 years) participating in the GAZEL cohort (www.gazel.inserm.fr) completed a self-administered questionnaire including the Nottingham Health Profile to assess HRQoL. UI was defined as self-reported involuntary loss of urine in the past 12 months. Adjusted logistic regression models were fitted to estimate the association between impaired HRQoL and UI, taking age, chronic conditions, and other confounders into account. For each QoL dimension, we compared the strength of the associations between UI and HRQoL between the sexes by tests of interaction. Women were more likely than men to report both UI (13.9% vs 2.7%) and impaired HRQoL. UI was associated with impaired HRQoL in both sexes, mainly in the dimensions of energy (OR = 3.17 in men [95% CI 2.49-4.04] and 2.11 in women [1.75-2.54]), social isolation (OR = 2.29 in men [1.74-3.02] and 1.75 in women [1.44-2.12]), and physical mobility (OR = 2.05 in men [1.62-2.60] and 2.27 in women [1.88-2.74]). There were no significant interactions between the sexes after adjustment. UI was associated negatively with HRQoL in both sexes, mostly in the dimensions of energy, social isolation, and physical mobility. The association was similar in men and women after we took age, sociodemographic characteristics, and chronic diseases into account. The cross-sectional design of the analysis prevents any conclusion that UI induced an impairment of HRQoL, and no causal relation can be inferred.

Should Sensory Impairment Be Considered in Frailty Assessment? A Study in the GAZEL Cohort.

The assessment of sensory difficulties is sometimes included in the screening of frailty in ageing population. This study aimed to compare the prevalence of frailty and associated risk of adverse outcomes depending on whether sensory difficulties participated in the definition of frailty. Prospective cohort study - GAZEL cohort. France. The 13,128 subjects who completed a questionnaire in 2012. According to the Strawbridge questionnaire, subjects were considered frail if they reported difficulties in two domains or more among physical, nutritive, cognitive and sensory domains. The risk of adverse health outcomes was assessed by using logistic regression models (hospitalisations, onset of difficulty in performing movements of everyday life) and multivariate Cox proportional hazards models (mortality). Mean age was 66.8 +/- 3.4 years and 73.8% were males. The prevalence of frailty varied from 4.4 to 14.2% depending on whether the sensory domain was excluded or included. During follow-up, 182 deaths (1.4%), 479 hospitalisations (3.6%) and 703 cases of new disability (8.0%) were observed. Both definitions of frailty predicted the onset of difficulties to perform everyday movements, with 2 to 3-fold increase in the risk. The inclusion of the sensory domain in the definition made frailty predictive of hospitalisations (Odds Ratio 1.31 [1.01-1.70]) but the association with mortality was only observed when sensory difficulties were ignored (Hazard Ratio 2.28 [1.32-3.92]). The inclusion of a sensory domain into a frailty screening instrument has a major impact in terms of prevalence and modifies the risk profile associated with frailty. In order to develop the use of frailty screening instruments in clinical practice, further researches will need to carefully evaluate the impact on risk prediction of the different domains involved.

Adolescent Repeated Alcohol Intoxication as a Predictor of Young Adulthood Alcohol Abuse: The Role of Socioeconomic Context

Aims. Trajectories of alcohol abuse from adolescence onwards are not well known. We examined the relationship between repeated alcohol intoxication in adolescence and later alcohol abuse, testing whether this association varies depending on individuals’ socioeconomic context. Methods. Study participants (n = 674, age 22–35 years in 2009) belong to the French TEMPO cohort study; their parents also participate in an epidemiological study—the GAZEL cohort. Repeated alcohol intoxication was assessed by questionnaire in adolescence (1999) (defined by ≥3 episodes of alcohol intoxication in the preceding 12 months). In young adulthood (2009), alcohol abuse was assessed by the WHO AUDIT questionnaire. Socioeconomic characteristic studied was childhood family income. Data were analyzed using logistic regression models controlling for age, sex, childhood temperament, parental history of alcohol use, and the quality of family relations. Results. Among adolescents who reported repeated alcohol intoxication, 30.8% reported alcohol abuse in young adulthood (adjusted OR=4.27, 95%CI 2.21–8.27). This association appeared stronger in participants who grew up in families with low income (adjusted OR=11.86, 95%CI 3.35–41.94 vs. 2.49, 95%CI 1.09–5.68 for youths from families with intermediate or high income). Conclusions. In most adolescents (69.2%), alcohol abuse is a time-limited behavior. Nonetheless, in participants from low income families, the likelihood of persistent alcohol abuse beyond adolescence may be increased. Although some limitations are noted, a preliminary conclusion is that alcohol abuse trajectories over time need to be monitored, particularly in certain subgroups.

Prevalence of Female Urinary Incontinence in the General Population According to Different Definitions and Study Designs

BackgroundEstimates of the prevalence of female urinary incontinence (UI) vary widely. ObjectiveTo estimate UI prevalence among women in France using data from five national surveys and analyse prevalence differences among the surveys according to their design (representative sample or not, survey focused on UI or not) and UI definition (based on symptoms or disease perception). Design, setting, and participantsData came from two representative telephone surveys, Fecond (5017 women aged 15–49 yr) and Barometer (3089 women aged 40–85 yr), general and urinary postal surveys of the GAZEL cohort (3098 women aged 54–69 yr), and the web-based NutriNet survey (85 037 women aged 18–87 yr). Outcome measurements and statistical analysisDefinitions of UI based on the International Conference on Incontinence Questionnaire UI short form (ICIQ-UI-SF) and on a list of health problems were considered. We compared age-adjusted prevalence rates among studies via logistic regression and generalised linear models. Results and limitationsOverall, 13% of the women in Fecond, 24% in Barometer, 15% in the GAZEL general survey, 39% in the GAZEL urinary survey, and 1.5% in the NutriNet survey reported any UI. Prevalence rates in representative samples with the same UI definition (ICIQ-UI-SF) were concordant. UI prevalence in the representative samples was 17%. The estimated number of women in France with UI was 5.35 million (95% confidence interval [CI] 5.34–5.36 million) for any UI and 1.54 million (95% CI 1.53–1.55 million) for daily UI. For the GAZEL sample, UI prevalence was lower but UI severity was greater for responses to a questionnaire with the list-based UI definition rather than to a questionnaire with the ICIQ-UI-SF-based definition. In all surveys, information about UI was self-reported and was not validated by objective measurements. ConclusionsUI definitions and sampling strategies influence estimates of UI prevalence among women. Precise estimates of UI prevalence should be based on non–UI-focused surveys among representative samples and using a validated standardised symptom-based questionnaire. Patient summaryWe looked at estimates of urinary incontinence (UI) prevalence in studies with different designs and different UI definitions in a large population of French women. We found that estimates varied with the definition and the design. We conclude that the most precise estimates of UI prevalence are obtained in studies of representative populations that are not focused on UI and use a validated international standard questionnaire with sufficient details to allow grading of UI severity. Most women reported rare urine leakages involving small amounts of urine with little impact on their quality of life.

Social engagement across the retirement transition among "young-old" adults in the French GAZEL cohort.

The objective of this study was to test predictors of change in social engagement across the retirement transition in a cohort of 10,692 French utility workers retiring between 1992 and 2004, aged 51-65 in 2004. Three measures of social engagement (organizational activity participation, number of close family members, and number of close friends) were collected in 1991 and 2004; 1991 scores were subtracted from 2004 scores to determine change. We used ordered logistic regression to model predictors of change. Compared with those retiring just before the follow-up measure, those retiring 2-5 years earlier had greater positive change in organizational activity participation (OR 1.22, 95% CI 1.07, 1.39) and greater positive change in number of close friends (OR 1.19, 95% CI 1.04, 1.37) after retirement compared with before, but no difference in family contact, and no clear linear trend by retirement timing relative to the follow-up measure. Women were less likely than men to increase organizational activities and contact with close family ties. Poor self-rated health at follow-up consistently predicted decreased engagement. For specific activities, those retired longest had not only the greatest odds of increased political/religious organizational involvement and sports/hobby/leisure involvement but also the greatest odds of decreased volunteering. Those of low midlife socioeconomic status (SES) were more likely to decrease levels of formal engagement from before retirement to after, compared to those of higher SES. Overall, certain changes in social engagement emerged with increasing time in retirement. However, retirement timing was a weaker predictor of change in engagement than factors such as low midlife SES or poor health. Findings suggest that disparities in social engagement may emerge during retirement.

The long shadows of early life events: Childhood adversity moderates depressive symptom changes following retirement in the GAZEL cohort

The long shadows of early life events: Childhood adversity moderates depressive symptom changes following retirement in the GAZEL cohort

Social position modifies the association between severe shoulder/arm and knee/leg pain, and quality of life after retirement.

Musculoskeletal disorders are extremely frequent and account for an important part of the global burden of disease. Risk factors for musculoskeletal disorders include sustained occupational exposure to physically demanding jobs. The effects of sustained occupational physical exposures on knee and shoulder pain are known to persist after retirement; also, several studies have shown a socio-economic gradient in health and quality-of-life outcomes, including for musculoskeletal pain. It is thus possible that prolonged occupational exposures affect workers differently in the long-term along a socio-economic gradient. This study was conducted to investigate whether the impacts of severe shoulder/arm and knee/leg pain on the quality of life of retired workers follow a socio-economic gradient. Data from the French GAZEL cohort study (n = 14,249) were used to compare the impacts of severe shoulder/arm and knee/leg pain separately on the SF-36, Nottingham Health Profile and limitations in activities of daily living measured in 2006 and 2007, between four groups of social position (measured in 1989). Analyses were made in 2014 with multiple linear and logistic regressions and stratified by sex. For both pain sites, in men and women, there was a strong general tendency for the impacts of severe pain to be smaller among participants in higher social positions. Most important differences were related to pain and physical limitations. These results suggest inequalities in the impacts of severe joint pain by socio-economic status. The source of these inequalities is still speculative and merits the scientific attention.

Psychological, Social and Familial Factors Associated with Tobacco Cessation among Young Adults

Background/Aims: The younger individuals quit smoking, the greater the health benefits. We studied the role of adolescent and concurrent psychological, social and familial factors in successful tobacco cessation in a general population sample of French young adults. Methods: Our data came from participants of the TEMPO cohort study and their parents (members of the GAZEL cohort study) in France. Among regular smokers (n = 678), Cox proportional hazards models were used to estimate hazard ratios of self-reported tobacco cessation of at least 12 months in relation to individual and socioenvironmental variables. Results: On average, participants (mean: 28.9 years) smoked for 10.51 years (SD = 5.9); the majority had attempted to quit smoking at least once (59.5%). In multiple regression analyses, cannabis use in the preceding year and recent financial difficulties were both negatively associated with successful smoking cessation. Conversely, living with a partner and, for women only, recent pregnancy or childbirth were associated with an increased likelihood of tobacco cessation. Conclusions: This study highlights the importance of young adults' cannabis use, family situation and socioeconomic context with regard to their smoking behavior. Physicians and public health decision makers aiming to decrease the burden of tobacco smoking should take into consideration these social and behavioral factors.

Effect of stressful life events on changes in smoking among the French: longitudinal findings from GAZEL.

Changes in life events may play a contributing role in changes in smoking behaviors. The objective was to examine the impact of stressful life events (SLEs) on smoking among French adults. We examined smoking prevalence in 20 625 employees of the French GAZEL cohort for up to 5 years before and after a SLE during three time periods (years -1 vs. -5; years +1 vs. -1; years +5 vs. +1). Repeated measures analysis of time series data indexed to events were used, employing generalized estimating equations. For women, comparing 1 year after vs. 1 year before SLEs, decreased odds of smoking were found for employment promotion (OR: 0.80; 95% CI = 0.67-0.95), marriage (OR: 0.57; 95% CI = 0.48-0.68) and divorce (OR: 0.78; 95% CI = 0.68-0.90). Comparing 5 years after to 1 year after SLEs, women had decreased odds of smoking for important purchase (OR: 0.87; 95% CI = 0.79-0.96), children leaving home (OR: 0.83; 95% CI = 0.74-0.93), retirement (OR: 0.73; 95% CI = 0.64-0.83) and death of loved one (OR: 0.86; 95% CI = 0.79-0.93). For men, decreased odds of smoking were observed in all three time periods for all SLEs except when comparing 1 year before to 5 years before marriage (OR: 1.66; 95% CI = 1.09-2.52) and divorce (OR: 1.49; 95% CI = 1.25-1.77). Time surrounding SLEs during which individuals are susceptible to changing smoking behaviors may be an important consideration.

Are People with Mental Disorders Less Likely to Be Treated for Somatic Diseases over Time? Longitudinal Analyses From the Gazel Cohort Study.

Introduction Although accumulating evidence suggests that individuals with mental disorders have an increased risk of mortality from physical illnesses, the underlying mechanisms remain to be fully understood. Objectives To examine the association between mental disorder status and self-reported treatment for major somatic diseases, including respiratory, cardiovascular (CVD), metabolic diseases, and cancer over a 12-year follow-up period. Aims To test whether people with mental disorders are less likely to be treated for somatic diseases. Methods In the large prospective French GAZEL cohort of 15 798 employees, mental disorder was defined as at least one sickness absence exceeding 7 days from 1989 – 2000 and self-reported treatment of somatic diseases was assessed from 2001 – 2011. Longitudinal logistic regression models based on generalized estimating equations were used to study the association. Results In fully adjusted-models, a diagnosis of severe mental disorder was associated with an 18% and a 6% greater annual increase in the likelihood of receiving treatment for respiratory disease and CVD over time, respectively. Any mental disorder was associated with a 2% greater annual decrease in the likelihood of receiving treatment for CVD over time. Depressive disorder (3%), mental disorders due to substance abuse, and mixed mental disorders (2%) had similar patterns of decrease. Conclusions This longitudinal study suggests that the impact of mental disorders on treatment receipt for somatic disorders depends on the diagnostic categories. People with depressive disorder, mental disorders due to substance use, and mixed mental disorders may be at risk of not receiving treatment for CVD.

Hostility and the risk of peptic ulcer in the GAZEL cohort.

Evidence for an association between hostility and peptic ulcer mainly relies on cross-sectional studies. Prospective studies are rare and have not used a validated measure of hostility. This prospective study aimed to examine the association between hostility and peptic ulcer in the large-scale French GAZEL cohort. In 1993, 14,674 participants completed the Buss and Durkee Hostility Inventory. Participants were annually followed-up from 1994 to 2011. Diagnosis of peptic ulcer was self-reported. The association between hostility scores and ulcer incidence was measured by hazard ratios (HR) and 95% confidence intervals computed through Cox regression. Among 13,539 participants free of peptic ulcer history at baseline, 816 reported a peptic ulcer during a mean follow-up of 16.8 years. Adjusting for potential confounders, including smoking, occupational grade, and a proxy for nonsteroidal anti-inflammatory drug exposure, ulcer incidence was positively associated with total hostility (HR per SD: 1.23, confidence interval: 1.14-1.31), behavioral hostility (HR per SD: 1.13, confidence interval: 1.05-1.21), cognitive hostility (HR per SD: 1.26, confidence interval: 1.18-1.35), and irritability (HR per SD: 1.20, confidence interval: 1.12-1.29). The risk of peptic ulcer increased from the lowest to the highest quartile for all hostility measures (p for linear trend < .05). Hostility might be associated with an increased risk of peptic ulcer. Should these results be replicated, further studies would be needed to explore the underlying mechanisms.

Long-term persistence of knee pain and occupational exposure in two large prospective cohorts of workers.

BackgroundThe persistence of knee pain (KP) and its relationship with occupational factors were investigated in two prospective cohorts of French workers: retirees of the Gazel cohort and workers in the Cosali cohort.MethodsKP was defined according to the Nordic questionnaire (>1 day in the last year), and the information was extracted from two questionnaires in 2006 and 2012 for the Gazel cohort, and in 2002–2005 and 2007–2010 for the Cosali cohort. The personal and occupational factors and the severity of KP were measured at baseline. Of the 4590 members of the Gazel cohort with KP at baseline, 4140(90.2%) were followed up, as were 637(63.1%) members of the Cosali cohort. Logistic models were used to evaluate associations (ORs) between occupational exposure and the persistence of KP separately by sex, adjusted on indicators of severity of KP.ResultsKP was no longer present at follow-up for 38.3% of Gazel men and 46.0% of Cosali men (33.4% of Gazel women and 50.6% of Cosali women). The persistence of KP in men was associated with carrying or handling heavy loads on univariate analyses and with kneeling on multivariate analyses, with ORs of 1.3(1.0-1.6) (Gazel) and 1.6(1.0-2.6) (Cosali). Climbing stairs was not significantly associated with the persistence of knee pain among men. The persistence of KP in women was not significantly associated with such occupational exposure.ConclusionsThis study highlights the role of occupational factors in the persistence of KP for men, in particular kneeling and handling/carrying loads.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-411) contains supplementary material, which is available to authorized users.

Cohort Profile Update: The GAZEL Cohort Study.

The original GAZEL cohort was composed of 20 625 employees of the French national gas and electricity companies (15 011 male employees then aged 40 to 50 years and 5614 women between 35 and 50 years old) at its inception in 1989. A Cohort Profile article was published in 2007. By the end of 2013, participants were aged 60-75, and almost all of them retired during follow-up. Accordingly, the main focus of research in the past decade was devoted to the study of the persistent, long-term effects of occupational exposures after retirement; of the transition between professionally active life and retirement; and on determinants of early ageing. Accordingly, in addition to the health, behavioural and social data collected yearly since the beginning of the follow-up, new data were thus collected on cognitive complaints, cognitive and physical functioning, limitations in daily activities, time use and social relationships of retirees. This update presents the main findings of research within the GAZEL Cohort Study during the past 7 years. Any research group, in France or elsewhere, can submit a research proposal to work on the GAZEL cohort. To do this, interested researchers should contact one of the principal investigators of the GAZEL Cohort Study.

Association between Long-Term Exposure to Air Pollution and Mortality: 20-Year Follow-Up of the French GAZEL Cohort

Association between Long-Term Exposure to Air Pollution and Mortality: 20-Year Follow-Up of the French GAZEL Cohort

Does Obesity Modify the Relationship between Exposure to Occupational Factors and Musculoskeletal Pain in Men? Results from the GAZEL Cohort Study

ObjectiveTo analyze relationships between physical occupational exposures, post-retirement shoulder/knee pain, and obesity.Methods9 415 male participants (aged 63–73 in 2012) from the French GAZEL cohort answered self-administered questionnaires in 2006 and 2012. Occupational exposures retrospectively assessed in 2006 included arm elevation and squatting (never, <10 years, ≥10 years). “Severe” shoulder and knee pain were defined as ≥5 on an 8-point scale. BMI was self-reported.ResultsMean BMI was 26.59 kg/m2 +/−3.5 in 2012. Long-term occupational exposure to arm elevation and squatting predicted severe shoulder and knee pain after retirement. Obesity (BMI≥30 kg/m2) was a risk factor for severe shoulder pain (adjusted OR 1.28; 95% CI 1.03, 1.90). Overweight (adjusted OR 1.71; 1.28,2.29) and obesity (adjusted OR 3.21; 1.90,5.41) were risk factors for severe knee pain. In stratified models, associations between long-term squatting and severe knee pain varied by BMI.ConclusionObesity plays a role in relationships between occupational exposures and musculoskeletal pain. Further prospective studies should use BMI in analyses of musculoskeletal pain and occupational factors, and continue to clarify this relationship.

Excess non‐psychiatric hospitalizations among employees with mental disorders: a 10‐year prospective study of the GAZEL cohort

ObjectiveTo examine whether non-psychiatric hospitalizations rates were higher in those with mental disorders.MethodIn a cohort of 15 811 employees, aged 35–50 years in 1989, mental disorder status was defined from 1989 to 2000. Hospitalizations for all-causes, myocardial infarction (MI), stroke, and cancer, were recorded yearly from 2001 to 2011. Negative binomial regression models were used to estimate hospitalization rates over the follow-up.ResultsAfter controlling for baseline sociodemographic factors, health-related behaviors, self-rated health, and self-reported medical conditions, participants with a mental disorder had significantly higher rates of all-cause hospitalization [incidence rate ratio, IRR = 1.20 (95%, 1.14–1.26)], as well as hospitalization due to MI [IRR = 1.44 (95%, 1.12–1.85)]. For stroke, the IRR did not reach statistical significance [IRR = 1.37 (95%, 0.95–1.99)] and there was no association with cancer [IRR = 1.01 (95%, 0.86–1.19)]. A similar trend was observed when mental disorders groups were considered (no mental disorder, depressive disorder, mental disorders due to psychoactive substance use, other mental disorders, mixed mental disorders, and severe mental disorder).ConclusionIn this prospective cohort of employees with stable employment as well as universal access to healthcare, we found participants with mental disorders to have higher rates of non-psychiatric hospitalizations.

Mid-life occupational grade and quality of life following retirement: a 16-year follow-up of the French GAZEL study

Objectives: This article aims to contribute to the literature on life course influences upon quality of life by examining pathways linking social position in middle age to quality of life following retirement in French men and women.Method: Data are from the GAZEL cohort study of employees at the French national gas and electricity company. A finely grained measure of occupational grade in 1989 was obtained from company records. Annual self-completion questionnaires provided information on quality of life in 2005, measured with the CASP-19 scale, and on participants’ recent circumstances 2002–2005: mental health, physical functioning, wealth, social status, neighbourhood characteristics, social support and social participation. Path analysis using full information maximum likelihood estimation was performed on 11,293 retired participants.Results: Higher occupational grade in 1989 was associated, in a graded relationship, with better quality of life 16 years later. This association was accounted for by individuals’ more recent circumstances, particularly their social status, mental health, physical functioning and wealth.Conclusion: The graded relationship between occupational grade in mid-life and quality of life after labour market exit was largely accounted for by more recent socio-economic circumstances and state of health. The results support a pathway model for the development of social disparities in quality of life, in which earlier social position shapes individual circumstances in later life.

Occupational biomechanical exposure predicts low back pain in older age among men in the Gazel Cohort.

Occupational biomechanical exposures are considered as risk factors for low back pain in the working population. It has also been suggested that their effects persist after retirement. Our objectives were to assess the role of past biomechanical occupational exposure on low back pain in early old age among male participants of the Gazel Cohort. Low back pain for more than 30 days in the past 12 months (LBP30) was assessed in 1996 and 2006 using a French version of the Nordic questionnaire in a subsample of the Gazel Cohort. Logistic regression models were used to study associations between LBP30 in 2006 and past occupational biomechanical exposure, self-reported in 1996, taking into account personal and psychosocial work factors self-reported in 1996, and the date of retirement provided by the company. A multinomial model served to study persistent and new cases, according to LBP30 in 1996. We studied 1,520 men aged 58-67 in 2006, most of them retired. Low back pain for more than 30 days in the past 12 months reported in 2006 was related to occupational biomechanical exposure encountered many years earlier (OR 1.55, 95% CI 1.05-2.27 for 10-20 years of exposure to bending/twisting, OR 1.71, 95% CI 1.17-2.49 for >20 years). These associations appeared specific to low back pain for more than 30 days in the past 12 months which persisted between 1996 and 2006. These results suggest that occupational biomechanical exposure during active life has persistent effects among men in early old age, even for people who left the workforce. They point out the importance of preventive measures at work for better health later and appear relevant for policy-making decisions concerning age at retirement.

Supplemental Material for Hostility and the Risk of Peptic Ulcer in the GAZEL Cohort

Supplemental Material for Hostility and the Risk of Peptic Ulcer in the GAZEL Cohort

Bioresource from the French Gazel Cohort Study

The GAZEL Cohort Study set up in 1989 is a general-purpose epidemiologic cohort. At inception in 1989, the cohort included 20,625 volunteers then aged from 35-50 (women; n= 5,614) or 40-50 (men; n= 15,011). The data collected routinely come from different sources, mainly annual self-administered questionnaires, socioeconomic and health administrative data, health examinations, and causes of death. The epidemiologic database is maintained and stored by our group in our own facilities; the biobank is stored in the “Centre de ressources biologiques”, in Dijon, France. Today, more than 50 epidemiological projects on diversified themes have been set up in the GAZEL Cohort Study by some 30 French and foreign teams.