Person-level Risk Factors Research Articles

Risk factors for burn contractures: A cross-sectional study in a lower income country

Risk factors for burn contractures require further study, especially in low and middle-income countries (LMICs); existing research has been predominantly conducted in high income countries (HICs). This study aimed to identify risk factors for burn contractures of major joints in a low-income setting. Potential risk factors (n = 104) for burn contracture were identified from the literature and a survey of clinicians with extensive experience in low and middle-income countries (LMIC). An observational cross-sectional study of adult burn survivors was undertaken in Bangladesh to evaluate as many of these risk factors as were feasible against contracture presence and severity. Forty-eight potential risk factors were examined in 48 adult patients with 126 major joints at risk (median 3 per participant) at a median of 2.5 years after burn injury. Contractures were present in 77% of participants and 52% of joints overall. Contracture severity was determined by measurement of loss of movement at all joints at risk. Person level risk factors were defined as those that were common to all joints at risk for the participant and only documented once, whilst joint level risk factors were documented for each of the participant’s included joints at risk. Person level risk factors which were significantly correlated with loss of range of movement (ROM) included employment status, full thickness burns, refusal of skin graft, discharged against medical advice, low frequency of follow up and lack of awareness of contracture development. Significant joint level risk factors for loss of ROM included anatomical location, non-grafted burns, and lack of pressure therapy. This study has examined the largest number of potential contracture risk factors in an LMIC setting to date. A key finding was that risk factors for contracture in low-income settings may differ substantially from those seen in high income countries, which has implications for effective prevention strategies in these countries. Better whole person and joint outcome measures are required for accurate determination of risk factors for burn contracture. Recommendations for planning and reporting on future contracture risk factor studies are made.

Risk factors for tooth loss in adult Japanese dental patients: 8020 Promotion Foundation Study.

The assessment of the risk of tooth loss in patients visiting a dental clinic is important for managing their oral health. In the present study, we examined the risk factors for tooth loss among dental patients. Data from the 8020 Promotion Foundation Study on the Health Promotion Effects of Dental Care were used in the present study. The study involved 2743 patients who visited a dental clinic in Japan and completed a questionnaire and oral health examination at baseline and at the 2-year follow up. Tooth- and person-level risk factors for tooth loss during 2 years were subjected to a multilevel multivariate logistic regression analysis. In both the person- and tooth-level analyses, age, smoking habit, reason for dental visit, economic status, number of remaining teeth, and periodontal status were significantly associated with tooth loss. In the tooth-level analysis, tooth type, tooth status, and periodontal status were significantly related to tooth loss. Persons who visited a dental clinic for periodic maintenance had a significantly lower risk of tooth loss than those who visited only to receive dental treatment. Various tooth-level factors and modifiable factors, such as smoking cessation and periodic maintenance, are important for the suppression of tooth loss in dental patients.

Epidemiology of osteoarthritis: literature update.

The purpose of this review is to highlight recent studies of osteoarthritis epidemiology, including research on prevalence, disease impact, and potential risk factors. Osteoarthritis is highly prevalent in the United States and around the globe. It is a leading cause of disability and can negatively impact people's physical and mental well being. Healthcare resources and costs associated with managing the disease can be substantial. There is increasing evidence that there are different osteoarthritis phenotypes that reflect different mechanisms of the disease. Various person-level risk factors are recognized, including sociodemographic characteristics (e.g. female sex, African-American race), genetic predispositions, obesity, diet-related factors, and high bone density/mass. Joint-level risk factors include specific bone/joint shapes, thigh flexor muscle weakness, joint malalignment, participation in certain occupational/sports activities, and joint injury. Recent studies have enhanced our understanding of preradiographic lesions associated with osteoarthritis. Application of these new findings may allow us to develop innovative strategies and novel therapies with the purpose of preventing new disease onset and minimizing disease progression.

Limb- and Person-Level Risk Factors for Lower-Limb Amputation in the Prospective Seattle Diabetic Foot Study.

Diabetes is the leading cause of nontraumatic lower-limb amputations in the U.S., but no research has prospectively examined associations between limb-specific measurements and amputation risk among patients without foot ulcer. We investigated amputation risk by limb in relation to the same limb- and person-level factors. We conducted a 22-year prospective study among 1,461 male patients with diabetes without foot ulcer (mean age 62.4 years), with 2,893 lower limbs among subjects recruited between 1990 and 2002 from one Department of Veterans Affairs general internal medicine clinic. The following information was collected: demographic, lifestyle, and diabetes characteristics; visual acuity; kidney function (estimated glomerular filtration rate [eGFR]); and lower-limb measurements including presence of Charcot deformity, sensory neuropathy by 10-g monofilament, dorsal foot transcutaneous oximetry (TcPO2) at 44°C, and ankle-brachial index (ABI). Over 25,735 limb-years, 136 amputations occurred. A multivariable Cox model identified multiple independent risk factors: sensory neuropathy (hazard ratio 3.09 [95% CI 2.02-4.74]), ABI ≤0.5 vs. >0.9 to <1.3 (3.98 [2.31-6.85]), ABI ≥1.3 vs. >0.9 to <1.3 (2.20 [1.18-4.09]), 1-SD decrease in eGFR (1.18 [1.00-1.38]), poor vision (1.70 [1.05-2.73]), body weight in 21.4-kg increments (0.78 [0.61-0.98]), and age >70 years vs. <57 years (0.13 [0.04-0.38]). Although TcPO2 was not significantly associated with amputation overall, TcPO2 <26 mmHg significantly predicted a higher risk in the ABI ≥1.3 category. Arterial disease and neuropathy emerged as the only limb-specific risk factors for amputation, but these and several person-level factors may be amenable to prevention or treatment interventions to potentially reduce diabetic amputation risk.

A daily process examination of episode-specific drinking to cope motivation among college students

ObjectiveTheory suggests that state- and trait-like factors should interact in predicting drinking to cope (DTC) motivation, yet no research to date has demonstrated this at the drinking episode level of analysis. Thus, we examined whether daily variation in positive and negative affect and avoidance and active coping were associated with DTC motivation during discrete drinking episodes and whether these associations were moderated by tension-reduction expectancies and other person-level risk factors. MethodsUsing a secure website, 722 college student drinkers completed a one-time survey regarding their tension reduction expectancies and then reported daily for 30days on their affect, coping strategies, drinking behaviors and motives for drinking. ResultsIndividuals reported higher levels of DTC motivation on days when negative affect and avoidance coping were high and positive affect was low. We found only little support for the predicted interactive effects among the day- and person-level predictors. ConclusionOur results support the state and trait conceptualizations of DTC motivation and provide evidence for the antecedent roles of proximal levels of daily affect and avoidance coping. Our inconsistent results for interaction effects including day-level antecedents raise the possibility that some of these synergistic processes might not generalize across level of analysis.

Diet-Intestinal Microbiota Axis in Osteoarthritis: A Possible Role.

Intestinal microbiota is highly involved in host physiology and pathology through activity of the microbiome and its metabolic products. Osteoarthritis (OA) is a common form of arthritis characterized by articular cartilage destruction and osteophyte formation. Although various person-level risk factors, such as age, sex, and obesity, have been proposed for the pathogenesis of OA, the underlying links between these person-level factors and OA are still enigmatic. Based on the current understanding in the crosstalk between intestinal microbiota and these risk factors, intestinal microbiota could be considered as a major hidden risk factor that provides a unifying mechanism to explain the involvement of these person-level risk factors in OA.

State of the evidence.

This review focuses on recent studies of osteoarthritis epidemiology, including research on prevalence, incidence, and a broad array of potential risk factors at the person level and joint level. Studies continue to illustrate the high impact of osteoarthritis worldwide, with increasing incidence. Person-level risk factors with strong evidence regarding osteoarthritis incidence and/or progression include age, sex, socioeconomic status, family history, and obesity. Joint-level risk factors with strong evidence for incident osteoarthritis risk include injury and occupational joint loading; the associations of injury and joint alignment with osteoarthritis progression are compelling. Moderate levels of physical activity have not been linked to increased osteoarthritis risk. Some topics of high recent interest or emerging evidence for association with osteoarthritis include metabolic pathways, vitamins, joint shape, bone density, limb length inequality, muscle strength and mass, and early structural damage. Osteoarthritis is a complex, multifactorial disease, and there is still much to learn regarding mechanisms underlying incidence and progression. However, there are several known modifiable and preventable risk factors, including obesity and joint injury; efforts to mitigate these risks can help to lessen the impact of osteoarthritis.

Patterns of joint involvement in foot osteoarthritis: findings from the clinical assessment study of the foot

Patterns of joint involvement in foot osteoarthritis: findings from the clinical assessment study of the foot

Osteoarthritis: What Does Imaging Tell Us about Its Etiology?

Osteoarthritis (OA) is the most common joint disorder and a leading cause of disability. Due to an aging population and increasing obesity, the incidence of OA is rising. The etiology of OA is multifactorial and complex; thus prevention of OA remains challenging. Risk factors can be divided into person-level factors such as age, sex, obesity, genetics, race/ethnicity, and diet, and joint-level factors including injury, malalignment, and abnormal loading of the joints. This review provides a brief overview of the person-level risk factors and a more in-depth analysis of those at the joint level. It is only through an improved understanding of risk factors for the disease that we may be able to intervene meaningfully and prevent its occurrence.

Neighborhood Socioeconomic Deprivation and Mortality: NIH-AARP Diet and Health Study

PurposeResiding in deprived areas may increase risk of mortality beyond that explained by a person's own SES-related factors and lifestyle. The aim of this study was to examine the relation between neighborhood socioeconomic deprivation and all-cause, cancer- and cardiovascular disease (CVD)-specific mortality for men and women after accounting for education and other important person-level risk factors.MethodsIn the longitudinal NIH-AARP Study, we analyzed data from healthy participants, ages 50–71 years at study baseline (1995–1996). Deaths (n = 33831) were identified through December 2005. Information on census tracts was obtained from the 2000 US Census. Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for quintiles of neighborhood deprivation.ResultsParticipants in the highest quintile of deprivation had elevated risks for overall mortality (HRmen = 1.17, 95% CI: 1.10, 1.24; HRwomen = 1.13, 95% CI: 1.05, 1.22) and marginally increased risk for cancer deaths (HRmen = 1.09, 95% CI: 1.00, 1.20; HRwomen = 1.09, 95% CI: 0.99, 1.22). CVD mortality associations appeared stronger in men (HR = 1.33, 95% CI: 1.19, 1.49) than women (HR = 1.18, 95% CI: 1.01, 1.38). There was no evidence of an effect modification by education.ConclusionHigher neighborhood deprivation was associated with modest increases in all-cause, cancer- and CVD-mortality after accounting for many established risk factors.

Abstract A46: Neighborhood socioeconomic deprivation and all-cause, cancer-, and CVD-specific mortality: NIH-AARP Study

Abstract Background: The impact of person-level socioeconomic status (SES) on mortality is well documented. However, residing in deprived areas may increase the risk of mortality beyond that explained by a person's own SES-related factors and lifestyle. As few studies possess both person-level and area-level data, the interaction between these measures, though potentially of significant importance, is poorly understood. The large longitudinal NIH-AARP Study provides a rich resource to personal characteristics and health risk factors and is linked to census tract data which details the composition and socioeconomic context of each participant's local environment. The purpose of the present study was to examine the relation between neighborhood socioeconomic deprivation and all-cause, cancer-and cardiovascular disease (CVD)-specific mortality for men and women after accounting for education and other important person-level risk factors. Design, Setting, and Participants: In the longitudinal National Institutes of Health (NIH)-AARP (formerly known as the American Association of Retired Persons) Diet and Health Study, we analyzed data from healthy participants, ages 50-71 years at baseline. Deaths (n=33831) were identified through linkage to Social Security Administration Death Master File and National Death Index from recruitment (1995-1996) to December 31,2005. Information on census tracts was obtained from the 2000 US Census. A multilevel analysis approach was employed; marginal and random effects (frailty) models for Cox proportional hazards regression, which account for correlation of individuals residing within the same census track, estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for quintiles of neighborhood deprivation. Multivariable models were adjusted for person-level risk factors, including age, education, smoking, physical activity, body mass index, and diet. Results: During a median follow-up of 9.5 years, 21843 men and 11988 women died. Participants residing in the highest vs. lowest quintile of the deprivation index had elevated risks for overall mortality (HRmen=1.17,95% CI=1.10-1.24; HRwomen=1.13,95% CI=1.05-1.22) and marginally increased risk for cancer mortality (HRmen=1.09,95% CI=1.00-1.20; HRwomen=1.09,95% CI=0.99-1.22). Regarding CVD mortality, associations appeared stronger in men (HR=1.33,95% CI=1.19-1.49) than women (HR=1.18,95% CI=1.01-1.38). There was no evidence of an effect modification by education. Conclusion: Higher neighborhood socioeconomic deprivation was associated with modest increases in all-cause mortality, cancer mortality, and cardiovascular disease mortality in both men and women even after accounting for a large number of established risk factors. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A46.