Physician-diagnosed Chronic Disease Research Articles

The Impact of Multimorbidity Patterns on Changes in Physical Activity and Physical Capacity Among Older Adults Participating in a Year-Long Exercise Intervention.

This study investigated the impact of multimorbidity patterns on physical activity and capacity outcomes over the course of a year-long exercise intervention, and on physical activity 1year later. Participants were 314 physically inactive community-dwelling men and women aged 70-85years, with no contraindications for exercise at baseline. Physical activity was self-reported. Physical capacity measurements included five-time chair-stand time, 6-minute walking distance, and maximal isometric knee-extension strength. The intervention included supervised and home-based strength, balance, and walking exercises. Multimorbidity patterns comprised physician-diagnosed chronic disease conditions as a predictor cluster and body mass index as a measure of obesity. Multimorbidity patterns explained 0%-12% of baseline variance and 0%-3% of the change in outcomes. The magnitude and direction of the impact of unique conditions varied by outcome, time point, and sex. Multimorbid older adults with no contraindications for exercise may benefit from multimodal physical training.

A Comparison Quality of Life of Children of Seasonal Agricultural Workers and Local Residents in Turkey

ABSTRACT Objectives Children of seasonal agricultural workers (SAW) live in the worst conditions of agricultural labor and, consequently, face many health risks. Therefore, it is essential to evaluate the quality of life (QoL) of these children. This study aimed to compare the QoL between children of SAW and local residents in semi-rural areas of Eskisehir, Turkey, and determine the factors affecting them. Methods In this cross-sectional study, we included children of SAW living in temporary camp areas and those of local residents visiting the Family Health Center close to the camp areas. Basic sociodemographic data collection forms and the Pediatric Quality of Life (PedsQL) scale were employed for data collection. Univariate and multivariate analyses were used to determine factors that had a significant effect on the QoL. Results We included 324 children of SAW and 256 local children. As per the multivariate analysis, QoL was lower in children aged between 8 and 12 years, with physician-diagnosed chronic diseases, and children of SAW. Also, there was no significant association between gender, parental education levels, family income, number of siblings, school attendance status, and QoL level. Conclusion The QoL of children of SAW families was significantly lower than their peer local children. Therefore, the appropriate authorities must prioritize the planning and implementation of health services for SAW families.

노년기 복합 만성질환 위험에 대한 신체활동과 하체 근력의 복합효과 분석

The purpose of this population-based study was to examine the relationships of multimorbidity with physical activity and lower body muscle strength in older adults aged 65 years and older who participated in the Korean Longitudinal Study of Aging in 2020. Multimorbidy was defined as having two or more physician-diagnosed chronic diseases. Physical activity in minutes per week was assessed with a self-reported questionnaire. Lower body muscle strength was assessed by performing 5 times sit-to-stand tests. Logistic regression analysis showed that individuals who did not meet the WHO recommendations for physical activity were at increased risk for multimorbidity (odds ratio, OR=1.207, p=0.044) compared with individuals without multimorbidity (OR=1). Individuals with weak lower body muscle strength were at increased risk for multimorbidity (OR=1.719, p0.001) compared with individuals with normal lower body muscle strength (OR=1). Finally, individuals who had the coexistence of insufficient physical activity and weak lower body muscle strength were at the highest risk for multimorbidity (OR=2.697, p0.001) compared with individuals with sufficient physical activity and normal lower body muscle strength (OR=1). The current findings of the study suggest that a lifestyle strategy targeting adequate amount of physical activity and normal lower body muscle strength is urgent for healthy aging.

Chronic disease clusters are associated with prolonged, bothersome, and multisite musculoskeletal pain: a population-based study on Northern Finns

Background Chronic diseases often accumulate with musculoskeletal (MSK) pain. However, less evidence is available on idiosyncratic patterns of chronic diseases and their relationships with the severity of MSK pain in general MSK pain populations. Material and methods Questionnaire-based data on physician-diagnosed chronic diseases, MSK pain and its dimensions (frequency, intensity, bothersomeness, and the number of pain sites), and confounders were collected from the Northern Finland Birth Cohort 1966 at the age of 46. Latent Class Analysis (LCA) was used to identify chronic disease clusters among individuals who reported any MSK pain within the previous year (n = 6105). The associations between chronic disease clusters, pain dimensions, and severe MSK pain, which was defined as prolonged (over 30 d within the preceding year), bothersome (Numerical Rating Scale >5), and multisite (two or more pain sites) pain, were analyzed using logistic regression and general linear regression models, adjusted for sex and educational level (n for the full sample = 4768). Results LCA resulted in three clusters: Metabolic (10.8% of the full sample), Psychiatric (2.9%), and Relatively Healthy (86.3%). Compared to the Relatively Healthy cluster, the Metabolic and Psychiatric clusters had higher odds for daily pain and higher mean pain intensity, bothersomeness, and the number of pain sites. Similarly, the odds for severe MSK pain were up to 75% (95% confidence interval: 44%–113%) and 155% (81%–259%) higher in the Metabolic and Psychiatric clusters, respectively, after adjustments for sex and educational level. Conclusions Distinct patterns of chronic disease accumulation can be identified in the general MSK pain population. It seems that mental and metabolic health are at interplay with severe MSK pain. These findings suggest a potential need to screen for psychiatric and metabolic entities of health when treating working-aged people with MSK pain. Key messages This large study on middle-aged people with musculoskeletal pain aimed to examine the idiosyncratic patterns of chronic diseases and their relationships with the severity of musculoskeletal pain. Latent class cluster analysis identified three chronic disease clusters: Psychiatric, Metabolic, and Relatively Healthy. People with accumulated mental (Psychiatric cluster) or metabolic diseases (Metabolic cluster) experienced more severe pain than people who were relatively healthy (Relatively Healthy cluster). These findings suggest a potential need to screen for psychiatric and metabolic entities of health when treating working-aged people with MSK pain.

Chronic Disease in China: Geographic and Socioeconomic Determinants Among Persons Aged 60 and Older.

This study aimed to reveal the epidemic characteristics of chronic diseases among the Chinese older population and provide empirical strategies for the prevention and management of chronic diseases in the seniors in China. A national cross-sectional study. A total of 224,640 Chinese residents aged 60 and older were invited, and 222,179 (98.9%) participated in our survey. Standardized questionnaires were used to collect socioeconomic information and self-reported physician-diagnosed chronic diseases. The associations between individual socioeconomic status and chronic diseases were estimated using generalized linear mixed-effects models. The national prevalence of any chronic diseases was 81.1% (95% CI 80.9-81.2), representing 179.9 million Chinese older adults. The prevalence increased with aging and peaked at 80 to 84years old (87.2, 95% CI 86.7-87.7), this is consistent with studies in developing countries. Women (84.2, 84.0-84.4), rural residents (82.6, 82.4-82.8), and ethnic minorities (82.2, 81.5-82.8) had a higher prevalence than men (77.7, 77.4-77.9), urban residents (79.7, 79.5-79.9), and people of Han ethnicity (81.0, 80.8-81.2), respectively. For provincial prevalence, Tibet had the highest prevalence of chronic diseases (91.8, 91.5-92.0), and Fujian had the lowest (72.7, 72.5-72.9). The absolute differences between the highest and lowest provinces for the specific chronic condition ranged from 2.78% for cancer to 36.3% for cardiovascular diseases. Chronic diseases were highly prevalent among older adults in China and varied geographically. Advanced socioeconomic status appeared to have double-edged impacts on the prevalence of chronic diseases. Our findings support that reducing gender and geographic disparities should be prioritized in China's chronic disease prevention and management, and an affordable long-term care services system for older adults should be established urgently in China.

Environmentally related gender health risks: findings from citizen science cross-sectional study

BackgroundPublic engagement in the research of environmental epidemiological problems is becoming an important measure to empower citizens to identify the local environmental and health problems and to explain different environmental exposures affect estimates for males and females. This HORIZON2020 CitieS-Health Kaunas Pilot study examines the relationship between urban built and social environment, health behaviors, and health in men and women.MethodsThis cross-sectional study included 1086 18–74-year-old participants residing in 11 districts of Kaunas city, Lithuania. Using GIS, we measured traffic flow, noise, NO2, PM2.5, PM10, and greenness NDVI for the participants’ home addresses, determined participants’ perceptions of environmental quality, linked this information with personal sociodemographic data, and used multivariate logistic regression to assess the associations with health issues (physician-diagnosed chronic disease and self-rated general health) in men and women.ResultsMen and women similar rated the quality of the neighborhood environment, except for air pollution and satisfaction with the public transport in the district. The traffic-related health associations were stronger for women than for men. The prevalence of poor health increased with the increasing age of men and women, yet no significant differences between gender health risks were found in the total sample. Perceived air pollution, irregular visits to green space, and chronic diseases were consistently associated with poor health risks in men and women, yet part-time jobs and low income had a higher impact on women’s poor health.ConclusionsQuality of the built neighborhood, air pollution, irregular visits to the green space, and chronic disease had a joint effect on the magnitude of the prevalence of poor health in men and women. Our results suggest that decreasing air pollution and improving the urban built neighborhood supporting citizens’ physical activity in green spaces, might reduce health risks for all.

The medium-term consequences of a COVID-19 lockdown on lifestyle among Spanish older people with hypertension, pulmonary disease, cardiovascular disease, musculoskeletal disease, depression, and cancer.

This study investigated the associations of chronic diseases with changes in lifestyle and health behaviours in older people following the coronavirus disease 2019 (COVID-19) lockdown in Spain and compared the differences in changes over time. 1,092 participants (80.3±5.6 years; 66.5% female) from 2 Spanish cohorts were included. Telephone-based questionnaires were conducted to evaluate lifestyle and health risk behaviours at the end of lockdown and 7 months post-lockdown. Participants were classified as having physician-diagnosed chronic diseases based on self-reported data. Cox proportional models adjusted for major confounders were used. Compared to those without the corresponding chronic diseases, older people with hypertension were less likely to report increased alcohol consumption (hazard ratio [HR], 0.73; 95% confidence interval [CI], 0.55 to 0.99). Pulmonary diseases were associated with lower risks of increased sedentary time (HR, 0.58; 95% CI, 0.39 to 0.86) and worsened sleep quality (HR, 0.56; 95% CI, 0.36 to 0.87), while cardiovascular diseases were associated with a lower risk of decreased sedentary time (HR, 0.58; 95% CI, 0.38 to 0.88). Depression was linked to a higher likelihood of improved diet quality (HR, 1.53; 95% CI, 1.00 to 2.36). Cancer pacients were less likely to have worsened sleep quality (HR, 0.44; 95% CI, 0.22 to 0.89) but more likely to have reduced their frequency of social contact (HR, 2.05; 95% CI, 1.05 to 3.99). Older people with chronic diseases showed beneficial changes in lifestyle and health risk behaviours after the COVID-19 lockdown. In particular, older people with hypertension, pulmonary disease, and cancer tended to make beneficial lifestyle and health behaviour changes. However, older people with cardiovascular disease and depression engaged in more health risk behaviours.

Testing Black-White Disparities in Biological Aging Among Older Adults in the United States: Analysis of DNA-Methylation and Blood-Chemistry Methods.

Biological aging is a proposed mechanism through which social determinants drive health disparities. We conducted proof-of-concept testing of 8 DNA-methylation (DNAm) and blood-chemistry quantifications of biological aging as mediators of disparities in healthspan between Black and White participants in the 2016 wave of the Health and Retirement Study (n = 9,005). We quantified biological aging from 4 DNAm "clocks" (Horvath, Hannum, PhenoAge, and GrimAge clock), a DNAm pace-of-aging measure (DunedinPoAm), and 3 blood-chemistry measures (PhenoAge, Klemera-Doubal method biological age, and homeostatic dysregulation). We quantified Black-White disparities in healthspan from cross-sectional and longitudinal data on physical performance tests, self-reported limitations in activities of daily living, and physician-diagnosed chronic diseases, self-rated health, and survival. DNAm and blood-chemistry quantifications of biological aging were moderately correlated (Pearson's r = 0.1-0.4). The GrimAge clock, DunedinPoAm, and all 3 blood-chemistry measures were associated with healthspan characteristics (e.g., mortality effect-size hazard ratios were 1.71-2.32 per standard deviation of biological aging) and showed evidence of more advanced/faster biological aging in Black participants than in White participants (Cohen's d = 0.4-0.5). These measures accounted for 13%-95% of Black-White differences in healthspan-related characteristics. Findings suggest that reducing disparities in biological aging can contribute to building health equity.

A study of job stress, suicidal ideation and suicide attempts in display manufacturing workers: a cross-sectional study.

BackgroundThis study aimed to investigate the association between job stress and suicide ideation/attempts among display manufacturing workers.MethodsData were collected from 836 workers in a display manufacturing company who participated in health screenings from May 22 to June 16, 2017. The data included general characteristics, night work, job tenure, previous physician-diagnosed chronic diseases, suicidal ideation/suicide attempts, and job stress. We investigated suicidal ideation/suicide attempts that covered the past year by using a self-reported questionnaire. Job stress was measured using the 43-item Korean Occupational Stress Scale. Multiple logistic regression analysis was used to investigate the association between job stress and suicidal ideation/suicide attempts. The mediator effect of depression on suicidal ideation/suicide attempts was tested using a series of logistic regression by applying Baron and Kenny's mediation method.ResultsIn the model adjusting for variables (e.g., age, body mass index, smoking, alcohol consumption, regular exercise, shift work, job tenure, chronic disease and depression), physical environment (OR: 3.60, 95% CI: 1.08–12.02), lack of reward (OR: 5.31, 95% CI: 1.54–18.34), and occupation climate (OR: 7.36, 95% CI: 2.28–23.72) were correlated with suicidal ideation/suicide attempts in women. However, all subscales of job stress were not significantly correlated with suicidal ideation/suicide attempts in men. In mediation analysis, job instability and occupational climate were correlated with suicidal ideation/suicide attempts and were mediated by depression in men workers.ConclusionsIn women workers, the experiences of suicidal ideation/suicide attempts were significantly correlated with the physical environment, lack of reward, and occupational climate that were subscales of job stress. In men workers, depression rather than job stress was correlated with experiences of suicidal ideation/suicide attempts.

The difference in risk of chronic pulmonary disease morbidity and mortality between former elite athletes and ordinary men in Finland

The impact of a history of competitive sports on later smoking behaviour and occurrence of chronic pulmonary diseases is poorly known. We investigated how a history of elite level sports predicted later pulmonary disease morbidity and mortality. Chronic pulmonary disease incidence was assessed from national hospital and cause-of-death registers from 1970 to 2015 among Finnish male former elite athletes (n = 2078) and matched controls (n = 1453) alive in 1970 (mean age 45.0 years). Hazard ratios (HRs) were calculated by Cox proportional hazards model. In 1985, cohort members reported on their smoking habits, engagement in physical activity/sports and physician-diagnosed chronic diseases. The risk of any chronic pulmonary disease or death was lower among former athletes than controls (age-adjusted HR 0.61; 95% CI 0.46–0.83). The risk was significantly lower among endurance (HR 0.54), mixed (HR 0.61), and power sports athletes (HR 0.66) compared to controls. The age- and smoking pack-year-adjusted HRs of incident diseases from the time of the 1985 questionnaire until the end of follow-up in former athletes was 0.58 (95% CI 0.37–0.93) compared to controls. In 1985 athletes smoked less and their cumulative smoking quantity was lower than that of controls. Former athletes were more physically active and self-reported less physician-diagnosed emphysema. The risk of any chronic pulmonary disease was lower among former athletes than controls even after considering smoking status and cumulative smoking quantity. Ability to compete at the highest level of sports in young adulthood associated with a reduced risk of pulmonary disease in later life.

Prevalences and trends of chronic diseases in Shaanxi Province, China: Evidence from representative cross-sectional surveys in 2003, 2008 and 2013.

ObjectivesNon-communicable diseases, which can refer to chronic diseases that are not caused by infectious agents and can endure for a long time, are currently regarded as a critical public health problem in China. This study aimed to estimate the prevalences of self-reported physician-diagnosed chronic diseases among urban and rural populations aged 15 years and older in Shaanxi Province, China, during 2003−2013 and explore how these changes differ by subpopulation.MethodsThree independent cross-sectional surveys were implemented in 2003, 2008 and 2013 in Shaanxi Province. A multistage stratified cluster random sampling method was used in each wave to collect representative samples. In total, 10,568 residents in 2003, 15,453 in 2008 and 48,808 in 2013 were included in this analysis. Information on self-reported physician-diagnosed chronic diseases was collected using face-to-face interviews in each survey. Multilevel Poisson regression with robust error variance was employed to calculate the adjusted prevalence ratios to estimate the relative change in chronic conditions in 2008 and 2013, compared to that in 2003.ResultsIn 2013, 23.9%/22.1% of urban/rural residents, respectively, reported having at least one chronic condition, which represents an increase from 17.0%/15.1%, respectively, in 2008 and 12.8%/10.9%, respectively, in 2003. Adjusted for socio-demographic characteristics, the prevalence of chronic diseases was significantly higher in 2013 than that in 2003. Among the chronic diseases studied, the prevalence of hypertension and diabetes has increased dramatically over a decade. The increase in chronic diseases occurred mainly among the middle-aged and elderly.ConclusionsChronic diseases are highly prevalent and continuously increasing in the adult population in Shaanxi Province from 2003 to 2013. Given its large aging population, China may face a greater chronic disease burden. A national chronic disease surveillance system and screening program should be established to acquire comprehensive information regarding the distribution and trends of chronic diseases.

Assessment of health-promoting lifestyle behaviors of adults living in the semi-rural area.

OBJECTIVE:The aim of the present study was to determine the level of healthy lifestyle behaviors and related factors in the individuals who applied to the primary health-care center.METHODS:The study is a cross-sectional study of adults aged 18 years and over who applied to the primary health-care center. The sample size of the study was calculated as 992 people and 995 participants were accessible. The health-promoting behaviors of the individuals were assessed by the Health-Promoting Lifestyle Profile II (HPLP-II). In the analysis of the data, Mann–Whitney U-test, Kruskal–Wallis tests, and multiple linear regression analysis were used to determine effective variables on scale score.RESULTS:The mean age of the participants was 43.8±17.1. Of the total participants, 45.7% (n=455) of them were female. The median score obtained from the HPLP-II was 132. Health responsibility, nutrition, and interpersonal relations subscale scores of male were lower than female patients, while physical activity subscale scores were higher in male patients. In participants under the age of 48 years in the study, health responsibility, nutrition, interpersonal relations, and stress management subscale scores were higher. The scores of the married participants were higher than the areas out of the stress management subdimension. Stress management subscale scores were higher in individuals with primary and lower education levels in terms of health care, nutrition, and interpersonal relations. Those who had good family income status and health perception scores also received higher scores in terms of all subscale scores.CONCLUSION:Gender, age group, marital status, education level, income level, physician-diagnosed chronic disease history, and perceived health status were found to be related to health-promoting behaviors. Educational programs should be prepared in these issues by determining the issues that individuals are lacking in protecting and developing their health and social needs should be taken into consideration when these programs are being prepared.

Urban–rural disparity in utilization of preventive care services in China

Preventive care service is considered pivotal on the background of demographic ageing and a rise in chronic diseases in China. The disparity in utilization of preventive care services between urban and rural in China is a serious issue. In this paper, we explored factors associated with urban–rural disparity in utilization of preventive care services in China, and determined how much of the urban–rural disparity was attributable to each determinant of utilization in preventive care services. Using representative sample data from China Health and Nutrition Survey in 2011 (N = 12,976), the present study performed multilevel logistic model to examine the factors that affected utilization of preventive care services in last 4 weeks. Blinder–Oaxaca decomposition method was applied to divide the utilization of preventive care disparity between urban and rural residents into a part that can be explained by differences in observed covariates and unobserved part. The percentage of rural residents utilizing preventive care service in last 4 weeks was lower than that of urban residents (5.1% vs 9.3%). Female, the aged, residents with higher education level and household income, residents reporting self-perceived illness in last 4 weeks and physician-diagnosed chronic disease had higher likelihood of utilizing preventive care services. Household income was the most important factor accounting for 26.6% of urban–rural disparities in utilization of preventive care services, followed by education (21.5%), self-perceived illness in last 4 weeks (7.8%), hypertension (4.4%), diabetes (3.3%), other chronic diseases (0.8%), and health insurance (−1.0%). Efforts to reduce financial barriers for low-income individuals who cannot afford preventive services, increasing awareness of the importance of obtaining preventive health services and providing more preventive health services covered by health insurance, may help to reduce the gap of preventive care services utilization between urban and rural.

Health literacy as a moderator of health-related quality of life responses to chronic disease among Chinese rural women.

BackgroundChronic disease is the leading global health threat and impairs patients’ health-related quality of life (HRQoL). Low health literacy is linked with chronic diseases prevalence and poor HRQoL. However, the interaction of health literacy with chronic disease on HRQoL remains unknown. Therefore, we examined how health literacy might modify the association between chronic disease and their HRQoL impacts.MethodsWe conducted a health survey of 913 poor rural women aged 23–57 years in Northwestern China. We assessed health literacy and HRQol using the revised Chinese Adult Health Literacy Questionnaire (R-CAHLQ) and Euroqol-5D (EQ-5D), respectively. Low health literacy was indicated by a cut-off of less than the mean of the factor score. Self-reported preexisting physician-diagnosed chronic disease and socio-demographic characteristics were also included. We fitted log-binomial regression models for each dimension of EQ-5D to examine its association with health literacy and chronic disease. We also ran linear regression models for EQ VAS scores and utility scores.ResultsThe low health literacy group was 1.33 times more likely to have a chronic disease than the high health literacy group. Pain/discomfort was the most prevalent impairment, and was more common in the low health literacy group (PR [prevalence ratio] = 1.23; 95% CI = 1.01, 1.50). Chronic disease strongly predicted impairments in all the EQ-5D dimensions, with PRs ranging from 2.14 to 4.07. The association between chronic disease and pain/discomfort varied by health literacy level (health literacy × chronic disease: P = 0.033), and was less pronounced in the low health literacy group (PR = 2.15; 95% CI = 1.76, 2.64) than in the high health literacy group (PR = 3.19; 95% CI = 2.52, 4.05). The low health literacy group had lower VAS scores and utility scores, and slightly less decrement of VAS scores and utility scores associated with chronic disease.ConclusionsHealth literacy modified the impacts of chronic disease on HRQoL, and low health literacy group reported less HRQoL impacts related to chronic disease. Research should address health literacy issues as well as root causes of health disparities for vulnerable populations.

Assessment of physical health status and quality of life among Saudi older adults.

[Purpose] This study investigated physical health status and quality of life among older Saudi adults. [Subjects and Methods] Participants included older adults (N = 55) aged 60–90 years (mean = 67.9± 7.71) from a major hospital in Jeddah. Subjects completed surveys and evaluations including assessments of personal and socio-demographic characteristics, caregiver presence, personal habits, perceived health, primary physical and psychological complaints, physician-diagnosed chronic diseases, and functional capacity (i.e., activities of daily living). [Results] Results showed a significant positive correlation between age and ADL; age and memory problems, anxiety, and loneliness; and sleep disturbance and falls. Main factors contributing to quality of life decline were chronic disease, falls, sedentary lifestyle, sleep disturbances, and financial concerns. Participants with diabetes mellitus (58.18%) and hypertension (29.0%) had a very high fall rate. Participants engaged in minimal physical activity (63%), often due to bone and joint pain (90.0%), and led sedentary lives (69%). Single sensory impairments were significantly and independently linked to high depression risk and decreased self-sufficiency. [Conclusion] Healthy lifestyle and behavioral changes should be promoted through community-based health education programs for older Saudi adults. Chronic disease screening programs for the elderly population (especially diabetes and hypertension) are recommended.

Association between self-rated health and mortality: 10 years follow-up to the Pró-Saúde cohort study.

BackgroundThe association between self-rated health (SRH) and mortality is well documented in the literature, but studies on the subject among young adults in Latin America are rare, as are those evaluating this association using repeated SRH measures, beyond the baseline measurement. This study aims to evaluate the association between SRH evaluated at three data collection stages and mortality.MethodsCox regression models were used to examine the association between SRH (Very good, Good, Fair/Poor) varying over time and mortality, over a 10 year period, in a cohort of non-faculty civil servants at a public university in Rio de Janeiro, Brazil (Pró-Saúde Study, n = 4009, men = 44.4%).ResultsAbout 40% of the population changed their self-rating over the course of follow-up. After adjustment for self-reported physician-diagnosed chronic diseases and other covariates, men who reported “Fair/Poor” SRH showed relative hazard of death of 2.13 (CI95% 1.03-4.40) and women, 3.43 (CI95% 1.23-9.59), as compared with those who reported “Very good” SRH.ConclusionsIn a population of young adults, our findings reinforce the role of SRH as a predictor of mortality, even controlling for objective measures of health.

Is There a Hispanic Epidemiologic Paradox in Later Life? A Closer Look at Chronic Morbidity

This study examined the morbidity patterns of foreign-born Hispanics, U.S.-born Hispanics, Blacks, and Whites aged 53 years and older using seven self-reported physician-diagnosed chronic diseases as well as six biomarkers. Drawing on the 2006 Health and Retirement Study and its biomarker data, the authors found that foreign-born Hispanics had comparable or lower rates of high blood pressure, heart disease, cancer, arthritis, chronic lung disease, and stroke, controlling for age and gender. The health advantages were robust when socioeconomic conditions and health behaviors were controlled. Foreign-born Hispanics were not significantly different from U.S.-born Hispanics except for a lower risk for arthritis. In terms of biomarkers, foreign-born Hispanics were not statistically different from Whites except for having higher risks of high systolic blood pressure and blood glucose. Future research should explore multiple factors contributing to the lower rates of major chronic diseases among older Hispanics who have faced social disadvantages over the life course.

Low cognitive ability in early adulthood is associated with reduced lung function in middle age: the Vietnam Experience Study

ObjectiveReduced lung function has been linked to poorer cognitive ability later in life. In the present study, the authors examined the converse: whether there was a prospective association between cognitive...

Association Between Unmet Needs for Medication Support and All‐Cause Hospitalization in Community‐Dwelling Disabled Elderly People

To clarify the association between unmet medication management need and 3-year mortality and hospitalization for community-dwelling older people with various levels of disabilities. Prospective cohort study (the Nagoya Longitudinal Study for Frail Elderly). Community-based. One thousand seven hundred seventy-two community-dwelling elderly subjects (611 men, 1,161 women). Data included the clients' demographic characteristics, a rating for basic and instrumental activities of daily living (ADLs), number of prescribed medications and physician-diagnosed chronic diseases, medication adherence, ability to manage medication, and presence or absence of medication assistance. Cox proportional hazard models and the Kaplan-Meier method were used to assess the association between the medication management at baseline and mortality or hospitalization during a 3-year period. Of 1,772 participants, 681 reported no difficulty with self-medication management, and 1,091 experienced difficulty with self-medication. Of participants with difficulty with self-medication management, 929 had medication assistance, and 162 did not. During a 3-year follow up, 424 participants died, and 758 were admitted to hospitals. The baseline data demonstrated that participants not receiving medication assistance were younger and had better ADL status and fewer comorbidities. Multivariate Cox regression models adjusting for potential confounders showed that the lack of assistance in those who needed medication assistance was associated with hospitalization but not mortality during the study period. In community-dwelling disabled elderly people, lack of medication assistance in those needing medication support was associated with higher risk of hospitalization.

Day Care Service Use Is Associated with Lower Mortality in Community‐Dwelling Frail Older People

To clarify the association between day care service use and 21-month mortality in community-dwelling frail older people. Prospective cohort study (the Nagoya Longitudinal Study for Frail Elderly). Community-based. One thousand six hundred seventy-three community-dwelling older people (540 men, 1,133 women). Data included the clients' demographic characteristics; depression as assessed using the short version of the Geriatric Depression Scale; a rating for basic activities of daily living (ADLs); comorbidity; number of prescribed medications and physician-diagnosed chronic diseases; use of home-care services, including day care, visiting nurse, and home-help services; and number of regular medical checkups. Survival analysis of 21-month mortality was conducted using Kaplan-Meier curves and multivariate Cox proportional hazards models. Of the 1,673 participants, 726 were day care service users at baseline, and 268 (94 day care service users, 174 nonusers) died during the 21-month follow-up. Multivariate Cox regression models adjusting for potential confounders showed that day care service use was associated with reduction in mortality. Subgroup analysis demonstrated that day care service use was associated with less risk of mortality in subjects who were female; were in the youngest age group (65-74); had higher ADL scores, lower comorbidity, depression, no dementia; and used a visiting nurse service. Participants using day care service two and three times or more a week had 63% or 44% lower relative hazard ratios, respectively, than participants not using the service. Among community-dwelling frail older people, day care service use two or more times per week was associated with 44% to 63% lower 21-month mortality.