Population-based Longitudinal Cohort Study Research Articles

Trends in incidence of recorded diagnosis of osteoporosis, osteopenia, and fragility fractures in people aged 50 years and above: retrospective cohort study using UK primary care data

SummaryThis study used primary care data to estimate the incidence of recorded diagnosis of osteoporosis, osteopenia, and fragility fracture in the UK during 2000–2018 accounting for age, sex, calendar year and social deprivation. More than 3 million people aged 50–99 years were included. We found that men living in the most deprived areas had a 45% higher risk of being diagnosed with osteoporosis and 50% higher risk of fragility fracture compared to men living in the least deprived areas.Purposea) To estimate the incidence trends of a recorded diagnosis of osteoporosis, osteopenia, and fragility fracture in the UK over time; b) to describe differences according to age, sex, and social deprivation.MethodsThis is a longitudinal population-based cohort study using routinely collected primary care data obtained via IQVIA Medical Research Database (IMRD). All patients aged 50–99 years registered with a practice participating in THIN (The Health Improvement Network) between 2000–2018 were included. The first recorded diagnosis of osteoporosis, osteopenia, or fragility fracture was used to estimate incidence rates (IR) per 10,000 person-years at risk. Poisson regression was used to provide Incidence Rate Ratios (IRR) adjusted by age, sex, social deprivation, calendar year, and practice effect.ResultsThe year-specific adjusted IRR of recorded osteoporosis was highest in 2009 in women [IRR 1.44(95%CI 1.38–1.50)], whereas in men it was highest in 2013–2014 [IRR 1.94(95%CI 1.72–2.18)] compared to 2000. The year-specific adjusted IRR of fragility fracture was highest in 2012 in women [IRR 1.77(95%CI 1.69–1.85)], whereas in men it was highest in 2013 [IRR 1.64(95%CI 1.51–1.78)] compared to 2000. Men in the most deprived areas had a higher risk of being diagnosed with osteoporosis [IRR 1.45(95%CI 1.38–1.53)], osteopenia [IRR 1.17(95%CI 1.09–1.26)], and fragility fracture [IRR 1.50(95%CI 1.44–1.56)] compared to those living in the least deprived areas, but smaller differences were seen in women.ConclusionUse of fracture risk assessment tools may enhance the detection of osteoporosis cases in primary care. Further research is needed on the effect of social deprivation on diagnosis of osteoporosis and fractures.

Earlier chronotype in midlife as a predictor of accelerated brain aging: A population-based longitudinal cohort study.

Evidence suggests that sleep-wake cycle disruption could be an early manifestation of neurodegeneration and might even be a risk factor for developing diseases in healthy adults. We investigated the impact of circadian phase change on structural and functional brain deterioration in a late-adulthood population. We analyzed the data of 1,874 participants (mean age 58.6 ± 6.3 years, 50.3% female) from the Korean Genome and Epidemiology Study, who were identified as cognitively unimpaired. The mid-sleep time on free days corrected for sleep debt on workdays (MSFsc) at baseline was adopted as an indicator of the chronotype and used to categorize the participants into three groups. The relationships between the chronotype and longitudinal changes in the gray matter volume (GMV) and cognitive function were investigated (mean interval: 4.2 ± 0.5 years). The mean MSFsc of the participants was 2:45 am. The earlier MSFsc was linearly associated with smaller right entorhinal GMV (β [SE] = 0.02 [0.01]; p = .001) and lower visual memory function test scores at baseline. Longitudinally, the earlier MSFsc at baseline was only significantly associated with more rapid atrophy in the temporal lobe (β [SE] = 0.18 [0.07]; p = .018) and not with other brain lobes or subregions. Moreover, the earlier MSFsc was associated with more deteriorated verbal learning and visual memory function test scores. An earlier chronotype in midlife, measured using a questionnaire, can be a valuable indicator for individuals who should be closely monitored for the development of neurodegenerative disorders.

Adherence to Mediterranean Diet: A Population-Based Longitudinal Cohort Study.

Adherence to the Mediterranean diet (MedDiet) is recommended for cardiovascular disease prevention. However, recent epidemiological studies report a shift toward lower adherence to MedDiet. We have conducted a prospective cohort study to evaluate changes in individual determinants of MedDiet adherence over time. Clinical information and MedDiet adherence score (MEDAS) were collected in 711 subjects (mean age 68 ± 10 years; 42% males), enrolled in the PLIC study (Progression of Intimal Atherosclerotic Lesions in Carotid arteries), during two visits conducted, on average, 4.5 years apart. MEDAS score worsening and improvements (absolute change, ΔMEDAS) and the variation in the proportion of subjects reporting to meet each MEDAS criteria were assessed. Overall, 34% of the subjects improved their MedDiet adherence (ΔMEDAS: +1.87 ± 1.13), by consuming more olive oil, legumes and fish and use of dishes seasoned with sofrito and 48% subjects worsened their MedDiet adherence (ΔMEDAS: -2.02 ± 1.14) by consuming less fruit, legumes, fish and nuts, with higher rates of worsening in women and subjects aged 50-65 years. Subjects who improved the score were more obese, had higher plasma glucose levels, and metabolic syndrome at the basal visit. In summary, we report an overall decrease in MedDiet adherence, evaluated during a timeframe heavily affected by the COVID-19 pandemic, underlining the need for better dietary interventions.

Analysis of Anxiety or Depression and Long-term Mortality Among Survivors of Out-of-Hospital Cardiac Arrest

The recent American Heart Association guidelines added a sixth link in the chain of survival highlighting recovery and emphasized the importance of psychiatric outcome and recovery for survivors of out-of-hospital cardiac arrest (OHCA). The prevalence of psychiatric disorders among this population was higher than that in the general population. To examine the prevalence of depression or anxiety and the association of these conditions with long-term mortality among individuals who survive OHCA. A longitudinal population-based cohort study was conducted to analyze long-term prognosis in patients hospitalized for OHCA between January 1, 2005, and December 31, 2015, who survived for 1 year or longer. Patients with cardiac arrest due to traumatic or nonmedical causes, such as injuries, poisoning, asphyxiation, burns, or anaphylaxis, were excluded. Data were extracted on depression or anxiety diagnoses in this population within 1 year from the database of the Korean National Health Insurance Service and analyzed April 7, 2022, and reanalyzed January 19 to 20, 2023. Follow-up data were obtained for up to 14 years, and the primary outcome was long-term cumulative mortality. Long-term mortality among patients with and without a diagnosis of depression or anxiety were evaluated. The analysis included 2373 patients; 1860 (78.4%) were male, and the median age was 53.0 (IQR, 44.0-62.0) years . A total of 397 (16.7%) patients were diagnosed with depression or anxiety, 251 (10.6%) were diagnosed with depression, and 227 (9.6%) were diagnosed with anxiety. The incidence of long-term mortality was significantly higher in the group diagnosed with depression or anxiety than in the group without depression or anxiety (141 of 397 [35.5%] vs 534 of 1976 [27.0%]; P = .001). With multivariate Cox proportional hazards regression analysis, the adjusted hazard ratio of long-term mortality for total patients with depression or anxiety was 1.41 (95% CI, 1.17-1.70); depression, 1.44 (95% CI, 1.16-1.79); and anxiety, 1.20 (95% CI, 0.94-1.53). In this study, among the patients who experienced OHCA, those diagnosed with depression or anxiety had higher long-term mortality rates than those without depression or anxiety. These findings suggest that psychological and neurologic rehabilitation intervention for survivors of OHCA may be needed to improve long-term survival.

Patterns of childhood adversity and health outcomes in early adolescence: Results from the Generation XXI cohort

This longitudinal population-based birth cohort study aims to identify childhood adversity patterns over the first 13 years of life and to examine its association with health-related behaviours and outcomes in early adolescence. Using data from the Portuguese birth cohort Generation XXI, we performed latent class analysis to explore the underlying patterns of adversity from birth to early adolescence, using 13 adversity items assessed in five time points. Health-related behaviours and outcomes were evaluated at 13 years. Adjusting for parental unemployment, logistic regression models were performed to determine the association between adversity patterns and outcomes. Among 8647 participants, three adversity patterns were identified: “low adversity” (56.1%), “household dysfunction” (17.2%) and “multiple adversities” (26.7%). For the “household dysfunction” pattern, girls and boys showed associations with increased odds of alcohol/tobacco use (adjusted odds ratio [AOR]: 1.78; 95% confidence interval [CI]: 1.32–2.40; AOR:1.84; CI:1.38–2.46, respectively) and depressive symptoms (AOR:2.34; CI:1.58–3.48; AOR:5.45; CI:2.86–10.38, respectively). Boys also presented low consumption of fruits/vegetables (AOR:1.51; CI:1.04–2.19). For the “multiple adversities” pattern, both girls and boys showed an increased probability of alcohol/tobacco use (AOR:1.82; CI:1.42–2.33; AOR:1.63; CI:1.30–2.05, respectively) and depressive symptoms (AOR:3.41; CI:2.46–4.72; AOR:5.21; CI:2.91–9.32, respectively). Boys also revealed increased odds of low consumption of fruits/vegetables (AOR:1.67; CI:1.24–2.23). Childhood adversity patterns are associated with unhealthy behaviours and depressive symptoms in early adolescence. Public policies and early interventions targeting vulnerable children, families and communities can potentially reduce the detrimental effects of adversities on health and promote individual and community resilience.

The association between unpaid labour and mental health in working-age adults in Australia from 2002 to 2020: a longitudinal population-based cohort study.

Unpaid labour is a daily part of most people's lives, none more so than for women. Yet, in comparison to paid work, the effect of unpaid labour on mental health is an under-researched area. This study aims to address key gaps in the extant literature, examining how unpaid labour is associated with mental health in working-age men and women, and whether gender differences exist. In this longitudinal population-based cohort study, 19 waves of the Household, Income, and Labour Dynamics in Australia (HILDA) survey were used to employ a fixed effects regression analysis to examine the associations between unpaid labour and mental health in working-age (aged 25-64 years) Australian adults. Mental health was assessed using the MHI-5 scale. Both the individual and the combined effects of four different domains of unpaid labour (household work, childcare, care for adults, and outdoor tasks) were interrogated, as were the gender differences. Of the 37 352 participants (297 036 observations) in waves 2002-20 of the HILDA Survey, 22 832 people (190 207 observations) were aged 25-64 years, and after excluding participants with missing data, 21 014 participants (150 163 observations) were included in the analysis. Increasing time in household work was negatively associated with mental health in both men (β coefficient=-0·026 [95% CI -0·04 to -0·01]) and women (β coefficient=-0·009 [-0·02 to 0·001]), as was care for adults (disabled or older people) in women (β coefficient=-0·027 [-0·04 to -0·01]). Conversely, increasing time in childcare for women (β coefficient=0·016 [0·01 to 0·02]) and outdoor tasks for men, was positively associated with mental health (β coefficient=0·067 [0·04 to 0·09]). A null finding for the overall cumulative total unpaid labour exposure for both men and women was probably attributable to the opposing direction of effects between the individual domains that constituted the total load. This study reveals considerable variance and nuance in how different domains of unpaid labour affect mental health, as well as continued inequity in the division of unpaid labour in households, with women doing considerably more unpaid labour than men. This study also exposes important challenges associated with measuring and understanding total (combined) unpaid labour as a determinant of health. University of Melbourne Research Training Scholarship, Australian Research Council Discovery Early Career Award, Australian Research Council Linkage Project.

Air Pollution and Acute Kidney Injury in the U.S. Medicare Population: A Longitudinal Cohort Study.

Recent studies have reported the association between air pollution exposure and reduced kidney function. However, it is unclear whether air pollution is associated with an increased risk of acute kidney injury (AKI). To address this gap in knowledge, we investigated the effect estimates of long-term exposures to fine particulate matter [PM in aerodynamic diameter ()], nitrogen dioxide (), and ozone () on the risk of first hospital admission for AKI using nationwide Medicare data. This nationwide population-based longitudinal cohort study included 61,300,754 beneficiaries enrolled in Medicare Part A fee-for-service (FFS) who were years of age and resided in the continental United States from the years 2000 through 2016. We applied Cox-equivalent Poisson models to estimate the association between air pollution and first hospital admission for AKI. Exposure to , , and was associated with increased risk for first hospital admission for AKI, with hazard ratios (HRs) of 1.17 (95% CI: 1.16, 1.19) for a increase in , 1.12 (95% CI: 1.11, 1.13) for a increase in , and 1.03 (95% CI: 1.02, 1.04) for a increase in summer-period (June to September). The associations persisted at annual exposures lower than the current National Ambient Air Quality Standard. This study found an association between exposures to air pollution and the risk of the first hospital admission with AKI, and this association persisted even at low concentrations of air pollution. Our findings provide beneficial implications for public health policies and air pollution guidelines to alleviate health care expenditures and the disease burden attributable to AKI. https://doi.org/10.1289/EHP10729.

Sex and gender differences in primary care help-seeking for common somatic symptoms: a longitudinal study

Objective Women are reported to consult general practitioners (GPs) more frequently than men. However, previous studies on sex differences in help-seeking behavior for somatic symptoms do not distinguish between sex and gender, do not account for sex differences in presented symptoms, and are frequently conducted in clinical settings, automatically excluding non-help seekers. Therefore, we aim to assess the independent associations of sex and gender with primary care help-seeking for somatic symptoms in the general population. Design and setting Records from the longitudinal population-based Lifelines Cohort Study were linked to routine electronic health records from GPs. Subjects Participants reporting new-onset common somatic symptoms. Main outcome measures Associations between sex and gender, operationalized via a novel gender-index, with primary care help-seeking for somatic symptoms and differences in the strength of the association between gender and help-seeking for somatic symptoms between women and men. Results Of 20,187 individuals with linked data, 8325 participants (67.5% female; mean age = 44.5 years [SD = 12.9]) reported at least one new-onset somatic symptom. Hereof, 255 (3.1%) consulted the GP within 6 weeks of symptom onset. Female sex was positively associated with consulting the GP (OR = 1.78; 95%CI = 1.13–2.80), whereas feminine gender was not (OR = 0.67; 95%CI = 0.39–1.16). The latter association did not differ in strength between men and women. More paid working days are negatively associated with help-seeking (OR = 0.95; 95%CI = 0.91–0.98). Conclusions The results suggest that female sex rather than feminine gender is associated with primary care help-seeking behavior for somatic symptoms. Nevertheless, clinicians should be aware that gender-related variables, such as mean paid working days, may be associated with help-seeking behavior.

Presence and severity of migraine is associated with development of primary open angle glaucoma: A population-based longitudinal cohort study.

To examine the association between the presence and severity of migraine and development of primary open-angle glaucoma (POAG) using a nationwide population-based longitudinal cohort data. Data were retrieved from the Korean National Health Insurance Service for 2,716,562 individuals aged ≥ 40 years and assessed for the development of POAG from 2009 through 2018. Subjects were classified into the following 3 groups: healthy control subjects, subjects with mild migraine, and those with severe migraine. Hazard ratios (HR) of glaucoma development were calculated for each group. Subgroup analyses of subjects stratified by age, sex, lifestyle factors (smoking, drinking, and body mass index (BMI)), and comorbidities (diabetes, hypertension, and dyslipidemia). During the 9-year follow-up period, the incidence rate of POAG per 1000 person-years was 2.41 and 3.25 in subjects without and with migraine, respectively. Among the migraine group, the incidence rate was 3.14 and 3.89 in mild and severe subgroups, respectively. The HR was 1.355 (95% CI, 1.300-1.412) and 1.188 (95% CI, 1.140-1.239) before and after adjusting for potential confounding factors in the migraine group per se. Regarding the severity of migraine, the adjusted HRs were 1.169 (95% CI, 1.117-1.224) in the mild migraine group, and 1.285 (95% CI, 1.166-1.415) in the severe migraine group compared to the control group. The results were consistent in subgroup analyses after stratifying by age, sex, lifestyle factors, and comorbidities. Migraine is associated with increased risk of POAG development. Furthermore, chronic and severe migraine is associated with greater risk of POAG development.

Ongoing increasing trends in central precocious puberty incidence among Korean boys and girls from 2008 to 2020.

Over the last few decades, there has been growing evidence of earlier onset and progression of puberty worldwide. This population-based longitudinal cohort study aimed to analyze the change in the annual incidence rate of central precocious puberty (CPP) among Korean children over the most recent decade, using the national registry data. The International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) and insurance claims for gonadotropin-releasing hormone agonist (GnRHa) treatment were used to identify CPP patients who were using the Korean Health Insurance Review & Assessment Service (HIRA) database between 2008 and 2020. Patients who began GnRHa therapy before the age of 9 and 10 for girls and boys, respectively, were included in the study. A total of 6,906 boys and 126,377 girls were diagnosed with CPP between 2008 and 2020. The annual incidence of CPP increased by 83.3 times in boys (from 1.2 to 100 per 100,000 persons) and by 15.9 times in girls (from 88.9 to 1414.7 per 100,000 persons). The age-specific annual incidence of CPP increased remarkably more in older children than in younger ones; the 2020 CPP incidence among 9-year-old boys and 8-year-old girls reached 705.2 and 7,967.3 per 100,000 persons, respectively. The annual prevalence of CPP in boys and girls increased from 2.7 to 206.5 (76.5 times) and from 141.8 to 3439.9 (24.3 times) per 100,000 persons, respectively. Based on GnRHa treatment insurance claims, our study suggests that the annual incidence of CPP has substantially increased in Korea during the past 13 years. These findings highlight the importance of meticulous judgment by doctors in determining GnRHa treatment.

The effect of maternal pre-pregnancy body mass index and gestational weight gain on behavioural outcomes in term normal birth weight children: UK birth cohort study

IntroductionExisting evidence in the association between maternal pregnancy and pre-pregnancy weight and behavioural outcomes in children.ObjectivesThis study aimed to examine these associations at six developmental time-points between ages 3 and 16.MethodsWe used data from the Avon Longitudinal Study of Parents and Children (ALSPAC), an ongoing population-based longitudinal pregnancy cohort study in Bristol, United Kingdom (UK). Data on behavioural outcomes were measured at ages 3.5, 7, 9, 11 and 16 years using the Strengths and Difficulties Questionnaire (SDQ). Over 7960 (at 3.5 years of age) and 4400 (at 16 years of age) mother-child pairs were included in the final analysis. Logistic regression analyses were used to examine the associations.ResultsPre-pregnancy BMI and gestational weight gain were associated with total behavioural difficulties in children across all age groups. In separate analyses using each SDQ subscale, however, we found that pre-pregnancy underweight was associated with emotional problems at ages 7 (OR = 1.66, 95% CI; 1.20 – 2.29), 11 (OR = 1.49, 95% CI; 1.02 – 2.18) and 16 (OR = 1.74, 95% CI; 1.16 – 2.60) years and hyperactivity/inattention problems at age 16 (OR = 1.96, 95% CI; 1.27 – 3.05). We also found an association between guideline-discordant gestational weight gain and peer relationship problems at age 9 and pro-social behaviour at ages 9 and 11.ConclusionsOur findings highlight that pre-pregnancy underweight than overweight, obesity or gestational weight gain may influence the emotional health of children and adolescents.Disclosure of InterestNone Declared

Physical and cognitive impairments in people suffering from long COVID: protocol for a longitudinal population-based cohort study

IntroductionApproximately 33% of people who contracted COVID-19 still experience symptoms 12 weeks after infection onset. This persistence of symptoms is now considered a syndrome itself called ‘long COVID’. Evidence regarding...

Health-related quality of life in patients with primary sclerosing cholangitis: A longitudinal population-based cohort study.

Data regarding health-related quality of life (HRQoL) in primary sclerosing cholangitis (PSC) are sparse and have only been studied cross-sectionally in a disease which runs a fluctuating and unpredictable course. We aim to describe HRQoL longitudinally by using repeated measurements in a population-based cohort. Every 3 months from May 2017 up to August 2020, patients received digital questionnaires at home. These included the EQ-5D, 5-D Itch, patient-based SCCAI and patient-based HBI. The SF-36, measuring HRQoL over eight dimensions as well as a physical component summary (PCS) and mental component summary (MCS) score, was sent annually. Data were compared with Dutch reference data and a matched IBD disease control from the population-based POBASIC cohort. Mixed-effects modelling was performed to identify factors associated with HRQoL. Three hundred twenty-eight patients completed 2576 questionnaires. A significant reduction of small clinical relevance in several mean HRQoL scores was found compared with the Dutch reference population: 46.4 versus 48.0, p=.018 for PCS and 47.5 versus 50.5, p=.004 for MCS scores. HRQoL outcomes were significantly negatively associated with coexisting active IBD (PCS -12.2, p < .001 and MCS -12.0, p < .001), which was not the case in case of quiescent IBD. Decreasing HRQoL scores were also negatively associated with increasing age (PCS -0.1 per 10 years, p=.002), female sex (PCS -2.8, p < .001), diagnosis of AIH overlap (PCS -3.7, p=.059), end-stage liver disease (PCS -3.7, p=.015) and presence of itch (PCS -9.2, p < .001 and MCS -3.1, p=.078). The odds of reporting a clinically relevant reduction in EQ-5D scores showed seasonal variation, being lowest in summer (OR=0.48 relative to spring, p=.037). In patients with liver transplant, HRQoL outcomes were comparable to the Dutch general population. PSC patients report impaired HRQoL of small clinical relevance compared with the general population. After liver transplantation, HRQoL scores are at comparable levels to the general population. HRQoL scores are associated with potentially modifiable factors such as itch and IBD activity.

Childhood adversity and risk of later labor market marginalization in young employees in Sweden.

The present study examined the independent and combined effects of childhood adversity (CA) and occupational class on the risk of future labor market marginalization (LMM) in young employees in Sweden. Occupational class (non-manual/manual workers) was also explored as a potential mediator. This population-based longitudinal cohort study included 556 793 employees, 19-29 years, residing in Sweden in 2009. CAs included parental death, parental mental and somatic disorders, parental separation, household public assistance, single-parent household and residential instability. Measures of LMM included long-term unemployment (LTU), long-term sickness absence (LTSA) and disability pension. Estimates of risk of each LMM measure, between 2010 and 2016 were calculated as hazard ratios (HRs) with 95% confidence intervals (CIs), using a Cox regression analysis. Those exposed to CA had an elevated risk for all measures of LMM. Manual workers with a history of household public assistance had the highest risk estimates compared to non-manual workers with no CAs [adjusted HR spanning from 1.59 (LTSA) to 2.50 (LTU)]. Regardless of occupational class, the risk of LMM grew higher with increasing number of CAs (e.g. adjusted HR of LMM in manual workers with 3+ CAs: 1.87, 95% CI: 1.81-1.94). These patterns persisted after adjustments for a range of confounders, including psychiatric and somatic morbidity. Last, we found a small but significant mediating effect of occupational class in the association between CA and LMM. Information on CAs are important determinants of LMM in young adults, and especially in manual workers.

Associations between greenness and kidney disease in Massachusetts: The US Medicare longitudinal cohort study

BackgroundRecent studies have identified the association of environmental stressors with reduced kidney function and the development of kidney disease. While residential greenness has been linked to many health benefits, the association between residential greenness and the development of kidney disease is not clear. We aimed to investigate the association between residential greenness and the development of kidney disease. MethodsWe performed a longitudinal population-based cohort study including all fee-for-service Medicare Part A beneficiaries (aged 65 years or older) in Massachusetts (2000–2016). We assessed greenness with the annual average Enhanced Vegetation Index (EVI) based on residential ZIP codes of beneficiaries. We applied Cox-equivalent Poisson models to estimate the association between EVI and first hospital admission for total kidney disease, chronic kidney disease (CKD), and acute kidney injury (AKI), separately. ResultsData for 1,462,949 beneficiaries who resided in a total of 644 ZIP codes were analyzed. The total person-years of follow-up for total kidney disease, CKD, and AKI were 9.8, 10.9, and 10.8 million person-years, respectively. For a 0.1 increase in annual EVI, the hazard ratios (HRs) were 0.95 (95% CI: 0.93 to 0.97) for the first hospital admission for total kidney disease, and the association was more prominent for AKI (HR: 0.94 with 95% CI: 0.92 to 0.97) than CKD (HR: 0.98 with 95% CI: 0.95–1.01]). The estimated effects of EVI on kidney disease were generally more evident in White beneficiaries and those residing in metropolitan areas compared to the overall population. ConclusionsThis study found that higher levels of annual residential greenness were associated with a lower risk of the first hospital admission for kidney diseases. Results are consistent with the hypothesis that higher residential greenness benefits kidney patients.

Association of Long-term Exposure to Air Pollution With Late-Life Depression in Older Adults in the US

Emerging evidence has suggested harmful associations of air pollutants with neurodegenerative diseases among older adults. However, little is known about outcomes regarding late-life mental disorders, such as geriatric depression. To investigate if long-term exposure to air pollution is associated with increased risk of late-life depression diagnosis among older adults in the US. This population-based longitudinal cohort study consisted of US Medicare enrollees older than 64 years. Data were obtained from the US Centers for Medicare and Medicaid Services Chronic Conditions Warehouse. The participants were continuously enrolled in the Fee-for-Service program and both Medicare Part A and Part B. After the 5-year washout period at entry, a total of 8 907 422 unique individuals were covered over the study period of 2005 to 2016, who contributed to 1 526 690 late-onset depression diagnoses. Data analyses were performed between March 2022 and November 2022. The exposures consisted of residential long-term exposure to fine particulate matter (PM2.5), measured in micrograms per cubic meter; nitrogen dioxide (NO2), measured in parts per billion; and ozone (O3), measured in parts per billion. Late-life depression diagnoses were identified via information from all available Medicare claims (ie, hospital inpatient, skilled nursing facility, home health agency, hospital outpatient, and physician visits). Date of the first occurrence was obtained. Hazard ratios and percentage change in risk were estimated via stratified Cox proportional hazards models accounting for climate coexposures, neighborhood greenness, socioeconomic conditions, health care access, and urbanicity level. A total of 8 907 422 Medicare enrollees were included in this study with 56.8% being female individuals and 90.2% being White individuals. The mean (SD) age at entry (after washout period) was 73.7 (4.8) years. Each 5-unit increase in long-term mean exposure to PM2.5, NO2, and O3 was associated with an adjusted percentage increase in depression risk of 0.91% (95% CI, 0.02%-1.81%), 0.61% (95% CI, 0.31%- 0.92%), and 2.13% (95% CI, 1.63%-2.64%), respectively, based on a tripollutant model. Effect size heterogeneity was found among subpopulations by comorbidity condition and neighborhood contextual backgrounds. In this cohort study among US Medicare enrollees, harmful associations were observed between long-term exposure to air pollution and increased risk of late-life depression diagnosis.

Reconciliation and Diversity for Educators: The Medicine Wheel, Bloom's Taxonomy, and CanMEDS Competencies.

Reconciliation and Diversity for Educators: The Medicine Wheel, Bloom's Taxonomy, and CanMEDS Competencies.

Associations between β-blockers and psychiatric and behavioural outcomes: A population-based cohort study of 1.4 million individuals in Sweden.

β-blockers are widely used for treating cardiac conditions and are suggested for the treatment of anxiety and aggression, although research is conflicting and limited by methodological problems. In addition, β-blockers have been associated with precipitating other psychiatric disorders and suicidal behaviour, but findings are mixed. We aimed to examine associations between β-blockers and psychiatric and behavioural outcomes in a large population-based cohort in Sweden. We conducted a population-based longitudinal cohort study using Swedish nationwide high-quality healthcare, mortality, and crime registers. We included 1,400,766 individuals aged 15 years or older who had collected β-blocker prescriptions and followed them for 8 years between 2006 and 2013. We linked register data on dispensed β-blocker prescriptions with main outcomes, hospitalisations for psychiatric disorders (not including self-injurious behaviour or suicide attempts), suicidal behaviour (including deaths from suicide), and charges of violent crime. We applied within-individual Cox proportional hazards regression to compare periods on treatment with periods off treatment within each individual in order to reduce possible confounding by indication, as this model inherently adjusts for all stable confounders (e.g., genetics and health history). We also adjusted for age as a time-varying covariate. In further analyses, we adjusted by stated indications, prevalent users, cardiac severity, psychiatric and crime history, individual β-blockers, β-blocker selectivity and solubility, and use of other medications. In the cohort, 86.8% (n = 1,215,247) were 50 years and over, and 52.2% (n = 731,322) were women. During the study period, 6.9% (n = 96,801) of the β-blocker users were hospitalised for a psychiatric disorder, 0.7% (n = 9,960) presented with suicidal behaviour, and 0.7% (n = 9,405) were charged with a violent crime. There was heterogeneity in the direction of results; within-individual analyses showed that periods of β-blocker treatment were associated with reduced hazards of psychiatric hospitalisations (hazard ratio [HR]: 0.92, 95% confidence interval [CI]: 0.91 to 0.93, p < 0.001), charges of violent crime (HR: 0.87, 95% CI: 0.81 to 0.93, p < 0.001), and increased hazards of suicidal behaviour (HR: 1.08, 95% CI: 1.02 to 1.15, p = 0.012). After stratifying by diagnosis, reduced associations with psychiatric hospitalisations during β-blocker treatment were mainly driven by lower hospitalisation rates due to depressive (HR: 0.92, 95% CI: 0.89 to 0.96, p < 0.001) and psychotic disorders (HR: 0.89, 95% CI: 0.85 to 0.93, p < 0.001). Reduced associations with violent charges remained in most sensitivity analyses, while associations with psychiatric hospitalisations and suicidal behaviour were inconsistent. Limitations include that the within-individual model does not account for confounders that could change during treatment, unless measured and adjusted for in the model. In this population-wide study, we found no consistent links between β-blockers and psychiatric outcomes. However, β-blockers were associated with reductions in violence, which remained in sensitivity analyses. The use of β-blockers to manage aggression and violence could be investigated further.

Risk factors for insomnia and burnout: A longitudinal population-based cohort study.

Insomnia and burnout are highly prevalent in the general population, calling for understanding of its causes. Taking a broad approach, the aim of this study was to determine various mental and somatic risk factors for development of insomnia and burnout and stratifying for sex and age group. Questionnaire data were used from a Swedish population-based sample aged 18-79years, from which cohorts without insomnia (n=1702) and without burnout (n=1972) at baseline were followed-up after 3 years. Self-reports of eight mental and somatic conditions at baseline were used as independent variables in logistic regression analyses to predict development of insomnia and burnout at 3-year follow-up. All eight studied conditions were significant risk factors for development of both insomnia (odds ratio, OR=1.62-2.73) and burnout (OR=2.20-3.21). Burnout and poor self-rated health had the highest ORs for insomnia, and poor self-rated health, anxiety and somatic symptoms had the highest ORs for burnout. The ORs were generally similar between men and women, whereas age groups tended to differ in some of the risk factors. The study highlights the importance of a broad assessment of both mental and somatic conditions in the prevention of insomnia and burnout.

Abdominal obesity and dsyglycemia are risk factors for liver fibrosis progression in NAFLD subjects:A population-based study.

To investigate longitudinal changes in the liver stiffness measurement (LSM) in the general adult population without known liver disease and to describe its association with metabolic risk factors, with a special focus on subjects with non-alcoholic fatty liver disease (NAFLD) and dysglycemia. A longitudinal adult population-based cohort study was conducted in Catalonia. LSM was measured by transient elastography (TE) at baseline and follow-up (median: 4.2 years). Subgroup with NAFLD and dysglycemia were analyzed. Moderate-to-advanced liver fibrosis was defined as LSM ≥8.0 kPa and LSM ≥9.2 kPa respectively. Among 1.478 subjects evaluated, the cumulative incidence of LSM ≥8.0 kPa and ≥9.2 kPa at follow-up was 2.8% and 1.9%, respectively. This incidence was higher in NAFLD (7.1% for LSM ≥8.0 kPa and 5% for LSM ≥9.2 kPa) and dysglycemia (6.2% for LSM ≥8.0 kPa and 4.7% for LSM ≥9.2 kPa) subgroups. In the global cohort, the multivariate analyses showed that dysglycemia, abdominal obesity and atherogenic dyslipidemia were significantly associated with progression to moderate-to-advanced liver fibrosis. Female sex was negatively associated. In subjects with NAFLD, abdominal obesity and dysglycemia were associated with changes in LSM to ≥8.0 kPa and ≥9.2 kPa at follow-up. A decline in LSM value to <8 kPa was observed in 64% of those subjects with a baseline LSM ≥8.0 kPa. In this population study, the presence of abdominal obesity and dysglycemia were the main risk metabolic factors associated with moderate-to-advanced liver fibrosis development over time in general populations as well as in subjects with NAFLD.