Population-based Prospective Cohort Study Research Articles

An epidemiological survey of visual impairment in rural populations aged 30 and above: the Handan Eye Study

Objective: To investigate the changes in prevalence and causes of blindness and visual impairment over six years among rural populations aged 30 and above in Yongnian County, Handan City, Hebei Province, a pilot area in northern China for blindness prevention and treatment, and to study the incidence of common blinding eye diseases. Methods: This population-based prospective cohort study included a baseline survey conducted from 2006 to 2007 using stratified cluster sampling, targeting 6 830 Han Chinese individuals aged 30 and above, with a response rate of 90.4%, and a follow-up survey conducted from 2012 to 2013 with 5 394 participants, maintaining a response rate of 85.3%. Visual impairment was defined according to World Health Organization standards as visual acuity<20/60 but ≥20/400, and blindness as visual acuity<20/400. Age-and gender-standardized prevalence rates of blindness and visual impairment, along with their 95% confidence intervals (CI), were estimated. The six-year incidence rates of primary glaucoma, age-related macular degeneration, and myopic maculopathy, along with their 95%CI, were reported. Results: At baseline, the standardized prevalence of bilateral blindness in individuals aged 30 and above was 0.6% (41/6 799) for presenting visual acuity and 0.5% (31/6 799) for best-corrected visual acuity. These rates were higher than those found in the follow-up survey, 0.5% (27/5 293) and 0.3% (17/5 276). Conversely, the standardized prevalence of bilateral visual impairment increased from 4.7% (361/6 799) and 1.0% (85/6 799) at baseline to 6.5% (355/5 293) and 1.4% (74/5 276) at follow-up, respectively. The leading cause of bilateral blindness was cataract in both baseline (13/31, 41.9%) and follow-up (7/17) surveys. Other major causes included myopic retinal degeneration (5/31, 16.1% at baseline; 2/17 at follow-up), glaucoma (3/31, 9.7% at baseline; 2/17 at follow-up), and corneal opacity (3/31, 9.7% at baseline; 2/17 at follow-up). Over six years, the incidence rates for primary glaucoma, early and late age-related macular degeneration, and myopic maculopathy in individuals aged 35 and above were 1.6% (95%CI: 1.2%-1.9%), 4.2% (95%CI: 3.8%-4.7%), 0.2% (95%CI: 0.2%-0.3%), and 0.1% (95%CI: 0.0%-0.2%), respectively. Conclusions: The prevalence of bilateral blindness in the rural population of Yongnian County, Handan City, Hebei Province, decreased over six years due to blindness prevention and treatment efforts but remained higher than in urban areas. Meanwhile, the prevalence of bilateral visual impairment increased since the baseline survey. Cataracts continued to be the primary cause of blindness, followed by myopic retinal degeneration, glaucoma, and corneal opacity.

Association of RAAS inhibitors on osteoporosis and fracture risk in the hypertensive population–A prospective population-based cohort study in Lanzhou, China

BackgroundRenin-angiotensin-aldosterone system (RAAS) inhibitors appear to benefit bone tissue in antihypertensive treatment. However, the association between RAAS inhibitors and bone metabolism was inconsistent.Methods and study designBased on the study of Risk Evaluation of Cancers in Chinese Diabetic Individuals(REACTION) conducted in 2011, We followed 6,252 Lanzhou residents aged 40–75 years from 2014 to 2016. Finally, 1,625 hypertension cases with complete data were included in the analysis. The study subjects were divided into four groups according to the type of antihypertensive drugs. We employed logistic or multivariate Cox proportional hazards regression to estimate the association between different antihypertensive drug use and osteoporosis, the risk of fracture, and the change in bone mineral density (BMD) level. The association of osteoporosis or the fracture risk by cumulative duration of use of these medications (< 3 years.) and (> 3 years.) was also estimated.ResultsThe cross-sectional study showed that there was no significant association between baseline antihypertensive drugs (angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB)) use and osteoporosis and fracture. During a mean follow-up of 3.4 years in the longitudinal study, there were 478 new osteoporosis cases and 76 fractures. Compared with patients without antihypertensive drug use, the hazard ratios (HRs) [95% confidence interval (CI)] for the risk of osteoporosis were 1.005(0.651,1.552) and 1.077(0.793,1.462) in ACEI or ARB use (p > 0.05). ACEI or ARB use was also not significantly associated with fracture risk (HR 1.102(0.326,3.726), 0.735(0.251,2.148), p > 0.05). Further analysis showed that the use of ACEI (HR 1.078(0.146,7.950)) or ARB (HR 1.169(0.347,3.939)) was not significantly associated with the improvement of osteoporosis (p > 0.05). In addition, the duration of RAAS inhibitors used showed no apparent correlation with the risk of osteoporosis (≤ 3 years: HR 0.872 (0.516, 1.474), > 3 years: HR 1.151 (0.574, 2.308)), nor with the improvement of osteoporosis and the risk of fracture. Meanwhile, the association mentioned above did not change compared to different RAAS inhibitors.ConclusionsThe use of RAAS inhibitors, including ACEIs and ARBs, was not significantly associated with osteoporosis, risk of fracture, or BMD change.

Adverse childhood experiences, economic challenges and suicide risk under COVID-19 pandemic: results from U-CORONA study

Purpose The purpose of this study is to examine the synergistic effect of adverse childhood experiences (ACEs) and economic challenges on suicide risk, under the coronavirus disease 2019 (COVID-19) pandemic, using a prospective population-based cohort study. Design/methodology/approach Participants included 435 adults (aged from 18 to 92 years, mean = 53.8) from the Utsunomiya COVID-19 seROprevalence Neighborhood Association (U-CORONA) study, a population-based longitudinal study in Utsunomiya city, Japan. The baseline survey was conducted in June 2020, between the first and the second wave of the COVID-19 pandemic in Japan. ACEs were assessed using 13 items, and economic challenges due to the COVID-19 were assessed using one item. In the follow-up study, conducted in October 2020 between the second and the third wave of the COVID-19 pandemic in Japan, suicide risk was assessed using six items from the Mini-International Neuropsychiatric Interview via a self-reported questionnaire. Findings This study found positive independent association between ACEs and economic challenges due to COVID-19 and suicide risk. Synergistic effects were also found: the participants with one ACE and economic challenges and those with 2+ ACEs and economic challenges were more likely to be at higher risk of suicide compared to those without ACEs and economic challenges. Originality/value The findings suggest that adults with a higher number of ACEs, in addition to severe economic challenges, were more likely to be at risk for suicide during the COVID-19 pandemic.

Association of Hyperandrogenaemia With Hypertension and Cardiovascular Events in Pre-menopausal Women- A Prospective Population-Based Cohort Study.

The present study aimed to clarify the conflicting association of premenopausal hyperandrogenaemia (HA) with the development of hypertension and CVDs in women. A population-based cohort study including 5889 women. The association of serum testosterone (T), sex hormone-binding globulin (SHBG), and free androgen index (FAI) at age 31 with blood pressure (BP) and hypertension (BP ≥140/90 mmHg and/or use of antihypertensive medication) at ages 31 and 46 and with CVDs (angina pectoris [AP] and/or acute myocardial infarction [AMI] n=74, transitory cerebral ischemia [TIA] and/or stroke n=150) and combined CVD events (AP, AMI, stroke, heart failure, or CVD mortality n=160) by age 53 was investigated. T and FAI were positively associated with systolic and diastolic BP at ages 31 and 46 in the multivariable model. Compared to their lowest quartile, the highest quartiles of T and FAI were positively associated with hypertension at age 31 in the multivariable model. During the 22-year follow-up, FAI was positively associated with increased risk of AP/AMI (hazard ratio [HR]:2.02, 95%CI:1.06-3.85) and overall CVD events or mortality (HR:1.54, 95%CI:1.02-2.33) in the unadjusted models. However, the significance disappeared after adjusting for BMI. Women with HA at premenopausal age had an elevated risk of hypertension, and together with BMI, increased risk of CVD events and CVD mortality during the 22-year follow-up. However, because of several study limitations regarding ethnicity and BMI characteristics, a longer follow-up of this cohort and future studies in ethnically diverse populations are needed to verify the results.

Acute kidney injury developed in the intensive care unit: a population-based prospective cohort study in the Brazilian Amazon

The Brazilian Amazon is a vast area with limited health care resources. To assess the epidemiology of critically ill acute kidney injury (AKI) patients in this area, a prospective cohort study of 1029 adult patients of the three intensive care units (ICUs) of Rio Branco city, the capital of Acre state, were evaluated from February 2014 to February 2016. The incidence of AKI was 53.3%. Risk factors for AKI included higher age, nonsurgical patients, admission to the ICU from the ward, higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores at ICU admission, and positive fluid balance > 1500 ml/24 hours in the days before AKI development in the ICU, with aOR of 1.3 (95% CI 1.03–1.23), 1.47 (95% CI 1.07–2.03), 1.96 (95% CI 1.40–2.74), 1.05 (95% CI 1.03–1.08) for each unit increase, and 1.62 (95% CI 1.16–2.26), respectively. AKI was associated with higher ICU mortality (aOR 2.03, 95% CI 1.29–3.18). AKI mortality was independently associated with higher age, nonsurgical patients, sepsis at ICU admission, presence of shock or use of vasoactive drugs, mechanical ventilation and mean positive fluid balance in the ICU > 1500 ml/24 hours, both during ICU follow-up, with aOR 1.27 (95% CI 1.14–1.43) for each 10-year increase, 1.64 (95% CI 1.07–2.52), 2.35 (95% CI 1.14–4.83), 1.88 (95% CI 1.03–3.44), 6.73 (95% CI 4.08–11.09), 2.31 (95% CI 1.52–3.53), respectively. Adjusted hazard ratios for AKI mortality 30 and 31–180 days after ICU discharge were 3.13 (95% CI 1.84–5.31) and 1.69 (95% CI 0.99–2.90), respectively. AKI incidence was strikingly high among critically ill patients in the Brazilian Amazon. The AKI etiology, risk factors and outcomes were similar to those described in high-income countries, but mortality rates were higher.

Risk of postpartum hemorrhage according to the planned mode of delivery among twin pregnancies with previous cesarean delivery

IntroductionBoth twin pregnancies and previous cesarean delivery are situations with increased risk of failed vaginal delivery. Cesarean delivery after a trial of labor is associated with an increased risk of postpartum hemorrhage Therefore, in twin pregnancies with a previous cesarean delivery, planned vaginal delivery could lead to an increased risk of postpartum hemorrhage due to an important rate of cesarean delivery after a trial of labor. Our objective was to evaluate the association between the planned mode of delivery and postpartum hemorrhage in women with twin pregnancies and a previous cesarean delivery. MethodsWe conducted a secondary analysis of the JUMODA French population-based prospective cohort study of twin pregnancies (n=8823). We included women with one previous cesarean and without contraindication to vaginal birth. The primary outcome was postpartum hemorrhage. ResultsAmong the 735 women included, 187 women (25.4%) had planned vaginal delivery and 548 (74.6%) had planned cesarean delivery. Among women with planned vaginal delivery, 125 (66.8%) had a successful vaginal delivery. The incidence of PPH was 8.2% in the planned cesarean group and 9.1% in the planned vaginal delivery group(p=0.709). After adjustment for confounders, the planned mode of delivery was not associated with the risk of postpartum hemorrhage (adjusted relative risk 0.94, 95% CI 0.56–1.60). There were only 2 uterine ruptures, both in the planned cesarean delivery group. ConclusionIn women with a twin pregnancy and a previous cesarean delivery, there is no overall association between the planned mode of delivery and the risk of postpartum hemorrhage.

Sex disparities in gallstone disease: insights from the MAUCO prospective population-based cohort study

ObjectiveTo investigate factors associated with the prevalence and incidence of gallstone disease (GSD) in women and men of the MAUCO population-based prospective cohort.Design8948 MAUCO participants (aged 38–74 years) underwent abdominal...

Preconception and Early-Pregnancy Body Mass Index in Women and Men, Time to Pregnancy, and Risk of Miscarriage

Obesity in women is associated with reduced fertility and an increased risk of miscarriage. These associations might also be present across the full range of body mass index (BMI) categories as well as among men. To investigate the associations of preconception BMI in both partners with time to pregnancy and miscarriage. This population-based prospective cohort study was conducted in Rotterdam, the Netherlands, between August 9, 2017, and July 1, 2021. A total of 3604 women and their partners were included from the preconception period onward with follow-up until birth. The date of analysis was July 12, 2024. Body mass index (calculated as weight in kilograms divided by height in meters squared) measured in preconception or early pregnancy. Fecundability, defined as the probability of conceiving within 1 month; subfertility, defined as time to pregnancy or duration of actively pursuing pregnancy of more than 12 months or use of assisted reproductive technology; and miscarriage, defined as pregnancy loss before 22 weeks of gestation. These measures were assessed using questionnaires and via the obstetric caregiver. The study population for time-to-pregnancy analyses consisted of 3033 episodes among women (median age, 31.6 years [IQR, 29.2-34.5 years]; median BMI, 23.5 [IQR, 21.2-26.5]) and 2288 episodes among men (median age, 33.4 years [IQR, 30.5-36.8 years]; median BMI, 24.9 [IQR, 23.0-27.4]). The study population for miscarriage analyses consisted of 2770 pregnancy episodes among women (median age, 31.5 years [IQR, 28.9-34.3 years]; median BMI, 23.5 [IQR, 21.3-26.7]) and 2189 pregnancy episodes among men (median age, 33.5 years [IQR, 30.4-36.8 years]; median BMI, 25.0 [IQR, 23.0-27.5]). Higher BMI in women and men was associated with lower fecundability: for every unit increase in BMI, fecundability decreased (fecundability ratio [FR]: women, 0.98 [95% CI, 0.97-0.99]; men, 0.99 [95% CI, 0.98-1.00]). Women with overweight (FR, 0.88 [95% CI, 0.80-0.98]) and obesity (FR, 0.72 [95% CI, 0.63-0.82]) had lower fecundability compared with women with normal weight. Compared with normal weight in women, underweight (odds ratio [OR], 1.88 [95% CI, 1.22-2.88]), overweight (OR, 1.35 [95% CI, 1.11-1.63]), and obesity (OR, 1.67 [95% CI, 1.30-2.13]) were associated with increased odds of subfertility. In men, obesity was associated with increased odds of subfertility (OR, 1.69 [95% CI, 1.24-2.31]). Compared with normal weight in women, overweight (OR, 1.49 [95% CI, 1.12-1.98]) and obesity (OR, 1.44 [95% CI, 1.00-2.08]) were associated with increased odds of miscarriage. In this cohort study, BMI outside of the normal category in women and men during the preconception or early-pregnancy periods was associated with time to pregnancy and miscarriage. Optimizing BMI in women and men from the preconception period onward might be an important strategy to improve fertility outcomes.

Population-based age- and type-specific prevalence of human papillomavirus among non-vaccinated women aged 30 years and above in Germany

BackgroundA persisting high-risk human papillomavirus (HR-HPV) infection is causal for cervical cancer; however, there is limited population-based data on the prevalence of HPV infections in Germany. We assessed the age and type-specific HPV prevalence, and associated risk factors in HPV unvaccinated women aged 30 and above.MethodsThe MARZY prospective population-based cohort study was conducted between 2005 and 2012 in Mainz and Mainz-Bingen, Germany. Eligible women were randomly recruited from population registries and invited for cervical cancer screening (n = 5,275). A study swab (liquid-based cytology) was taken and HPV testing was performed with GP5+/6 + polymerase chain reaction (PCR) followed by genotyping. We assessed HPV types as HR-HPV, ‘moderate’ risk and low-risk (LR-HPV). Logistic regression was performed to identify factors associated with HPV infection, stratified by HPV types.Results2,520 women were screened with a valid PCR result. Overall HPV prevalence was 10.6% (n = 266), with 6.5% HR-HPV positive (n = 165), 1.5% ’moderate’ risk type (n = 38) and 3.3% LR-HPV type (n = 84) positive. 8.9% had a single infection (n = 225) and 1.6% had multiple types (n = 41). The most common HR-HPV types were 16, 56, 52 and 31 and LR-HPV 90 and 42. Of 187 HR-HPV infections detected (among 165 women), 55.1% (n = 103) were with HPV types not covered by available bivalent or quadrivalent HPV vaccines. About 23% (n = 43) were of types not covered by the nonavalent vaccine (HPV 35, 39, 51, 56, 59). The HR and LR-HPV prevalence were highest in the age group 30–34 years (HR 9.8%, ‘moderate’ risk 3.0% and LR 5.6%), decreasing with increasing age. HR-HPV prevalence in women with normal cytology was 5.5%. In women with a high-grade squamous intraepithelial lesion (HSIL), prevalence was 66.7%. Women currently not living with a partner and current smokers had increased chances of an HR-HPV infection.ConclusionThe overall population-based HPV prevalence was relatively high. An important share of prevalent HR-HPV infections constituted types not covered by current HPV vaccines. With the advent of HPV screening and younger vaccinated cohorts joining screening, HPV types should be monitored closely, also in older women who were not eligible for HPV vaccination.

Neighborhood Safety Concerns and the Onset of Depressive Symptoms Among Women: A Population-based Prospective Cohort Study in South Korea.

Neighborhood safety is crucial for the well-being of residents; however, longitudinal evidence is scarce. This study explored the association between neighborhood safety concerns and depressive symptoms among women. A nationally representative sample of 10,008 women was surveyed in 2016. Six dimensions of neighborhood safety concerns were assessed: crime, food, safety at night, traffic accidents, building and facility, and general safety. The total score for neighborhood safety concerns ranged from 6 to 24, with higher scores indicating greater concerns. Depressive symptoms were assessed using the 10-item version of the Center for Epidemiologic Studies Depression. For cross-sectional analyses, we explored how neighborhood safety concerns were associated with concurrent depressive symptoms at baseline. For the longitudinal analyses, we explored how they were associated with depressive symptom onset at the 2-year follow-up (2018) among women without depressive symptoms at baseline (n = 7,643). Logistic regressions were employed. The mean (standard deviation [SD]) of the neighborhood safety concern score was 12.7 (3.3). In the cross-sectional analysis, a 1-SD increase in neighborhood safety concern score was associated with 1.23-fold (95% CI: 1.13-1.35) increase in the odds of concurrent depressive symptoms at the baseline year. In the longitudinal analysis, a 1-SD increase in neighborhood safety concern score was associated with 1.15-fold (95% CI: 1.03-1.29) increase in the odds of experiencing the onset of depressive symptoms at the follow-up year. This study suggests that neighborhood safety concerns are risk factors for the development of depressive symptoms of female residents. Policy efforts are necessary to ensure community safety.

Traumatic Brain Injury and Risk of Incident Dementia: Forensic Applications of Current Research

Abstract Objective Traumatic Brain Injury (TBI) has been purported to increase risk for later developing neurodegenerative disorders (ND). Forensic neuropsychologists are frequently asked to opine on risk for ND after an alleged TBI. We provide an evidence-based foundation to aid forensic practice by summarizing the: role of the neuropsychologist in TBI-related litigation, complexities associated with identifying TBIs in forensic cases, science of TBI in relation to incident dementia, and current scientific evidence for chronic traumatic encephalopathy. Data Selection The most applicable studies to forensic settings are large prospective cohort and population-based cohort studies given their wider generalizability and long periods of follow-up/tracking for outcomes. Data Synthesis Developing ND after TBI is the exception rather than the rule. Only a small subset (&amp;lt; 5%) of individuals with moderate-to-severe TBI, and even fewer (&amp;lt; 1%) with mild TBI, appear to develop ND, and the characteristics that place some at risk remain unclear. Positive evidence for risk of ND after mild TBI is weak and mostly consists of observational studies characterized by methodological limitations. Conclusions Forensic methods used to establish the likely occurrence of TBI are typically more extensive than those used in clinical evaluations, while TBI definitions used in current research are even more rudimentary and inconsistent. Applying clinical research findings regarding TBI and dementia outcomes to forensic cases at an individual level carries significant limitations. Estimating the contribution of remote TBI/concussion in a causal manner to ND risk is a challenge forensic experts sometimes face, yet at present, the task is impossible beyond correlations and speculation.

Telomere length is associated with increased risk of cardiovascular events in patients with end-stage kidney disease on hemodialysis.

Patients with chronic kidney disease (CKD), especially those with end-stage kidney disease (ESKD) on hemodialysis (HD), are at increased risk for cardiovascular disease (CVD), including myocardial infarction and ischemic stroke. A shortening in telomere length, as a parameter for accelerated vascular aging, is an established biomarker for CVD in the general population. We aimed to elucidate the role of telomere length in ESKD patient on HD and its association with cardiovascular outcomes. Telomere length was measured in a prospective population-based cohort study of prevalent HD patients. DNA was isolated from whole blood, sampled at baseline, and analyzed for telomere length via a qPCR-based approach. The risk for the occurrence of the independently adjudicated 3P-MACE outcome (myocardial infarction, ischemic stroke, and cardiovascular death) was statistically analyzed considering the competing risk of non-cardiovascular death. In the cohort of 308 patients with ESKD (115 (37.3%) women, median (25th-75th percentile) age: 67.0 (56.8 - 76.0), the median telomere length was 1.51 kb (25th-75th percentile 0.6-3.2 kb). The 3P-MACE outcome occurred with an incidence rate of 9.4 per 100 patient-years. Patients with longer telomere length more frequently had vascular nephropathy compared to patients with shorter telomere length. Interestingly, patients in the highest quartile of telomere length had a 1.8-fold increased risk for 3P-MACE (95%CI 1.051-3.201, p=0.033), after multivariable adjustment for age, history of stroke, myocardial infarction, venous thromboembolism, presence of heart valve replacement, atrial fibrillation, smoking, anticoagulation, or immunosuppressive use. Surprisingly, in this high-risk cohort of patients with ESKD on HD, longer telomere lengths were associated with increased risk of cardiovascular events.

The association between poverty and longitudinal patterns of adverse childhood experiences across childhood and adolescence: Findings from a prospective population-based cohort study in the UK

BackgroundAdverse childhood experiences (ACEs) affect up to half the general population, they are known to co-occur, and are particularly common among those experiencing poverty. Yet, there are limited studies examining specific patterns of ACE co-occurrence considering their developmental timing. ObjectiveTo examine the longitudinal co-occurrence patterns of ACEs across childhood and adolescence, and to examine the role of poverty in predicting these. Participants and settingThe sample was 8859 children from the Avon Longitudinal Study of Parents and Children, a longitudinal prospective population-based UK birth cohort. MethodsRepeated measures of ten ACEs were available, occurring in early childhood (birth-5 years), mid-childhood (6–10 years), and adolescence (11–16 years). Latent class analysis was used to identify groups of children with similar developmental patterns of ACEs. Multinomial regression was used to examine the association between poverty during pregnancy and ACE classes. ResultsSixteen percent of parents experienced poverty. A five-class latent model was selected: “Low ACEs” (72·0 %), “Early and mid-childhood household disharmony” (10·6 %), “Persistent parental mental health problems” (9·7 %), “Early childhood abuse and parental mental health problems” (5·0 %), and “Mid-childhood and adolescence ACEs” (2·6 %). Poverty was associated with a higher likelihood of being in each of the ACE classes compared to the low ACEs reference class. The largest effect size was seen for the “Early and mid-childhood household disharmony” class (OR 4·70, 95 % CI 3·68–6·00). ConclusionsA multifactorial approach to preventing ACEs is needed – including support for parents facing financial and material hardship, at-risk families, and timely interventions for those experiencing ACEs.

Sickness absence after work accidents and post-traumatic stress among white-collar workers in the retail and wholesale industry; a longitudinal Swedish cohort study

BackgroundMost studies about accidents and about PTSD, respectively, have been conducted either on blue-collar workers, or on the entire working population. There are very few such studies on white-collar workers.AimTo examine diagnosis-specific sickness absence (SA) and disability pension (DP) after a work accident or PTSD, respectively, among white-collar workers in the private retail and wholesale industry.MethodsA prospective population-based cohort study of all 192,077 such workers aged 18–67 (44% women) in Sweden in 2012, using linked microdata from nationwide registers. We identified individuals who had secondary healthcare due to work-related accidents (n = 1114; 31% women) or to PTSD (n = 216; 79% women) in 2012–2016. Their average number of net days of diagnosis-specific SA (in SA spells > 14 days) and DP were calculated for 365 days before and 365 days after the healthcare visit.Results35% of the women and 24% of the men had at least one new SA spell during the 365 days after healthcare due to work accidents. Among women, the average number of SA/DP days increased from 14 in the year before the visit to 31 days the year after; among men from 9 to 21 days. SA days due to fractures and other injuries increased most, while SA days due to mental diagnoses increased somewhat. 73% of women and 64% of men who had healthcare due to PTSD had at least one new SA spell in the next year. Women increased from 121 to 157 SA/DP days and men from 112 to 174. SA due to stress-related disorders and other mental diagnoses increased the most, while DP due to stress-related diagnoses and SA due to musculoskeletal diagnoses increased slightly.ConclusionsAbout a quarter of those who had secondary healthcare due to work accidents, and the majority of those with such healthcare due PTSD, had new SA in the following year. SA due to injury and mental diagnoses, respectively, increased most, however, SA/DP due to other diagnoses also increased slightly. More knowledge is needed on factors associated with having or not having SA/DP in different diagnoses after work accidents and among people with PTSD.

Intergenerational Educational Mobility and Cognitive Trajectories Among Middle-Aged and Older Chinese People: An Application of Growth Mixture and Mobility Contrast Models in Longitudinal Analysis.

Due to statistical challenges in disentangling the mobility effect (i.e., intergenerational educational mobility) from the position effect (i.e., parental and person's own education), the impact of intergenerational educational mobility on cognitive function remains unclear. We employed a novel approach to identify the mobility effect and investigate the net impact of intergenerational educational mobility on heterogeneous patterns of cognition among middle-aged and older adults in China. Participants aged 45 and older were recruited from the China Health and Retirement Longitudinal Study, a population-based prospective cohort study between 2011 and 2018. We identified cognitive trajectories using the growth mixture model (GMM) and subsequently employed the mobility contrast model (MCM) to examine the effects of intergenerational educational mobility on cognitive patterns stratified by gender. Almost two thirds of respondents experienced intergenerational educational mobility, and 55% experienced upward mobility. Men had a higher rate of upward mobility than women. Three population-based cognitive patterns were identified: the low cognitive function with decline group (28%), the moderate cognitive function group (47%), and the high cognitive function group (26%). MCM analysis revealed that both upward and downward intergenerational educational mobility negatively affected cognitive trajectory patterns, extending beyond the influence of individuals' current and parental education. In future research, the impact of mobility can be studied in longitudinal data sets by combining the GMM and MCM approaches. The net negative effect of intergenerational educational mobility on cognitive trajectory patterns indicates that it should be recognized as an independent predictor of cognitive decline.

Association of Hormonal Exposures With Grip Strength in Women >45 Years: Data From the CONSTANCES Cohort Study.

Although biological findings show that estrogens are beneficial for muscular mass maintenance and bone resorption inhibition, the association of hormonal exposure with physical performance are controversial. We investigated the association of reproductive history and exogenous hormone use with hand-grip strength (GS) in women. Using the data from the CONSTANCES French prospective population-based cohort study, we ran linear mixed models to investigate the association of reproductive history and exogenous hormones use with maximal GS in 37 976 women aged 45 to 69 years recruited between 2012 and 2020. We used multiple imputation by chained equations to control missing values and corrections for multiple testing. The mean age of women was 57.2 years. Mean GS was 26.6 kg. After adjustment for age and confounders, GS increased with age at menarche (β+1 year = 0.14; 95% CI, 0.10-0.17) and duration of breastfeeding (β for ≥10 months vs <5 months = 0.39; 95% CI, 0.20-0.59; P for linear trend <.01). Compared to nonmenopausal women, postmenopausal women had significantly lower GS (β = -0.78; 95% CI, -0.98 to -0.58). GS was negatively associated with hormone therapy (HT) past use (β = -0.25; 95% CI, -0.42 to -0.07). Our results suggested that menopausal transition was strongly associated with lower GS. However, despite our hypothesis, increased age at menarche and duration of breastfeeding were associated with higher GS and HT past users presented lower GS than HT never users. These findings could help identify women at high risk of poor physical performance.

Mortality after partner's cancer diagnosis or death: A population-based prospective cohort study in Japan.

The health statuses of closely connected individuals are interdependent. Little is known about mortality risk associated with partner's cancer diagnosis and cause-specific mortality risk associated with partner's death. Relative risks for all-cause and cause-specific mortality following a partner's cancer diagnosis or death compared to the period when the partner is cancer-free and alive were investigated in the population-based prospective cohort study that enrolled 140,420 people at the age between 40-69 in 1990-1994. 55,050 participants (27,665 men and 27,385 women) who were identified as married couples were followed-up for 1,073,746.1 (518,368.5 in men and 555,377.6 in women) person-years, during which 9,816 deaths (7,217 in men and 2,599 in women) were observed. After a partner's cancer diagnosis, the mortality rate ratio (MRR) of all-cause mortality was not increased among both men and women, while an increase of externally-caused MRR was observed. The suicide MRR significantly increased among men (MRR = 2.90 [95% CI, 1.70-4.93]) and it persisted for more than 5 years. After a partner's death, the MRRs of all-cause, cardiovascular disease (CVD), respiratory disease (RD), and externally-caused mortality significantly increased only among men. Stratified analysis by smoking status among men showed significantly increased MRRs of CVD and RD mortality among former/current smokers, but not among never-smokers. Partner's cancer diagnosis did not increase all-cause mortality risk, but increased externally-caused mortality risk, especially suicide among men. The impact of partner's death on mortality risk differed by the mortality causes and sex, and smoking affected some of cause-specific mortality risk.

Association of combined body mass index and central obesity with cardiovascular disease in middle-aged and older adults: a population-based prospective cohort study

BackgroundCardiovascular diseases (CVDs) pose a significant threat to public health. Evidence indicates that the combination of central obesity and normal body mass index (BMI) is associated with an increased risk of cardiovascular disease and mortality. However, limited evidences exists in middle aged and elderly adults in China.MethodsThis was a prospective cohort study that utilized a nationally representative sample of 6,494 adults aged 45 years and above. These individuals participated in the China Health and Retirement Longitudinal Study spanning from 2011 to 2018. Height, weight and waist circumference (WC) were measured, and BMI was calculated by height and weight. Other variables were obtained through self-reported questionnaires. Association analysis was conducted using Cox proportional hazard regression models.ResultsA total of 10,186 participants were investigated, with 57,185 person-years of follow-up. During this period, 1,571 CVDs occurred, including 1,173 heart diseases and 527 strokes. After adjusting for various factors including age, gender, education, marital status, smoking status, alcohol intake, social activity, hypertension, dyslipidemia, diabetes, cancer, chronic lung diseases, liver disease, kidney disease, digestive disease, ENP(emotional, nervous, or psychiatric problems), memory related disease, arthritis or rheumatism, asthma, self-rated health and depression, the results revealed that compared to those with normal WC normal body mass index (BMI), individuals with central obesity normal BMI had a 27.9% higher risk of CVD incidence (95% confidence interval [CI]:1.074–1.524), and a 33.4% higher risk of heart disease incidence (95% CI:1.095–1.625), while no significant association was found with stroke. Additionally, those with normal WC high BMI showed a 24.6% higher risk of CVD incidence (95% CI:1.046–1.483), and a 29.1% higher risk of heart disease incidence (95% CI:1.045–1.594), again with no significant association with stroke. Finally, individuals with central obesity high BMI exhibited a 49.3% higher risk of CVD incidence (95% CI:1.273–1.751), a 61% higher risk of heart disease incidence (95% CI:1.342–1.931), and a 34.2% higher risk of stroke incidence (95% CI:1.008–1.786). Age- and sex- specific analyses further revealed varying trends in these associations.ConclusionsWe discovered that the combined association of body mass index(BMI) and central obesity with CVD incidence exhibited a significantly enhanced predictive value. Specifically, a high BMI with central obesity was notably linked to an increased risk of CVD incidence. Additionally, central obesity with a normal BMI or a normal WC coupled with a high BMI significantly augmented the risk of heart disease incidence, but not stroke. Notably, male and middle-aged adults demonstrated a greater propensity for heart disease incidence. Our study underscores the importance of maintaining an optimal BMI and preventing abdominal obesity in promoting cardiovascular health.

Sex-specific associations among neck circumference, the rs9939609 FTO gene polymorphism, and the 14-year risk of metabolic syndrome.

Limited data exist on the relation between neck circumference (NC) and the risk of developing metabolic syndrome (MS). This study investigated sex-specific associations between NC and the 14-year risk of MS and explored the impact of the FTO rs9939609 polymorphism on these associations. This population-based prospective cohort study involved 2,666 participants (1,301 men and 1,365 women), who were free of MS at baseline (2005-2006). Incident MS cases, defined by the presence of 3 or more criteria regarding blood pressure and blood levels of glucose, triglycerides, and high-density lipoprotein cholesterol, were identified through biennial examinations until 2020. NC measurements taken at baseline and between 2013 and 2014 were analyzed using Cox proportional hazard regression to determine sex-specific associations with MS risk. Controlling for potential confounders such as waist circumference (WC), significant associations were observed in both sexes. Individuals in the highest NC quartile exhibited more than a 2-fold higher MS risk than those in the lowest quartile; with hazard ratios of 2.37 (95% CI, 1.74 to 3.22) for men and 2.65 (95% CI, 1.89 to 3.72) for women (p-value for trend <0.001). No significant interaction was found between the FTO polymorphism and NC. In diagnostic test analyses, NC and WC demonstrated comparable area under the curve values in both sexes. The findings suggest that NC is as effective as WC for predicting the incidence of MS.

The effectiveness of nirsevimab in reducing the burden of disease due to respiratory syncytial virus (RSV) infection over time in the Madrid region (Spain): a prospective population-based cohort study.

Respiratory syncytial virus (RSV) infection is one of the main causes of morbidity and mortality from lower respiratory tract infections in children under 5 years of age worldwide. Given that, the objective of this study was estimate the effectiveness of nirsevimab (a single-dose, long-acting, human recombinant monoclonal antibody against RSV) over time for the prevention of respiratory episodes treated at different levels of care. A prospective and dynamic population-based cohort study was performed including infants born between April 1 and December 31, 2023, in the Madrid region who resided there during the follow-up period from October 1, 2023, to February 29, 2024. Infants were considered immunized from the day after receiving one dose (50 or 100 mg) of nirsevimab or nonimmunized individuals if they did not receive any dose. There were 4,100 episodes of primary care, 1,954 hospital emergencies, and 509 admissions, 82 of which required intensive care in the 33,859 participants analyzed. The adjusted effectiveness of nirsevimab in preventing hospitalization due to RSV infection was 93.6% (95% CI: 89.7 to 96.1) at 30 days and 87.6% (95% CI: 67.7 to 95.3) at 150 days. The number needed to treat to prevent one hospitalization were 314.19 (95% CI: 306.22 to 327.99) at 30 days and 24.30 (95% CI: 22.31 to 31.61) at 150 days. The adjusted effectiveness of nirsevimab in avoiding admission to an intensive care unit was 94.4% (95% CI: 87.3 to 97.5) at 30 days and 92.1% (95% CI: 64.0 to 98.3) at 90 days. The adjusted effectiveness of nirsevimab for avoiding primary care consultations and hospital emergency visits was lower. Immunization with nirsevimab is an effective measure for reducing the burden of care related to RSV at all levels of care albeit it decreases throughout follow-up. At 150 days it remained high for preventing hospital admissions. Other articles already published have also demonstrated high effectiveness although with preliminary results, short follow-up periods and wide confidence intervals. None have detected a decrease in effectiveness over time. These results can be quite useful in individual infant prevention and in the design of immunization campaigns.