scholarly journals Assessing the Role of Selection Bias in the Protective Relationship Between Caregiving and Mortality

2019 ◽  
Vol 188 (11) ◽  
pp. 1961-1969
Author(s):  
Meghan L Smith ◽  
Timothy C Heeren ◽  
Lynsie R Ranker ◽  
Lisa Fredman
Keyword(s):  
Selection Bias ◽  
Osteoporotic Fractures ◽  
Mortality Rates ◽  
Sociodemographic Factors ◽  
Population Based ◽  
Ancillary Study ◽  
Participation Bias ◽  
Hazard Ratios ◽  
Key Points

Abstract Caregivers have lower mortality rates than noncaregivers in population-based studies, which contradicts the caregiver-stress model and raises speculation about selection bias influencing these findings. We examined possible selection bias due to 1) sampling decisions and 2) selective participation among women (baseline mean age = 79 years) in the Caregiver-Study of Osteoporotic Fractures (Caregiver-SOF) (1999–2009), an ancillary study to the Study of Osteoporotic Fractures (SOF). Caregiver-SOF includes 1,069 SOF participants (35% caregivers) from 4 US geographical areas (Baltimore, Maryland; Minneapolis, Minnesota; the Monongahela Valley, Pennsylvania; and Portland, Oregon). Participants were identified by screening all SOF participants for caregiver status (1997–1999; n = 4,036; 23% caregivers) and rescreening a subset of caregivers and noncaregivers matched on sociodemographic factors 1–2 years later. Adjusted hazard ratios related caregiving to 10-year mortality in all women initially screened, subsamples representing key points in constructing Caregiver-SOF, and Caregiver-SOF. Caregivers had better functioning than noncaregivers at each screening. The association between caregiving and mortality among women invited to participate in Caregiver-SOF (41% died; adjusted hazard ratio (aHR) = 0.73, 95% confidence interval (CI): 0.61, 0.88) was slightly more protective than that in all initially screened women (37% died; aHR = 0.83, 95% CI: 0.73, 0.95), indicating little evidence of selection bias due to sampling decisions, and was similar to that in Caregiver-SOF (39% died; aHR = 0.71, 95% CI: 0.57, 0.89), indicating no participation bias. These results add to a body of evidence that informal caregiving may impart health benefits.

scholarly journals Late-life suicidal behaviours among new users of antidepressants: a prospective population-based study of sociodemographic and gender factors in those aged 75 and above

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e022703 ◽  
Author(s):  
Khedidja Hedna ◽  
Karolina Andersson Sundell ◽  
Gunnel Hensing ◽  
Ingmar Skoog ◽  
Sara Gustavsson ◽  
...  
Keyword(s):  
Suicide Attempts ◽  
Nordic Country ◽  
Age Groups ◽  
Antidepressant Medication ◽  
Late Life ◽  
Sociodemographic Factors ◽  
Population Based ◽  
Entire Cohort ◽  
Hazard Ratios ◽  
And Gender

ObjectiveTo investigate sociodemographic and gender factors associated with suicide and suicide attempts among new users of antidepressants aged 75 and above.DesignRegister-based cohort study.SettingNational population-based cohort of Swedish residents aged ≥75 years.Participants185 225 patients who initiated antidepressant medication between 1 January 2007 and 31 December 2013 were followed until 31 December 2014.Main outcome measuresSuicide and suicide attempts. Fine and Gray regression models were used to analyse the sociodemographic factors (age, country of birth, marital status, education level, last occupation, income and social allowance) associated with suicidal behaviours in the entire cohort and by gender.ResultsDuring follow-up, 295 suicides and 654 suicide attempts occurred. Adjusted sub-hazard ratios (aSHRs) for suicide were lower among older age groups (aSHR 0.73, 95% CI 0.53 to 0.99 for those 85–89 years; and aSHR 0.53, 95% CI 0.33 to 0.86 for those ≥90 years). A similar pattern was observed for suicide attempts. Suicide attempts were more common among those born in foreign countries (aSHR 1.58, 95% CI 1.16 to 2.15 for those born in another Nordic country; and aSHR 1.43, 95% CI 1.06 to 1.93 for those born in non-Nordic countries). In the gender-stratified analyses, being single or divorced, and born in another Nordic country was associated with a higher risk of suicide among men. Educational and occupational history and being born in a non-Nordic country influenced risk of suicidal behaviours in women.ConclusionSuicidal behaviours occurred more commonly among new users who were ‘younger’ old adults and those with foreign background, suggesting that those groups might require greater support when initiating antidepressant therapy. Our findings suggest the need for gender-specific, multifaceted approaches to the prevention of suicidal behaviours in late life.

Incident Atrial Fibrillation, Dementia and the Role of Anticoagulation: A Population-Based Cohort Study

2019 ◽  
Vol 119 (06) ◽  
pp. 981-991 ◽  
Author(s):  
Thalia S. Field ◽  
Bob Weijs ◽  
Antonio Curcio ◽  
Michela Giustozzi ◽  
Saulius Sudikas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Population Based ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Dementia Diagnosis ◽  
Hazard Ratios ◽  
Co Morbidity ◽  
History Of ◽  
Observation Period

Introduction Atrial fibrillation (AF) is associated with dementia. Anticoagulation may modify this relationship, but it is unclear if this is due to stroke reduction alone. Methods Age- and sex-matched individuals from the U.K. Clinical Practice Research Datalink (2008–2016) with and without an incident diagnosis of AF were followed for a new dementia diagnosis. We estimated adjusted hazard ratios (aHRs) for incident dementia diagnosis in the AF cohort, overall and stratified by anticoagulation status, using the matched non-AF cohorts as reference. We performed a sensitivity analysis excluding individuals with stroke/transient ischaemic attack (TIA) before the observation period. Results Over 193,082 person-years (mean follow-up 25.7 ± 0.1 months), 347/15,276 AF (2.3%) and 1,085/76,096 non-AF (1.4%) were newly diagnosed with dementia (aHR, 1.31, 95% confidence interval, 1.15–1.49). The AF group had more co-morbidity and higher rates of dementia, both with and without anticoagulation, than non-AF. When those with history of stroke/ TIA before the observation period were excluded and those with incident stroke/TIA during the observation period were censored, AF individuals not on anticoagulation had significantly higher rates of dementia compared with non-AF, aHR 1.30 (1.06–1.58). Conclusion Our findings support the hypothesis that AF is a distinct risk factor for dementia, independent of stroke/TIA and other vascular risk factors. In those without stroke/TIA, risk of dementia is increased only in those who are not on anticoagulation, suggesting anticoagulation is protective presumably through reduction of sub-clinical embolic events. Further prospective research is needed to better ascertain the role of anticoagulation amongst targeted therapeutic strategies to reduce cognitive decline in AF.

Depression as a Mediator of the Association Between Wealth Status and Risk of Cognitive Impairment and Dementia: A Longitudinal Population-Based Cohort Study

2021 ◽  
pp. 1-11
Author(s):  
Rui Zhou ◽  
Hua-Min Liu ◽  
Fu-Rong Li ◽  
Hai-Lian Yang ◽  
Jia-Zhen Zheng ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Population Based ◽  
Cognitive Status ◽  
Wealth Status ◽  
Cox Models ◽  
Mediating Role ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Time Dependent Covariates

Background: Wealth and income are potential modifiable risk factors for dementia, but whether wealth status, which is composed of a combination of debt and poverty, and assessed by wealth and income, is associated with cognitive impairment among elderly adults remains unknown. Objective: To examine the associations of different combinations of debt and poverty with the incidence of dementia and cognitive impairment without dementia (CIND) and to evaluate the mediating role of depression in these relationships. Methods: We included 15,565 participants aged 51 years or older from the Health and Retirement Study (1992–2012) who were free of CIND and dementia at baseline. Dementia and CIND were assessed using either the modified Telephone Interview for Cognitive Status (mTICS) or a proxy assessment. Cox models with time-dependent covariates and mediation analysis were used. Results: During a median of 14.4 years of follow-up, 4,484 participants experienced CIND and 1,774 were diagnosed with dementia. Both debt and poverty were independently associated with increased dementia and CIND risks, and the risks were augmented when both debt and poverty were present together (the hazard ratios [95% confidence intervals] were 1.35 [1.08–1.70] and 1.96 [1.48–2.60] for CIND and dementia, respectively). The associations between different wealth statuses and cognition were partially (mediation ratio range: 11.8–29.7%) mediated by depression. Conclusion: Debt and poverty were associated with an increased risk of dementia and CIND, and these associations were partially mediated by depression. Alleviating poverty and debt may be effective for improving mental health and therefore curbing the risk of cognitive impairment and dementia.

A 8-year population-based cohort study of irritable bowel syndrome in childhood with history of atopic dermatitis

2018 ◽  
Vol 66 (4) ◽  
pp. 755-761 ◽  
Author(s):  
Jeng-Dau Tsai ◽  
I-Chung Wang ◽  
Te-Chun Shen ◽  
Cheng-Li Lin ◽  
Chang-Ching Wei
Keyword(s):  
Atopic Dermatitis ◽  
Irritable Bowel Syndrome ◽  
Cohort Analysis ◽  
Gastrointestinal Disorder ◽  
Population Based ◽  
Trend Test ◽  
Hazard Ratios ◽  
History Of ◽  
Irritable Bowel

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder affecting a large number of people worldwide. Based on the concept of central sensitization, we conducted a population-based cohort analysis to investigate the risk of IBS in children with atopic dermatitis (AD) as one of the first steps in the atopic march. From 2000 to 2007, 1 20 014 children with newly diagnosed AD and 1 20 014 randomly selected non-AD controls were included in the study. By the end of 2008, incidences of IBS in both cohorts and the AD cohort to non-AD cohort hazard ratios (HRs) and CIs were measured. The incidence of IBS during the study period was 1.45-fold greater (95% CI: 1.32 to 1.59) in the AD cohort than in the non-AD cohort (18.8 vs 12.9 per 10 000 person-years). The AD to non-AD HR of IBS was greater for girls (1.60, 95% CI: 1.39 to 1.85) and children≥12 years (1.59, 95% CI: 1.23 to 2.05). The HR of IBS in AD children increased from 0.84 (95% CI: 0.75 to 0.94) for those with ≤3 AD related visits to 16.7 (95% CI: 14.7 to 18.9) for those with >5 visits (P<0.0001, by the trend test). AD children had a greater risk of developing IBS. Further research is needed to clarify the role of allergy in the pathogenesis of IBS.

Chronic Myeloproliferative Neoplasms and Risk of Osteoporosis. A Nationwide Population-Based Cohort Study.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2835-2835
Author(s):  
Sarah Farmer ◽  
Erzsebet Horváth-Puhó ◽  
Hanne Vestergaard ◽  
Henrik Frederiksen ◽  
Pernille Hermann ◽  
...  
Keyword(s):  
Femoral Fracture ◽  
Comparison Group ◽  
Myeloproliferative Neoplasms ◽  
Osteoporotic Fractures ◽  
Population Based ◽  
Diagnosis Code ◽  
Chronic Myeloproliferative Neoplasms ◽  
Hazard Ratios ◽  
Comparison Cohort ◽  
Cumulative Rate

Abstract Abstract 2835 Background: The classical chronic myeloproliferative neoplasms (CMPNs), including essential thrombocytemia (ET), polycythemia vera (PV), and chronic myeloid leukemia (CML), are disorders characterized by accelerated proliferation of hematopoietic tissue. Systemic mastocytosis, also a chronic myeloproliferative neoplasm, has been associated with increased risk of osteoporosis. However, to our knowledge, no data is available on the risk of osteoporosis among patients with classical CMPNs. Method: We conducted a Danish population-based cohort study of the risk of osteoporosis among patients with ET, PV, and CML using data from the Danish health care system. ET, PV, and CML patients were identified from Danish National Registry of Patients (DNRP), and linked to the Danish Civil Registration System (CRS) in the study period 1 January 1980 to 31 December 2010. Each Danish resident has a unique, permanent 10-digit civil registry number allowing unambiguous individual-level linkage among all Danish registries. Patients with a first-ever CMPN diagnosis in the DNRP were identified by means of their ICD-8 diagnosis code until 1994 and ICD-10 diagnosis code thereafter. By this means, we established three distinct cohorts of ET, PV, and CML patients. For each CMPN patient, 50 general population comparison cohort members without CMPN were identified in the CRS matched on age, sex, and calendar year, creating three comparison cohorts. Follow-up started 1-year from the date of diagnosis for CMPN patients. The comparison cohort members were assigned the same index date as their index CMPN case. A diagnosis of proximal femoral fracture was used an indicator of osteoporosis, since this fracture type invariably leads to hospitalization, and therefore would be registered in the DNRP throughout our observation period. The CMPN and comparison cohorts were followed until a diagnosis of femoral fracture, emigration, death, or 31 December 2010, whichever came first. Patients and comparison cohort members with a previous diagnosis of osteoporosis or osteoporotic fractures were excluded. The Kaplan-Meier method was used to estimate the cumulative rate of fractures. Cox regression was used to estimate hazard ratios (HRs) as a measure of relative risk of femoral fracture for each CMPN cohort compared to the comparison cohort, adjusted for comorbidity. Results: We identified 7,595 MPN patients (1,864 with ET; 4,418 with PV; and 1,313 with CML) and 338,974 comparison cohort members. The cumulative rate of proximal femoral fractures was higher among CMPN patients than among comparison cohort members, as depicted in the Figures. The rate of fractures per 1,000 person-years were: 6.6 (95% confidence interval (CI): 5.2–8.3) for ET patients [comparison group: 5.3 (95% CI: 5.1–5.4)], 9.9 (95% CI: 8.8–11.0) for PV patients [comparison group: 6.2 (95% CI: 6.1–6.3)]; and 8.2 (95% CI: 6.0–10.7) for CML patients [comparison group: 4.4 (95% CI: 4.3–4.6)]. The resulting adjusted hazard ratios (HR) were: HRET = 1.2 (95% CI: 0.9–1.5), HRPV = 1.8) (95% CI: 1.6–2.0), and HRCML = 2.7 (95% CI: 2.0–3.6). Conclusion: CMPN patients are at higher risk of osteoporotic fractures than the general population. Disclosures: No relevant conflicts of interest to declare.

scholarly journals 25-Hydroxyvitamin D and Risk of Osteoporotic Fractures: Mendelian Randomization Analysis in 2 Large Population-Based Cohorts

2020 ◽  
Vol 66 (5) ◽  
pp. 676-685 ◽  
Author(s):  
Yunus Çolak ◽  
Shoaib Afzal ◽  
Børge G Nordestgaard
Keyword(s):  
Vitamin D ◽  
Mendelian Randomization ◽  
Osteoporotic Fractures ◽  
Population Based ◽  
Hydroxyvitamin D ◽  
Mendelian Randomization Analysis ◽  
Hazard Ratios ◽  
Increased Risk ◽  
25 Hydroxyvitamin D ◽  
Randomization Analysis

Abstract Background Whether low plasma 25-hydroxyvitamin D concentrations cause osteoporotic fractures is unclear. We tested the hypothesis that low plasma 25-hydroxyvitamin D concentrations are associated with increased risk of osteoporotic fractures using a Mendelian randomization analysis. Methods We genotyped 116 335 randomly chosen white Danish persons aged 20–100 years in 2 population-based cohort studies for plasma 25-hydroxyvitamin D decreasing genotypes in CYP2R1 (rs117913124 and rs12794714), DHCR7 (rs7944926 and rs11234027), GEMIN2 (rs2277458), and HAL (rs3819817); 35 833 had information on plasma 25-hydroxyvitamin D. We assessed risk of total, osteoporotic, and anatomically localized fractures from 1981 through 2017. Information on fractures and vital status was obtained from nationwide registries. Results During up to 36 years of follow-up, we observed 17 820 total fractures, 10 861 osteoporotic fractures, and 3472 fractures of hip or femur. Compared with individuals with 25-hydroxyvitamin D ≥ 50nmol/L, multivariable adjusted hazard ratios (95% CIs) for total fractures were 1.03 (0.97–1.09) for individuals with 25–49.9 nmol/L, 1.19 (1.10–1.28) for individuals with 12.5–24.9 nmol/L, and 1.39 (1.21–1.60) for individuals with 25-hydroxyvitamin D &lt; 12.5 nmol/L. Corresponding hazard ratios were 1.07 (1.00–1.15), 1.25 (1.13–1.37), and 1.49 (1.25–1.77) for osteoporotic fractures and 1.09 (0.98–1.22), 1.37 (1.18–1.57), and 1.41 (1.09–1.81) for fractures of hip or femur, respectively. Hazard ratios per 1 increase in vitamin D allele score, corresponding to 3.0% (approximately 1.6 nmol/L) lower 25-hydroxyvitamin D concentrations, were 0.99 (0.98–1.00) for total fractures, 0.99 (0.97–1.00) for osteoporotic fractures, and 0.98 (0.95–1.00) for fractures of hip or femur. Conclusions Low plasma 25-hydroxyvitamin D concentrations were associated with osteoporotic fractures; however, Mendelian randomization analysis provided no evidence supporting a causal role for vitamin D in the risk for osteoporotic fractures.

scholarly journals Potential role of selection bias in the association between childhood leukemia and residential magnetic fields exposure: A population-based assessment

2014 ◽  
Vol 38 (3) ◽  
pp. 307-313 ◽  
Author(s):  
Danna A. Slusky ◽  
Monique Does ◽  
Catherine Metayer ◽  
Gabor Mezei ◽  
Steve Selvin ◽  
...  
Keyword(s):  
Magnetic Fields ◽  
Selection Bias ◽  
Childhood Leukemia ◽  
Potential Role ◽  
Population Based

scholarly journals Having a child without wanting to? Estimates and contributing factors from a population-based survey in Sweden

2020 ◽  
pp. 140349482096576
Author(s):  
Charlotte Deogan ◽  
Klara Abrahamsson ◽  
Louise Mannheimer ◽  
Charlotte Björkenstam
Keyword(s):  
Sexual Violence ◽  
Contraceptive Use ◽  
Fertility Control ◽  
Good Health ◽  
National Sample ◽  
Sociodemographic Factors ◽  
Population Based ◽  
Induced Abortion ◽  
Contributing Factors

Aims: The aims of the current study were to identify the prevalence of unwanted childbirth (UC), to explore the association with sociodemographic factors and to identify possible contributing factors such as psychosomatic health, contraceptive use, experiences of induced abortion and sexual violence. Methods: We used Swedish data from the randomised population-based study SRHR2017 on sexual and reproductive health and rights (SRHR), based on self-administered surveys, linked to nationwide registers. The national sample consisted of 14,537 women and men aged between 16 and 84 years. With logistic regression, we examined differences in self-reported experience of UC, stratified by sex, in relation to socio-economic factors, as well as several possible contributing factors. Results: Despite advances in SRHR and fertility control, 6% of women and men in Sweden reported UC. This experience tends to be unevenly distributed in the population according to age, country of birth and, to some extent, income and educational attainment. Previous experience of induced abortion, sexual violence and threat from a partner were significantly associated with UC, whereas self-reported good health was protective. Conclusions: Mechanisms behind unintended, unplanned, unwanted or mistimed pregnancies are complex. Current results focus on the role of individual factors and personal experiences. In addition, in line with previous understanding, there is a need for adopting a broader socio-ecological perspective on fertility intentions.

Geographic and demographic disparities in neuroendocrine tumors (NETs): A population-based study.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e15694-e15694 ◽  
Author(s):  
Rohit Gosain ◽  
Somedeb Ball ◽  
Navpreet Kaur Rana ◽  
Adrienne Groman ◽  
Elizabeth Gage-Bouchard ◽  
...  
Keyword(s):  
Neuroendocrine Tumors ◽  
Tumor Biology ◽  
Sociodemographic Factors ◽  
Population Based ◽  
Population Based Study ◽  
Specific Mortality ◽  
Sociodemographic Disparities ◽  
Male Patients ◽  
Socio Demographic Factors

e15694 Background: The incidence and prevalence of Neuroendocrine Tumors (NETs) are rapidly rising. There are very few studies investigating the role of sociodemographic factors on NETs. The aim of our study was to identify the disparities in the NET population. Methods: We conducted a retrospective analysis utilizing the Surveillance, Epidemiology, and End Results (SEER) database, and studied NETs patient population from 1973 to 2015. Univariate and multivariate analyses were performed to evaluate patients’ disease-specific survival (DSS) and overall survival (OS). Different socio-demographic factors including location of residence: urban area (UA) versus rural area (RA), gender, race, insurance status and marital status were included in the analysis. Results: A total of 53,522[ RA: N = 9,053; UA: N = 43,981] patients were included in the analysis. The incidence of NETs was found to be rising in both RA and UA but more rapidly in UA. RA was associated with more advanced stage at presentation in comparison to UA (p < 0.001). Cause-specific mortality remained higher in RA than UA throughout the study period. In the multivariate model, RA had a trend towards poorer DSS (HR:1.03, p = 0.399) and a worse OS compared to UA (HR = 1.06, p = 0.0003). Blacks had a poorer OS compared to non-Hispanic Whites (HR = 1.16, p < 0.001). Multivariate analysis showed significantly worse DSS and OS in uninsured, single and male patients compared to insured, married and female patients respectively. Conclusions: Our study identified sociodemographic disparities on NET outcomes. Access to healthcare could be a potential contributing factor although differences in environmental exposure, health behavior and tumor biology could also be responsible. Further population-based studies are required to address these disparities.

scholarly journals Personality Traits and Changes in Health Behaviors and Depressive Symptoms during the COVID-19 Pandemic: A Longitudinal Analysis from Pre-pandemic to Onset and End of the Initial Emergency Conditions in Finland

2021 ◽  
Vol 18 (15) ◽  
pp. 7732
Author(s):  
Tiia Kekäläinen ◽  
Enni-Maria Hietavala ◽  
Matti Hakamäki ◽  
Sarianna Sipilä ◽  
Eija K. Laakkonen ◽  
...  
Keyword(s):  
Physical Activity ◽  
Depressive Symptoms ◽  
Alcohol Consumption ◽  
Health Behaviors ◽  
Personality Traits ◽  
Eating Habits ◽  
Sociodemographic Factors ◽  
Population Based ◽  
Lifestyle Changes

The COVID-19 pandemic and social distancing measures targeting the transmission of the virus impacted everyday life in 2020. This study investigated pre- to in-pandemic changes in health behaviors and depressive symptoms during the COVID-19 pandemic and the role of personality traits in these changes in Finland. Data from a larger population-based cohort study of 51–59-year-old Finnish women were used (n = 358). Self-reported questionnaires gathered information about depressive symptoms, eating behavior, physical activity, and alcohol consumption before the pandemic time, at the onset, and at the end of the COVID-19 emergency conditions. Information about personality traits (extraversion and neuroticism) and sociodemographic factors was available from the pre-pandemic baseline. Women reported more depressive symptoms and unhealthier eating habits at the end of the emergency conditions compared to the pre-pandemic time. An increase in depressive symptoms was associated with changing to unhealthier eating habits. Higher extraversion was associated with a perceived decrease in alcohol consumption and with changing to healthier eating habits. Women with higher neuroticism reported changing to either healthier or unhealthier eating habits. In general, some women reported healthier lifestyle changes while other women reported the opposite. Personality traits help to understand these individual differences in adaptation to the pandemic situation.

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