Sex-specific intergenerational trends in morbidity burden and multimorbidity status in Hong Kong community: an age-period-cohort analysis of repeated population surveys

ObjectivesPrevalence of multimorbidity has been increasing worldwide. While population ageing undoubtedly contributes, secular trends have seldom been decomposed into age, period and cohort effects to investigate intergenerational differences. This study examines the birth cohort effect on morbidity burden and multimorbidity in Hong Kong community.DesignSex-specific age-period-cohort analysis with repeated cross-sectional surveys.SettingA territory-wide population survey database.Participants69 636 adults aged 35 or above who participated in the surveys in 1999, 2001, 2005 or 2008.Main outcome measuresMorbidity burden was operationalised as number of chronic conditions from a list of 14, while multimorbidity was defined as a dichotomous status of whether participants had two or more conditions.ResultsFor both sexes, there was an upward inflection (positive change) of risk of increased morbidity burden starting from cohort 1955–1959. For men born after 1945–1954, there was a trend of lower risk (relative risk=0.63, 95% CI 0.50 to 0.80 for 1950–1954 vs 1935–1939) which continued through subsequent cohorts but with no further declines. In women, there had been a gradual increase of risk, although only significant for cohort 1970–1974 (relative risk=1.90, 95% CI 1.08 to 1.34 vs 1935–1939). Similar results were found for dichotomous multimorbidity status.ConclusionsThe trend of lower risk starting from men born in 1945–1954 may be due to a persistent decline in smoking rates since the 1980s. On the other hand, the childhood obesity epidemic starting from the late 1950s coincided with the observed upward inflection of risk for both sexes, that is, notably more drastic increase of risk in women and the levelling-off of the decline of risk in men. These findings highlight that the cohort effects on morbidity burden and multimorbidity may be sex-specific and contextual. By examining such effects in different world populations, localised sex-specific and generation-specific risk factors can be identified to inform policy-making.

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Age period cohort analysis of chewing ability in Korea from 2007 to 2018

Scientific Reports ◽

10.1038/s41598-021-94086-8 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Nam-Hee Kim ◽

Ichiro Kawachi

Keyword(s):

Cohort Analysis ◽

Cohort Effect ◽

Cohort Effects ◽

Period Effect ◽

The Past ◽

Health And Nutrition ◽

Period Effects ◽

Chewing Ability ◽

Main Variable ◽

Observation Period

AbstractThere have been marked improvements in oral health in Korea during the past 10 years, including chewing ability. We sought to disentangle age, period, and cohort effects in chewing ability between 2007 and 2018. We analyzed data from the Korea National Health and Nutrition Examination Survey. The main variable was chewing difficulty, which was assessed among participants aged 20 years and older. APC analysis revealed three trends in chewing difficulty: (1) there was an increase in chewing difficulty starting at around 60 years of age (age effect), (2) there was a steady decrease in chewing difficulty during the observation period (period effect), and (3) chewing ability improved with each successive generation born after 1951 (cohort effect). Regarding recent improvements in chewing ability, cohort effects were somewhat more important than period effects.

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Historical Trends in Incidence of Breast Cancer in Shanghai, Hong Kong and Los Angeles, 1973–2012: A Joinpoint and Age-Period-Cohort Analysis

International Journal of Public Health ◽

10.3389/ijph.2021.603810 ◽

2021 ◽

Vol 66 ◽

Author(s):

Hang-Hang Luan ◽

Li-Sha Luo ◽

Zhi-Yan Lu

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Hong Kong ◽

Los Angeles ◽

Cancer Incidence ◽

White Women ◽

Cohort Analysis ◽

Breast Cancer Incidence ◽

Cohort Effects ◽

Period Effect

Objectives: This study aimed to estimate the long-term trends of breast cancer incidence in Shanghai, Hong Kong, and Los Angeles (LA).Methods: Data were obtained from Cancer Incidence in Five Continents (CI5plus) database. The average annual percent change (AAPC) was conducted by joinpoint regression analysis, and the age, period and cohort effects were estimated by age-period-cohort (APC) analysis.Results: The age-standardized incidence rates (ASIRs) in LA were higher than Shanghai and Hong Kong. During 1988–2012, the ASIRs significantly decreased in white women in LA (AAPC = −0.6%, 95% CI: −0.9% to −0.4%) while increased in Shanghai (2.5%: 2.1%–2.9%) and Hong Kong (2.2%: 2.0%–2.5%). The APC analysis revealed significantly increased effects of age and period, and decreased effect of birth cohort.Conclusion: Although age and cohort effects were relatively strong, the period effect may be the key factor affecting trends of incidence, which may be caused by increasing exposures to carcinogens and risk factors. Therefore, more effective measures should be carried out promptly to protect high-risk populations such as elder women, to avoid exposures to risk factors of breast cancer.

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Cohort Effects in the Prevalence of Caries in Child Populations in Tanzania

Journal of Dental Research ◽

10.1177/00220345890680121101 ◽

1989 ◽

Vol 68 (12) ◽

pp. 1777-1780 ◽

Cited By ~ 4

Author(s):

J.E. Frencken ◽

M.A. Van't Hof ◽

G.-J. Truin ◽

B.S. Lembariti ◽

K.G. König

Keyword(s):

Longitudinal Study ◽

Oral Health ◽

Longitudinal Studies ◽

Developing Country ◽

Cohort Analysis ◽

Cohort Effect ◽

Cohort Effects ◽

External Information ◽

Upward Trend ◽

Period Effects

In 1984, a four-year mixed-longitudinal study of oral health was begun in Morogoro Town and Morogoro District, Tanzania. Its main goal was to detect a possible upward trend in prevalence of caries in child cohorts in this developing country. The sample consisted of 722 seven-to nine-year-olds in 1984, 833 seven- to 11-year-olds in 1986, and 989 seven- to 13-year-olds in 1988. Mixed-longitudinal studies provide the opportunity for application of the Age-Period-Cohort analysis. On the basis of external information, either age and/or cohort and/or period effects can thus be isolated. Apart from significant age and period effects, a cohort effect was found, indicating that the prevalence of caries has decreased in these child populations between 1984 and 1988.

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Gender-specific temporal trends in overweight prevalence among Chinese adults: a hierarchical age-period-cohort analysis from 2008 to 2015

Global Health Research and Policy ◽

10.1186/s41256-020-00169-w ◽

2020 ◽

Vol 5 (1) ◽

Author(s):

Yinmei Yang ◽

Mohammedhamid Osman Kelifa ◽

Bin Yu ◽

Carly Herbert ◽

Yongbo Wang ◽

...

Keyword(s):

Cohort Analysis ◽

Temporal Trends ◽

General Social Survey ◽

Cohort Effects ◽

Chinese Adults ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Gender Specific ◽

Overweight Prevalence ◽

Age And Cohort Effects

Abstract Background As a key health risk, the prevalence of overweight has been strikingly increasing worldwide. This study aimed to disentangle the net age, period, and cohort effects on overweight among Chinese adults by gender. Methods Data came from the Chinese General Social Survey from 2008 to 2015, which was a repeated cross-sectional survey (n = 55,726, aged 18 and older). χ2 or t tests were used to estimate the gender disparities in overweight and socioeconomic status (SES). A series of hierarchical age-period-cohort cross-classified random-effects models were performed using SAS version 9.4 to estimate the overall and gender-specific temporal trends of overweight, as well as the association between SES and overweight. Further, a series of line charts were used to present the age and cohort variations in overweight. Results After controlling for covariates, significant age and cohort effects were observed among adults in China (b = 0.0205, p < 0.001; b = 0.0122, p < 0.05; respectively). Specifically, inverted U-shaped age effects were identified for both genders, with a high probability of overweight occurring in middle age (b = –0.0012, p < 0.001). Overweight was more prevalent among men than women before 60 years old, and this trend reversed thereafter (b = –0.0253, p < 0.001). Moreover, men born during the war (before 1950) and reform cohorts (after the 1975s) demonstrated a substantial decline in overweight, while men born in 1950–1975 showed an increasing trend in overweight prevalence (b = 0.0378, p < 0.05). However, the cohort effect on women was not statistically significant. Additionally, a higher SES was related to an elevated probability of overweight. Conclusion Gender-specific age and cohort effects on the prevalence of overweight were observed among Chinese adults. Both China and other developing countries need to pay attention to the coming obesity challenge and related health inequality. Full life-cycle overweight prevention interventions should focus on middle-aged adults, men born in the war and reform eras, and adults with a higher SES.

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Addressing the Younger Age at Onset in Breast Cancer Patients in Asia: An Age-Period-Cohort Analysis of Fifty Years of Quality Data from the International Agency for Research on Cancer

ISRN Oncology ◽

10.1155/2013/429862 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Seyed Houssein Mousavi-Jarrrahi ◽

Amir Kasaeian ◽

Kamyar Mansori ◽

Mehdi Ranjbaran ◽

Mahmoud Khodadost ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Cohort Analysis ◽

Age At Onset ◽

Cohort Effect ◽

Asian Population ◽

Cohort Effects ◽

International Agency ◽

Breast Cancer Patients ◽

Younger Age

Introduction. There is an established fact that Asian breast cancer patients are, on average, younger than their European counterparts. This study aimed to utilize the data from the Cancer Incidence in Five Continents I through XIII (published by the International Agency for Research on Cancer) to examine what contributes to the younger age at onset in the Asian population. Material and Methods. Data (number of breast cancer cases and corresponding population figures) for 29 registries in Europe and 9 registries in Asia for the period of 1953–2002 was accessioned and pooled to form two distinct populations, Asia and Europe. The age specific rates were defined and analyzed cross-sectionally (period wise) and longitudinally (cohort wise). The magnitude and the pattern of age specific rates were analyzed using the age-period-cohort analysis. The constrained generalized linear model with a priority assumption of cohort effect as contributing factor to changing rates was used to analyze the data. Result. During the last 50 years, the rate of breast cancer increased for both populations with an estimated annual percent change of 1.03% (with 95% CI of 1.029, 1.031) for Asia and 1.016% (95% CI of 1.015, 1.017) for Europe. There were stronger cohort effects in the magnitude of rates among the Asian population compared to the European population. The cohort effects, expressed as the rate ratio with cohort born in 1970 as reference, ranged from 0.06 (95% CI 0.05, 0.08) to 0.94 (95% CI 0.93, 0.96) for Asians and 0.35 (95% CI 0.33, 0.36) to 1.03 (95% CI 1.02, 1.04) for Europeans. The estimated longitudinal age specific rates (adjusted for cohort and period effects) showed similar patterns between the two populations. Conclusion. It was concluded that a strong cohort effect contributes to the younger age at onset among Asian breast cancer patients.

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Mobile Phone Use and Brain Tumor: An Age-Period-Cohort Analysis of Brain Tumor Rates in the Nordic Population

Asian Pacific Journal of Cancer Biology ◽

10.31557/apjcb.2016.1.1.19-29 ◽

2016 ◽

Vol 1 (1) ◽

pp. 19-29

Author(s):

Mehdi Ranjbaran ◽

Mahmood Khodadost ◽

Kamyar Mansori ◽

Seyed Houssien Mousavi Jarrahi ◽

Erfan Ayubi ◽

...

Keyword(s):

Brain Tumor ◽

Mobile Phone ◽

Cohort Analysis ◽

Latency Period ◽

Cohort Effect ◽

Positive Association ◽

Incidence Rates ◽

Cohort Effects ◽

Mobile Phone Use ◽

Study Results

Background: The association of the mobile phone use and risk of brain tumor remains controversial among radiation epidemiologists. Methods: We hypothesized if an association between brain tumor and mobile phone use exists, this association will be manifested as a cohort effect (as a proxy of association between mobile phone use and brain tumor) in the incidence rates of brain tumor during the period of 1990 to 2009. We used age-period-cohort methodology (generalized log-linear model) and compared the distribution of cohort effects in the observed rates of brain tumor from 1990 to 2009 to the cohort effects from rates driven based on epidemiological study results that reported a positive association between brain tumor and mobile phone use in the Nordic population. Three latency period of 1-4 years with odds ratio (OR) of 1.2, latency period of 5-9 years with OR of 1.3, and latency period of more than 10 years with OR of 2.7 were used to estimate expected rates. Results: The distribution of cohort effects between observed and expected rates were more similar among the males compared with females. A shorter latency was more con¬sistent to observed rates. Conclusion: Our study supports a possible a weak association between mobile phone use and brain tumor; further fueling the controversies in association.

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Cohort effects of tobacco control policy: evidence to support a tobacco-free norm through smoke-free policy

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054536 ◽

2018 ◽

Vol 29 (1) ◽

pp. 96-102 ◽

Cited By ~ 6

Author(s):

Heewon Kang ◽

Sung-il Cho

Keyword(s):

Cohort Effect ◽

Control Policy ◽

Adolescent Smoking ◽

Cohort Effects ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Public Places ◽

Korean Adolescents ◽

South Korean ◽

Cigarette Prices

BackgroundThe prevalence of cigarette smoking among South Korean adolescents has decreased markedly over the past decade, which may indicate a norm shift between generations of adolescents. The present study aims to identify the effect of banning smoking in public places and increasing cigarette prices on current adolescent smoking, and to determine whether these policies additionally resulted in cohort effects.MethodsRepeated cross-sectional survey data, nationally representative of South Korean adolescents, were used. A total of 853 441 adolescents ranging in age from 12 to 18 years (mean age, 15 years) were identified. Models applied were segmented regression model to detect changes in smoking trends and age-period-cohort model to determine the cohort effects on the trends.FindingsBetween 2006 and 2017, smoking decreased from 16% to 9% in boys and from 9% to 3% in girls. After a complete ban on smoking in public places, there were significantly negative trends in the prevalence of smoking for both boys (β=−1.1; 95% CI: −1.9 to −0.2) and girls (β=−0.4; 95% CI: −0.6 to −0.1). Immediate decrease among girls was found after cigarette prices increased (β=−0.8; 95% CI: −1.5 to −0.2). For the cohort effect, the risk of smoking decreased with every consecutive year for boys born after 1998 and girls born after 1997.ConclusionsOur results indicate the presence of cohort effects in the reduction of adolescent smoking. The cohort effect was induced by smoke-free legislation. Research on cohort effects, and methods to denormalise tobacco, will contribute to preventing adolescents from ever trying a cigarette.

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On the age-period-cohort analysis of suicide rates

Psychological Medicine ◽

10.1017/s0033291700008357 ◽

1988 ◽

Vol 18 (3) ◽

pp. 677-681 ◽

Cited By ~ 16

Author(s):

Stephen C. Newman ◽

Ronald J. Dyck

Keyword(s):

Mathematical Model ◽

Cohort Analysis ◽

Cohort Effect ◽

Cohort Effects ◽

Period Effect ◽

Simple Mathematical Model ◽

Data Set ◽

Popular Method ◽

Suicide Rates ◽

National Trends

SynopsisCohort analysis has become a popular method of examining national trends in suicide rates. Most of the studies investigating this phenomenon have reported a cohort effect to be present. Using a graphical approach, this paper places cohort analysis within the broader framework of age-period-cohort analysis. It is shown that published reports may have failed to identify cohort effects due to using only portions of the available data. With a simple mathematical model it is demonstrated that what appears to be a cohort effect may be a period effect, and conversely. It is recommended that suicide rates be examined for both period and cohort effects before conclusions are drawn regarding trends, and that the complete data set be used for this purpose.

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Age–period–cohort analysis of the incidence of schizophrenia in Scotland

Psychological Medicine ◽

10.1017/s0033291700035297 ◽

1996 ◽

Vol 26 (5) ◽

pp. 963-973 ◽

Cited By ~ 27

Author(s):

Noriyoshi Takei ◽

Glyn Lewis ◽

Pak C. Sham ◽

Robin M. Murray

Keyword(s):

Birth Cohort ◽

Cohort Analysis ◽

Cohort Effect ◽

National Sample ◽

Period Effect ◽

Cross Sectional ◽

Admission Rates ◽

Schizophrenic Patients ◽

Birth Cohort Effect ◽

First Admission

SynopsisStudies examining a possible decline in the incidence of schizophrenia over the last two to three decades have paid little attention to the possible role of birth cohort effects. We collected data on a Scottish national sample of all schizophrenic patients, admitted for the first time between 1966 and 1990 (N = 11348; male = 6301). In an Age–Period–Cohort analysis, a full model, incorporating three factors, had a substantially better fit to the data than other models (especially, an Age–Period model), providing clear evidence of the presence of a cohort effect. After adjustment for the effects of age and period, there was a 55% reduction in the rate of schizophrenia in men and a 39% fall in the number of women over the 50-year birth period from 1923 to 1973. The marked decline in the first admission rates observed in Scotland cannot, however, be attributed entirely to this cohort effect. Rather, a greater proportion of the declining first admission rates (88%) is ascribed to the period effect (i.e. artefactual or causally related cross-sectional effects). Nevertheless, the fact that a birth-cohort effect accounts for part of the declining incidence, suggests that causal environmental factors operating early in life have been diminishing in intensity.

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Relative risk of cardiovascular disease is higher in women with type 2 diabetes, but not in those with prediabetes, as compared with men

10.2337/figshare.12915272 ◽

2020 ◽

Author(s):

Elena Succurro ◽

Teresa Vanessa Fiorentino ◽

Sofia Miceli ◽

Maria Perticone ◽

Angela Sciacqua ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Longitudinal Study ◽

Relative Risk ◽

Hdl Cholesterol ◽

Cross Sectional Study ◽

Adverse Outcomes ◽

Cross Sectional ◽

Normal Glucose

Objective: Most, but not all studies suggested that women with type 2 diabetes have higher relative risk (RR) for cardiovascular disease (CVD) than men. More uncertainty exists on whether the RR for CVD is higher in prediabetic women compared to men. Research Design and Methods: In a cross-sectional study, in 3540 normal glucose tolerant (NGT), prediabetic, and diabetic adults, we compared the RR for prevalent non-fatal CVD between men and women. In a longitudinal study including 1658 NGT, prediabetic, and diabetic adults, we compared the RR for incident major adverse outcomes, including all-cause death, coronary heart disease, and cerebrovascular disease events after 5.6 years follow-up. Results: Women with prediabetes and diabetes exhibited greater relative differences in BMI, waist circumference, blood pressure, total, LDL and HDL cholesterol, triglycerides, fasting glucose, hsCRP, and white blood cell count than men with prediabetes and diabetes when compared with their NGT counterparts. We found a higher RR for prevalent CVD in diabetic women (RR 9.29; 95% CI 4.73-18.25; P<0.0001) than in men (RR 4.56; 95% CI 3.07-6.77; P<0.0001), but no difference in RR for CVD was observed comparing prediabetic women and men. In the longitudinal study, we found that diabetic, but not prediabetic women have higher RR (RR 5.25; 95% CI 3.22-8.56; P<0.0001) of incident major adverse outcomes than their male counterparts (RR 2.72; 95% CI 1.81-4.08; P<0.0001). Conclusions: This study suggests that diabetic, but not prediabetic, women have higher RR for prevalent and incident major adverse outcomes than men.

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