Socioeconomic inequalities across life and premature mortality from 1971 to 2016: findings from three British birth cohorts born in 1946, 1958 and 1970

IntroductionDisadvantaged socioeconomic position (SEP) in early and adult life has been repeatedly associated with premature mortality. However, it is unclear whether these inequalities differ across time, nor if they are consistent across different SEP indicators.MethodsBritish birth cohorts born in 1946, 1958 and 1970 were used, and multiple SEP indicators in early and adult life were examined. Deaths were identified via national statistics or notifications. Cox proportional hazard models were used to estimate associations between ridit scored SEP indicators and all-cause mortality risk—from 26 to 43 years (n=40 784), 26 to 58 years (n=35 431) and 26 to 70 years (n=5353).ResultsMore disadvantaged SEP was associated with higher mortality risk—magnitudes of association were similar across cohort and each SEP indicator. For example, HRs (95% CI) from 26 to 43 years comparing lowest to highest paternal social class were 2.74 (1.02 to 7.32) in 1946c, 1.66 (1.03 to 2.69) in 1958c, and 1.94 (1.20 to 3.15) in 1970c. Paternal social class, adult social class and housing tenure were each independently associated with mortality risk.ConclusionsSocioeconomic circumstances in early and adult life show persisting associations with premature mortality from 1971 to 2016, reaffirming the need to address socioeconomic factors across life to reduce inequalities in survival to older age.

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Socioeconomic inequalities across life and premature mortality from 1971 to 2016: findings from three British birth cohorts born in 1946, 1958, and 1970

10.1101/2020.04.09.20059410 ◽

2020 ◽

Author(s):

Meg E Fluharty ◽

Rebecca Hardy ◽

George B. Ploubidis ◽

Benedetta Pongiglione ◽

David Bann

Keyword(s):

Social Class ◽

Mortality Risk ◽

Adult Life ◽

Premature Mortality ◽

Housing Tenure ◽

Proportional Hazard ◽

Birth Cohorts ◽

Proportional Hazard Models ◽

Cox Proportional Hazard ◽

Cox Proportional Hazard Models

AbstractIntroductionDisadvantaged socioeconomic position (SEP) in early and adult life has been repeatedly associated with premature mortality. However, it is unclear whether these inequalities differ across time, nor if they are consistent across different SEP indicators.MethodsBritish birth cohorts born in 1946, 1958 and 1970 were used, and multiple SEP indicators in early and adult life were examined. Deaths were identified via national statistics or notifications. Cox proportional hazard models were used to estimate associations between SEP indicators and mortality risk—from 26-43 (n=40,784), 26-58 (n=35,431), and 26-70 years (n=5,353).ResultsMore disadvantaged SEP was associated with higher mortality risk—magnitudes of association were similar across cohort and each SEP indicator. For example, hazards ratios (95% CI) between 26-43 years comparing lowest to highest father’s social class were 2.74 (1.02—7.32) in 1946c, 1.66 (1.03—2.69) in 1958c, and 1.94 (1.20—3.15) in 1970c. Childhood social class, adult social class, and housing tenure were each independently associated with mortality risk.ConclusionsSocioeconomic circumstances in early and adult life appear to have had persisting associations with premature mortality from 1971—2016. This reaffirms the need to address socioeconomic factors across life to reduce inequalities in survival to older age.

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Abstract P153: Dose-Response Associations Between Physical Activity And All-Cause Mortality Among A Multi-Ethnic Sample With Diabetes: NHANES 1999-2006

Circulation ◽

10.1161/circ.143.suppl_1.p153 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

William Boyer ◽

Madison Brenton ◽

Allison Milano

Keyword(s):

Mortality Risk ◽

Mexican American ◽

Statistical Significance ◽

Significant Risk ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

All Cause Mortality ◽

Cox Proportional Hazard Models ◽

Physician Diagnosis ◽

Hispanic White

Introduction: Emerging evidence has suggested that those identifying as non-Hispanic white (NHW) or non-Hispanic black (NHB) have consistent and similar all-cause mortality risk reductions across dose of aerobic PA. In the same analyses, those identifying as Mexican American (MA) receive no protection from all-cause mortality across dose of aerobic PA. However, a single study has suggested that MAs meeting both the aerobic and muscular strengthening activity (MSA) recommendations have similar all-cause mortality risk reductions compared to NHW and NHB, highlighting the importance of MSA among MA. It is unknown, however, if these results translate to those who have diabetes. Hypothesis: NHW or NHB participants will have similar all-cause mortality risk reductions associated with aerobic PA independent of MSA participation. MA meeting both recommendations will have significant all-cause mortality risk reductions. Methods: The study sample (n=1,999) included adult (≥20 years of age) participants with diabetes from the 1999-2006 NHANES. Diabetes was defined as having one of the following: reported physician diagnosis, reported taking anti-hyperglycemic medication, or HbA1c ≥6.5%. PA was categorized into 6 categories based around the 2018 PA guidelines: category 1 (no aerobic PA and insufficient MSA), category 2 (insufficient aerobic PA and insufficient MSA), category 3 (active and insufficient MSA), category 4 (no aerobic PA and sufficient MSA), category 5 (insufficient aerobic PA and sufficient MSA), and category 6 (meeting both recommendations). Cox-proportional hazard models were used for all analyses. Results: A significant interaction (p<0.001) was found between categories of PA and race. Statistically significant risk reductions were found for categories 2,3 and 6 among NHW, and categories 2 and 3 among NHB; with a non-statistically significant risk reduction of 67% in category 6 (p=0.13) for NHB. A 45% reduction in risk was found among MA for category 6, however the estimate did not attain statistical significance (p=0.17). Conclusions: Similar to previous studies in those without diabetes, aerobic PA of any volume significantly reduced risk for all-cause mortality only among NHW and NHB with diabetes. While the risk reductions were clinically meaningful for both NHB and MA in category 6 compared to category 1, there was a lack of statistical significance. It is probable this may be, in part, influenced by a relatively low sample size within these two race-ethnic groups.

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Individual testosterone decline and future mortality risk in men

Acta Endocrinologica ◽

10.1530/eje-17-0280 ◽

2018 ◽

Vol 178 (1) ◽

pp. 121-128 ◽

Cited By ~ 6

Author(s):

Stine A Holmboe ◽

Niels E Skakkebæk ◽

Anders Juul ◽

Thomas Scheike ◽

Tina K Jensen ◽

...

Keyword(s):

Mortality Risk ◽

Serum Levels ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Age Related ◽

National Mortality ◽

All Cause Mortality ◽

Specific Mortality ◽

Cox Proportional Hazard Models

Objective Male aging is characterized by a decline in testosterone (TS) levels with a substantial variability between subjects. However, it is unclear whether differences in age-related changes in TS are associated with general health. We investigated associations between mortality and intra-individual changes in serum levels of total TS, SHBG, free TS and LH during a ten-year period with up to 18 years of registry follow-up. Design 1167 men aged 30–60 years participating in the Danish Monitoring Trends and Determinants of Cardiovascular Disease (MONICA1) study and who had a follow-up examination ten years later (MONICA10) were included. From MONICA10, the men were followed up to 18 years (mean: 15.2 years) based on the information from national mortality registries via their unique personal ID numbers. Methods Cox proportional hazard models were used to investigate the association between intra-individual hormone changes and all-cause, CVD and cancer mortalities. Results A total of 421 men (36.1%) died during the follow-up period. Men with most pronounced decline in total TS (<10th percentile) had a higher all-cause mortality risk compared to men within the 10th to 90th percentile (hazard ratio (HR): 1.60; 95% confidence interval (CI): 1.08–2.36). No consistent associations were seen in cause-specific mortality analyses. Conclusion Our study showed that higher mortality rates were seen among the men who had the most pronounced age-related decline in TS, independent of their baseline TS levels.

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Low rather than high mean corpuscular volume is associated with mortality in Japanese patients under hemodialysis

Scientific Reports ◽

10.1038/s41598-020-72765-2 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Hirokazu Honda ◽

Miho Kimachi ◽

Noriaki Kurita ◽

Nobuhiko Joki ◽

Masaomi Nangaku

Keyword(s):

Mean Corpuscular Volume ◽

Japanese Patients ◽

Cubic Spline ◽

Hazard Models ◽

Proportional Hazard ◽

Corpuscular Volume ◽

Proportional Hazard Models ◽

Cox Proportional Hazard ◽

All Cause Mortality ◽

Cox Proportional Hazard Models

Abstract Recent studies have reported that high mean corpuscular volume (MCV) might be associated with mortality in patients with advanced chronic kidney disease (CKD). However, the question of whether a high MCV confers a risk for mortality in Japanese patients remains unclear. We conducted a longitudinal analysis of a cohort of 8571 patients using data derived from the Japan Dialysis Outcomes and Practice Patterns Study (J-DOPPS) phases 1 to 5. Associations of all-cause mortality, vascular events, and hospitalization due to infection with baseline MCV were examined via Cox proportional hazard models. Non-linear relationships between MCV and these outcomes were examined using restricted cubic spline analyses. Associations between time-varying MCV and these outcomes were also examined as sensitivity analyses. Cox proportional hazard models showed a significant association of low MCV (< 90 fL), but not for high MCV (102 < fL), with a higher incidence of all-cause mortality and hospitalization due to infection compared with 94 ≤ MCV < 98 fL (reference). Cubic spline analysis indicated a graphically U-shaped association between baseline MCV and all-cause mortality (p for non-linearity p < 0.001). In conclusion, a low rather than high MCV might be associated with increased risk for all-cause mortality and hospitalization due to infection among Japanese patients on hemodialysis.

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Reduced Mortality with Ondansetron Use in SARS-CoV-2 Infected Inpatients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab336 ◽

2021 ◽

Author(s):

Vafa Bayat ◽

Russell Ryono ◽

Steven Phelps ◽

Eugene Geis ◽

Farshid Sedghi ◽

...

Keyword(s):

Clinical Trials ◽

Length Of Hospital Stay ◽

Proportional Hazard ◽

Lengths Of Stay ◽

Cox Proportional Hazard ◽

All Cause Mortality ◽

Cox Proportional Hazard Models ◽

At Risk Populations ◽

Approved Drugs

Abstract Background The COVID-19 pandemic has led to a surge in clinical trials evaluating investigational and approved drugs. Retrospective analysis of drugs taken by COVID-19 inpatients provides key information on drugs associated with better or worse outcomes. Method We conducted a retrospective cohort study of 10,741 patients testing positive for SARS-CoV-2 infection within three days of admission to compare risk of 30-day all-cause mortality in patients receiving ondansetron using multivariate Cox proportional-hazard models. All-cause mortality, length of hospital stay, adverse events such as ischemic cerebral infarction, and subsequent positive COVID-19 tests were measured. Results Administration of ≥8 mg ondansetron within 48 hours of admission was correlated with an adjusted hazard ratio for 30-day all-cause mortality of 0.55 (95% CI 0.42–0.70, p<0.001) and 0.52 (95% CI 0.31–0.87, p=0.012) for all and ICU-admitted patients, respectively. Decreased lengths of stay (9.2 vs. 11.6, p<0.001), frequencies of subsequent positive SARS-CoV-2 tests (53.6% vs. 75.0%, p=0.01), and long-term risks of ischemic cerebral ischemia (3.2% vs. 6.1%, p<0.001) were also noted. Conclusions If confirmed by prospective clinical trials, our results suggest ondansetron, a safe, widely available drug, could be used to decrease morbidity and mortality in at-risk populations.

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Changes in Proteinuria on the Risk of All-Cause Mortality in People with Diabetes or Prediabetes: A Prospective Cohort Study

Journal of Diabetes Research ◽

10.1155/2017/8368513 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7

Author(s):

Yang Sun ◽

Anxin Wang ◽

Xiaoxue Liu ◽

Zhaoping Su ◽

Junjuan Li ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Mortality Risk ◽

Prospective Cohort ◽

Cox Proportional Hazard ◽

Baseline Mortality ◽

All Cause Mortality ◽

Cox Proportional Hazard Models ◽

Study Participants

Background. Proteinuria has been related to all-cause mortality, showing regression or progression. However, few studies have focused on the relationship between proteinuria changes and all-cause mortality. The main purpose of this paper is to examine the associations between proteinuria changes and all-cause mortality in people with diabetes or prediabetes. Methods. Dipstick proteinuria at baseline and a 2-year follow-up were determined in the participants attending the Kailuan prospective cohort study. Participants were then divided into three categories: elevated proteinuria, stable proteinuria, and reduced proteinuria. Four Cox proportional hazard models were built to access the relations of proteinuria changes to all-cause mortality, adjusting for other confounding covariates. Results. A total of 17,878 participants were finally included in this study. There were 1193 deaths after a median follow-up of 6.69 years. After adjusting for major covariates and proteinuria at baseline, mortality risk was significantly associated with elevated proteinuria (hazard ratio (HR): 1.54, 95% confidence interval (CI): 1.33–1.79) and reduced proteinuria (HR: 0.70, 95% CI: 0.55–0.89), compared to those with stable proteinuria. Conclusion. Proteinuria changes were independently associated with mortality risk in either diabetic or prediabetic population.

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Multiple Dimensions of Perceived Discrimination, Race-Ethnicity, and Mortality Risk Among Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.1936 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 581-581

Author(s):

Ryon Cobb

Keyword(s):

Mortality Risk ◽

Perceived Discrimination ◽

Later Life ◽

Proportional Hazard ◽

Vital Status ◽

Cox Proportional Hazard ◽

Multiple Dimensions ◽

Risk Of Mortality ◽

Cox Proportional Hazard Models ◽

Everyday Discrimination

Abstract The present study utilized data from the Health and Retirement Study (N=12,988) to investigate the joint consequences of multiple dimensions of perceived discrimination on mortality risk. Perceived discrimination is based on responses from the 2006/2008 HRS waves and included everyday discrimination, the number of attributed reasons for everyday discrimination, and major lifetime discrimination. Vital status was obtained from the National Death Index and reports from key household informants (spanning 2006–2016). Cox proportional hazard models were used to estimate the risk of mortality. During the observation period, 3,494 deaths occurred. Only the number of attributed reasons for discrimination predicted mortality risk when all discrimination measures were estimated in the same model (Hazard Ratio [HR]=1.09; 95%, Confidence Interval [CI]=1.05 - 1.14), holding all else constant. Overall, the number of attributed reasons for everyday discrimination is a particularly salient risk factor for mortality in later life.

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Living longer with help from others: Seeking advice lowers mortality risk

Journal of Health Psychology ◽

10.1177/1359105316664133 ◽

2016 ◽

Vol 23 (12) ◽

pp. 1590-1597 ◽

Cited By ~ 5

Author(s):

Rebecca K Delaney ◽

Nicholas A Turiano ◽

JoNell Strough

Keyword(s):

Mortality Risk ◽

The United States ◽

Future Research ◽

Proportional Hazard ◽

Standard Deviation Increase ◽

Cox Proportional Hazard ◽

Advice Seeking ◽

Self Sufficiency ◽

Cox Proportional Hazard Models

Associations between self-sufficiency and advice seeking with mortality risk were examined to assess the long-term implications of individualistic and interpersonally oriented strategies. Wave 1 participants from the National Survey of Midlife Development in the United States ( N = 6116, 25–75 years, Mage = 46.38 years) completed questionnaires assessing demographics, self-sufficiency, advice seeking, social support, and health. Cox proportional hazard models indicated that each standard deviation increase in seeking advice was associated with an 11 percent decreased hazard of dying 20 years later. Self-sufficiency was not significantly related. Future research should examine contexts in which interpersonal strategies are adaptive, as seeking advice from others promotes longevity.

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Lipids and All-Cause Mortality among Older Adults: A 12-Year Follow-Up Study

The Scientific World JOURNAL ◽

10.1100/2012/930139 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 10

Author(s):

Marcos Aparecido Sarria Cabrera ◽

Selma Maffei de Andrade ◽

Renata Maciulis Dip

Keyword(s):

Older Adults ◽

Positive Association ◽

Premature Mortality ◽

Proportional Hazard ◽

High Tc ◽

Lipid Disorders ◽

Cox Proportional Hazard ◽

All Cause Mortality ◽

Adjusted Model

This is a 12-year follow-up cohort study with 800 people (60–85 years old). The association between lipid disorders and mortality was analysed by Cox proportional hazard adjusted model. All-cause mortality was considered the dependent variable, and lipid disorders as independent variables: total cholesterol (TC) >200 and <170 mg/dl, HDL-c <35 and 40, LDL-c >100 and 130, and triglycerides (TG) >50. An initial analysis of all subjects was performed and a second was carried out after having excluded individuals with a body mass index (BMI) <20 kg/m2or mortality in ≤2 years. The mortality showed a positive association with low TC and a negative association with high TC and high LDL-c. After the exclusion of underweight and premature mortality, there was a positive association only with TC <170 mg/dl (HR = 1.36, CI95%: 1.02–1.82). The data did not show a higher risk with high levels of TC, LDL-c, and TG. However, they showed higher mortality among older adults with low TC.

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Abstract 069: Sporadic Step Accumulation And All-cause Mortality In The Women’S Health Study: Do All Steps Count?

Circulation ◽

10.1161/circ.143.suppl_1.069 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Christopher C Moore ◽

Kelly R Evenson ◽

Eric J Shiroma ◽

Annie G Howard ◽

Carmen C Cuthbertson ◽

...

Keyword(s):

Health Study ◽

Proportional Hazard ◽

Cox Proportional Hazard ◽

Hazard Ratios ◽

All Cause Mortality ◽

Before And After ◽

Step Counting ◽

Cox Proportional Hazard Models ◽

Restricted Cubic Splines ◽

The Relationship

Background: With the popularity of step counting and feasibility of accumulating physical activity (PA) through sporadic spurts (e.g., taking the stairs), the 2018 PA Guidelines Committee called for research to inform step-based PA recommendations by quantifying relationships between patterns of stepping and health. Purpose: To examine the relationship between daily steps accumulated outside of “bouts” (sporadic steps/d) and all-cause mortality, before and after accounting for bouted steps/d. Methods: From 2011-2015, 16,732 women (mean 72 [standard deviation 6] years) wore a hip-worn accelerometer for 7 days to assess steps and met wear time criteria. Stepping bouts were defined as ≥10 consecutive minutes at ≥40 steps/min (purposeful stepping or faster), allowing for ≤20% of time and ≤5 mins at <40 steps/min. Total steps/d were partitioned into steps accrued outside of bouts (sporadic steps/d; SS) and in bouts (bouted steps/d; BS). We estimated hazard ratios (HRs) for mortality through Dec 31, 2019 using Cox proportional hazard models fitted to SS in quartiles and using restricted cubic splines. Analyses were adjusted for covariates and repeated with further adjustment for BS, categorized as 0, 1-2000, and >2000 steps/d in bouts. Results: Adjusted HRs (95% confidence intervals) in increasing quartiles of SS were 1.00 (reference); 0.63 (0.52, 0.76); 0.60 (0.49, 0.74); 0.54 (0.42, 0.70). In spline analyses, initial increases in SS corresponded to the greatest mortality reductions (Figure 1), with HRs of 0.69 (0.64, 0.76) per additional 1000 SS below 3200. After further adjusting for BS, initial 1000 steps/d increases in SS were association with HRs of 0.72 (0.66, 0.78). In increasing categories of BS, HRs adjusted for SS were 1.00 (reference); 0.91 (0.76, 1.09); 0.69 (0.56, 0.84). Conclusion: Daily step counts were inversely associated with mortality, regardless of how they were accumulated. These results can help inform step-based target PA volumes that communicate the benefits of increasing everyday walking behaviors.

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