Early Predictors of Trajectories of Tobacco Use Level from Adolescence to Young Adulthood: A 16-Year Follow-Up of the TEMPO Cohort Study (1999–2015)

ObjectivesTo examine the causes of premature mortality (<70 years) and associated risk factors in the Golestan Cohort Study.DesignProspective.SettingThe Golestan Cohort Study in northeastern Iran.Participants50 045 people aged 40 or more participated in this population-based study from baseline (2004–2008) to August 2017, with over 99% success follow-up rate.Main outcome measuresThe top causes of premature death, HR and their 95% CI and population attributable fraction (PAF) for risk factors.ResultsAfter 444 168 person-years of follow-up (median of 10 years), 6347 deaths were reported, of which 4018 (63.3%) occurred prematurely. Ischaemic heart disease (IHD) accounted for 33.9% of premature death, followed by stroke (14.0%), road injuries (4.7%), stomach cancer (4.6%) and oesophageal cancer (4.6%). Significant risk/protective factors were: wealth score (HR for highest vs lowest quintile: 0.57, PAF for lowest four quintiles vs top quintile: 28%), physical activity (highest vs lowest tertile: 0.67, lowest two tertiles vs top tertile: 22%), hypertension (1.50, 19%), opium use (1.69, 14%), education (middle school or higher vs illiterate: 0.84, illiterate or primary vs middle school or higher: 13%), tobacco use (1.38, 11%), diabetes (2.39, 8%) and vegetable/fruit consumption (highest vs lowest tertile: 0.87, lowest two tertiles vs top tertile: 8%). Collectively, these factors accounted for 76% of PAF in men and 69% in women.ConclusionIHD and stroke are the leading causes of premature mortality in the Golestan Cohort Study. Enhancing socioeconomic status and physical activity, reducing opium and tobacco use, increasing vegetable/fruit consumption and controlling hypertension and diabetes are recommended to reduce premature deaths.

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Associations with kidney transplant survival and eGFR decline in children and young adults in the United Kingdom: a retrospective cohort study

BMC Nephrology ◽

10.1186/s12882-020-02156-2 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Alexander J. Hamilton ◽

Lucy A. Plumb ◽

Anna Casula ◽

Manish D. Sinha

Keyword(s):

Young Adults ◽

Cohort Study ◽

Young Adulthood ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Graft Loss ◽

Glomerular Diseases ◽

Children And Young Adults ◽

Egfr Decline

Abstract Background Although young adulthood is associated with transplant loss, many studies do not examine eGFR decline. We aimed to establish clinical risk factors to identify where early intervention might prevent subsequent adverse transplant outcomes. Methods Retrospective cohort study using UK Renal Registry and UK Transplant Registry data, including patients aged < 30 years transplanted 1998–2014. Associations with death-censored graft failure were investigated with multivariable Cox proportional hazards. Multivariable linear regression was used to establish associations with eGFR slope gradients calculated over the last 5 years of observation per individual. Results The cohort (n = 5121, of whom n = 371 received another transplant) was 61% male, 80% White and 36% had structural disease. Live donation occurred in 48%. There were 1371 graft failures and 145 deaths with a functioning graft over a 39,541-year risk period. Median follow-up was 7 years. Fifteen-year graft survival was 60.2% (95% CI 58.1, 62.3). Risk associations observed in both graft loss and eGFR decline analyses included female sex, glomerular diseases, Black ethnicity and young adulthood (15–19-year and 20–24-year age groups, compared to 25–29 years). A higher initial eGFR was associated with less risk of graft loss but faster eGFR decline. For each additional 10 mL/min/1.73m2 initial eGFR, the hazard ratio for graft loss was 0.82 (95% CI 0.79, 0.86), p < 0.0001. However, compared to < 60 mL/min/1.73m2, higher initial eGFR was associated with faster eGFR decline (> 90 mL/min/1.73m2; − 3.55 mL/min/1.73m2/year (95% CI -4.37, − 2.72), p < 0.0001). Conclusions In conclusion, young adulthood is a key risk factor for transplant loss and eGFR decline for UK children and young adults. This study has an extended follow-up period and confirms common risk associations for graft loss and eGFR decline, including female sex, Black ethnicity and glomerular diseases. A higher initial eGFR was associated with less risk of graft loss but faster rate of eGFR decline. Identification of children at risk of faster rate of eGFR decline may enable early intervention to prolong graft survival.

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Maternal hypertensive disorder of pregnancy and offspring early-onset cardiovascular disease in childhood, adolescence, and young adulthood: A national population-based cohort study

PLoS Medicine ◽

10.1371/journal.pmed.1003805 ◽

2021 ◽

Vol 18 (9) ◽

pp. e1003805

Author(s):

Chen Huang ◽

Jiong Li ◽

Guoyou Qin ◽

Zeyan Liew ◽

Jing Hu ◽

...

Keyword(s):

Cardiovascular Disease ◽

Cohort Study ◽

Young Adulthood ◽

Early Onset ◽

Gestational Hypertension ◽

Population Based ◽

Hypertensive Disorder ◽

Fetal Life ◽

Timing Of Onset

Background The prevalence of cardiovascular disease (CVD) has been increasing in children, adolescents, and young adults in recent decades. Exposure to adverse intrauterine environment in fetal life may contribute to the elevated risk of early-onset CVD. Many studies have shown that maternal hypertensive disorders of pregnancy (HDP) are associated with increased risks of congenital heart disease, high blood pressure, increased BMI, and systemic vascular dysfunction in offspring. However, empirical evidence on the association between prenatal exposure to maternal HDP and early-onset CVD in childhood and adolescence remains limited. Methods and findings We conducted a population-based cohort study using Danish national health registers, including 2,491,340 individuals born in Denmark from 1977 to 2018. Follow-up started at birth and ended at the first diagnosis of CVD, emigration, death, or 31 December 2018, whichever came first. Exposure of maternal HDP was categorized as preeclampsia or eclampsia (n = 68,387), gestational hypertension (n = 18,603), and pregestational hypertension (n = 15,062). Outcome was the diagnosis of early-onset CVD from birth to young adulthood (up to 40 years old). We performed Cox proportional hazards regression to evaluate the associations and whether the association differed by maternal history of CVD or diabetes before childbirth. We further assessed the association by timing of onset and severity of preeclampsia. The median follow-up time was 18.37 years, and 51.3% of the participants were males. A total of 4,532 offspring in the exposed group (2.47 per 1,000 person-years) and 94,457 in the unexposed group (2.03 per 1,000 person-years) were diagnosed with CVD. We found that exposure to maternal HDP was associated with an increased risk of early-onset CVD (hazard ratio [HR]: 1.23; 95% CI = 1.19 to 1.26; P < 0.001). The HRs for preeclampsia or eclampsia, gestational hypertension, and pregestational hypertension were 1.22 (95% CI, 1.18 to 1.26; P < 0.001), 1.25 (95% CI, 1.17 to 1.34; P < 0.001), and 1.28 (95% CI, 1.15 to 1.42; P < 0.001), respectively. We also observed increased risks for type-specific CVDs, in particular for hypertensive disease (HR, 2.11; 95% CI, 1.96 to 2.27; P < 0.001) and myocardial infarction (HR, 1.49; 95% CI, 1.12 to 1.98; P = 0.007). Strong associations were found among offspring of mothers with CVD history (HR, 1.67; 95% CI, 1.41 to 1.98; P < 0.001) or comorbid diabetes (HR, 1.56; 95% CI, 1.34 to 1.83; P < 0.001). When considering timing of onset and severity of preeclampsia on offspring CVD, the strongest association was observed for early-onset and severe preeclampsia (HR, 1.48, 95% CI, 1.30 to 1.67; P < 0.001). Study limitations include the lack of information on certain potential confounders (including smoking, physical activity, and alcohol consumption) and limited generalizability in other countries with varying disparities in healthcare. Conclusions Offspring born to mothers with HDP, especially mothers with CVD or diabetes history, were at increased risks of overall and certain type-specific early-onset CVDs in their first decades of life. Further research is warranted to better understand the mechanisms underlying the relationship between maternal HDP and early-onset CVD in offspring.

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Intelligence in young adulthood and alcohol use disorders in a prospective cohort study of Danish men: the role of psychiatric disorders and parental psychiatric history

BMJ Open ◽

10.1136/bmjopen-2019-028997 ◽

2019 ◽

Vol 9 (9) ◽

pp. e028997

Author(s):

Emilie Just-Østergaard ◽

Trine Flensborg-Madsen ◽

Joachim Knop ◽

Holger Jelling Sørensen ◽

Ulrik Becker ◽

...

Keyword(s):

Cohort Study ◽

Alcohol Use ◽

Psychiatric Disorders ◽

Young Adulthood ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Primary Outcome ◽

Alcohol Use Disorders ◽

Parental Psychiatric Disorders

ObjectivesThe aims were to estimate the association between intelligence measured in young adulthood and risk of alcohol use disorders (AUD) in men and to investigate the potential modification of this association by psychiatric disorders, parental AUD and parental psychiatric disorders.DesignProspective cohort study based on a linkage of intelligence test scores from draft board examinations and register data on AUD diagnoses during 36 years of follow-up.SettingDenmark.Participants3287 Danish men from the Copenhagen Perinatal Cohort (born 1959–1961) who appeared before the draft board at a mean age of 18.7 years.Primary outcome measureFirst registration with AUD during follow-up was the primary outcome. Information on AUD was based on diagnoses retrieved from national hospital and outpatient treatment registers, defined according to the International Classification of Diseases.Results361 (11.0%) men were registered with AUD during follow-up. Low intelligence scores were associated with increased odds of AUD adjusting for parental AUD, parental psychiatric disorders, maternal smoking during pregnancy, birth weight, maternal age at birth, parity and childhood socioeconomic position (OR per SD decrease in intelligence=1.69, 95% CI 1.49 to 1.92). Separate analyses indicated significant interaction (p<0.001) between intelligence and psychiatric disorders. The adjusted OR per SD decrease in intelligence score was 2.04 (95% CI 1.67 to 2.49) in men without other psychiatric disorders whereas the OR was 1.21 (95% CI 1.01 to 1.46) in men with other psychiatric disorders. No interaction was found between intelligence and parental AUD or between intelligence and parental psychiatric disorders.ConclusionsThe association between intelligence in young adulthood and AUD is modified by other psychiatric disorders as low intelligence is primarily a risk factor for men without other psychiatric disorders. Future studies should take other psychiatric disorders into account when investigating associations between intelligence and AUD.

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Association between obesity and life courses in young adulthood. Results from the KiGGS cohort study

European Journal of Public Health ◽

10.1093/eurpub/ckab164.755 ◽

2021 ◽

Vol 31 (Supplement_3) ◽

Author(s):

P Rattay ◽

A Schienkiewitz ◽

F Vogelgesang

Keyword(s):

Young Adults ◽

Cohort Study ◽

Young Adulthood ◽

Single Parent ◽

Parental Home ◽

Related Individual ◽

Early Parenthood ◽

Life Courses ◽

Education And Employment

Abstract In the last decades, young adulthood has established as an independent phase of life with important biographical transitions impacting further life course and health. In turn, health in adolescence can also affect the transitions into young adulthood. So far, for Germany there are no analyses on the association between family-related and employment-related biographies and obesity in young adults. The analysis is based on data from the KiGGS cohort study on 3,100 participants aged 23-31 at second follow-up (t2). Using BMI measurements at t0 (2003-2006) and at t2 (2014-2017), obesity groups were formed (no obesity, incidence, remission, persistence). Sequence analysis was used to retrospectively determine family-related and education/employment-related individual trajectories. Differences in life courses between obesity groups were calculated using discrepancy tests. Young adults with incident obesity were more likely to have children or to be a single parent than young adults without obesity at t2. Young adults with obesity at t0 lived longer in the parental home than those without obesity. Young adults with incident or persistent obesity were less likely to attend university and had experienced longer periods of unemployment than those without obesity at t0 and t2. The employment sequences of those without obesity at t2 were not statistically different. Both family and employment biographies were associated with obesity trajectories in young people. However, based on the analysis, it cannot be clarified whether early parenthood led to obesity or early transitions into parenthood led to interruptions in education or employment and subsequently to obesity. The finding that young adults with obesity were less likely to attend university and more likely to be unemployed could be related to disadvantages or discrimination in school, education or work. Obesity in adolescence that did not persist into young adulthood had less adverse effects on education and employment. Key messages Young people’s obesity trajectories were linked to different family/employment biographies. The life courses of young adults with obesity were more often marked by early parenthood and unemployment.

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Decline in Dental Fluorosis Severity during Adolescence: A Cohort Study

Journal of Dental Research ◽

10.1177/0022034520906089 ◽

2020 ◽

Vol 99 (4) ◽

pp. 388-394 ◽

Cited By ~ 1

Author(s):

A.M. Curtis ◽

S.M. Levy ◽

J.E. Cavanaugh ◽

J.J. Warren ◽

J.L. Kolker ◽

...

Keyword(s):

Differential Diagnosis ◽

Cohort Study ◽

Young Adulthood ◽

Dental Fluorosis ◽

Risk Index ◽

Lower Percentage ◽

Tooth Formation ◽

Adolescence And Young Adulthood ◽

Over Time

Dental fluorosis occurs from overingestion of fluoride during tooth formation. However, there is little evidence in the literature on whether or how fluorosis prevalence and severity change over time after tooth eruption. Permanent dentition dental examinations were conducted at ages 9, 13, 17, and 23 as part of the Iowa Fluoride Study, which has followed a cohort from birth. Fluorosis was assessed using the Fluorosis Risk Index (FRI) and Russell’s criteria for differential diagnosis. Measures of fluorosis severity at the person and tooth level were calculated: second highest FRI score at the person level (the maximum FRI score for each tooth was determined and the tooth with the second highest maximum FRI score was used) and highest FRI score at the tooth level. At both the person and tooth levels, a decline in mild to moderate fluorosis severity was observed across adolescence and young adulthood. Across each pair of adjacent examinations at the person level, for participants with a baseline second highest FRI of 0, most participants stayed at 0 (82% to 91%). Many participants with a baseline second highest FRI of 1 had a follow-up score of 0 (47% to 54%), while about a third had a follow-up score of 1 (34% to 38%), and a lower percentage had an increase to a score of 2 (9% to 15%). For participants with baseline second highest FRI score of 2, between 25% and 44% of participants had follow-up FRI scores each of 0, 1, and 2. Similar patterns were observed at the tooth level. These results were consistent with most of the existing, limited literature. Overall, fluorosis severity, which was initially mild to moderate, tended to decline during adolescence and young adulthood. Additional study of how this trend affects esthetic perceptions of fluorosis is warranted.

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