Low Health Literacy is Associated with the Onset of CKD during the Life Course

BackgroundHealth literacy, the ability to deal with information related to one’s health, is a predictor of health outcomes in CKD. However, research has not explored whether low health literacy predicts the onset of CKD.MethodsWe used data from participants of Lifelines, a prospective population-based cohort study of individuals living in The Netherlands, to assess the share of individuals with low health literacy by eGFR category, whether low health literacy is associated with CKD onset in the general population and in the subgroup of older adults, and whether established CKD risk factors mediate this association.ResultsIn the total sample of 93,885 adults (mean follow-up 3.9 years), low health literacy was more likely among individuals in worse eGFR categories, increasing from 26.4% in eGFR category 1 to 50.0% in category 5 (P=0.02). Low health literacy, compared with adequate health literacy, was associated with the onset of CKD in the total sample (3.0% versus 2.1%) and in the subgroup of older adults (13.4% versus 11.3%), with odds ratios (ORs) of 1.44 (95% confidence interval (95% CI), 1.31 to 1.59) and 1.21 (95% CI, 1.04 to 1.41), respectively. After adjustment for sex, age, education, and income, health literacy was associated with CKD onset only in older adults (OR, 1.25; 95% CI, 1.04 to 1.50). This association was mediated by hypertension and high body mass index (BMI) in the crude model, but only by BMI after adjustment (with BMI explaining 18.8% of the association).ConclusionsLow health literacy is a risk factor for CKD onset among older adults, which suggests that CKD prevention might benefit from strategies to address low health literacy.

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Abstract P169: Health Literacy and Outcomes in Heart Failure: a Prospective Community Study

Circulation ◽

10.1161/circ.135.suppl_1.p169 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Matteo Fabbri ◽

Kathleen Yost ◽

Lila Finney Rutten ◽

Sheila Manemann ◽

Susan Weston ◽

...

Keyword(s):

Heart Failure ◽

Health Literacy ◽

Proportional Hazards ◽

International Classification Of Diseases ◽

Cox Proportional Hazards ◽

Low Literacy ◽

Adequate Health Literacy ◽

Low Health Literacy ◽

Increased Risk

Background: Growing evidence documents the association between low health literacy and poorer health outcomes. However, less is known about the relationship between health literacy and outcomes among patients with heart failure (HF). We examined the association of health literacy with risk of hospitalization and mortality in patients with HF. Methods: Residents in an 11-county region in southeastern Minnesota with incident HF from 1/01/2013 to 3/31/2015 were identified using the International Classification of Diseases, Ninth Revision code 428 (n=3715) and prospectively surveyed to measure health literacy using established screening questions. A total of 1992 patients returned a survey (response rate 54%); 1779 patients with complete clinical data and adequate follow up were retained for analysis. Health literacy, measured as a composite on three 5-point scales, was categorized as adequate (≤ 10) or low (> 10). Cox proportional hazards regression and Andersen-Gill models were used to determine the association of health literacy with mortality and hospitalization. Results: Among 1779 patients (mean age 74, 53% male), 10% had low health literacy. After a mean follow-up of 8±4 months, 72 deaths and 600 hospitalizations occurred. Low health literacy was associated with increased mortality and hospitalizations (Figure). After adjusting for age, sex, comorbidity, education and marital status, the hazard ratio for death and hospitalization in patients with low health literacy was 2.84 (95% CI: 1.63, 4.96) and 1.43 (95% CI: 1.04, 1.96) respectively, compared to patients with adequate health literacy. Conclusions: Low health literacy is associated with increased risk of hospitalization and death among patients with HF. Health literacy is critical to the self-management demands of living with heart failure. Evaluation of health literacy in the clinical setting may guide inventions to target patients with low literacy.

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Multimorbidity prevalence and patterns and their associations with health literacy among chronic kidney disease patients

Journal of Nephrology ◽

10.1007/s40620-021-01229-1 ◽

2022 ◽

Author(s):

M. S. Gurgel do Amaral ◽

S. A. Reijneveld ◽

L. M. G. Meems ◽

J. Almansa ◽

G. J. Navis ◽

...

Keyword(s):

Chronic Kidney Disease ◽

Health Literacy ◽

Kidney Disease ◽

Latent Class ◽

Multinomial Logistic Regression ◽

Management Skills ◽

Adequate Health Literacy ◽

Low Health Literacy ◽

Crude Model ◽

Adjusted Model

Abstract Background Health literacy is the ability to deal with information related to one’s health. Patients with low health literacy have poor disease-management skills for chronic diseases, such as chronic kidney disease (CKD). This could influence the number and combination of their diseases. Methods We included adult patients with CKD stages 1–5 from the Lifelines Study (n = 2,742). We assessed the association between low health literacy and the number and patterns of comorbidities, considering them globally and stratified by age and sex, using multinomial logistic regression and latent class analysis, respectively. Results Low health literacy was associated with a higher number of comorbidities in the crude models, and after adjustment for age, sex, eGFR, smoking, and BMI. In the crude model, the OR for low health literacy increased from 1.71 (1.25–2.33) for two comorbidities to 2.71 (2.00–3.68) for four comorbidities. In the fully-adjusted model, the associations remained significant with a maximum OR of 1.70 (1.16–2.49) for four comorbidities. The patterns of multimorbidity were similar for low and adequate health literacy, overall and by sex, bur tended to be different for patients older than 65. Older patients with low health literacy had higher comorbidity prevalence and a relatively greater share of cardiovascular, psychiatric, and central nervous system diseases. Conclusions Among CKD patients, low health literacy is associated with more multimorbidity. Health literacy is not associated with patterns of multimorbidity in younger patients, but a difference was observed in older ones. Improving low health literacy could be an intervention efficient also in decreasing multimorbidity in CKD patients. Graphical abstract

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High education accelerates cognitive decline in dementia: A brief report from the population-based NEDICES cohort

Dementia & Neuropsychologia ◽

10.1590/1980-57642016dn11-030012 ◽

2017 ◽

Vol 11 (3) ◽

pp. 297-300 ◽

Cited By ~ 4

Author(s):

Israel Contador ◽

Félix Bermejo-Pareja ◽

D. Lora Pablos ◽

Alberto Villarejo ◽

Julián Benito-León

Keyword(s):

Older Adults ◽

Cohort Study ◽

High Education ◽

Cognitive Decline ◽

Effect Size ◽

Educational Level ◽

Total Sample ◽

Population Based ◽

Low Educated

ABSTRACT High education has been associated with faster cognitive decline after diagnosis of Alzheimer's disease (AD), but it is unclear whether these findings extend to other dementia subtypes. OBJECTIVE: We investigated whether educational attainment influences the cognitive trajectories of older adults with different dementia subtypes. METHODS: All participants were selected from NEDICES, a prospective population-based cohort study of Spanish older adults. A total sample of 53 individuals with dementia completed the MMSE-37 at Times 1 and 2 (mean follow-up=2.8±0.5 years) to assess cognitive decline. RESULTS: At follow-up, MMSE-37 scores had decreased by 3.34±4.98 points in low-educated individuals with dementia versus 7.90±4.88 points in high-educated subjects (effect size (r)=0.32, p=0.02). CONCLUSION: Educational level influenced the cognitive trajectories of patients with dementia assessed by the MMSE-37.

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The Association of Sensory Impairment With Incident Disability-Related Cessation of Employment in Older Adults

Innovation in Aging ◽

10.1093/geroni/igaa057.697 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 216-216

Author(s):

Ahmed Shakarchi ◽

Emmanuel Garcia Morales ◽

Nicholas Reed ◽

Bonnielin Swenor

Keyword(s):

Older Adults ◽

Hearing Aids ◽

Population Based ◽

Sensory Impairment ◽

Loss To Follow Up ◽

Increased Risk ◽

Cox Proportional Hazard Regression ◽

Study Participants ◽

Adjusted Model

Abstract Sensory impairment (SI) is common among older adults, and it is an increasingly important public health challenge as the population ages. We evaluated the association between SI and incident disability-related cessation of employment in older adults using the population-based Health and Retirement Study. Participants employed in 2006 completed biennial interviews until self-reported incident disability-related cessation of employment. Participants were censored at loss to follow-up, retirement, or 2018. Participants rated their vision and hearing, using eyeglasses or hearing aids if applicable, on a Likert scale (poor, fair, good, very good, excellent). SI was defined as poor or fair ability, and SI was categorized as neither SI (NSI), vision impairment alone (VI), hearing impairment alone (HI), and dual SI (DSI). Cox proportional hazard regression assessed the association between SI and incident disability-related cessation of employment, adjusting for demographic and health covariates. Overall, 4726 participants were included: 421 (8.9%) were with VI, 487 (10.3) with HI, and 203 (4.3%) with DSI. Mean age was 61.0 ± 6.8 years, 2488 (52.6%) were women, and 918 (19.4) were non-White. In the fully adjusted model, incident disability-related cessation of employment over the 12-year follow-up period was higher in VI (Hazard Ratio (HR)=1.30, 95% confidence interval (CI)=0.92, 1.85), HI (HR=1.60, CI=1.16, 2.22), and DSI (HR=2.02, CI=1.38, 2.96). These findings indicate that employed older adults with SI are at increased risk of incident disability-related cessation of employment, and that older adults with DSI are particularly vulnerable. Addressing SI in older adults may lengthen their contribution to the workforce.

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Is Continuous Eruption Related to Periodontal Changes? A 16-Year Follow-up

Journal of Dental Research ◽

10.1177/0022034521999363 ◽

2021 ◽

pp. 002203452199936

Author(s):

C. Wiedemann ◽

C. Pink ◽

A. Daboul ◽

S. Samietz ◽

H. Völzke ◽

...

Keyword(s):

Tooth Wear ◽

Total Sample ◽

Population Based ◽

Tooth Eruption ◽

Reference Points ◽

3 Dimensional ◽

Probing Depth ◽

Molar Teeth ◽

Using Data

The aims of this study were to 1) determine if continuous eruption occurs in the maxillary teeth, 2) assess the magnitude of the continuous eruption, and 3) evaluate the effects of continuous eruption on the different periodontal parameters by using data from the population-based cohort of the Study of Health in Pomerania (SHIP). The jaw casts of 140 participants from the baseline (SHIP-0) and 16-y follow-up (SHIP-3) were digitized as 3-dimensional models. Robust reference points were set to match the tooth eruption stage at SHIP-0 and SHIP-3. Reference points were set on the occlusal surface of the contralateral premolar and molar teeth, the palatal fossa of an incisor, and the rugae of the hard palate. Reference points were combined to represent 3 virtual occlusal planes. Continuous eruption was measured as the mean height difference between the 3 planes and rugae fix points at SHIP-0 and SHIP-3. Probing depth, clinical attachment levels, gingiva above the cementoenamel junction (gingival height), and number of missing teeth were clinically assessed in the maxilla. Changes in periodontal variables were regressed onto changes in continuous eruption after adjustment for age, sex, number of filled teeth, and education or tooth wear. Continuous tooth eruption >1 mm over the 16 y was found in 4 of 140 adults and averaged to 0.33 mm, equaling 0.021 mm/y. In the total sample, an increase in continuous eruption was significantly associated with decreases in mean gingival height ( B = −0.34; 95% CI, −0.65 to −0.03). In a subsample of participants without tooth loss, continuous eruption was negatively associated with PD. This study confirmed that continuous eruption is clearly detectable and may contribute to lower gingival heights in the maxilla.

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Challenging the “jolly fat” hypothesis among older adults: High body mass index predicts increases in depressive symptoms over a 5-year period

Journal of Health Psychology ◽

10.1177/1359105316675209 ◽

2016 ◽

Vol 23 (1) ◽

pp. 48-58 ◽

Cited By ~ 9

Author(s):

Peter Joseph Dearborn ◽

Michael A Robbins ◽

Merrill F Elias

Keyword(s):

Older Adults ◽

Body Mass Index ◽

Depressive Symptoms ◽

Body Mass ◽

Functional Limitations ◽

High Body Mass Index ◽

Obesity Prevalence ◽

Community Based ◽

Objectively Measured

Several investigators have observed lowered risk of depression among obese older adults, coining the “jolly fat” hypothesis. We examined this hypothesis using baseline and a 5-year follow-up body mass index, depressive symptoms, and covariates from 638 community-based older adults. High objectively measured body mass index and functional limitations predicted increased future depressive symptoms. However, symptoms did not predict future body mass index. Self-reported body mass index showed similar associations despite underestimating obesity prevalence. Results did not differ on the basis of gender. Results for this study, the first longitudinal reciprocal risk analysis between objectively measured body mass index and depressive symptoms among older adults, do not support the “jolly fat” hypothesis.

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Self-reported segregation experience throughout the life course and its association with adequate health literacy

Health & Place ◽

10.1016/j.healthplace.2012.04.010 ◽

2012 ◽

Vol 18 (5) ◽

pp. 1115-1121 ◽

Cited By ~ 7

Author(s):

Melody S. Goodman ◽

Darrell J. Gaskin ◽

Xuemei Si ◽

Jewel D Stafford ◽

Christina Lachance ◽

...

Keyword(s):

Health Literacy ◽

Life Course ◽

Adequate Health Literacy ◽

The Life Course

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Nonfatal Stroke and All-Cause Mortality among Community-Dwelling Older Adults Living in Rural Ecuador: A Population-Based, Prospective Study

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_79_18 ◽

2018 ◽

Vol 09 (04) ◽

pp. 551-555

Author(s):

Oscar H. Del Brutto ◽

Robertino M. Mera ◽

Victor J. Del Brutto

Keyword(s):

Older Adults ◽

Proportional Hazards ◽

Population Based ◽

Cox Proportional Hazards ◽

Rural Setting ◽

Nonfatal Stroke ◽

All Cause Mortality ◽

History Of ◽

Univariate Analyses

ABSTRACT Background: Stroke is a leading cause of disability in developing countries. However, there are no studies assessing the impact of nonfatal strokes on mortality in rural areas of Latin America. Using a population-based, prospective cohort study, we aimed to assess the influence of nonfatal strokes on all-cause mortality in older adults living in an underserved rural setting. Methods: Deaths occurring during a 5-year period in Atahualpa residents aged ≥60 years were identified from overlapping sources. Tests for equality of survivor functions were used to estimate differences between observed and expected deaths for each covariate investigated. Cox proportional hazards models were used to estimate Kaplan–Meier survival curves of variables reaching significance in univariate analyses. Results: Of 437 individuals enrolled over 5 years, follow-up was achieved in 417 (95%), contributing 1776 years of follow-up (average 4.3 ± 1.3 years). Fifty-one deaths were detected, for an overall cumulative 5-year mortality rate of 12.2% (8.9%–15.6%). Being older than 70 years of age, having poor physical activity, edentulism, and history of a nonfatal stroke were related to mortality in univariate analyses. A fully adjusted Cox proportional hazards model showed that having history of a nonfatal stroke (P = 0.024) and being older than 70 years of age (P = 0.031) independently predicted mortality. In contrast, obesity was inversely correlated with mortality (P = 0.047). Conclusions: A nonfatal stroke and increasing age increase the risk of all-cause mortality in inhabitants of a remote rural village. The body mass index is inversely related to death (obesity paradox).

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Cardiovascular health and near visual impairment among older adults in the Republic of Congo: a population-based study

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa304 ◽

2020 ◽

Author(s):

Antoine Gbessemehlan ◽

Catherine Helmer ◽

Cécile Delcourt ◽

Farid Boumediene ◽

Bébène Ndamba-Bandzouzi ◽

...

Keyword(s):

Older Adults ◽

Visual Acuity ◽

Visual Impairment ◽

Cardiovascular Health ◽

Central Africa ◽

Population Based ◽

Sub Saharan Africa ◽

Logistic Regression Models ◽

Sub Saharan

Abstract Background Visual impairment (VI) and determinants of poor cardiovascular health are very common in sub-Saharan Africa. However, we do not know whether these determinants are associated to VI among older adults in this region. This study aimed at investigating the association between the determinants of poor cardiovascular health and near VI among older adults living in Congo. Methods Participants were Congolese older adults aged ≥ 65 years included in EPIDEMCA-FU (Epidemiology of Dementia in Central Africa - Follow-up) population-based cohort. Near VI was defined as visual acuity < 20/40 measured at 30 cm. Associations between determinants of poor cardiovascular health collected at baseline and near visual acuity measured at 1 st follow-up were investigated using multivariable logistic regression models. Results Among the 549 participants included, 378 (68.8% [95% Confidence Interval: 64.9%-72.7%]) had near VI. Of the determinants of poor cardiovascular health explored, we found that having high BMI ≥ 25 kg/m 2 (Odds Ratio= 2.15 [95% CI: 1.25–3.68]), diabetes (OR=2.12 [95% CI: 1.06–4.25]) and hypertension (OR=1.65 [95% CI: 1.02–2.64]) were independently associated with near VI. Conclusions Several determinants of poor cardiovascular health were associated to near VI in this population. This study suggests that promoting a good cardiovascular health could represent a target for VI prevention among older adults.

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