Domestic Work, Self-Reported Diagnosed Depression and Related Costs among Women and Men—Results from a Population-Based Study in Sweden

Background: In contrast to paid work, few studies have investigated the association between unpaid domestic work and mental health. The aim of this study was to investigate the association between domestic work and self-reported diagnosed depression and to estimate related costs in a general population. Method: The study is based on women (N = 7981) and men (N = 6203) aged 30–69 years who responded to a survey questionnaire in Mid-Sweden in 2017 (overall response rate 43%). Multivariate logistic regression models, adjusting for age group, educational level, family status, employment status, economic difficulties, and social support, were used to study the association between domestic work and depression. The estimation of direct and indirect costs was based on the calculation of population attributable risks, the literature, and administrative data. Results: In total, 25% of the women and 14% of the men spent more than 20 h a week on domestic work, and 57% of the women and 39% of the men experienced domestic work sometimes or more often as burdensome. A strong independent association between experiencing domestic work as burdensome and depression was observed both in women and men. The total cost of depression possibly related to burdensome domestic work was estimated up to EUR 135.1 million (min EUR 20.7 million–max EUR 21.4 billion) of the total EUR 286.4 million per year in Mid-Sweden. Conclusions: The association between experiencing domestic work as burdensome and depression was strong among both women and men and was not restricted to employed persons or to parents with children. Even though the cross-sectional design does not allow one to assess the direction of the association between domestic work and depression, and longitudinal studies are needed, the results imply that strain in domestic work should be taken into account when considering factors that contribute to the prevalence of depression in the general population and its high societal costs.

Monitoring Self-Perceived Occupational Health Inequities in Central America, 2011 and 2018

Objectives. To analyze changes in occupational health inequity between 2011 and 2018 among workers in Central America. Methods. Data were collected by face-to-face interviews at the workers’ homes for the 2 Central America Working Conditions Surveys (n=12 024 in 2011 and n=9030 in 2018). We estimated health inequity gaps by means of absolute and relative population attributable risks and the weighted Keppel index. We stratified all analyses by gender. Results. Between 2011 and 2018, the proportion of workers reporting poor self-perceived health decreased both in women (from 32% to 29%) and men (from 33% to 30%). However, the health inequity gaps remained wide in the 4 stratifiers. Measured by the Keppel index, health inequity gaps between countries increased from 22% to 39% in women and from 20% to 29% in men. Conclusions. While health improved between 2011 and 2018, health inequity gaps remained wide. Wider health inequity gaps were observed between countries than by gender, age, occupation, or education. Public Health Implications. This first benchmark of occupational health inequities in Central America could be useful when developing and evaluating the impact of public policies on work. (Am J Public Health. Published online ahead of print June 10, 2021: e1–e10. https://doi.org/10.2105/AJPH.2021.306276 )

Chlamydia pneumoniae and chronic asthma: Updated systematic review and meta-analysis of population attributable risk

Background Chlamydia pneumoniae (Cp) is an obligate intracellular human respiratory pathogen producing persisting lung infection with a plausible link to asthma pathogenesis. The population attributable risk of potentially treatable Cp infection in asthma has not been reported. Methods The author searched from 2000 to 2020 inclusive for previously un-reviewed and new cross sectional and prospective controlled studies of Cp biomarkers and chronic asthma in both children and adults. Qualitative descriptive results and quantitative estimates of population attributable risk for selected biomarkers (specific IgG, IgA and IgE) are presented. Findings No large, long-term prospective population-based studies of Cp infection and asthma were identified. About half of case-control studies reported one or more significant associations of Cp biomarkers and chronic asthma. Heterogeneity of results by age group (pediatric v adult asthma), severity category (severe/uncontrolled, moderate/partly controlled, mild/controlled) and antibody isotype (specific IgG, IgA, IgE) were suggested by the qualitative results and confirmed by meta-analyses. The population attributable risks for Cp-specific IgG and IgA were nul in children and were 6% (95% confidence interval 2%-10%, p = 0.002) and 13% (9%-18%, p<0.00001) respectively in adults. In contrast to the nul or small population attributable risks for Cp-specific IgG and IgA, the population attributable risk for C. pneumoniae-specific IgE (children and adults combined) was 47% (39%-55%, p<0.00001). In the subset of studies that reported on asthma severity categories, Cp biomarkers were positively and significantly (P<0.00001) associated with asthma severity. Interpretation C. pneumoniae-specific IgE is strongly associated with asthma and asthma severity, suggesting a possible mechanism linking chronic Cp infection with asthma in a subset of individuals with asthma. Infection biomarkers should be included in future macrolide treatment trials for severe and uncontrolled asthma.

A comparison between two different definitions of contrast-associated acute kidney injury for long-term mortality in patients with diabetes undergoing coronary angiography: a prospective cohort study

Background The definitions of contrast-associated acute kidney injury (CA-AKI) are diverse and have different predictive effects for prognosis, which are adverse for clinical practice. Few articles have discussed the relationship between these definitions and long-term prognosis in patients with diabetes. Methods A total of 1154 diabetic patients who were undergoing coronary angiography (CAG) were included in this study. Two definitions of CA-AKI were used: CA-AKIA was defined as an increase ≥ 0.3 mg/dl or > 50% in serum creatinine (SCr) from baseline within 72 h after CAG, and CA-AKIB was defined as an increase ≥ 0.5 mg/dl or > 25% in SCr from baseline within 72 h after CAG. We used Cox regression to evaluate the association of these two CA-AKI definitions with long-term mortality and calculate the population attributable risks (PARs) of different definitions for long-term prognosis. Results During the median follow-up period of 7.4 (6.2–8.2) years, the overall long-term mortality was 18.84%, and the long-term mortality in patients with CA-AKI according to both CA-AKIA and CA-AKIB criteria were 36.73% and 28.86%, respectively. We found that CA-AKIA (HR: 2.349, 95% CI 1.570–3.517, p = 0.001) and CA-AKIB (HR: 1.608, 95% CI 1.106–2.339, p = 0.013) were associated with long-term mortality. The PARs were the highest for CA-AKIA (31.14%), followed by CA-AKIB (14.93%). Conclusions CA-AKI is a common complication in diabetic patients receiving CAG. The two CA-AKI definitions are significantly associated with a poor long-term prognosis, and CA-AKIA, with the highest PAR, needs more clinical attention.

A comparison of approaches for estimating combined population attributable risks (PARs) for multiple risk factors

ObjectivesThe methods to estimate the population attributable risk (PAR) of a single risk factor or the combined PAR of multiple risk factors have been extensively studied and well developed. Ideally, the estimation of combined PAR of multiple risk factors should be based on large cohort studies, which account for both the joint distributions of risk exposures and for their interactions. However, because such individual-level data are often lacking, many studies estimate the combined PAR using a comparative risk assessment framework. It involves estimating PAR of each risk factor based on its prevalence and relative risk, and then combining the individual PARs using an approach that relies on two key assumptions: that the distributions of exposures to the risk factors are independent and that the relative risks are multiplicative. While such assumptions rarely hold true in practice, no studies have investigated the magnitude of bias incurred if the assumptions are violated.MethodsUsing simulation-based models, we compared the combined PARs obtained with this approach to the more accurate estimates of PARs that are available when the joint distributions of exposures and risks can be established.ResultsWe show that the assumptions of exposure independence and risk multiplicativity are sufficient but not necessary for the combined PAR to be unbiased. In the simplest situation of two risk factors, the bias of this approach is a function of the strength of association and the magnitude of risk interaction, for any values of exposure prevalence and their associated risks. In some cases, the combined PAR can be strongly under- or over-estimated, even if the two assumptions are only slightly violated.ConclusionsWe encourage researchers to quantify likely biases in their use of the M–S method, and here, we provided level plots and R code to assist.

Healthy Lifestyle for Prevention of Premature Death Among Users and Nonusers of Common Preventive Medications: A Prospective Study in 2 US Cohorts

Background It remains unknown whether individuals who regularly use preventive medications receive the same benefit from healthy lifestyle as those who do not use medications. We aimed to examine the associations of healthy lifestyle with mortality according to use of major preventive medications, including aspirin, antihypertensives, and lipid‐lowering medications. Methods and Results Among 79 043 women in the Nurses' Health Study (1988–2014) and 39 544 men in the Health Professionals Follow‐up Study (1986–2014), we defined a healthy lifestyle score based on body mass index, smoking, physical activity, diet, and alcohol intake. We estimated multivariable hazard ratios (HRs) and population‐attributable risks of death from any cause, cardiovascular disease, cancer, and other causes in relation to healthy lifestyle according to medication use. We documented 35 195 deaths. A similar association of healthy lifestyle score with lower all‐cause mortality was observed among medication users (HR, 0.82 per unit increment; 95% CI, 0.81–0.82) and nonusers (HR, 0.81; 95% CI, 0.79–0.83) ( P interaction=0.54). The fraction of premature deaths that might be prevented by adherence to the 5 healthy lifestyle factors among medication users and nonusers was 38% (95% CI, 32%–42%) and 40% (95% CI, 29%–50%) for all‐cause mortality, 37% (95% CI, 27%–46%) and 45% (95% CI, 18%–66%) for cardiovascular disease mortality, and 38% (95% CI, 28%–46%) and 33% (95% CI, 14%–49%) for cancer mortality, respectively. Conclusions Adherence to a healthy lifestyle confers substantial benefit for prevention of premature death among both regular users and nonusers of preventive medications. Adherence to a healthy lifestyle remains important even among individuals regularly using preventive medications.

Identifying significant contributors for smoking cessation among male prisoners in Australia: results from a randomised clinical trial

IntroductionIn Australia, an estimated 90% of those entering prison are current tobacco smokers and three-quarters of current prisoners are tobacco smokers.AimsTo identify factors and their relative contributions to smoking cessation among male prisoners.MethodsA total of 425 male tobacco smokers with a median age of 32 years in Australian prisons. The primary outcome was continuous abstinence at 3, 6 and 12 months. We measured various sociodemographic characteristics, drug use, psychological distress and the mental and physical health status of the participants. Multivariate logistic regression models and population attributable risks (PAR%) were used to identify the significant factors and their contributions to smoking cessation rates.ResultsThe median age of participants was 32 years (IQR 25–41 years). High smoking cessation rates were collectively associated with not using drugs, lower psychological distress, good mental health scores and better physical health (PAR%: 93%, 98% and 88% at 3, 6 and 12 months).ConclusionOur study suggests that not using drugs and being in good mental/physical health are the important contributors to continuous abstinence among prisoners. Thus, effective smoking cessation programmes require a multicomponent approach that includes addressing drug problems and mental health functioning.Trial registration number12606000229572.

Healthy Lifestyle for Prevention of Premature Death Among Users and Nonusers of Common Preventive Medications: A Prospective Study in Two US Cohorts

Objectives Adherence to healthy lifestyle and pharmacological therapies represent two major approaches to chronic disease prevention. It remains unknown whether individuals who regularly use preventive medications still benefit from adherence to healthy lifestyle as those not using the medications. We aimed to examine the associations of healthy lifestyle with all-cause and cause-specific mortality among regular users and nonusers of major preventive medications. Methods We prospectively assessed lifestyles and regular use of aspirin, antihypertensives, and lipid-lowering medications through biennial questionnaires among 79,043 women in the Nurses’ Health Study (1988–2014) and 39,544 men in the Health Professionals Follow-up Study (1986–2014). A healthy lifestyle score (ranging 0–5) was defined based on body mass index of ≥18.5 and &lt; 27.5 kg/m2, never smoking, moderate-to-vigorous intensity activity for ≥30 minutes/day, alternate healthy eating index in the upper 40%, and light-to-moderate alcohol intake. We calculated multivariable hazard ratios (HRs) and population-attributable risks (PARs) of death from any cause, cardiovascular disease (CVD), cancer, and other causes in relation to healthy lifestyle according to medication use. Results During a median of 26 years of follow-up, we documented 35,195 deaths. A similar association of healthy lifestyle score with lower all-cause mortality was observed among medication users (HR, 0.82 per one-unit increment; 95% CI, 0.81–0.82) and nonusers (HR, 0.81 per one-unit increment; 95% CI, 0.79–0.83) (P-interaction = 0.54). The fraction of premature deaths that may potentially be prevented by adherence to all the 5 healthy lifestyle factors among medication users and nonusers was 38% (95% CI, 32–42%) and 40% (95% CI, 29–50%) for all-cause mortality, 37% (95% CI, 27–46%) and 45% (95% CI, 18–66%) for CVD mortality, 38% (95% CI, 28–46%) and 33% (95% CI, 14–49%) for cancer mortality, 33% (95% CI, 25–41%) and 38% (95% CI, 20–54%) for other mortality, respectively. Conclusions Adherence to healthy lifestyle confers substantial benefit for prevention of premature death among both regular users and nonusers of preventive medications. Adherence to healthy lifestyle remains important even among individuals regularly using preventive medications. Funding Sources American Cancer Society and NIH.

Unraveling the risk factors for spontaneous intracerebral hemorrhage among West Africans

ObjectiveTo characterize risk factors for spontaneous intracerebral hemorrhage (sICH) occurrence and severity among West Africans.MethodsThe Stroke Investigative Research and Educational Network (SIREN) study is a multicenter case-control study involving 15 sites in Ghana and Nigeria. Patients were adults ≥18 years old with CT-confirmed sICH with age-, sex-, and ethnicity-matched stroke-free community controls. Standard instruments were used to assess vascular, lifestyle, and psychosocial factors. Factors associated with sICH and its severity were assessed using conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% confidence intervals (CIs) for factors.ResultsOf 2,944 adjudicated stroke cases, 854 were intracerebral hemorrhage (ICH). Mean age of patients with ICH was 54.7 ± 13.9 years, with a male preponderance (63.1%), and 77.3% were nonlobar. Etiologic subtypes of sICH included hypertension (80.9%), structural vascular anomalies (4.0%), cerebral amyloid angiopathy (0.7%), systemic illnesses (0.5%), medication-related (0.4%), and undetermined (13.7%). Eight factors independently associated with sICH occurrence by decreasing order of PAR with their adjusted OR (95% CI) were hypertension, 66.63 (20.78–213.72); dyslipidemia, 2.95 (1.84–4.74); meat consumption, 1.55 (1.01–2.38); family history of CVD, 2.22 (1.41–3.50); nonconsumption of green vegetables, 3.61 (2.07–6.31); diabetes mellitus, 2.11 (1.29–3.46); stress, 1.68 (1.03–2.77); and current tobacco use, 14.27 (2.09–97.47). Factors associated with severe sICH using an NIH Stroke Scale score >15 with adjusted OR (95% CI) were nonconsumption of leafy green vegetables, 2.03 (1.43–2.88); systolic blood pressure for each mm Hg rise, 1.01 (1.00–1.01); presence of midline shift, 1.54 (1.11–2.13); lobar ICH, 1.72 (1.16–2.55); and supratentorial bleeds, 2.17 (1.06–4.46).ConclusionsPopulation-level control of the dominant factors will substantially mitigate the burden of sICH in West Africa.