Socioeconomic status, lifestyle factors and asthma prevalence: results from a population-based study in Sweden

Aim: To examine differences in the prevalence of self-reported diagnosed asthma by socioeconomic status and the contribution of lifestyle factors to these differences. Methods: The study was based on 28,531 persons aged 18 years or older who answered a survey questionnaire sent to a random population sample in mid-Sweden in 2017. The overall response rate was 44%. Socioeconomic status was measured with educational level and economic difficulties, and lifestyle factors with physical activity, smoking, snuff use, risk-drinking of alcohol and obesity. The associations between socioeconomic status and asthma were analysed using multivariate logistic regression. Results: The overall asthma prevalence was 9% among women and 7% in men and decreased with increasing age. Educational level was not independently associated with asthma, but a statistically significant odds ratio (with 95% confidence intervals) for the prevalence of asthma was observed for economic difficulties 1.5 (1.3–1.7). Also, physical inactivity 1.2 (1.1–1.3) and obesity 1.6 (1.4–1.8) were associated with increased asthma prevalence. Smoking and risk-drinking were not statistically significantly associated with asthma whereas snuff users had a higher prevalence of asthma among women. Adjusting for lifestyle factors did not affect the association between socioeconomic status and asthma. Conclusions: In this population-based study, self-reported diagnosed asthma was independently associated with economic difficulties but not with educational level. Lifestyle factors did not explain the association between economic difficulties and asthma prevalence. This applies to both men and women as well as younger and older age groups.

Prediction of COPD by the single-breath nitrogen test and various respiratory symptoms

Early identification of subjects running an increased risk of contracting COPD enables focus on individual preventive measures. The slope of the alveolar plateau of the single-breath nitrogen washout test (N2-slope) is a sensitive measure of small-airway dysfunction. However, its role remains unexplored in predicting hospital admission or death related to COPD, i.e. incident COPD events, in relation to the presence of various respiratory symptoms.A random population sample of 625 men, aged 50 (n=218) or 60 years (n=407), was followed for 38 years for incident COPD events. At baseline, a questionnaire on respiratory symptoms and smoking habits was collected, spirometry and the single-breath nitrogen test were performed, and the N2-slope was determined. Proportional hazard regression (Cox regression) analysis was used for the prediction model.The N2-slope improved the prediction of COPD events significantly beyond that of respiratory symptoms weighted all together and other covariates (hazard ratio 1.63, 95% CI 1.20–2.22; p<0.005), a prediction applicable to subjects without (p=0.001) and with (p<0.05) airway obstruction. Dyspnoea and wheezing were the most predictive symptoms. The combination of the N2-slope and number of respiratory symptoms notably resulted in an effective prediction of incident COPD events even in nonobstructive subjects, as evidenced by a predicted incidence of ∼70% and ∼90% for a very steep N2-slope combined with many respiratory symptoms in subject without and with airway obstruction, respectively.The alveolar N2-slope should be considered in the critical need for further research on early diagnosis of COPD.

Prejudice in disguise: Which features determine the subtlety of ethnically prejudicial statements?

In current immigration debates ethnic prejudice is often expressed in a subtle manner, which conceals its xenophobic content. However, previous research has only insufficiently examined the specific features that make certain ethnically prejudicial statements subtler, i.e., less readily identifiable as xenophobic, than others. The current study employs an experimental factorial survey design and assesses the subtlety of systematically manipulated prejudicial statements. Our data from a German random population sample (N = 895) indicate that the subtlety of ethnically prejudicial statements is manipulable along the dimensions of topic, linguistic (essentialist) phrasing, and target group: Prejudicial statements that refer to culture, that are phrased weakly essentialistically, and that target Muslims were subtlest, in being evaluated as least xenophobic by the respondents. Moreover, with an increasing internal and a decreasing external motivation to respond without prejudice, individuals reacted more strongly to the variation of the statements’ topic and linguistic phrasing and were thus more sensitive to features determining subtler and more blatant ways of ethnic prejudice expression. These findings contribute to a better understanding of current migration discourses, in demonstrating that the specific manner in which ethnic prejudice is communicated can camouflage the xenophobic nature of a statement, so that it is less readily recognized as prejudicial.

A comparison of spleen size measured by ultrasound in a random population sample and a matched sample of patients at a university hospital, and the determination of normal values and influencing factors

Objectives This study aimed to compare spleen sizes in a hospital and a population sample using ultrasound and define normal values and factors influencing spleen size. Methods Both samples’ spleen sizes (n = 1520) were measured using ultrasound under the same conditions. Blood counts and other laboratory parameters were determined under the same conditions in both samples. Results In the hospital sample (n = 760), the mean spleen size was 114.7 mm, and in the population sample (n = 760), it was 99.1 mm. In both, spleen size in men was significantly higher than in women (p < 0.0001) and influenced by body height, weight, and BMI (body mass index) (p < 0.0001). In the hospital sample, there was a correlation with higher values for ALT (p = 0.0160), AST (p = 0.0394), AP (p = 0.0482), and ferritin (p = 0.0008) and lower values for HDL (p = 0.0091) and thrombocytes (p < 0.0001). In the multivariate analysis, higher values for AP (p = 0.0059) and lower values for hemoglobin (p = 0.0014) and thrombocytes (p = 0.0001) were found. Stratified for sex (men, women), spleen size increased with higher values for ALT (p = 0.0116, p = 0.0113), AST (p = 0.0014, p = 0.0113), and AP (p = 0.0001, p = 0.0012), and with lower values of hemoglobin (p = 0.0057, p = 0.0016), thrombocytes (p < 0.0001, p = 0.0003), and albumin (p = 0.0029, p = 0.0432). In women, there was a discordant correlation with red blood cells (p = 0.0005) and a concordant correlation with GGT (p = 0.0241), and in men discordant correlations with cholesterol (p = 0.0010) and HDL (p = 0.0404). Conclusions The already proven impact of anthropometric data on spleen size was confirmed. The role of laboratory values should be further analyzed.

HYPERURICEMIA AS A MARKER OF LIPID PEROXIDATION INTENSITY IN A POPULATION

The prevalence of hyperuricemia in the world has been steadily increasing over the past decade. According to various authors, the frequency of asymptomatic hyperuricemia in the population ranges from 5 to 35.1 per cent. The study of the relationship between purine metabolism disorders and the state of lipid peroxidation is still relevant due to numerous reports on the relationship between the processes of urate formation and free radical oxidation. Therefore, the aim of the study was to find out the value of hyperuricemia as a marker of the intensity of lipid peroxidation in a random population sample. Materials and methods. The group of participants was formed according to generally accepted epidemiological approaches using a random sample of workers and employees of an industrial enterprise (n=727 people, 457 men and 270 women, age ranged from 18 to 65 years, the average age was 38.13±5.10 years. Metabolic syndrome was diagnosed according to the recommendations of International Diabetes Federation, National Heart, Lung and Blood Institute, American Heart Association, World Heart Federation, International Atherosclerosis Society, and International Association for the Study of Obesity. Glucose homeostasis was evaluated according to the recommendations of the research society for the study of diabetes in India, Endocrine Society of India, 2020. Venous blood samples were taken on an empty stomach. We assessed the immunoreactive insulin content by immunochemiluminescent method, the concentration of triglycerides, cholesterol, high density lipoprotein by enzyme colorimetric method, xanthine and hypoxanthine were assessed by the method of S. V. Oreshnikov et al., uric acid was evaluated by colorimetric method, acylhydrazines – by the method of V. B. Gavrilov and M. I. Mishkorudny, malonic dialdehyde was assessed by the method of I. D. Steel, Garishvili T. G. in modification of L. I. Andreeva et al.; the level of total reduced SH groups was evaluated by the Elman photometric method, xanthine oxidase activity was studied by the photometric method, superoxide dismutase was examined by the T. V. Sirota method, and catalase in plasma and red blood cells – by the H. Aebi method. Results and discussion. Hyperuricemia was diagnosed in 118 (16.2%) patients. Violation of glucose homeostasis was diagnosed in 76 patients (10.5%): type 2 diabetes was found in 22 (3.03%) patients, glucose tolerance disorders were found in 47 (6.5%) patients, fasting hyperglycemia – in 7 (0, 96%), respectively. In a random population sample with hyperuricemia, the concentration of intermediate and final products of lipid peroxidation in the blood is significantly higher than in individuals with normouricemia. The concentration of reducing equivalents in the form of free SH groups does not significantly depend on the intensity of purine catabolism. The maximum intensity of lipid peroxidation is observed in the representatives of a random population sample with hyperuricemia in the presence of impaired glucose homeostasis. For this combination of pathological conditions, the concentrations of intermediate and final products of lipid peroxidation are significantly higher than for hyperuricemia by itself and hyperuricemia in combination with other components of the metabolic syndrome. The established links between disorders of purine metabolism and activation of lipid peroxidation demonstrate a close integration of purine metabolism pathology into hormonal and metabolic disorders of diabetogenic and atherogenic orientation at the level of a random population sample.

Alcohol consumption and self-rated health among older people: population-based study in Sweden

Objective To analyse alcohol consumption and its association with self-rated health among a representative sample of older people in mid-Sweden. Background Over the past decades, alcohol consumption has increased in the older population in Sweden, but few studies have investigated the association between alcohol consumption and self-rated health in this group. The aim was therefore to investigate alcohol consumption and self-rated health among older Swedes. Methods The study is based on a cross-sectional study of 11,716 men and women, 65 years and over, answering a survey questionnaire sent to a random population sample in mid-Sweden in 2012. We assessed alcohol consumption with AUDIT-C and its association with self-rated health using logistic regression analysis, adjusting for age, economic situation, educational level, BMI, physical activity, social support and medication use. Results Men (83%) were more prone to drink alcohol compared to women (71%). The prevalence of risk drinking was about 2% for both genders. Alcohol consumption declined with age. Moderate consumption of alcohol was associated with lower probability of poor self-rated health compared to non-drinking with an adjusted odds ratio 0.64 (95% confidence interval: 0.54-0.76) for men and 0.68 (0.59-0.79) for women. Conclusion Since the study was cross-sectional the direction of the association could not be determined, and the results should not be interpreted as an argument for promoting alcohol consumption among older people.

Impact of changes in heart rate with age on all-cause death and cardiovascular events in 50-year-old men from the general population

BackgroundResting heart rate (RHR), a known cardiovascular risk factor, changes with age. However, little is known about the association between changes in RHR and the risk of cardiovascular events. The purpose of this study was therefore to assess the impact of RHR at baseline, and the change in RHR over time, on the risk of all-cause death and cardiovascular events.DesignA random population sample of men born in 1943 who were living in Gothenburg, Sweden was prospectively followed for a 21-year period.MethodsParticipants were examined three times: first in 1993 and then re-examined in 2003 and 2014. At each visit, a clinical examination, an ECG and laboratory analyses were performed. Change in RHR between 1993 and 2003 was defined as a decrease if RHR decreased by 5 beats per minute (bpm), an increase if RHR increased by 5 bpm or stable if the RHR change was <4bpm).ResultsParticipants with a baseline RHR of >75 bpm in 1993 had about a twofold higher risk of all-cause death (HR 2.3, CI 1.2 to 4.7, p=0.018), cardiovascular disease (CVD) (HR 1.8, CI 1.1 to 3.0, p=0.014) and coronary heart disease (CHD) (HR 2.2, CI 1.1 to 4.5, p=0.025) compared with those with <55 bpm in 1993. Participants with a stable RHR between 1993 and 2003 had a 44% decreased risk of CVD (HR 0.56, CI 0.35 to 0.87, p=0.011) compared with participants with an increasing RHR. Furthermore, every beat increase in heart rate from 1993 was associated with a 3% higher risk for all-cause death, 1% higher risk for CVD and 2% higher risk for CHD.ConclusionHigh RHR was associated with an increased risk of death and cardiovascular events in men from the general population. Moreover, individuals with an increase in RHR between 50 and 60 years of age had worse outcome.