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Guo, X; Tang, P, Zhang, L, Li, R. Pages: 349 - 354 Abstract: BackgroundEpidemiological data have suggested that tobacco and alcohol consumption were associated with the risk of frailty and falling, but it is yet unclear whether these associations are of a causal nature. Thus, we conducted two-sample Mendelian randomisation analysis using genetic instruments to determine the causal associations of tobacco and alcohol consumption on frailty and falls.MethodsIndependent instrumental variables strongly (p Keywords: Editor's choice PubDate: 2023-05-10T00:45:17-07:00 DOI: 10.1136/jech-2022-219855 Issue No:Vol. 77, No. 6 (2023)
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Baek, S.-U; Lee, W.-T, Kim, M.-S, Lim, M.-H, Yoon, J.-H, Won, J.-U. Pages: 355 - 361 Abstract: BackgroundWe investigated associations for long working hours in relation to physical inactivity and high-level physical activity among middle-aged and older adults.MethodsOur study included 5402 participants and 21 595 observations from the Korean Longitudinal Study of Ageing (2006–2020). Logistic mixed models were used to estimate ORs and 95% CIs. Physical inactivity was defined as not engaging in any type of physical activity, while high-level physical activity was defined as engaging in ≥150 min per week of physical activity.ResultsWorking>40 hours weekly was positively related to physical inactivity (OR (95% CI) 1.48 (1.35 to 1.61)) and negatively related to high-level physical activity (0.72 (95% CI 0.65 to 0.79)). Exposure to long working hours consecutively for ≥3 waves was associated with the highest OR for physical inactivity (1.62 (95% CI 1.42 to 1.85)) and the lowest OR for high-level physical activity (0.71 (95% CI 0.62 to 0.82)). Furthermore, compared with persistent short working hours (≤40 hours -> ≤40 hours), long working hours in a previous wave (>40 hours -> ≤40 hours) were associated with a higher OR of physical inactivity (1.28 (95% CI 1.11 to 1.49)). Exposure to an increase in working hours (≤40 hours ->>40 hours) was also associated with a higher OR of physical inactivity (1.53 (95% CI 1.29 to 1.82)).ConclusionWe found that having working long hours was associated with a higher risk of physical inactivity and a lower likelihood of high-level physical activity. Moreover, accumulation of long working hours was associated with a higher risk of physical inactivity. PubDate: 2023-05-10T00:45:17-07:00 DOI: 10.1136/jech-2022-220129 Issue No:Vol. 77, No. 6 (2023)
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Lallukka, T; Lahelma, E, Pietiläinen, O, Kuivalainen, S, Laaksonen, M, Rahkonen, O, Lahti, J. Pages: 362 - 368 Abstract: BackgroundOccupational class inequalities in physical functioning and their changes after retirement are poorly understood. We examined occupational class trajectories in physical functioning 10 years before and after transition to old-age and disability retirement. We included working conditions and behavioural risk factors as covariates, given their established link to health and retirement.MethodsWe used the Helsinki Health Study cohort data from surveys 2000–2002 to 2017, and included 3901 women, who were employed by the City of Helsinki, Finland, and retired during the follow-up. Mixed-effect growth curve models were used to examine changes in RAND-36 Physical Functioning subscale (range 0–100) 10 years before and after the retirement date by occupational class.ResultsOld-age (n=3073) and disability retirees (n=828) lacked class differences in physical functioning 10 years before retirement. By retirement transition, physical functioning declined and class inequalities emerged, the predicted scores being 86.1 (95% CI 85.2 to 86.9) for higher class and 82.2 (95% CI 81.5 to 83.0) for lower class old-age retirees, and 70.3 (95% CI 67.8 to 72.9) for higher class and 62.2 (95% CI 60.4 to 63.9) for lower class disability retirees. Physical functioning declined and class inequalities slightly widened among old-age retirees after the retirement, whereas among disability retirees the decline plateaued and class inequalities narrowed over time after retirement. Physical work and body mass index somewhat attenuated the class inequalities after adjustment.ConclusionsClass inequalities in physical functioning widened after old-age retirement and narrowed after disability retirement. The examined work and health-related factors contributed weakly to the inequalities. PubDate: 2023-05-10T00:45:17-07:00 DOI: 10.1136/jech-2022-219963 Issue No:Vol. 77, No. 6 (2023)
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Nersesjan, S. C; Nilsson, C. J, Davidsen, K, Kriegbaum, M, Lund, R. Pages: 369 - 374 Abstract: BackgroundPartnership break-up and living alone is associated with several negative health-related outcomes. Little is known about the association with physical functional ability in a life course perspective. The aim of this study is to investigate (1) the association between number of partnership break-ups and years living alone across 26 years of adult life respectively and objectively measured physical capability in midlife, (2) how the joint exposure of accumulated break-ups or years living alone respectively, and education relates to physical capability in midlife and (3) potential gender differences.MethodsLongitudinal study of 5001 Danes aged 48–62. Accumulated number of partnership break-ups and years living alone were retrieved from national registers. Handgrip strength (HGS) and number of chair rises (CR) were recorded as outcomes in multivariate linear regression analyses adjusted for sociodemographic factors, early major life events and personality.ResultsIncreasing number of years living alone was associated with poorer HGS and fewer CR. Concomitant exposure to short educational level and break-ups or long duration of time living alone respectively was associated with poorer physical capability compared with the groups with long educational level and no break-ups or few years lived alone.ConclusionAccumulated number of years living alone but not break-ups was associated with poorer physical functional ability. Joint exposure to a high number of years lived alone or break-ups respectively and having a short education was associated with the lowest levels of functional ability, which points towards an important target group for interventions. No gender differences were suggested. PubDate: 2023-05-10T00:45:17-07:00 DOI: 10.1136/jech-2022-220194 Issue No:Vol. 77, No. 6 (2023)
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Sharma, A; Deng, L, Wang, Y.-C. Pages: 375 - 383 Abstract: BackgroundExtreme temperatures are triggering and exacerbating hospital admissions and health burdens; however, it is still understudied. Therefore, we evaluated the effects of the average temperature on overall hospitalisation and the average length of hospital stay.MethodsDaily area-specific age-sex stratified hospitalisation records from 2006 to 2020 were collected from the National Health Research Institutes of Taiwan. The distributed lag non-linear model was used to estimate the area-specific relative risk (RR) and 95% CI associated with daily average temperature. Overall cumulative RR was pooled from area-specific RRs using random effects meta-analysis. Temperature effects of extreme high and low thresholds were also evaluated based on the 99th (32°C) and 5th (14°C) percentiles, respectively.ResultsOur findings suggested that the elderly (age ≥65 years) are vulnerable to temperature effects, while differential gender effects are not explicit in Taiwan. A higher risk of in-patient visits was seen among the elderly during extreme low temperatures (RR 1.08; 95% CI 1.04 to 1.11) compared with extreme high temperatures (RR 1.07; 95% CI 1.05 to 1.10). Overall, high-temperature extremes increased the risk of hospitalisation with an RR of 1.05 (95% CI 1.03 to 1.07) among the all-age-sex population in Taiwan. Additionally, lag-specific analysis of the study revealed that high-temperature effects on in-patient visits are effective on the same day of exposure, while cold effects occurred after 0–2 days of exposure. The average length of hospital stays can also increase with high-temperature extremes among age group 41–64 years and the elderly.ConclusionPublic health preparedness should consider the increased load on health facilities and health expenditures during extreme temperatures. PubDate: 2023-05-10T00:45:17-07:00 DOI: 10.1136/jech-2022-220142 Issue No:Vol. 77, No. 6 (2023)
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Silventoinen, K; Lahtinen, H, Davey Smith, G, Morris, T. T, Martikainen, P. Pages: 384 - 390 Abstract: BackgroundThe associations between height, socioeconomic position (SEP) and coronary heart disease (CHD) incidence are well established, but the contribution of genetic factors to these associations is still poorly understood. We used a polygenic score (PGS) for height to shed light on these associations.MethodsFinnish population-based health surveys in 1992–2011 (response rates 65–93%) were linked to population registers providing information on SEP and CHD incidence up to 2019. The participants (N=29 996; 54% women) were aged 25–75 at baseline, and there were 1767 CHD incident cases (32% in women) during 472 973 person years of follow-up. PGS-height was calculated based on 33 938 single-nucleotide polymorphisms, and residual height was defined as the residual of height after adjusting for PGS-height in a linear regression model. HRs of CHD incidence were calculated using Cox regression.ResultsPGS-height and residual height showed clear gradients for education, social class and income, with a larger association for residual height. Residual height also showed larger associations with CHD incidence (HRs per 1 SD 0.94 in men and 0.87 in women) than PGS-height (HRs per 1 SD 0.99 and 0.97, respectively). Only a small proportion of the associations between SEP and CHD incidence was statistically explained by the height indicators (6% or less).ConclusionsResidual height associations with SEP and CHD incidence were larger than for PGS-height. This supports the role of material and social living conditions in childhood as contributing factors to the association of height with both SEP and CHD risk. PubDate: 2023-05-10T00:45:17-07:00 DOI: 10.1136/jech-2022-219907 Issue No:Vol. 77, No. 6 (2023)
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Ng, C. S; Au, M, Tian, L, Quan, J. Pages: 391 - 397 Abstract: BackgroundInterpersonal violence is a major public health concern with alcohol use a known risk factor. Despite alcohol taxation being an effective policy to reduce consumption; Hong Kong, contrary to most developed economies, embarked on an alcohol tax reduction and elimination policy.MethodsTo assess the impact of the alcohol tax reductions, we analysed population-based hospitalisation data for assault from the Hong Kong Hospital Authority, and violent and sexual crimes recorded by the Hong Kong Police Force (2004–2018). We conducted an interrupted time series using seasonal autoregressive integrated moving average models on monthly rates. Breakpoints in March 2007 and March 2008 were applied separately.ResultsThe 2007 tax cut was associated with sustained increases in violence-related hospitalisation rates for 35–49 age group (female: 0.19%, p=0.007; male: 0.22%, p PubDate: 2023-05-10T00:45:17-07:00 DOI: 10.1136/jech-2022-219996 Issue No:Vol. 77, No. 6 (2023)
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Long, D; Mackenbach, J. P, Klokgieters, S, Kalediene, R, Deboosere, P, Martikainen, P, Heggebo, K, Leinsalu, M, Bopp, M, Bronnum-Hansen, H, Costa, G, Eikemo, T, Nusselder, W. J. Pages: 400 - 408 Abstract: BackgroundStudies of period changes in educational inequalities in mortality have shown important changes over time. It is unknown whether a birth cohort perspective paints the same picture. We compared changes in inequalities in mortality between a period and cohort perspective and explored mortality trends among low-educated and high-educated birth cohorts.Data and methodsIn 14 European countries, we collected and harmonised all-cause and cause-specific mortality data by education for adults aged 30–79 years in the period 1971–2015. Data reordered by birth cohort cover persons born between 1902 and 1976. Using direct standardisation, we calculated comparative mortality figures and resulting absolute and relative inequalities in mortality between low educated and high educated by birth cohort, sex and period.ResultsUsing a period perspective, absolute educational inequalities in mortality were generally stable or declining, and relative inequalities were mostly increasing. Using a cohort perspective, both absolute and relative inequalities increased in recent birth cohorts in several countries, especially among women. Mortality generally decreased across successive birth cohorts among the high educated, driven by mortality decreases from all causes, with the strongest reductions for cardiovascular disease mortality. Among the low educated, mortality stabilised or increased in cohorts born since the 1930s in particular for mortality from cardiovascular diseases, lung cancer, chronic obstructive pulmonary disease and alcohol-related causes.ConclusionsTrends in mortality inequalities by birth cohort are less favourable than by calendar period. In many European countries, trends among more recently born generations are worrying. If current trends among younger birth cohorts persist, educational inequalities in mortality may further widen. Keywords: Open access PubDate: 2023-05-10T00:45:17-07:00 DOI: 10.1136/jech-2023-220342 Issue No:Vol. 77, No. 6 (2023)
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Hetherington, E; Harper, S, Davidson, R, Festo, C, Lampkin, N, Mtenga, S, Teixeira, C, Vincent, I, Nandi, A. Pages: 410 - 416 Abstract: BackgroundThe Tabora Maternal and Newborn Health Initiative project was a multicomponent intervention to improve maternal and newborn health in the Tabora region of Tanzania. Components included training healthcare providers and community health workers, infrastructure upgrades, and improvements to health management. This study aimed to examine the impact of trainings on four key outcomes: skilled birth attendance, antenatal care, respectful maternity care and patient–provider communication.MethodsTrainings were delivered sequentially at four time points between 2018 and 2019 in eight districts (two districts at a time). Cross-sectional surveys were administered to a random sample of households in all districts at baseline and after each training wave. Due to practical necessities, the original stepped wedge cluster randomised design of the evaluation was altered mid-programme. Therefore, a difference-in-differences for multiple groups in multiple periods was adopted to compare outcomes in treated districts to not yet treated districts. Risk differences were estimated for the overall average treatment effect on the treated and group/time dynamic effects.ResultsRespondents reported 3895 deliveries over the course of the study. The intervention was associated with a 12.9 percentage point increase in skilled birth attendance (95% CI 0.4 to 25.4), which began to increase 4 months after the end of training in each district. There was little evidence of impact on antenatal care visits, respectful treatment during delivery and patient–provider communication.ConclusionInterventions to train local healthcare workers in basic and comprehensive emergency obstetric and newborn care increased skilled birth attendance but had limited impact on other pregnancy-related outcomes. PubDate: 2023-05-10T00:45:17-07:00 DOI: 10.1136/jech-2022-219995 Issue No:Vol. 77, No. 6 (2023)
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