The general external exposome and the development or progression of chronic kidney disease: A systematic review and meta-analyses.

The impact of environmental risk factors on chronic kidney disease (CKD) remains unclear. This systematic review aims to provide an overview of the literature on the association between the general external exposome and CKD development or progression. We searched MEDLINE and EMBASE for case-control or cohort studies, that investigated the association of the general external exposome with a change in eGFR or albuminuria, diagnosis or progression of CKD, or CKD-related mortality. The risk of bias of included studies was assessed using the Newcastle-Ottawa Scale. Summary effect estimates were calculated using random-effects meta-analyses. Most of the 66 included studies focused on air pollution (n = 33), e.g. particulate matter (PM) and nitric oxides (NOx), and heavy metals (n = 21) e.g. lead and cadmium. Few studies investigated chemicals (n = 7) or built environmental factors (n = 5). No articles on other environment factors such as noise, food supply, or urbanization were found. PM2.5 exposure was associated with an increased CKD and end-stage kidney disease incidence, but not with CKD-related mortality. There was mixed evidence regarding the association of NO2 and PM10 on CKD incidence. Exposure to heavy metals might be associated with an increased risk of adverse kidney outcomes, however, evidence was inconsistent. Studies on effects of chemicals or built environment on kidney outcomes were inconclusive. In conclusion, prolonged exposure to PM2.5 is associated with an increased risk of CKD incidence and progression to kidney failure. Current studies predominantly investigate the exposure to air pollution and heavy metals, whereas chemicals and the built environment remains understudied. Substantial heterogeneity and mixed evidence were found across studies. Therefore, long-term high-quality studies are needed to elucidate the impact of exposure to chemicals or other (built) environmental factors and CKD.

Longitudinal associations of air pollution and green space with cardiometabolic risk factor clustering among children in the Netherlands.

BACKGROUND: This study examines longitudinal associations of air pollution and green space with cardiometabolic risk among children in the Netherlands. METHODS: Three Dutch prospective cohorts with a total of 13,822 participants aged 5 to 17 years were included: (1) the Amsterdam Born Children and their Development (ABCD) study from Amsterdam (n = 2,547), (2) the Generation R study from Rotterdam (n = 5,431), and (3) the Lifelines study from northern Netherlands (n = 5,844). Air pollution (PM2.5, PM10, NO2, and elemental carbon (EC)) and green space exposures (density in multiple Euclidean buffer sizes) from 2006 to 2017 at home address level were used. Cardiometabolic risk factor clustering was assessed by a MetScore, which was derived from a confirmatory factor analysis of six cardiometabolic risk factors to assess the overall risk. Linear regression models with change in Metscore as the dependent variable, adjusted for multiple confounders, were conducted for each cohort separately. Meta-analyses were used to pool cohort-specific estimates. RESULTS: Exposure to higher levels of NO2 and EC was significantly associated with increases in MetScore in Lifelines (per SD higher exposure: ßNO2 = 0.006, 95 % CI = 0.001 to 0.010; ßEC = 0.008, 95 % CI = 0.002 to 0.014). In the other two cohort studies, these associations were in the same direction but these were not significant. Higher green space density in 500-meter buffer zones around participants' residential addresses was not significantly associated with decreases of MetScore in all three cohorts. Higher green space density in 2000-meter buffer zones was significantly associated with decreases of MetScore in ABCD and Lifelines (per SD higher green space density: ßABCD = -0.008, 95 % CI = -0.013 to -0.003; ßLifelines = -0.002, 95 % CI = -0.003 to -0.00003). The pooled estimates were ßNO2 = 0.003 (95 % CI = -0.001 to 0.006) for NO2, ßEC = 0.003 (95 % CI = -0.001, 0.007) for EC, and ß500m buffer = -0.0014 (95 % CI = -0.0026 to -0.0001) for green space. CONCLUSIONS: More green space exposure at residence was associated with decreased cardiometabolic risk in children. Exposure to more NO2 and EC was also associated with increased cardiometabolic risk.

Impact of green space exposure on blood pressure in Guangzhou, China: Mediation by air pollution, mental health, physical activity, and weight status.

Green space exposure has been inversely associated with blood pressure (BP) levels and hypertension risk. However, empirical evidence on the underlying mechanisms are lacking. This study examined the association of green space exposure with BP and hypertension, and assessed the mediating effects by air pollution, mental health, physical activity, and weight status. Survey data from 719 adults, who lived in Guangzhou (China) in 2016, were used. Three area-level green space indicators, including network distance to the nearest park, percentage of green space and Normalized Difference Vegetation Index within a 1 km Euclidean buffer around residence and workplace, were calculated and linked to individual-level BP measurements. Structural equation models were applied to estimate the direct and indirect associations of the various green space indicators on systolic BP (SBP), diastolic BP (DBP), and hypertension, respectively. After adjusting for multiple covariates, longer network distance to green space was directly associated with higher SBP. Compared to the reference group (0-500m), the differences were 0.11 mmHg (95% CI = 0.03 to 0.19, P = 0.006) for 500-1000m, 0.03 mmHg (95% CI = -0.05 to 0.12, P = 0.45) for 1000-1500m, and 0.16 mmHg (95% CI = 0.09 to 0.23, P < 0.001) for >1500m, respectively. The overall and direct associations were significant for all three indicators (distance or density) with or without considering workplace exposure. The association between network distance to green and SBP was partially (18.4%, 95% CI = 0-42.1%) mediated by mental health. There was no statistical evidence that air pollution, physical activity, or weight status mediate the association. Secondary analyses for other indicators and other outcomes showed similar results. Both distance to green space and more green space around residence and workplace were associated with lower BP and lower risk of hypertension in adults living in a Chinese metropolitan. Mental health partly mediated the association.

The built environment and cardiovascular disease: an umbrella review and meta-meta-analysis.

AIMS: To provide a comprehensive overview of the current evidence on objectively measured neighbourhood built environment exposures in relation to cardiovascular disease (CVD) events in adults. METHODS AND RESULTS: We searched seven databases for systematic reviews on associations between objectively measured long-term built environmental exposures, covering at least one domain (i.e. outdoor air pollution, food environment, physical activity environment like greenspace and walkability, urbanization, light pollution, residential noise, and ambient temperature), and CVD events in adults. Two authors extracted summary data and assessed the risk of bias independently. Robustness of evidence was rated based on statistical heterogeneity, small-study effect, and excess significance bias. Meta-meta-analyses were conducted to combine the meta-analysis results from reviews with comparable exposure and outcome within each domain. From the 3304 initial hits, 51 systematic reviews were included, covering 5 domains and including 179 pooled estimates. There was strong evidence of the associations between increased air pollutants (especially PM2.5 exposure) and increased residential noise with greater risk of CVD. Highly suggestive evidence was found for an association between increased ambient temperature and greater risk of CVD. Systematic reviews on physical activity environment, food environment, light pollution, and urbanization in relation to CVD were scarce or lacking. CONCLUSION: Air pollutants, increased noise levels, temperature, and greenspace were associated with CVD outcomes. Standardizing design and exposure assessments may foster the synthesis of evidence. Other crucial research gaps concern the lack of prospective study designs and lack of evidence from low-to-middle-income countries (LMICs). REGISTRATION: PROSPERO: CRD42021246580.

This study is a review of published systematic reviews on the relation between the neighbourhood built environment and cardiovascular disease (CVD) in adults. There was strong evidence of a relation between increased air pollutants and a greater risk of CVD. There was also strong evidence of a relation between increased residential noise and a greater risk of CVD. There was highly suggestive evidence of a relation between increased ambient temperature and a greater risk of CVD. Systematic reviews that examined other aspects of the built environment, such as the physical activity environment, food environment, light pollution, and urbanization, were scarce or lacking.

Association of perceived and objective neighborhood walkability with accelerometer-measured physical activity and sedentary time in the Maastricht Study.

BACKGROUND: We investigated the association of neighborhood walkability with accelerometer-measured physical activity (PA) and sedentary behavior (SB) and examined whether objective and subjective measures of walkability resulted in similar findings. METHODS: PA and SB from the first 7689 Maastricht Study participants ages 40-75 from 2010 to 2017 were measured using accelerometers for 7 days. Mean daily step count, light-intensity PA, moderate- to vigorous- intensity PA (MVPA), and SB were calculated. Objective walkability was measured by the 7-component Dutch Walkability Index within 500 m Euclidean buffers around residential addresses of participants. Subjective walkability was obtained from the Abbreviated Neighborhood Environment Walkability Scale. Linear regression models analyzed the associations of walkability with PA and SB, controlling for potential confounders. RESULTS: Objective walkability was negatively associated with light intensity PA in the most walkable quartile (b = -14.58, 95% CI = -20.94, -8.23). Compared to participants living in the least walkable neighborhoods, those in the most walkable quartile had statistically significantly higher SB levels (b = 11.64, 95% CI = 4.95, 18.32). For subjective walkability, mean daily step count was significantly higher in the most walkable quartile (b = 509.60, 95% CI = 243.38, 775.81). Higher subjective walkability was positively associated with MVPA (b = 4.40, 95% CI = 2.56, 6.23). CONCLUSION: Living in a neighborhood with higher objective walkability was associated with lower levels of PA and higher SB levels while higher subjective walkability was associated with higher levels of PA. These results show discordant findings and thus, the effect of walkability on participant PA and SB within our sample is to be determined.

Social and physical neighbourhood characteristics and 10-year incidence of depression and anxiety in older adults: Results from the Longitudinal Aging Study Amsterdam.

OBJECTIVE: A growing literature suggests that neighbourhood characteristics are associated with mental health outcomes, but the evidence in older adults is inconsistent. We investigated the association of neighbourhood characteristics, pertaining to demographic, socio-economic, social and physical environment domains, with the subsequent 10-year incidence of depression and anxiety, in Dutch older adults. METHODS: In the Longitudinal Aging Study Amsterdam depressive and anxiety symptoms were assessed four times between 2005/2006 and 2015/2016, using the Center for Epidemiological Studies Depression Scale (n = 1365) and the Anxiety subscale of the Hospital Anxiety and Depression Scale (n = 1420). Neighbourhood-level data on urban density, percent population over 65 years of age, percent immigrants, average house price, average income, percent low-income earners, social security beneficiaries, social cohesion, safety, proximity to retail facilities, housing quality, percent green space, percent water coverage, air pollution (particulate matter (PM2.5)), and traffic noise, were obtained for study baseline years 2005/2006. Cox proportional hazard regression models, clustered within neighbourhood, were used to estimate the association between each neighbourhood-level characteristic and the incidence of depression and anxiety. RESULTS: The incidence of depression and anxiety was 19.9 and 13.2 per 1000 person-years, respectively. Neighbourhood characteristics were not associated with the incidence of depression. However, various neighbourhood characteristics were associated with an increased incidence of anxiety, including: higher urban density level, higher percent immigrants, greater proximity to retail facilities, lower housing quality score, lower safety score, higher PM2.5 levels and less green space. CONCLUSION: Our results indicate that several neighbourhood characteristics are associated with anxiety but not with depression incidence in older age. Several of these characteristics have the potential to be modifiable and thus could serve as a target for interventions at the neighbourhood-level in improving anxiety, provided that future studies replicate our findings and provide further evidence for a causal effect.

Development of a neighborhood obesogenic built environment characteristics index for the Netherlands.

OBJECTIVE: Environmental factors that drive obesity are often studied individually, whereas obesogenic environments are likely to consist of multiple factors from food and physical activity (PA) environments. This study aimed to compose and describe a comprehensive, theory-based, expert-informed index to quantify obesogenicity for all neighborhoods in the Netherlands. METHODS: The Obesogenic Built Environment CharacterisTics (OBCT) index consists of 17 components. The index was calculated as an average of componential scores across both food and PA environments and was scaled from 0 to 100. The index was visualized and summarized with sensitivity analysis for weighting methods. RESULTS: The OBCT index for all 12,821 neighborhoods was right-skewed, with a median of 44.6 (IQR = 10.1). Obesogenicity was lower in more urbanized neighborhoods except for the extremely urbanized neighborhoods (>2500 addresses/km2 ), where obesogenicity was highest. The overall OBCT index score was moderately correlated with the food environment (Spearman ρ = 0.55, p <0.05) and with the PA environment (ρ = 0.38, p <0.05). Hierarchical weighting increased index correlations with the PA environment but decreased correlations with the food environment. CONCLUSIONS: The novel OBCT index and its comprehensive environmental scores are potentially useful tools to quantify obesogenicity of neighborhoods.

Neighbourhood walkability in relation to cognitive functioning in patients with disorders along the heart-brain axis.

This study examined associations of neighbourhood walkability with cognitive functioning (i.e., global cognition, memory, language, attention-psychomotor speed, and executive functioning) in participants without or with either heart failure, carotid occlusive disease, or vascular cognitive impairment. Neighbourhood walkability at baseline was positively associated with global cognition and attention-psychomotor speed. These associations were stronger in patients with vascular cognitive impairment. Individuals who live in residential areas with higher walkability levels were less likely to have impairments in language and executive functioning at two-year follow-up. These findings highlight the importance of the built environment for cognitive functioning in healthy and vulnerable groups.

Longitudinal Aging Study Amsterdam COVID-19 exposure index: a cross-sectional analysis of the impact of the pandemic on daily functioning of older adults.

OBJECTIVES: The aim of this study was to develop an index to measure older adults' exposure to the COVID-19 pandemic and to study its association with various domains of functioning. DESIGN: Cross-sectional study. SETTING: The Longitudinal Aging Study Amsterdam (LASA), a cohort study in the Netherlands. PARTICIPANTS: Community-dwelling older adults aged 62-102 years (n=1089) who participated in the LASA COVID-19 study (June-September 2020), just after the first wave of the pandemic. PRIMARY OUTCOME MEASURES: A 35-item COVID-19 exposure index with a score ranging between 0 and 1 was developed, including items that assess the extent to which the COVID-19 situation affected daily lives of older adults. Descriptive characteristics of the index were studied, stratified by several sociodemographic factors. Logistic regression analyses were performed to study associations between the exposure index and several indicators of functioning (functional limitations, anxiety, depression and loneliness). RESULTS: The mean COVID-19 exposure index score was 0.20 (SD 0.10). Scores were relatively high among women and in the southern region of the Netherlands. In models adjusted for sociodemographic factors and prepandemic functioning (2018-2019), those with scores in the highest tertile of the exposure index were more likely to report functional limitations (OR: 2.24; 95% CI: 1.48 to 3.38), anxiety symptoms (OR: 3.14; 95% CI: 1.82 to 5.44), depressive symptoms (OR: 2.49; 95% CI: 1.55 to 4.00) and loneliness (OR: 2.97; 95% CI: 2.08 to 4.26) than those in the lowest tertile. CONCLUSIONS: Among older adults in the Netherlands, higher exposure to the COVID-19 pandemic was associated with worse functioning in the physical, mental and social domain. The newly developed exposure index may be used to identify persons for whom targeted interventions are needed to maintain or improve functioning during the pandemic or postpandemic.

Development of an objectively measured walkability index for the Netherlands.

BACKGROUND: Walkability indices have been developed and linked to behavioural and health outcomes elsewhere in the world, but not comprehensively for Europe. We aimed to 1) develop a theory-based and evidence-informed Dutch walkability index, 2) examine its cross-sectional associations with total and purpose-specific walking behaviours of adults across socioeconomic (SES) and urbanisation strata, 3) explore which walkability components drive these associations. METHODS: Components of the index included: population density, retail and service density, land use mix, street connectivity, green space, sidewalk density and public transport density. Each of the seven components was calculated for three Euclidean buffers: 150 m, 500 m and 1000 m around every 6-digit postal code location and for every administrative neighbourhood in GIS. Componential z-scores were averaged, and final indices normalized between 0 and 100. Data on self-reported demographic characteristics and walking behaviours of 16,055 adult respondents (aged 18-65) were extracted from the Dutch National Travel Survey 2017. Using Tobit regression modelling adjusted for individual- and household-level confounders, we assessed the associations between walkability and minutes walking in total, for non-discretionary and discretionary purposes. By assessing the attenuation in associations between partial indices and walking outcomes, we identified which of the seven components drive these associations. We also tested for effect modification by urbanization degree, SES, age and sex. RESULTS: In fully adjusted models, a 10% increase in walkability was associated with a maximum increase of 8.5 min of total walking per day (95%CI: 7.1-9.9). This association was consistent across buffer sizes and purposes of walking. Public transport density was driving the index's association with walking outcomes. Stratified results showed that associations with minutes of non-discretionary walking were stronger in rural compared to very urban areas, in neighbourhoods with low SES compared to high SES, and in middle-aged (36-49 years) compared to young (18-35 years old) and older adults (50-65 years old). CONCLUSIONS: The walkability index was cross-sectionally associated with Dutch adult's walking behaviours, indicating its validity for further use in research.

Predictors of resilience in older adults with lower limb osteoarthritis and persistent severe pain.

BACKGROUND: Resilience refers to the process in which people function well despite adversity. Persistent severe pain may be considered an adversity in people with lower limb osteoarthritis (LLOA). The objectives of this study are: (1) to identify what proportion of older adults with LLOA and persistent severe pain show good functioning; and (2) to explore predictors of resilience. METHODS: Data from the European Project on OSteoArthritis (EPOSA) were used involving standardized data from six European population-based cohort studies. LLOA is defined as clinical knee and/or hip osteoarthritis. Persistent severe pain is defined as the highest tertile of the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index both at baseline and follow-up. Resilience is defined as good physical, mental or social functioning at follow-up despite having LLOA with persistent severe pain. RESULTS: In total, 95 (14.9%) out of 638 individuals with LLOA had persistent severe pain. Among these, 10 (11.0%), 54 (57.4%) and 49 (53.8%) had good physical, mental and social functioning, respectively. Only 4 individuals (4.5%) were resilient in all three domains of functioning. Younger age, male sex, higher education, higher mastery, smoking and alcohol use, higher physical activity levels, absence of chronic diseases, and more contacts with friends predicted resilience in one or more domains of functioning. CONCLUSIONS: Few people with LLOA and persistent severe pain showed good physical functioning and about half showed good mental or social functioning. Predictors of resilience differed between domains, and might provide new insights for treatment.

Associations of changes in neighbourhood walkability with changes in walking activity in older adults: a fixed effects analysis.

BACKGROUND: Supporting older adults to engage in physically active lifestyles requires supporting environments. Walkable environments may increase walking activity in older adults, but evidence for this subgroup is scarce, and longitudinal studies are lacking. This study therefore examined whether changes in neighbourhood walkability were associated with changes in walking activity in older adults, and whether this association differed by individual-level characteristics and by contextual conditions beyond the built environment. METHODS: Data from 668 participants (57.8-93.4 years at baseline) across three waves (2005/06, 2008/09 and 2011/12) of the Longitudinal Aging Study Amsterdam (LASA) were used. These individuals did not relocate during follow-up. Self-reported outdoor walking activity in minutes per week was assessed using the LASA Physical Activity Questionnaire. Composite exposure measures of neighbourhood walkability (range: 0 (low)-100 (high)) within 500-m Euclidean buffer zones around each participant's residential address were constructed by combining objectively measured high-resolution Geographic Information System data on population density, retail and service destination density, land use mix, street connectivity, green space density, and sidewalk density. Fixed effects linear regression analyses were applied, adjusted for relevant time-varying confounders. RESULTS: Changes in neighbourhood walkability were not statistically significantly associated with changes in walking activity in older adults (ß500m = - 0.99, 95% CI = -6.17-4.20). The association of changes in neighbourhood walkability with changes in walking activity did not differ by any of the individual-level characteristics (i.e., age, sex, educational level, cognitive impairment, mobility disability, and season) and area-level characteristics (i.e., road traffic noise, air pollution, and socioeconomic status). CONCLUSIONS: This study did not show evidence for an association between changes in neighbourhood walkability and changes in walking activity in older adults. If neighbourhood walkability and walking activity are causally linked, then changes in neighbourhood walkability between 2005/06 and 2011/12 might have been not substantial enough to produce meaningful changes in walking activity in older adults.

Capturing Subjective Age, Subjective Life Expectancy, and Their Links With Older Adults' Health: The Dutch Longitudinal Aging Study Amsterdam.

Objectives: This study compares the associations of two subjective lifetime perspectives, subjective age (SA) and subjective life expectancy (SLE), with physical performance, self-rated health, and depressive symptoms. Methods: 64 91-year-old participants were selected from three waves of the Longitudinal Aging Study Amsterdam (2008/09, 2011/12, 2015/16; n = 1822 participants, n = 3500 observations) that included graphical and numerical measures of SA and SLE. We used generalized estimating equations to examine their associations with health. Results: Associations of SA/SLE with health were weaker for physical performance than for self-rated health and depressive symptoms. The associations of SA and SLE with physical performance were of similar magnitude but with self-rated health depended on the type of measure. Depressive symptoms, instead, showed a stronger association with SA than with SLE. Graphical measures showed weaker associations than numerical measures. Discussion: The way in which subjective lifetime perspectives and health are conceptualized and measured influences the strength of their associations.

Green spaces, subjective health and depressed affect in middle-aged and older adults: a cross-country comparison of four European cohorts.

BACKGROUND: Studies on associations between urban green space and mental health have yielded mixed results. This study examines associations of green space exposures with subjective health and depressed affect of middle-aged and older adults in four European cohorts. METHODS: Data came from four Western-European and Central-European ageing cohorts harmonised as part of the Mindmap project, comprising 16 189 adults with an average age of 50-71 years. Green space exposure was based on the distance to the nearest green space and the amount of green space within 800 m buffers around residential addresses. Cohort-specific and one-step individual participant data (IPD) meta-analyses were used to examine associations of green space exposures with subjective health and depressed affect. RESULTS: The amount of green spaces within 800 m buffers was lowest for Residential Environment and CORonary heart Disease (Paris, 15.0 hectares) and highest for Health, Alcohol and Psychosocial factors In Eastern Europe (Czech Republic, 35.9 hectares). IPD analyses indicated no evidence of an association between the distance to the nearest green space and depressed affect (OR 0.98, 95% CI 0.96 to 1.00) or good self-rated health (OR 1.01, 95% CI 0.99 to 1.02). Likewise, the amount of green space within 800 m buffers did not predict depressed affect (OR 0.98, 95% CI 0.96 to 1.00) or good self-rated health (OR 1.01, 95% CI 0.99 to 1.02). Findings were consistent across all cohorts. CONCLUSIONS: Data from four European ageing cohorts provide no support for the hypothesis that green space exposure is associated with subjective health or depressed affect. While longitudinal evidence is required, these findings suggest that green space may be less important for older urban residents.

Neighborhood environment, social participation, and physical activity in older adults with lower limb osteoarthritis: A mediation analysis.

Older adults with lower limb osteoarthritis (LLOA) are highly dependent on their physical and social environment for being physically active. Longitudinal data from 2286 older adults (Mage = 73.8 years; 50.3% female) in six European countries were analyzed using cross-lagged Structural Equation Modeling (SEM) and multi-group SEM. In cross-sectional analyses, neighborhood resources were associated with physical activity (r = 0.26;p < .001) and social participation (r = 0.13;p = .003). Physical activity at follow-up was associated with neighborhood resources, with this relationship mediated by social participation in people with LLOA (ß = 0.018;p = .013). To promote future physical activity, opportunities to socially engage in neighborhoods need to be targeted primarily to people with LLOA.

Gender, marital and educational inequalities in mid- to late-life depressive symptoms: cross-cohort variation and moderation by urbanicity degree.

BACKGROUND: Although ageing populations are increasingly residing in cities, it is unknown whether depression inequalities are moderated by urbanicity degree. We estimated gender, marital and educational inequalities in depressive symptoms among older European and Canadian adults, and examined whether higher levels of urbanicity, captured by population density, heightened these inequalities. METHODS: Harmonised cross-sectional data on 97 826 adults aged ≥50 years from eight cohorts were used. Prevalence ratios (PRs) were calculated for probable depression, depressed affect and depressive symptom severity by gender, marital status and education within each cohort, and combined using random-effects meta-analysis. Using a subsample of 73 123 adults from six cohorts with available data on population density, we tested moderating effects measured by the number of residents per square kilometre. RESULTS: The pooled PRs for probable depression by female gender, unmarried or non-cohabitating status and low education were 1.48 (95% CI 1.28 to 1.72), 1.44 (95% CI 1.29 to 1.61) and 1.29 (95% CI 1.18 to 1.41), respectively. PRs for depressed affect and high symptom severity were broadly similar. Except for one Dutch cohort with findings in an unexpected direction, there was no evidence that population density modified depressive symptom inequalities. CONCLUSIONS: Despite cross-cohort variation in gender, marital status and educational inequalities in depressive symptoms, there was weak evidence that these inequalities differed by levels of population density.

Social and physical neighbourhood characteristics and loneliness among older adults: results from the MINDMAP project.

BACKGROUND: Loneliness is associated with several adverse mental and physical health outcomes in older adults. Previous studies have shown that a variety of individual-level and perceived area-level characteristics are associated with loneliness. This study examined the associations of objectively measured social and physical neighbourhood characteristics with loneliness. METHODS: We used cross-sectional data from 1959 older adults (63-98 years) who participated in the Longitudinal Ageing Study Amsterdam (LASA; wave 2011/12) and the Health and Living Conditions of the Population of Eindhoven and Surroundings study (GLOBE; wave 2014) in the Netherlands. Study-specific loneliness scores were harmonised across both cohort studies and divided into tertiles denoting low, medium and high levels of loneliness. Objectively measured neighbourhood characteristics, including area-level percentages of low educated residents, social security beneficiaries and unoccupied dwellings, average income, crime levels and land use mix, were linked to individual-level data. Multinomial logistic regression analyses were conducted to examine the associations of interest. RESULTS: There was no statistical evidence for an association of the included neighbourhood characteristics with loneliness. Although not statistically significant, the observed associations suggested that participants living in neighbourhoods with more heterogeneous land use mix were less likely to have a medium and high level of loneliness than those living in more homogeneous neighbourhoods in terms of land use mix (ORmedium=0.54, 95% CI=0.18-1.67; ORhigh=0.67, 95% CI=0.21-2.11). CONCLUSION: The results indicate that the included objectively measured social and physical neighbourhood characteristics are not associated with loneliness in old age.

Aircraft noise control policy and mental health: a natural experiment based on the Longitudinal Aging Study Amsterdam (LASA).

BACKGROUND: This study examines the impact of environmental noise policy on depressive symptoms by exploiting the national experiment afforded by the New Deal aircraft noise control policy introduced in Schiphol (Amsterdam) in 2008. METHODS: Data came from older adults (ages 57-102) participating in three waves (2005/2006, 2008/2009 and 2011/2012) of the Longitudinal Aging Study Amsterdam (LASA) (N=1746). Aircraft noise data from the Netherlands Environmental Assessment Agency were linked to LASA cohort addresses using the GeoDMS software. The Centre for Epidemiologic Studies-Depression (CES-D) scale was used to measure depressive symptoms. Using a difference-in-dfferences (DiD) approach, we compared changes in CES-D levels of depressive symptoms before and after the policy between people living close (≤15 km) and those living far away (>15 km) from Schiphol airport. RESULTS: There were few changes in noise levels after the introduction of the policy. Estimates suggested that the policy did not lead to a reduction in noise levels in the treatment areas relative to the control areas (DiD estimate=0.916 dB(A), SE=0.345), and it had no significant impact on levels of depressive symptoms (DiD estimate=0.044, SE=0.704). Results were robust to applying different distance thresholds. CONCLUSION: The New Deal aircraft noise control policy introduced in Amsterdam was not effective in reducing aircraft noise levels and had no impact on depressive symptoms in older people. Our results raise questions about the effectiveness of the current noise control policy to improve the well-being of residents living near the airport.

Factors Associated With Functional Decline in Hand and Hip/Knee Osteoarthritis After One Year: Data From a Population-Based Study.

OBJECTIVE: To investigate factors that together with hand or hip/knee osteoarthritis (OA) could contribute to functional decline over a year's time in elderly individuals. METHODS: The data of 1,886 individuals between ages 65 and 85 years in a prospective, observational population-based study with 12-18 months of follow-up in the context of the European Project on Osteoarthritis were analyzed. The outcome measures were self-reported hand and hip/knee functional decline, evaluated using a minimum clinically important difference of 4 on the Australian/Canadian Hand OA Index and of 2 on the Western Ontario and McMaster Universities Osteoarthritis Index hip/knee physical function subscales, both normalized to 0-100. Using regression models adjusted for sex, age, country, and education level, the baseline factors considered were clinical hand or hip/knee OA, pain, analgesic/antiinflammatory medications, comorbidities, social isolation, income, walking time, grip strength, physical activity time, and medical/social care. RESULTS: After a year, 453 participants were identified as having worse hand functionality and 1,389 as not worse. Hand OA, anxiety, walking time, and grip strength were risk factors for hand functional decline; pain was a confounder of the effect of hand OA. Analgesic/antiinflammatory medications mediated the combined effect of hip/knee OA plus pain on functional decline in the 554 individuals classified as having worse hip/knee functionality and the 1,291 persons who were not worse. Peripheral artery disease, obesity, and cognitive impairment were other baseline risk factors. CONCLUSION: Study findings showed that together with emotional status and chronic physical and cognitive conditions, OA affects hand and hip/knee functional decline.

Overview of retrospective data harmonisation in the MINDMAP project: process and results.

BACKGROUND: The MINDMAP project implemented a multinational data infrastructure to investigate the direct and interactive effects of urban environments and individual determinants of mental well-being and cognitive function in ageing populations. Using a rigorous process involving multiple teams of experts, longitudinal data from six cohort studies were harmonised to serve MINDMAP objectives. This article documents the retrospective data harmonisation process achieved based on the Maelstrom Research approach and provides a descriptive analysis of the harmonised data generated. METHODS: A list of core variables (the DataSchema) to be generated across cohorts was first defined, and the potential for cohort-specific data sets to generate the DataSchema variables was assessed. Where relevant, algorithms were developed to process cohort-specific data into DataSchema format, and information to be provided to data users was documented. Procedures and harmonisation decisions were thoroughly documented. RESULTS: The MINDMAP DataSchema (v2.0, April 2020) comprised a total of 2841 variables (993 on individual determinants and outcomes, 1848 on environmental exposures) distributed across up to seven data collection events. The harmonised data set included 220 621 participants from six cohorts (10 subpopulations). Harmonisation potential, participant distributions and missing values varied across data sets and variable domains. CONCLUSION: The MINDMAP project implemented a collaborative and transparent process to generate a rich integrated data set for research in ageing, mental well-being and the urban environment. The harmonised data set supports a range of research activities and will continue to be updated to serve ongoing and future MINDMAP research needs.