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BACKGROUND: More women are living with dementia than men worldwide and there is a need to investigate causes for this female preponderance. While reproductive factors have been investigated as risk factors, the results are conflicting. We aim to clarify this using a large cohort with a long observation time, adjusting for multiple health and lifestyle variables and encompassing a wider range of cognitive impairment. OBJECTIVE: To study the association between menopause age, menarche age and risk of and risk of mild cognitive impairment (MCI) and dementia. SETTING: The Trøndelag Health study (HUNT), a longitudinal population health study in Norway (1984-2019). PARTICIPANTS: Women who were ≥70 years in 2017-2019 were assessed for cognitive impairment. MEASUREMENTS: Data on menopause age and menarche age were obtained from questionnaires. Diagnosis of MCI or dementia was set using a standardised procedure by a diagnostic group of nine physicians. Multinomial logistic regression was used to study the association between menopause age, menarche age and risk of MCI and dementia with adjustment for birth year, education, smoking, ApoE4, number of children, diabetes, body mass index, alcohol use and physical inactivity. RESULTS: We evaluated 5314 women where 900 (16.9%) had dementia, and 1747 (32.8%) had MCI. Multiple adjusted relative risk ratio (RRR) and 95% confidence intervals (CI) for dementia were: 0.96(95%CI 0.95-0.98) (p<0.001) for menopause age, 0.97(95%CI 0.94-0.99) (p=0.007) for natural menopause age (excluding hysterectomy and/or oophorectomyp<55 years) and 0.97(95%CI 0.95-0.99) (pp<0.001) for reproductive span (menopause age minus menarche age). Menopause age p<45years was associated with a 56% higher risk compared to mean menopause age 50 years. We found no significant associations between menarche age and dementia and no associations with MCI. CONCLUSIONS: Older menopause age and longer reproductive span corresponding to longer oestrogen exposure were associated with a lower dementia risk. Future studies should explore therapeutical options to offset this risk in women.
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Disfunción Cognitiva , Demencia , Menarquia , Menopausia , Humanos , Disfunción Cognitiva/epidemiología , Femenino , Anciano , Demencia/epidemiología , Noruega/epidemiología , Factores de Riesgo , Estudios Longitudinales , Menopausia/fisiología , Factores de Edad , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Protein intake is suggested as an important dietary factor in the prevention of frailty, however, the influence of lifelong intake remains unclear. OBJECTIVES: The present study investigated the relationship between daily protein intake and patterns of protein intake over 21 years and the risk of pre-frailty/frailty. DESIGN: Prospective cohort study. SETTING: The population-based Tromsø Study in Tromsø municipality, Norway. PARTICIPANTS: In total, 1,906 women and 1,820 men aged ≥45 years in 1994 who participated in both Tromsø4 (1994-95) and Tromsø7 (2015-16). MEASUREMENTS: Frailty status in Tromsø7 was measured according to Fried's phenotype, classifying participants as "robust" (frailty components present: 0), "pre-frail" (1-2) or "frail" (≥3). Daily intake of protein was estimated from self-reported habitual dietary intake using food frequency questionnaires and assessed as grams per kilogram bodyweight (g/kg BW) and per megajoule energy intake (g/MJ). The protein-frailty association was assessed via longitudinal and cross-sectional multivariable logistic regression analyses. RESULTS: The prevalence of pre-frailty and frailty in this study was 27% and 1.0%, respectively. Longitudinal analysis showed that the odds of pre-frailty/frailty decreased by 57% (odds ratio (OR) = 0.43, 95% confidence interval (CI) = 0.31;0.58, p<0.001) with the increase in intake of one additional gram of dietary protein per kg BW. The results obtained from cross-sectional analysis were similar. Tracking analysis showed that, compared to a stable high intake of protein in g/kg BW over time, other patterns of protein intake increased the risk of pre-frailty/frailty. No associations were found between intake of protein in g/MJ and pre-frailty/frailty. CONCLUSIONS: Intake of protein in g/kg BW both in mid-life and later in life was inversely associated with pre-frailty/frailty in older adults. This emphasizes the importance of an adequate protein intake to facilitate healthy ageing in Norwegian older adults.
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Fragilidad , Anciano , Peso Corporal , Estudios Transversales , Femenino , Anciano Frágil , Fragilidad/epidemiología , Evaluación Geriátrica/métodos , Humanos , Estudios ProspectivosRESUMEN
Since muscles can influence bone growth and vice versa, we examined if level of physical activity and physical capability tests can predict areal bone mineral density (aBMD). Both high activity level and good test performance were associated with higher aBMD, especially in women. INTRODUCTION: Muscle influences bone formation and vice versa. Tests of physical capability and level of physical activity reflect various muscle qualities. We assessed the associations between total hip aBMD and physical activity as well as a range of standardized physical capability tests in an adult general population. METHODS: A total of 3 533 women and men aged 40-84 years, participating in the population-based cross-sectional Tromsø study in Norway in 2015-2016, were included. Linear regression was used to assess associations between aBMD and physical activity and the physical capability tests grip strength, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), and standing balance. Non-linear associations were examined in cubic spline models. Standardized regression coefficients were calculated to compare effect sizes across physical capability measures. RESULTS: In fully adjusted models, higher physical activity was positively associated with total hip aBMD in both sexes compared to a sedentary lifestyle. All tests of physical capability were associated with aBMD in women, SPPB showing the strongest association although effect sizes were too small to indicate clinically significant differences (1 point increase corresponded to an aBMD increase of 0.009 g/cm2, CI = 0.005 to 0.012). In men, SPPB and its subtests were associated with aBMD with chair rises showing the strongest association (1 s increase in execution time corresponded to an aBMD decrease of 0.005 g/cm2, CI = 0.008 to 0.002). CONCLUSION: Physical activity was associated with aBMD, and tests of physical capability can account for some of the aBMD variations in adults aged 40 years and older, especially in women.
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Densidad Ósea , Ejercicio Físico , Absorciometría de Fotón , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega/epidemiologíaRESUMEN
BACKGROUND: Workforce inclusion is an important political goal in many countries. However, nearly 70% of Norwegians registered with mild intellectual disabilities (IDs) are not registered employed or attending in day care centres. This study investigates the association between age, gender, functional level and hospital admissions with employment or attendance in public financed, community-based day care centres for adults with mild IDs in Norway. METHOD: This study is based on data from a linkage of the national population-based registries from 2013 to 2015: Statistics Norway (SSB), the Norwegian Information System for the Nursing and Care Sector (IPLOS) and the Norwegian Patient Registry (NPR). The sample consisted of 2370 adults registered with a mild ID, receiving disability pension in Norway, aged 18-67 years. Binary and multinomial logistic analyses, adjusted for age, gender, functional level and hospital admissions, were performed. RESULTS: In 2015, 45.7% and 19.6% of the samples aged 20-31 and 52-63 years, respectively, were registered as employed or in day care centres. Participation in day care is a public service registered in IPLOS, which requires registration of functional level, while attendance in employment support is registered in SSB, where functional level is not registered. Compared with people registered with a high functional level, the probability of being employed or in day care centres was lower for people without registration of functional level. People with hospital admissions were less likely to be employed, especially if they had both psychiatric and somatic hospital admissions. People were less likely to attend day care and open employment only if they had a combination of both types of hospital admissions. Attendance in day care centres was less likely for men than women. CONCLUSIONS: Older people with mild ID, without registered functional level (meaning not receiving public community-based services) and with a history of hospital admissions were significantly less likely to be employed or participate in day care centres. The clear association between not being employed or attending day care centres and not having one's functional level registered implies there is a need for increased focus on how to enhance work participation among people with mild IDs who are not within the system of receiving public services.
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Servicios de Salud Comunitaria/estadística & datos numéricos , Centros de Día/estadística & datos numéricos , Empleo/estadística & datos numéricos , Discapacidad Intelectual/rehabilitación , Admisión del Paciente/estadística & datos numéricos , Personas con Discapacidades Mentales/rehabilitación , Personas con Discapacidades Mentales/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Femenino , Estado Funcional , Humanos , Masculino , Persona de Mediana Edad , Noruega , Índice de Severidad de la Enfermedad , Factores Sexuales , Adulto JovenRESUMEN
In 50-79-year-olds who participated in the Tromsø Study (1994-1995), the risk of non-vertebral osteoporotic fractures during 15 years follow-up increased by 22% in men and 9% in women per 1 SD lower grip strength. The strongest association was observed in men aged 50-64 years. INTRODUCTION: We aimed to explore whether low grip strength was associated with increased risk of non-vertebral osteoporotic fracture in the population-based Tromsø Study 1994-1995. METHODS: Grip strength (bar) was measured by a Martin Vigorimeter and fractures were retrieved from the X-ray archives at the University Hospital of North Norway between 1994 and 2010. At baseline, weight and height were measured, whereas information on the other covariates were obtained through self-reported questionnaires. Cox regression was used to estimate the hazard ratio (HR) of fracture in age- and gender-specific quintiles of grip-strength, and per 1 SD lower grip strength. Similar analyses were done solely for hip fractures. Adjustments were made for age, height, body mass index (BMI), marital status, education, smoking, physical activity, use of alcohol, self-perceived health, and self-reported diseases. RESULTS: In 2891 men and 4002 women aged 50-79 years, 1099 non-vertebral osteoporotic fractures-including 393 hip fractures-were sustained during the median 15 years follow-up. Risk of non-vertebral osteoporotic fracture increased with declining grip strength: hazard ratios per SD decline was 1.22 (95% CI 1.05-1.43) in men and 1.09 (95% CI 1.01-1.18) in women. HR for fracture in lower vs. upper quintile was 1.58 (95% CI 1.02-2.45) in men and 1.28 (95% CI 1.03-1.59) in women. The association was most pronounced in men aged 50-64 years with HR = 3.39 (95% CI 1.76-6.53) in the lower compared to the upper quintile. CONCLUSIONS: The risk of non-vertebral osteoporotic fracture increased with declining grip-strength in both genders, particularly in men aged 50-64 years.
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Fuerza de la Mano , Fracturas de Cadera , Fracturas Osteoporóticas , Fracturas de la Columna Vertebral , Anciano , Densidad Ósea , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Fracturas Osteoporóticas/epidemiología , Fracturas Osteoporóticas/etiología , Factores de Riesgo , Fracturas de la Columna Vertebral/epidemiologíaRESUMEN
Low bone mineral density (BMD) gives an increased risk of fractures, which can lead to premature death. Can BMD of the wrist predict mortality? BMD consistent with osteopenia and osteoporosis gave a significantly increased risk of death for both men and women in a general population in Tromsø, Norway. INTRODUCTION: To investigate if bone mineral density (BMD) levels of the distal forearm, consistent with osteopenia and osteoporosis, can predict mortality and if grip strength is an effect modifier. METHODS: The study population constituted 6565 participants aged 50-79 years at baseline in the Tromsø Study wave 4 conducted in 1994-1995. Forearm BMD measured by SXA was categorized as "normal," "osteopenia," or "osteoporosis" following WHO's definition. Cox regression with all-cause mortality as the outcome over 22 years of follow-up was performed for men and women separately, adjusting for health-related factors, as well as BMD by grip strength interaction. A secondary analysis with a 15-year follow-up also adjusted for hip fractures and osteoporotic fractures. RESULTS: During follow-up, 3176 of participants died (47%). Those categorized as osteoporotic had higher mortality hazard ratio (HR) compared to those with normal BMD; men HR = 1.37 (95% confidence interval (CI) 1.19, 1.58) and women HR = 1.32 (1.14, 1.53) were adjusted for age, body mass index, physical activity, smoking habits, education, health status, chronic diseases, and grip strength. Corresponding HRs for osteopenia were men HR = 1.13 (1.00, 1.27) and women HR = 1.17 (1.01, 1.35). Further adjustments for fractures did only marginally attenuate the results, and HRs were still significant. There was no grip strength by BMD interaction. CONCLUSION: Men and women with low distal forearm BMD values, consistent with osteoporosis or osteopenia, had an increased mortality compared to normal BMD participants. High grip strength did not modify this association, and the association remained after adjustment for a range of health-related factors.
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Enfermedades Óseas Metabólicas/mortalidad , Antebrazo/fisiopatología , Fuerza de la Mano/fisiología , Absorciometría de Fotón/métodos , Distribución por Edad , Anciano , Densidad Ósea/fisiología , Enfermedades Óseas Metabólicas/fisiopatología , Femenino , Estudios de Seguimiento , Fracturas de Cadera/mortalidad , Fracturas de Cadera/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Osteoporosis/mortalidad , Osteoporosis/fisiopatología , Fracturas Osteoporóticas/mortalidad , Fracturas Osteoporóticas/fisiopatología , Valores de Referencia , Distribución por SexoRESUMEN
This study aims to investigate the association between educational level and breast cancer mortality in Europe in the 2000s. Unlike most other causes of death, breast cancer mortality tends to be positively related to education, with higher educated women showing higher mortality rates. Research has however shown that the association is changing from being positive over non-existent to negative in some countries. To investigate these patterns, data from national mortality registers and censuses were collected and harmonized for 18 European populations. The study population included all women aged 30-74. Age-standardized mortality rates, mortality rate ratios, and slope and relative indexes of inequality were computed by education. The population was stratified according to age (women aged 30-49 and women aged 50-74). The relation between educational level and breast cancer mortality was predominantly negative in women aged 30-49, mortality rates being lower among highly educated women and higher among low educated women, although few outcomes were statistically significant. Among women aged 50-74, the association was mostly positive and statistically significant in some populations. A comparison with earlier research in the 1990s revealed a changing pattern of breast cancer mortality. Positive educational differences that used to be significant in the 1990s were no longer significant in the 2000s, indicating that inequalities have decreased or disappeared. This evolution is in line with the "fundamental causes" theory which stipulates that whenever medical insights and treatment become available to combat a disease, a negative association with socio-economic position will arise, independently of the underlying risk factors.
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Neoplasias de la Mama/mortalidad , Escolaridad , Educación en Salud , Adulto , Anciano , Neoplasias de la Mama/patología , Monitoreo Epidemiológico , Etnicidad , Europa (Continente) , Femenino , Humanos , Persona de Mediana Edad , Factores de RiesgoRESUMEN
OBJECTIVE: To describe the magnitude of socioeconomic inequalities in tuberculosis (TB) mortality by level of education in male, female, urban and rural populations in several European countries. DESIGN: Data were obtained from the Eurothine Project, covering 16 populations between 1990 and 2003. Age- and sex-standardised mortality rates, the relative index of inequality and the slope index of inequality were used to assess educational inequalities. RESULTS: The number of TB deaths reported was 8530, with a death rate of 3 per 100 000 per year, of which 73% were males. Educational inequalities in TB mortality were present in all European populations. Inequalities in TB mortality were greater than in total mortality. Relative and absolute inequalities were large in Eastern European and Baltic countries but relatively small in Southern European countries and in Norway, Finland and Sweden. Inequalities in mortality were observed among both men and women, and in both rural and urban populations. CONCLUSIONS: Socio-economic inequalities in TB mortality exist in all European countries. Firm political commitment is required to reduce inequalities in the social determinants of TB incidence. Targeted public health measures are called for to improve access to treatment of vulnerable groups and thereby reduce TB mortality.
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Escolaridad , Salud Rural/estadística & datos numéricos , Tuberculosis/mortalidad , Salud Urbana/estadística & datos numéricos , Poblaciones Vulnerables/estadística & datos numéricos , Adulto , Distribución por Edad , Factores de Edad , Anciano , Europa (Continente)/epidemiología , Femenino , Humanos , Incidencia , Modelos Lineales , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Distribución por Sexo , Factores Sexuales , Factores de TiempoRESUMEN
Following a long-distance outbreak of Legionnaires' disease from an industrial air scrubber in Norway in 2005, a seroepidemiological study measuring levels of immunoglobulin G (IgG) and IgM antibodies to Legionella pneumophila was performed with a polyvalent enzyme-linked immunosorbent assay. One year after the outbreak, IgG levels in employees (n = 213) at the industrial plant harboring the scrubber and in blood donors (n = 398) from the outbreak county were low but significantly higher (P < or = 0.002) than those in blood donors (n = 406) from a nonexposed county. No differences in IgM levels among the three groups were found after adjustment for gender and age. Home addresses of the seroresponders in the exposed county clustered to the city of the outbreak, in contrast to the scattering of addresses of the seroresponding donors in the nonexposed county. Factory employees who operated at an open biological treatment plant had significantly higher IgG and IgM levels (P < or = 0.034) than those working >200 m away. Most of the healthy seroresponders among the factory employees worked near this exposure source. Immunoblotting showed that IgG and IgM antibodies in 82.1% of all seroresponders were directed to the lipopolysaccharide of the L. pneumophila serogroup 1 outbreak strain. In conclusion, 1 year after the long-distance industrial outbreak a small increase in IgG levels of the exposed population was observed. The open biological treatment plant within the industrial premises, however, constituted a short-distance exposure source of L. pneumophila for factory employees working nearby.
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Brotes de Enfermedades , Legionella pneumophila/inmunología , Enfermedad de los Legionarios/epidemiología , Adolescente , Adulto , Anciano , Anticuerpos Antibacterianos/sangre , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Humanos , Inmunoglobulina G/sangre , Inmunoglobulina M/sangre , Masculino , Persona de Mediana Edad , Noruega/epidemiología , Exposición Profesional , Estudios Seroepidemiológicos , Adulto JovenRESUMEN
We used longitudinal mortality data sets for the 1990s to compare socioeconomic inequalities in total cancer mortality between women and men aged 30-74 in 12 different European populations (Madrid, Basque region, Barcelona, Slovenia, Turin, Switzerland, France, Belgium, Denmark, Norway, Sweden, Finland) and to investigate which cancer sites explain the differences found. We measured socioeconomic status using educational level and computed relative indices of inequality (RII). We observed large variations within Europe for educational differences in total cancer mortality among men and women. Three patterns were observed: Denmark, Norway and Sweden (significant RII around 1.3-1.4 among both men and women); France, Switzerland, Belgium and Finland (significant RII around 1.7-1.8 among men and around 1.2 among women); Spanish populations, Slovenia and Turin (significant RII from 1.29 to 1.88 among men; no differences among women except in the Basque region, where RII is significantly lower than 1). Lung, upper aerodigestive tract and breast cancers explained most of the variations between gender and populations in the magnitude of inequalities in total cancer mortality. Given time trends in cancer mortality, the gap in the magnitude of socioeconomic inequalities in cancer mortality between gender and between European populations will probably decrease in the future.
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Neoplasias/mortalidad , Adulto , Anciano , Escolaridad , Europa (Continente)/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Caracteres Sexuales , Factores SocioeconómicosRESUMEN
Even though the causes of suicide may be rooted in childhood, it is unknown how socioeconomic position (SEP) in childhood is related to suicide in adulthood. We describe the association between childhood SEP and suicide mortality in adulthood in Norway using registry data on 613807 Norwegians born in 1955-1965. Data on 1013 suicide deaths between 1990 and 2001 were linked to data on SEP indicators, using Cox regression. Suicide mortality was higher among women with high childhood SEP than among women with low childhood SEP. This association was explained in part by family situation in adulthood, but not by adult SEP. For males, after adjustment for adult SEP, we observed a similar but weaker association between suicide and childhood SEP. We discuss several mechanisms which may explain the direct positive association of childhood SEP with suicide mortality in adulthood, especially among females. These are downward mobility, not meeting high demands set by highly educated parents, psychological distress, mental disorder, gender differences and social networks and norms.
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Clase Social , Suicidio/tendencias , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Noruega , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Medición de RiesgoRESUMEN
BACKGROUND: Norwegian authorities have decided to start a mass mammography screening programme. One third of the population has been included in a pilot study from 1996. The Cancer Registry of Norway maintains that there will be at least a 30% reduction in mortality, but that an effect may not be detected until the ten-year follow-up. METHODS: We assume that the effect of mammography screening is constantly increasing over a ten-year period before maximum effect is reached. We also assume that the effect of screening in the age group 50-74 years is 80% of maximum effect. We simulate Norwegian breast cancer mortality rates under the assumption that mammography screening reduces breast cancer mortality in the age group 50-69 years with 15% and 30% effects, respectively. We also simulate 30% and 50% effect in the pilot study. RESULTS: If the effect in the Norwegian population is 30%, one may expect to see a significant decline after five years; however, if the effect is only 15%, one has to wait for a longer time. If the effect is 50%, as the Cancer Registry of Norway has argued, one should see a significant effect in the pilot study after six years. CONCLUSIONS: We think it a contradiction to argue that mammography screening reduces breast cancer mortality by 30%, but that one has to wait ten years to observe an effect on national mortality rates. We suggest that the breast cancer mortality rate in the pilot study is estimated. We also argue that observed reductions of less than 10% in Sweden, Finland and England are strong evidence that the effect of mammography today is far less than 30%.