Social inequality in prevalence of NCD risk factors: a cross-sectional analysis from the population-based Tromsø Study 2015-2016.

OBJECTIVE: We aimed to examine associations between educational level, serving as an indicator of socioeconomic position, and prevalence of WHO-established leading behavioural and biological risk factors for non-communicable diseases (NCDs), in middle-aged to older women and men. DESIGN: Population-based cross-sectional study. SETTING: All inhabitants of the municipality of Tromsø, Norway, aged ≥40 years, were invited to the seventh survey (2015-2016) of the Tromsø Study; an ongoing population-based cohort study. PARTICIPANTS: Of the 32 591 invited; 65% attended, and a total of 21 069 women (53%) and men aged 40-99 years were included in our study. OUTCOME MEASURES: We assessed associations between educational level and NCD behavioural and biological risk factors: daily smoking, physical inactivity (sedentary in leisure time), insufficient fruit/vegetable intake (<5 units/day), harmful alcohol use (>10 g/day in women, >20 g/day in men), hypertension, obesity, intermediate hyperglycaemia and hypercholesterolaemia. These were expressed as odds ratios (OR) per unit decrease in educational level, with 95% CIs, in women and men. RESULTS: In women (results were not significantly different in men), we observed statistically significant associations between lower educational levels and higher odds of daily smoking (OR 1.69; 95% CI 1.60 to 1.78), physical inactivity (OR 1.38; 95% CI 1.31 to 1.46), insufficient fruit/vegetable intake (OR 1.54, 95% CI 1.43 to 1.66), hypertension (OR 1.25; 95% CI 1.20 to 1.30), obesity (OR 1.23; 95% CI 1.18 to 1.29), intermediate hyperglycaemia (OR 1.12; 95% CI 1.06 to 1.19), and hypercholesterolaemia (OR 1.07; 95% CI 1.03 to 1.12), and lower odds of harmful alcohol use (OR 0.75; 95% CI 0.72 to 0.78). CONCLUSION: We found statistically significant educational gradients in women and men for all WHO-established leading NCD risk factors within a Nordic middle-aged to older general population. The prevalence of all risk factors increased at lower educational levels, except for harmful alcohol use, which increased at higher educational levels.

Regional and temporal differences in the associations between cardiovascular disease and its classic risk factors: an analysis of 49 cohorts from 11 European countries.

AIMS: The regional and temporal differences in the associations between cardiovascular disease (CVD) and its classic risk factors are unknown. The current study examined these associations in different European regions over a 30-year period. METHODS AND RESULTS: The study sample comprised 553 818 individuals from 49 cohorts in 11 European countries (baseline: 1982-2012) who were followed up for a maximum of 10 years. Risk factors [sex, smoking, diabetes, non-HDL cholesterol, systolic blood pressure (BP), and body mass index (BMI)] and CVD events (coronary heart disease or stroke) were harmonized across cohorts. Risk factor-outcome associations were analysed using multivariable-adjusted Cox regression models, and differences in associations were assessed using meta-regression. The differences in the risk factor-CVD associations between central Europe, northern Europe, southern Europe, and the UK were generally small. Men had a slightly higher hazard ratio (HR) in southern Europe (P = 0.043 for overall difference), and those with diabetes had a slightly lower HR in central Europe (P = 0.022 for overall difference) compared with the other regions. Of the six CVD risk factors, minor HR decreases per decade were observed for non-HDL cholesterol [7% per mmol/L; 95% confidence interval (CI), 3-10%] and systolic BP (4% per 20 mmHg; 95% CI, 1-8%), while a minor HR increase per decade was observed for BMI (7% per 10 kg/m2; 95% CI, 1-13%). CONCLUSION: The results demonstrate that all classic CVD risk factors are still relevant in Europe, irrespective of regional area. Preventive strategies should focus on risk factors with the greatest population attributable risk.

All classic cardiovascular disease (CVD) risk factors are still relevant in Europe, irrespective of regional area. The differences in the associations of CVD risk factors with overt CVD between regions of Europe are generally small. Minor temporal hazard decreases were observed for non-HDL cholesterol and systolic blood pressure, while a minor hazard increase was observed for body mass index.

Educational patterning in biological health seven years apart: Findings from the Tromsø Study.

BACKGROUND: Social-to-biological processes is one set of mechanisms underlying the relationship between social position and health. However, very few studies have focused on the relationship between social factors and biology at multiple time points. This work investigates the relationship between education and the dynamic changes in a composite Biological Health Score (BHS) using two time points seven years apart in a Norwegian adult population. METHODS: We used data from individuals aged 30 years and above who participated in Tromsø6 (2007-2008) and Tromsø7 (2015-2016) (n = 8117). BHS was defined using ten biomarkers measured from blood samples and representing three physiological systems (cardiovascular, metabolic, inflammatory). The higher the BHS, the poorer the health status. FINDINGS: Linear regression models carried out on BHS revealed a strong educational gradient at two distinct time points but also over time. People with lower educational attainment were at higher risk of poor biological health at a given time point (ßlow education Tromsø6=0.30 [95 %-CI=0.18-0.43] and ßlow education Tromsø7=0.30 [95 %-CI=0.17-0.42]). They also presented higher longitudinal BHS compared to people with higher education (ßlow education = 0.89 [95 %-CI=0.56-1.23]). Certain biomarkers related to the cardiovascular system and the metabolic system were strongly socially distributed, even after adjustment for sex, age, health behaviours and body mass index. CONCLUSION: This longitudinal analysis highlights that participants with lower education had their biological health deteriorated to a greater extent over time compared to people with higher education. Our findings provide added evidence of the biological embodiment of social position, particularly with respect to dynamic aspects for which little evidence exists.

National health registries - a 'goldmine' for studying non-communicable disease occurrence in Norway - the NCDNOR project.

To estimate occurrence of non-communicable diseases (NCDs) over the life-course in the Norwegian population, national health registries are a vital source of information since they fully represent the entire non-institutionalised population. However, as they are mainly established for administrative purposes, more knowledge about how NCDs are recorded in the registries is needed. To establish this, we begin by counting the number of individuals registered annually with one or more NCDs in any of the registries. The study population includes all inhabitants who lived in Norway from 2004 to 2020 (N~6.4m). The NCD outcomes are diabetes, cardiovascular diseases, chronic obstructive lung diseases, cancer and mental disorders/substance use disorders. Further, we included hip fractures in our NCD concept. The data sources used to identify individuals with NCDs, including detailed information on diagnoses in primary and secondary health care and dispensings of prescription drugs, are the Cancer Registry of Norway, The Norwegian Patient Registry, The Norwegian Control and Payment of Health Reimbursement database, and The Norwegian Prescription Database. The number of individuals registered annually with an NCD diagnosis and/or a dispensed NCD drug increased over the study period. Changes over time may reflect changes in disease incidence and prevalence, but also changes in disease-specific guidelines, reimbursement schemes and access to and use of health services. Data from more than one health registry to identify individuals with NCDs are needed since the registries reflect different levels of health care services and therefore may reflect disease severity.

Lifestyle factors as mediators of area-level socioeconomic differentials in mental health and cognitive function: the Tromsø Study.

INTRODUCTION: Low socioeconomic status (SES) is associated with poor mental health and cognitive function. Individual-level SES and area-level SES (ASES) may affect mental health and cognitive function through lifestyle. We aimed to quantify the associations of ASES with mental health and cognitive function and examine the mediating role of lifestyle behaviours independent of individual-level SES in a Norwegian population. METHODS: In this cross-sectional study, we included 7211 participants (54% women) from the seventh survey of the Tromsø Study (2015-2016) (Tromsø7). The exposure variable ASES was created by aggregating individual-level SES variables (education, income, housing ownership) from Statistics Norway at the geographical subdivision level. Tromsø7 data were used as mediators (smoking, snuff, alcohol, physical activity, diet) and outcomes (cognitive function, anxiety, depression, insomnia). Mediation and mediated moderation analysis were performed with age as a moderator, stratified by sex. RESULTS: Higher ASES was associated with better cognitive function and fewer depression and insomnia symptoms, independent of individual-level SES. These associations were mediated by smoking and physical activity. Alcohol was a mediator for depression and cognitive function in women. Age was a significant moderator of the association between ASES and global cognitive function in women. The largest total indirect effect of ASES was found for depression, with the joint effect of the mediators accounting for 36% of the total effect. CONCLUSIONS: People living in areas with lower ASES are at higher risk of poor mental health, such as depression and insomnia, and have lower cognitive function possibly due to unhealthy lifestyle (smoking, alcohol and physical inactivity).

Comparing associations of handgrip strength and chair stand performance with all-cause mortality-implications for defining probable sarcopenia: the Tromsø Study 2015-2020.

BACKGROUND: Widely adopted criteria suggest using either low handgrip strength or poor chair stand performance to identify probable sarcopenia. However, there are limited direct comparisons of these measures in relation to important clinical endpoints. We aimed to compare associations between these two measures of probable sarcopenia and all-cause mortality. METHODS: Analyses included 7838 community-dwelling participants (55% women) aged 40-84 years from the seventh survey of the Tromsø Study (2015-2016), with handgrip strength assessed using a Jamar + Digital Dynamometer and a five-repetition chair stand test (5-CST) also undertaken. We generated sex-specific T-scores and categorised these as "not low", "low", and "very low" handgrip strength or 5-CST performance. Cox Proportional Hazard regression models were used to investigate associations between these two categorised performance scores and time to death (up to November 2020 ascertained from the Norwegian Cause of Death registry), adjusted for potential confounders including lifestyle factors and specific diseases. RESULTS: A total of 233 deaths occurred (median follow-up 4.7 years) with 1- and 5-year mortality rates at 3.1 (95% confidence interval [CI] 2.1, 4.6) and 6.3 (95% CI 5.5, 7.2) per 1000 person-years, respectively. There was poor agreement between the handgrip strength and 5-CST categories for men (Cohen's kappa [κ] = 0.19) or women (κ = 0.20). Fully adjusted models including handgrip strength and 5-CST performance mutually adjusted for each other, showed higher mortality rates among participants with low (hazard ratio [HR] 1.22, 95% CI 0.87, 1.71) and very low (HR 1.68, 95% CI 1.02, 2.75) handgrip strength compared with the not low category. Similar associations, although stronger, were seen for low (HR 1.88, 95% CI 1.38, 2.56) and very low (HR 2.64, 95% CI 1.73, 4.03) 5-CST performance compared with the not low category. CONCLUSIONS: We found poor agreement between T-score categories for handgrip strength and 5-CST performance and independent associations with mortality. Our findings suggest that these tests identify different people at risk when case-finding probable sarcopenia. As discussions on an international consensus for sarcopenia definitions proceed, testing both handgrip strength and chair stand performance should be recommended rather than viewing these as interchangeable assessments.

Associations between postprandial triglyceride concentrations and sex, age, and body mass index: cross-sectional analyses from the Tromsø study 2015-2016.

Introduction: Elevated serum triglyceride concentrations increase the risk of developing atherosclerosis, the leading cause of cardiovascular disease. Postprandial triglyceride concentrations have shown to be a stronger predictor of cardiovascular disease compared to fasting triglycerides. It is therefore clinically relevant to study patterns of postprandial triglyceride concentrations in a general adult population. Aims: The aim of this cross-sectional analysis was to examine postprandial triglyceride concentrations in women and men, and the association with age, body mass index and menopausal status. Methods: Non-fasting blood samples from 20,963 women and men aged 40 years and older, attending the seventh survey of the Tromsø Study (2015-2016), were analyzed for postprandial triglyceride concentrations using descriptive statistics and linear regression models. Self-reported time since last meal before blood sampling was categorized into 1-h intervals with 7+ hours considered fasting. Results: Men had higher triglyceride concentrations compared to women. The pattern of postprandial triglyceride concentrations differed between the sexes. In women, the highest triglyceride concentration (19% higher compared to fasting level, p < 0.001) was found 3-4 h postprandially compared to 1-3 h in men (30% higher compared to fasting level, p < 0.001). In women, all subgroups of age and BMI had higher triglyceride concentrations than the reference group (age 40-49 years and BMI < 25 kg/m2), but no linear trend for age was observed. In men, triglyceride concentrations were inversely associated with age. Body mass index was positively associated with triglyceride concentration in both women (p < 0.001) and men (p < 0.001), although this association was somewhat modified by age in women. Postmenopausal women had significantly higher triglyceride concentrations compared to premenopausal women (p < 0.05). Conclusion: Postprandial triglyceride concentrations differed in groups of sex, age, body mass index, and menopausal status.

Lipid Levels During Adult Lifetime in Men and Women With and Without a Subsequent Incident Myocardial Infarction: A Longitudinal Analysis of Data From the Tromsø Study 1974 to 2016.

Background The atherosclerotic effect of an adverse lipid profile is assumed to accumulate throughout life, leading to increased risk of myocardial infarction (MI). Still, little is known about age at onset and duration of unfavorable lipid levels before MI. Methods and Results Longitudinal data on serum lipid levels for 26 130 individuals (50.5% women, aged 20-89 years) were obtained from 7 population-based health surveys in Tromsø, Norway. Diagnoses of MI were obtained from national registers. A linear mixed model was applied to compare age- and sex-specific mean values of total cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglyceride concentration by MI status (MI versus non-MI). Already from young adulthood, 20 to 35 years before the incident MI, individuals with a subsequent incident MI had on average more adverse lipid levels than individuals of the same age and sex without MI. Analogous to a dose-response relationship, there was a clear trend toward more severe adverse lipid levels the lower the age at incident MI (P<0.001, test for trend through ordered categories <55, 55-74, ≥75 years). This trend was particularly pronounced for high-density lipoprotein cholesterol in percentage of total cholesterol (both sexes) and for the relative relationship between triglyceride, high-density lipoprotein cholesterol, and total cholesterol level (women). The difference in mean lipid level by MI status was just as large in women as in men, but the age pattern differed (P≤0.05, tests of 3-way interaction). Conclusions Compared with general population mean levels, adverse lipid levels were seen 20 to 35 years before the incident MI in both men and women.

Patient and public involvement in health research in Norway: a survey among researchers and patient organisations.

BACKGROUND: Patient and public involvement (PPI) in health research may improve both the relevance and quality of the research. There is however a lack of research investigating the experiences, attitudes and barriers towards PPI in clinical research in Norway. The Norwegian Clinical Research Infrastructure Network therefore conducted a survey among researchers and PPI contributors aiming to investigate experiences with PPI and identify current challenges for successful involvement. METHODS: Two survey questionnaires were developed and distributed in October and November 2021. The survey targeting 1185 researchers was distributed from the research administrative system in the Regional Health Trusts. The survey targeting PPI contributors was distributed through Norwegian patient organisations, regional and national competence centers. RESULTS: The response rate was 30% among researchers and was unobtainable from PPI contributors due to the survey distribution strategy. PPI was most frequently used in the planning and conduct of the studies, and less utilized in dissemination and implementation of results. Both researchers and user representatives were generally positive to PPI, and agreed that PPI might be more useful in clinical research than in underpinning research. Researchers and PPI contributors who reported that roles and expectations were clarified in advance, were more likely to experience a common understanding of roles and responsibilities in the research project. Both groups pointed to the importance of earmarked funding for PPI activities. There was a demand for a closer collaboration between researchers and patient organisations to develop accessible tools and effective models for PPI in health research. CONCLUSIONS: Surveys among clinical researchers and PPI contributors indicate overall positive attitudes towards PPI in clinical research. However, more resources, such as budget, time, and accessible tools, are needed. Clarifying roles and expectations, and creating new PPI models under resource constraints can enhance its effectiveness. PPI is underutilized in disseminating and implementing research results, presenting an opportunity for improving healthcare outcomes.

Patient and public involvement (PPI) in health research can make the research more relevant and of better quality. However, in Norway, there has not been much research on the experiences, attitudes, and barriers related to PPI in clinical research. To address this gap, we conducted a survey among researchers and PPI contributors to understand their experiences and identify current challenges. We found that PPI was most common during planning and execution of studies. PPI was less used in the process of sharing the results from the studies, and in the process of putting the findings into practice. Those who reported that roles and expectations were clarified in advance were more likely to have a shared understanding of their roles and responsibilities in the research project. Both groups emphasized the importance of funding for PPI activities. There was also a desire for closer collaboration between researchers and patient organisations to develop accessible tools and for PPI. In summary, the survey revealed a generally positive attitude towards PPI in health research. However, more resources, such as budget, time, and accessible tools, are needed. Clarification of roles and expectations also stand out a crucial part of the PPI process, and should receive much attention in all research projects where PPI is used.

Drinking alcohol in moderation is associated with lower rate of all-cause mortality in individuals with higher rather than lower educational level: findings from the MORGAM project.

The association between socioeconomic status (SES) and alcohol-related diseases has been widely explored. Less is known, however, on whether the association of moderate drinking with all-cause mortality is modified by educational level (EL). Using harmonized data from 16 cohorts in the MORGAM Project (N = 142,066) the association of pattern of alcohol intake with hazard of all-cause mortality across EL (lower = primary-school; middle = secondary-school; higher = university/college degree) was assessed using multivariable Cox-regression and spline curves. A total of 16,695 deaths occurred in 11.8 years (median). In comparison with life-long abstainers, participants drinking 0.1-10 g/d of ethanol had 13% (HR = 0.87; 95%CI: 0.74-1.02), 11% (HR = 0.89; 0.84-0.95) and 5% (HR = 0.95; 0.89-1.02) lower rate of death in higher, middle and lower EL, respectively. Conversely, drinkers > 20 g/d had 1% (HR = 1.01; 0.82-1.25), 10% (HR = 1.10; 1.02-1.19) and 17% (HR = 1.17; 1.09-1.26) higher rate of death. The association of alcohol consumption with all-cause mortality was nonlinear, with a different J-shape by EL levels. It was consistent across both sexes and in various approaches of measuring alcohol consumption, including combining quantity and frequency and it was more evident when the beverage of preference was wine. We observed that drinking in moderation (≤ 10 g/d) is associated with lower mortality rate more evidently in individuals with higher EL than in people with lower EL, while heavy drinking is associated with higher mortality rate more evidently in individuals with lower EL than in people with higher EL, suggesting that advice on reducing alcohol intake should especially target individuals of low EL.

Trends in prevalence, treatment and control of hypertension in 38,825 adults over 36 years in Tromsø prospective study.

AIMS/BACKGROUND: Serial blood pressure surveys in cohort studies can inform public health policies to control blood pressure for prevention of cardiovascular diseases. METHODS: Mean levels of systolic blood pressure (SBP) were collected in six sequential surveys, involving 38,825 individuals aged 30-79 years (51% female), between 1979 and 2015 in the Tromsø Study in Norway. Mean levels of SBP, prevalence of hypertension and use of blood pressure-lowering treatment were estimated by age, sex and calendar year of survey. RESULTS: Age-specific mean levels of SBP in each decade of age increased by 20-25 mmHg in men and 30-35 mmHg in women and the prevalence of hypertension increased from 25% to 75% among adults aged 30-79 years. Among successive cohorts of adults aged 40-49 years at the time of the six surveys between 1979 and 2015, the mean levels of SBP declined by about 10 mmHg and the prevalence of hypertension declined from 46% to 25% in men and from 30% to 14% in women. The proportion of individuals with hypertension who were treated increased sixfold (from 7% to 42%) between 1979 and 2015, and the proportion of adults with hypertension that were successfully controlled also increased sixfold from 10% to 60% between 1979 and 2015. CONCLUSIONS: Although this study demonstrated a halving in the age-specific prevalence of hypertension in men and women and a sixfold increase in treatment and control of hypertension, the burden of hypertension remains high among older people in Norway.

Association between neighborhood health behaviors and body mass index in Northern Norway: evidence from the Tromsø Study.

AIM: The prevalence of overweight and obesity has risen rapidly worldwide, and the ongoing obesity pandemic is one of the most severe public health concerns in modern society. The average body mass index (BMI) of people living in Northern Norway has also steadily increased since the late 1970s. This study aimed to understand how individuals' health behavior is associated with the general health behavior of the people in their neighborhood. METHODS: Using the population-based Tromsø Study, we examined the life course association between average leisure time physical activity at the neighborhood level and the BMI of individuals living in the same neighborhood. We used a longitudinal dataset following 25,604 individuals living in 33 neighborhoods and performed a linear mixed-effects analysis. RESULTS: The results showed that participants living in neighborhoods whose residents were more physically active during their leisure time, were likely to have a significantly lower BMI (-0.9 kg/m², 95% CI -1.5 to -0.4). Also, individuals living in neighborhoods whose residents were doing mainly manual work, had significantly higher BMIs (0.7 kg/m², 95% CI 0.4-1.0). CONCLUSIONS: Our results showed a strong association between the average leisure time physical activity level of neighborhood residents and the higher BMI levels of residents of the same neighborhood.

Data from national health registers as endpoints for the Tromsø Study: Correctness and completeness of stroke diagnoses.

AIM: To assess whether stroke diagnoses in national health registers are sufficiently correct and complete to replace manual collection of endpoint data for the Tromsø Study, a population-based epidemiological study. METHOD: Using the Tromsø Study Cardiovascular Disease Register for 2013-2014 as the gold standard, we calculated correctness (defined as positive predictive value, PPV) and completeness (defined as sensitivity) of stroke cases in four different data subsets derived from the Norwegian Patient Register and the Norwegian Stroke Register. We calculated the sensitivity and PPV with 95% confidence intervals (CIs) assuming a normal approximation of the binomial distribution. RESULTS: In the Norwegian Stroke Register we found a sensitivity of 79.8% (95% CI 74.2-85.4) and a PPV of 97.5% (95% CI 95.1-99.9). In the Norwegian Patient Register the sensitivity was 86.4% (95% CI 81.6-91.1) and the PPV was 84.2% (95% CI 79.2-89.2). The overall highest levels were found in a subset based on a linkage between the Norwegian Stroke Register and the Norwegian Patient Register, with a sensitivity of 88.9% (95% CI 84.5-93.3), and a PPV of 89.3% (95% CI 85.0-93.6). CONCLUSIONS: Data from the Norwegian Patient Register and from the linked data set between the Norwegian Patient Register and the Norwegian Stroke Register had acceptable levels of correctness and completeness to be considered as endpoint sources for the Tromsø Study Cardiovascular Disease Register. The benefits of using data from national registers as endpoints in epidemiological studies must be weighed against the impact of potentially decreased data quality.

Lifestyle factors as mediators of area-level socio-economic differentials in cardiovascular disease risk factors. The Tromsø Study.

Introduction: Cardiovascular disease (CVD) is a leading cause of death and disability and living in areas with low socio-economic status (SES) is associated with increased risk of CVD. Lifestyle factors such as smoking, physical inactivity, an unhealthy diet and harmful alcohol use are main risk factors that contribute to other modifiable risk factors, such as hypertension, raised blood cholesterol, obesity, and diabetes. The potential impact of area-level socio-economic status (ASES) on metabolic CVD risk factors via lifestyle behaviors independent of individual SES has not been investigated previously. Aims: To estimate associations of ASES with CVD risk factors and the mediating role of lifestyle behaviors independent of individual-level SES. Methods: In this cross-sectional study, we included 19,415 participants (52% women) from the seventh survey of the Tromsø Study (2015-2016) (Tromsø7). The exposure variable ASES was created by aggregating individual-level SES variables (education, income, housing ownership) at the geographical subdivision level. Individual-level SES data and geographical subdivision of Tromsø municipality (36 areas) were obtained from Statistics Norway. Variables from questionnaires and clinical examinations obtained from Tromsø7 were used as mediators (smoking, snuff, alcohol, and physical activity), while the outcome variables were body mass index (BMI), total/high-density lipoprotein (HDL) cholesterol ratio, waist circumference, hypertension, diabetes. Mediation and mediated moderation analysis were performed with age as a moderator, stratified by sex. Results: ASES was significantly associated with all outcome variables. CVD risk factor level declined with an increase in ASES. These associations were mediated by differences in smoking habits, alcohol use and physical activity. The associations of ASES with total/HDL cholesterol ratio and waist circumference (women) were moderated by age, and the moderating effects were mediated by smoking and physical activity in both sexes. The largest mediated effects were seen in the associations of ASES with total/HDL cholesterol ratio, with the mediators accounting for 43% of the observed effects. Conclusions: Living in lower SES areas is associated with increased CVD risk due to unhealthy lifestyle behaviors, such as smoking, alcohol use and physical inactivity. These associations were stronger in women and among older participants.

Dataset of fitness trackers and smartwatches to measuring physical activity in research.

OBJECTIVES: Accelerometer-based wrist-worn fitness trackers and smartwatches (wearables) appeared on the consumer market in 2011. Many wearable devices have been released since. The objective of this data paper is to describe a dataset of 423 wearables released before July 2017. DATA DESCRIPTION: We identified wearables and extracted information from six online and offline databases. We also visited websites for all identified companies/brands to identify additional wearables, as well as obtained additional information for each identified device. Twelve attributes were collected: wearable name, company/brand name, release year, country of origin, whether the wearable was crowd funded, form factor (fitness tracker or smartwatch), and sensors supported. Support for the following sensors were mapped: accelerometer, magnetometer, gyroscope, altimeter or barometer, global-positioning-system, and optical pulse sensor (i.e., photoplethysmograph). The search was conducted between May 15th and July 1st, 2017. The included data gives an overview of most in-scope wearables released before July 2017 and allows researchers to conduct additional analysis not performed in the related article. Further insights can be achieved by complementing this list with wearable models released after July 2017.

Polar Vantage and Oura Physical Activity and Sleep Trackers: Validation and Comparison Study.

BACKGROUND: Consumer-based activity trackers are increasingly used in research, as they have the potential to promote increased physical activity and can be used for estimating physical activity among participants. However, the accuracy of newer consumer-based devices is mostly unknown, and validation studies are needed. OBJECTIVE: The objective of this study was to compare the Polar Vantage watch (Polar Electro Oy) and Oura ring (generation 2; Oura Health Oy) activity trackers to research-based instruments for measuring physical activity, total energy expenditure, resting heart rate, and sleep duration in free-living adults. METHODS: A total of 21 participants wore 2 consumer-based activity trackers (Polar watch and Oura ring), an ActiGraph accelerometer (ActiGraph LLC), and an Actiheart accelerometer and heart rate monitor (CamNtech Ltd) and completed a sleep diary for up to 7 days. We assessed Polar watch and Oura ring validity and comparability for measuring physical activity, total energy expenditure, resting heart rate (Oura), and sleep duration. We analyzed repeated measures correlations, Bland-Altman plots, and mean absolute percentage errors. RESULTS: The Polar watch and Oura ring values strongly correlated (P<.001) with the ActiGraph values for steps (Polar: r=0.75, 95% CI 0.54-0.92; Oura: r=0.77, 95% CI 0.62-0.87), moderate-to-vigorous physical activity (Polar: r=0.76, 95% CI 0.62-0.88; Oura: r=0.70, 95% CI 0.49-0.82), and total energy expenditure (Polar: r=0.69, 95% CI 0.48-0.88; Oura: r=0.70, 95% CI 0.51-0.83) and strongly or very strongly correlated (P<.001) with the sleep diary-derived sleep durations (Polar: r=0.74, 95% CI 0.56-0.88; Oura: r=0.82, 95% CI 0.68-0.91). Oura ring-derived resting heart rates had a very strong correlation (P<.001) with the Actiheart-derived resting heart rates (r=0.9, 95% CI 0.85-0.96). However, the mean absolute percentage error was high for all variables except Oura ring-derived sleep duration (10%) and resting heart rate (3%), which the Oura ring underreported on average by 1 beat per minute. CONCLUSIONS: The Oura ring can potentially be used as an alternative to the Actiheart to measure resting heart rate. As for sleep duration, the Polar watch and Oura ring can potentially be used as replacements for a manual sleep diary, depending on the acceptable error. Neither the Polar watch nor the Oura ring can replace the ActiGraph when it comes to measuring steps, moderate-to-vigorous physical activity, and total energy expenditure, but they may be used as additional sources of physical activity measures in some settings. On average, the Polar Vantage watch reported higher outputs compared to those reported by the Oura ring for steps, moderate-to-vigorous physical activity, and total energy expenditure.

The seventh survey of the Tromsø Study (Tromsø7) 2015-2016: study design, data collection, attendance, and prevalence of risk factors and disease in a multipurpose population-based health survey.

AIMS: The Tromsø Study is an ongoing population-based health study in Tromsø, Norway, initiated in 1974. The purpose of the seventh survey (Tromsø7) 2015-2016 was to advance the population risk factor surveillance and to collect new types of data. We present the study design, data collection, attendance, and prevalence of risk factors and disease. METHODS: All inhabitants in Tromsø municipality, Norway, aged 40 years and older (N=32,591) were invited to a health screening including extensive questionnaires, face-to-face interviews, biological sampling (blood, urine, saliva, nasal/throat swabs, faeces), measurements (anthropometry, blood pressure, pulse, pulse oximetry) and clinical examinations (pain sensitivity, echocardiography, cognitive, physical, and lung function, accelerometer measurements, eye examinations, carotid ultrasound, electrocardiography, dual-energy X-ray absorptiometry, and heart, lung and carotid auscultation). New research areas in this round were dental and oral health examinations, collection of faecal samples for studies of normal bacterial flora and antibiotic resistance, and 24-hour urine samples for examination of sodium and iodine intakes. RESULTS: Attendance was 65% (N=21,083), and was higher in women, age group 50-79 years, previous attenders, and Norwegian-born individuals. Cardiovascular risk factor levels and prevalence of chronic obstructive lung disease decreased since the last survey, while the prevalence of obesity and diabetes increased. CONCLUSIONS: Attendance was stable from the sixth survey. Interaction with participants might be key to maintain participation. Favourable trends in risk factors continue, except for a continued increase in obesity. Both new data collection technology and traditional physical examinations will be crucial for the impact of future population studies.

Dataset of consumer-based activity trackers as a tool for physical activity monitoring in epidemiological studies during the COVID-19 Pandemic.

Physical activity (PA) data were downloaded from 113 participants who owned a Garmin or Fitbit activity tracker in 2019 and 2020. Upon participant authorization, data were automatically downloaded from the Garmin and Fitbit cloud storages. The mSpider tool, a solution for automatic and continuous data extraction from activity tracker providers, were used to download participant data. Available data are daily averages by year, as well as monthly averages between 2019 and 2020, for steps, activity energy expenditure (AEE), total energy expenditure (TEE), moderate-to-vigorous physical activity (MVPA), light PA (LPA), moderate PA (MPA), vigorous PA (VPA), and sedentary time. In addition, March 2020 was divided in two, giving the daily average before and after the Norwegian COVID-19 lockdown date. Raw daily values for these variables are also included in a separate file. In addition, daily values for non-wear time are also include as raw data. In a previous study, differences between months, i.e., comparing 2019 with 2020 for months between March to December, were analysed for steps, MVPA, and AEE [1]. Further insights may be achieved by exploring other variables. This includes: (1) monthly averages for TEE, LPA, MPA, VPA, and sedentary time, (2) yearly averages (2019 and 2020) for steps, MVPA, TEE, AEE, LPA, MPA, VPA, and sedentary time (3) monthly average for steps, MVPA, TEE, AEE, LPA, MPA, VPA, and sedentary time for January, February, and March 2019, as well as March 2020. Additional analysis can also be conducted on the raw data.

Simple cardiovascular risk stratification by replacing total serum cholesterol with anthropometric measures: The MORGAM prospective cohort project.

To assess whether anthropometric measures (body mass index [BMI], waist-hip ratio [WHR], and estimated fat mass [EFM]) are independently associated with major adverse cardiovascular events (MACE), and to assess their added prognostic value compared with serum total-cholesterol. The study population comprised 109,509 individuals (53% men) from the MORGAM-Project, aged 19-97 years, without established cardiovascular disease, and not on antihypertensive treatment. While BMI was reported in all, WHR and EFM were reported in âˆ¼52,000 participants. Prognostic importance of anthropometric measurements and total-cholesterol was evaluated using adjusted Cox proportional-hazards regression, logistic regression, area under the receiver-operating-characteristic curve (AUCROC), and net reclassification improvement (NRI). The primary endpoint was MACE, a composite of stroke, myocardial infarction, or death from coronary heart disease. Age interacted significantly with anthropometric measures and total-cholesterol on MACE (P ≤ 0.003), and therefore age-stratified analyses (<50 versus ≥ 50 years) were performed. BMI, WHR, EFM, and total-cholesterol were independently associated with MACE (P ≤ 0.003) and resulted in significantly positive NRI when added to age, sex, smoking status, and systolic blood pressure. Only total-cholesterol increased discrimination ability (AUCROC difference; P < 0.001). In subjects < 50 years, the prediction model with total-cholesterol was superior to the model including BMI, but not superior to models containing WHR or EFM, while in those ≥ 50 years, the model with total-cholesterol was superior to all models containing anthropometric variables, whether assessed individually or combined. We found a potential role for replacing total-cholesterol with anthropometric measures for MACE-prediction among individuals < 50 years when laboratory measurements are unavailable, but not among those ≥ 50 years.