Association of pre-existing maternal cardiovascular diseases with neurodevelopmental disorders in offspring: a cohort study in Sweden and British Columbia, Canada.

BACKGROUND: We aimed to investigate the associations of pre-existing maternal cardiovascular disease (CVD) with attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and intellectual disability (ID) in offspring. METHODS: This population-based cohort study included singletons live-born without major malformations in Sweden (n = 2 699 675) and British Columbia (BC), Canada (n = 887 582) during 1990-2019, with follow-up from age 1 year until the outcome, death, emigration or December 2020, whichever came first. The primary exposure was defined as a composite CVD diagnosed prior to conception: cerebrovascular disease, arrhythmia, heart failure, valvular and congenital heart diseases. The incidences of ADHD, ASD and ID, comparing offspring of mothers with versus without CVD, were calculated as adjusted hazard ratios (aHRs). These results were compared with models using paternal CVD as negative control exposure. RESULTS: Compared with offspring of mothers without CVD, offspring of mothers with CVD had 1.15-fold higher aHRs of ADHD [95% confidence interval (CI): 1.10-1.20] and ASD (95% CI 1.07-1.22). No association was found between maternal CVD and ID. Stratification by maternal CVD subtypes showed increased hazards of ADHD for maternal heart failure (HR 1.31, 95% CI 1.02-1.61), cerebrovascular disease (HR 1.20, 95% CI 1.08-1.32), congenital heart disease (HR 1.18, 95% CI 1.08-1.27), arrhythmia (HR 1.13, 95% CI 1.08-1.19) and valvular heart disease (HR 1.12, 95% CI 1.00-1.24). Increased hazards of ASD were observed for maternal cerebrovascular disease (HR 1.25, 95% CI 1.04-1.46), congenital heart disease (HR 1.17, 95% CI 1.01-1.33) and arrythmia (HR 1.12, 95% CI 1.01-1.21). Paternal CVD did not show associations with ADHD, ASD or ID, except for cerebrovascular disease which showed associations with ADHD and ASD. CONCLUSIONS: In this large cohort study, pre-existing maternal CVD was associated with increased risk of ADHD and ASD in offspring.

Latent class trajectories of socioeconomic position over four time points and mortality: the Uppsala Birth Cohort Study.

BACKGROUND: The study assessed socioeconomic position (SEP) over four time points and employed a latent class analysis (LCA) to explore the associations between longitudinal SEP trajectories and late-life mortality. METHODS: We analyzed a cohort of 11 336 members born at the Uppsala University Hospital, Sweden during 1915-29 and followed up for mortality during 1980-2008. SEP was measured at birth, age 10, mid-adulthood and late adulthood. LCA was used to identify SEP trajectories, which were linked to all-cause and cause-specific mortality through Cox proportional hazard regression models. RESULTS: The age and birth cohort adjusted hazard ratio (HR) of all-cause mortality among the upwardly mobile from middle vs. stable low SEP was 28% lower in men [HR: 0.72; 95% confidence interval (95% CI): 0.65, 0.81] and 30% lower in women (HR: 0.70; 95% CI: 0.62, 0.78). The corresponding HR of cardiovascular mortality was 30% lower in men (HR: 0.70; 95% CI: 0.60, 0.82) and 31% lower in women (HR: 0.69; 95% CI: 0.58, 0.83). Upward mobility was also associated with decreased HR of mortality from respiratory diseases and injuries among men and from cancer, respiratory diseases, injuries and mental disorders among women. The upwardly mobile were similar to the stable high group in terms of their HRs of mortality from all-causes and cardiovascular, cancer and mental diseases. CONCLUSIONS: Upward mobility appeared to be protective of mortality from a wide range of causes. Interventions aiming to prevent deaths can benefit from creating optimal conditions earlier in the life course, letting disadvantaged children maximize their socioeconomic and health potentials.

Is there a gradient in the association between internet addiction and health?

BACKGROUND: Internet Addiction (IA) is often shown to be associated with health issues, but no study explicitly examined a possible gradient in the association between different levels of IA and health. This study aimed to examine if the levels of IA had a graded relationship with poor sleep quality, psychological distress, and self-rated health among university students in Bangladesh. METHODS: In this cross-sectional study, a sample of 625 students from six universities/colleges responded to an online survey that contained measures of internet addiction test (IAT), general health questionnaire (GHQ-12), sleep quality, and self-rated health. Modified Poisson regression models were fitted to estimate the adjusted risk ratios (RR) and confidence intervals (CI) of the associations between IA and health outcomes. RESULTS: The IA levels were associated with each of the three health outcomes in a linear fashion. Compared to the lowest IA quintile, the highest quintile remained associated with an increased risk of poor-quality sleeping (RR: 1.77; 95% CI: 1.26, 2.48), psychological distress (RR: 2.09; 95% CI: 1.55, 2.82), and worse self-rated health (RR: 1.46; 95% CI: 1.09, 1.96) after adjusting for socio-demographic covariates. There were also dose-response associations between IAT z-scores and health outcomes. The association between IAT z-scores and psychological distress was significantly stronger in males compared to females (p-value for interaction<0.05). CONCLUSIONS: The study found strong gradients between levels of addiction to internet and health outcomes, suggesting that increased health risks may exist even at lower levels of internet addiction. The findings highlight the need for departure of current research from a focus on the classic dichotomy of problematic versus not problematic internet use and a move toward recognizing the potential hierarchical effects of IA on health.

Associations between family social circumstances and psychological distress among the university students of Bangladesh: To what extent do the lifestyle factors mediate?

BACKGROUND: While there is a growing body of empirical studies focusing on the social and behavioral predictors of psychological health, the mechanisms that may underlie the reported associations have not been adequately explored. This study aimed to examine the association of social and lifestyle factors with psychological distress, and the potential mediating role of the lifestyle factors in the estimated associations between social circumstances and psychological distress. METHODS: A total of 742 tertiary level students (53% females) from a range of socio-economic backgrounds and multiple educational institutions participated in this cross-sectional study. The 12-items General Health Questionnaire (GHQ-12) was utilized for measuring psychological distress. Data related to students' socio-demographic characteristics, family social circumstances, and lifestyle factors were also collected. Modified Poisson regression analysis was used to estimate the risk ratios (RR) and their 95% confidence intervals (CI). RESULTS: The multivariable regression analysis suggests heightened risks of psychological distress associated with low parental Socio-Economic Position (SEP) (RR: 1.36; 95% CI: 1.07, 1.76), childhood poverty (RR: 1.31; 95% CI: 1.11, 1.55), and living away from the family (RR: 1.28; 95% CI: 1.07, 1.54). Among the lifestyle factors, past smoking, physical inactivity, inadequate fruit intake, and poor sleep quality were strongly associated with psychological distress and these associations persisted when the family social circumstances and lifestyle factors were mutually adjusted for. The lifestyle factors did not considerably mediate the estimated associations between family social circumstances and psychological distress. CONCLUSION: The social and lifestyle factors operated independently to increase students' risk of psychological distress. Accordingly, while promoting students' healthy lifestyles may reduce the overall burden of psychological distress, any equity initiative aiming to minimize the social inequalities in psychological health should be targeted to improving the living conditions in early life.

Early life programming of adult ischemic heart disease within and across generations: The role of the socioeconomic context.

BACKGROUND: The developmental origins of ischemic heart disease (IHD) have been widely documented but little is known about their persistence across more than one generation. This study aimed to investigate whether the effects of early life disadvantages on adult IHD have changed between generations and are mediated by adult socioeconomic circumstances, and further explore the transgenerational effects of grandparental and parental exposures to disadvantaged circumstances on adult offspring's IHD. METHODS: We used register-based data from the Uppsala Multigenerational Study, Sweden. The study populations were the parents born 1915-1929 and their offspring born 1932-1972 with available obstetric data. The offspring were further linked to grandparents who had their socioeconomic and demographic data recorded. The outcome was incident IHD assessed at ages 32-75 during a follow-up from January 1, 1964 till December 31, 2008. The exposures included birthweight standardized-for-gestational age, ponderal index, gestational length, and parental socioeconomic position (SEP). Education and income were analyzed as mediators. Potential transgenerational associations were explored by linking offspring IHD to parents' standardized birthweight and gestational length, grandparental SEP, and to grandmothers' age, parity, and marital status at parental birth. All associations were examined in Cox proportional hazard regression models. RESULTS: Lower standardized birthweight and lower parental SEP were found to be associated with higher IHD rates in both generations, with no evidence of effect modification by generation. Education and income did not mediate the association between standardized birthweight and IHD. Disadvantaged grandparental SEP, younger and older childbearing ages of grandmothers, and paternal preterm birth affected offspring's IHD independent of parental education, income, or IHD history. CONCLUSIONS: The findings point to similar magnitudes of IHD inequalities by early life disadvantages across two historical periods and the existence of transgenerational effects on IHD. Epigenetic dysregulation involving the germline is a plausible candidate mechanism underlying the transgenerational associations that warrant further research.

The male disadvantage in life expectancy: can we close the gender gap?

Men are usually considered to be the stronger sex. However, when it comes to health, they are evidently weaker than their female counterparts. In almost all countries around the world, men consistently live shorter lives than women. The gender gap in longevity has once again been evident during the ongoing coronavirus disease 2019 (COVID-19) pandemic, which kills men disproportionately. Drawing on the relevant scientific literature and updated information, this article aimed to provide useful insights into the biological and social mechanisms that potentially underlie the gender gap in life expectancy.

Inequality in hospitalization due to non-communicable diseases in Sweden: Age-cohort analysis of the Uppsala Birth Cohort Multigenerational Study.

We aimed to investigate cohort differences in age trajectories of hospitalization due to non-communicable conditions, and if these varied by paternal socioeconomic position. We used the Uppsala Birth Cohort Multigenerational Study-including virtually complete information on medical diagnoses. Our sample constituted 28,448 individuals (103,262 observations). The outcome was five-year prevalence of hospitalization due to major non-communicable conditions in 1989-2008. The exposures were age (19-91), year-of-birth (1915-1929; 1938-1972), gender (man vs woman), and parental socioeconomic position (low, medium, and high). We used multilevel logit models to examine associations between exposures and the hospitalization outcome. Younger cohorts had a higher prevalence of hospitalization at overlapping ages than those born earlier, with inter-cohort differences emerging from early-adulthood and increasing with age. For instance, at age 40 predicted probability of hospitalization increased across birth-cohorts-from 1.2% (born in 1948-52) to 2.0% (born in 1963-67)-whereas at age 50 it was 2.9% for those born in 1938-42 compared with 4.6% among participants born in 1953-57. Those with medium and low socioeconomic position had 13.0% and 20.0% higher odds of experiencing hospitalization during the observation period, respectively-when age, year-of-birth and gender were accounted for. We found that no progress was made in reducing the socioeconomic inequalities in hospitalization across cohorts born between 1915 and 1972. Hence, more effective policies and interventions are needed to reduce the overall burden of morbidity-particularly among the most vulnerable.

International migration and health: it is time to go beyond conventional theoretical frameworks.

The large-scale international migration in the 21st century has emerged as a major threat to the global health equity movement. Not only has the volume of migration substantially increased but also the patterns of migration have become more complex. This paper began by focusing on the drivers of international migration and how health inequalities are linked to migration. Situating migration within the broader structural contexts, the paper calls for using the unharnessed potential of the intersectionality framework to advance immigrant health research. Despite coming from poorer socioeconomic backgrounds and facing disparities in the host society, the immigrants are often paradoxically shown to be healthier than the native population, although this health advantage diminishes over time. Studies on immigrant health, however, are traditionally informed by the acculturation framework which holds the assimilation of unhealthy lifestyles primarily responsible for immigrant health deterioration, diverting the attention away from the structural factors. Although the alternative structural framework came up with the promise to explore the structural factors, it is criticised for an overwhelming focus on access to healthcare and inadequate attention to institutional and societal contexts. However, the heterogeneity of the immigrant population across multiple dimensions of vulnerability demands a novel approach that can bring to the fore both premigratory and postmigratory contextual factors and adequately capture the picture of immigrant health. The paper concludes by questioning the acculturation perspective and pushing the structural paradigm to embrace the intersectionality framework which has the potential to address a wide range of vulnerabilities that intersect to produce health inequalities among the immigrants.

Early-life social and health determinants of adult socioeconomic position: associations and trends across generations.

BACKGROUND: Social and biological circumstances at birth are established predictors of adult socioeconomic position (SEP). This study aims to assess the trends in these associations across two generations and examine the effects of parental early-life characteristics on descendants' adult SEP. METHODS: We studied men and women born in the Uppsala University Hospital 1915-1929 (G1) and their offspring born 1932-1960 (G2). Data were collected in archives and routine registers. Adult SEP was assessed as an aggregate measure combining education and occupation. The exposures were family SEP, mother's marital status, mother's parity, mother's age, standardised birth weight, gestational length and birth multiplicity. Linear regression was used to examine the associations across generations. RESULTS: The difference in adult SEP between low and high family SEP at birth was 15.8 (95% CI: 13.3 to 18.3) percentage points smaller in G2 compared with G1, although a considerable difference was still evident in G2. The associations of adult SEP with small birth weight for gestational age, post-term birth and high parity were stable between the generations: the generational differences in adjusted coefficients were 1.5 (95% CI: -1.1 to 4.1), 0.6 (-1.7 to 2.9) and 1.8 (-0.2 to 3.8) percentage points, respectively. The association between grandparental and grandchildren's SEPs was largely explained by parental socioeconomic conditions. Father's preterm birth was independently associated with offspring's SEP. CONCLUSION: The stability of the associations between early-life biological disadvantages and adult SEP and the persistent, although attenuated, association between early-life and adult SEPs necessitates increased policy attention to both social and health conditions at birth.

Social and Psychological Predictors of Body Mass Index among South Africans 15 Years and Older: SANHANES-1.

This study investigated how psychological distress and the proxies for social position combine to influence the risk of both underweight and overweight in South Africans aged 15 years and older. This was a cross-sectional study that included 2254 men and 4170 women participating in the first South African National Health and Nutrition Examination Survey (SANHANES-1). An analysis exploring the associations of social and mental health characteristics with body mass index (BMI) was conducted using binary and multinomial logistic regressions. Results suggested that, overall, women had a higher risk of overweight/obesity compared to men (age-adjusted odds ratio [AOR] 4.65; 95% confidence intervals [CI] 3.94-5.50). The gender effect on BMI was smaller in non-African participants (AOR 3.02; 95% CI 2.41-3.79; p-value for interaction = 0.004). Being employed and having a higher level of education were associated with higher risks of overweight and obesity and a lower risk of underweight. Being single or without a spouse and poor mental health were found to increase the odds of being underweight, especially in men. To conclude, there are strong social gradients and important gender and ethnic differences in how BMI is distributed in the South African population.

Early life socioeconomic position and mortality from cardiovascular diseases: an application of causal mediation analysis in the Stockholm Public Health Cohort.

OBJECTIVE: We aimed to quantify the mediating impact of adult social and behavioural mechanisms in the association between childhood socioeconomic position (SEP) and cardiovascular disease (CVD) mortality by employing a weighting approach to mediation analysis. DESIGN: Prospective cohort study. SETTING: Stockholm County, Sweden. PARTICIPANTS: 19 720 individuals who participated in the Stockholm Public Health Cohort survey in 2002 and were older than 40 years. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was CVD mortality. Non-CVD mortality was additionally analysed for comparison. METHODS: Study subjects were followed in routine registers from 2002 to 2011 for mortality. Data on father's SEP and adult social and behavioural factors came from questionnaire survey. The inverse odds weighting method was used to estimate the total effect, the natural direct effect and the natural indirect effect (NIE) in Poisson regression models. All results were adjusted for gender, age, country of birth and marital status. Multiple imputation was used to handle missing data. RESULTS: The total effect of manual versus non-manual father's SEP on CVD mortality was estimated as an incidence rate ratio (IRR) of 1.24 (95% CI 1.09 to 1.41). When the social and behavioural factors were accounted for, the IRR for the NIE was 1.09 (95% CI 1.04 to 1.14), suggesting a mediation of 44% of the total effect. As for non-CVD mortality, father's manual SEP was associated with 1.15 fold excess risk (IRR: 1.15; 95% CI 1.04 to 1.27) of which the effect represented by the whole set of mediators was 1.06 (95% CI 1.01 to 1.10). CONCLUSION: Adult social and behavioural factors had a considerable mediating effect on the early life social origin of mortality from CVDs and other causes. Future research employing causal mediation analysis may nevertheless have to consider additional factors for a fuller understanding of the mechanisms.

Is the Association Between Late Life Morbidity and Disability Attenuated Over Time? Exploring the Dynamic Equilibrium of Morbidity Hypothesis.

OBJECTIVE: There is evidence suggesting that the prevalence of disability in late life has declined over time while the prevalence of chronic diseases has increased. The dynamic equilibrium of morbidity hypothesis suggests that these patterns are due to the attenuation of the morbidity-disability link over time. This study aimed to test this assumption empirically. METHODS: Data were drawn from three repeated cross-sections of SWEOLD, a nationally representative survey of the Swedish population aged 77 years and older. Poisson regression models were fitted to assess the trends in the prevalence of Activities of Daily Living (ADL) disability, Instrumental ADL (IADL) disability, and selected groups of chronic conditions. The changes in the associations between chronic conditions and disabilities were examined on both multiplicative and additive scales. RESULTS: Between 1992 and 2011, the prevalence of both ADL and IADL disabilities decreased whereas the prevalence of nearly all chronic morbidities increased. Significant attenuations of the morbidity-disability associations were found for cardiovascular diseases, metabolic disorders, poor lung function, and psychological distress. DISCUSSION: In agreement with the dynamic equilibrium of morbidity hypothesis, this study concludes that the morbidity-disability associations among the Swedish older adults largely waned between 1992 and 2011.

Socioeconomic inequality in maternal healthcare: An analysis of regional variation in Bangladesh.

Socioeconomic inequality in the utilisation of maternal healthcare services is well-documented in Bangladesh. However, the spatial dimension of this inequality is largely unexplored in the literature. This study examined the regional variation of wealth-related inequality in the utilisation of maternal healthcare services using data from Bangladesh Demographic and Health Survey, 2014. The highest extent of pro-wealthy inequality was found in Chittagong and Sylhet for ANC services compared to Khulna and Rangpur where inequality was the lowest. Pro-wealthy inequality was the lowest in Rangpur while Dhaka and Barisal tended to have the greatest degree of inequality for delivery care services. Policy efforts aiming to tackle socioeconomic inequality in maternal healthcare should consider this spatial dimension of inequality in Bangladesh.

Couple's concordance and discordance in household decision-making and married women's use of modern contraceptives in Bangladesh.

BACKGROUND: Although a large body of studies documents that women's autonomy in the household is associated with better reproductive health outcomes, these studies typically examined autonomy only from women's point of view. The current study employs husband's and wife's perspectives together to examine the relationship between the decision-making arrangements in the household and the women's use of modern contraceptives in Bangladesh. METHODS: The study used the couple dataset of 2007 Bangladesh Demographic and Health Survey. The sample was comprised of 3336 married couples. Binary logistic regression models were used to examine the associations between the selected items on household decision-making and the use of modern contraceptives. RESULTS: Our results indicate that the couples disagree considerably as to who in the household exercises the decision-making power. The pattern of decision-making regarding visiting family and relatives emerged as an important predictor of use of modern contraceptives in the multivariate regression analysis. The results suggest that compared to the couple's concordant joint decision-making, the husband-only decision-making is associated with lower odds of contraceptives use (OR 0.49; 95% CI 0.28-0.85). Only a small part of this association is explained by spousal communication about family planning issues while the socio-demographic correlates hardly affected the association. On the contrary, the wife-only decision-making did not result in increased contraceptives use (OR 0.71; 95% CI 0.45-1.13). CONCLUSIONS: The study findings imply that women's greater autonomy may not necessarily result in improved reproductive health behavior, and therefore, a balance of power in the spousal relationship is warranted.

Prevalence and risk factors of problematic internet use and the associated psychological distress among graduate students of Bangladesh.

A growing body of epidemiological literature suggests that problematic Internet use (PIU) is associated with a range of psychological health problems in adolescents and young adults. This study aimed to explore socio-demographic and behavioural correlates of PIU and examine its association with psychological distress. A total of 573 graduate students from Dhaka University of Bangladesh responded to a self-administered questionnaire that included internet addiction test (IAT), 12-items General Health Questionnaire and a set of socio-demographic and behavioural factors. The study found that nearly 24% of the participants displayed PIU on the IAT scale. The prevalence of PIU significantly varied depending on gender, socioeconomic status, smoking habit and physical activity (p < 0.05). The multiple regression analyses suggested that PIU is strongly associated with psychological distress regardless of all other explanatory variables (adjusted OR 2.37, 95% CI 1.57, 3.58). Further research is warranted to confirm this association by employing prospective study designs.

From habitual sleep hours to morbidity and mortality: existing evidence, potential mechanisms, and future agenda.

Epidemiological studies consistently show a strong U-shaped association between sleep duration and health outcomes. That is, both short and long sleepers are exposed to greater risks of death and diseases than normal length sleepers. Moreover, long sleep is often demonstrated as a stronger predictor of mortality than short sleep. While there is some experimental evidence in favor of a causal connection between short sleep and health, no such evidence exists to explain why excessive sleep might be associated with poor health. One possible explanation is that long duration sleep, instead of being a real cause of illness, is merely a marker of poor sleep quality or some unmeasured risk factor that confounds the association of long habitual sleep with mortality and other health outcomes. As for short sleep, the effect is said to be mediated via the hormones that alters glucose metabolism and appetite regulation as well as via an overactivity of the stress systems that causes increased heart rate and blood pressure. The mechanisms, however, are still poorly understood and future investigations should take into account sleep quality, objective and longitudinal sleep measures, more confounding biases, and the broad social context that influences the length and quality of sleep.

Healthcare-seeking behavior among the Chakma ethnic group in Bangladesh: can accessibility and cultural beliefs shape healthcare utilization?

Existing studies lack qualitative information on the perceived reasons for ethnic minority groups' healthcare choices, attitudes toward healthcare services, and common practices based on traditional cultural belief systems in Bangladesh. This study noted the important influence of culture and beliefs with regard to availing healthcare services. Informal sector providers such as para-professionals and traditional healers take the lead in rendering physically, financially, and culturally accessible healthcare services in the context of under-utilization of public healthcare facilities. Salient factors determining the choice of therapy were the perceived causes of illness and physical and financial access to the health services. These drivers of health seeking behavior in an increasingly pluralistic healthcare system need to be taken into account to strengthen the current healthcare delivery system and to design specific health education and healthcare promotion programs for the poor, hard-to-reach, and under-served ethnic minority.