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2.
Soc Sci Med ; 246: 112781, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31986347

RESUMO

RATIONALE: Socioeconomic disparities have been documented in major non-communicable diseases and in their risk factors, such as obesity, hypertension, diabetes, smoking, physical inactivity, unhealthful diet and heavy drinking. However, a key research question has remained unanswered: is there a separate biological embodiment of socio-economic conditions underlying health disparities, additional and independent of those risk factors? As lifelong socioeconomic circumstances cannot be randomised, one way forward is the examination of different biological layers of evidence, including molecular changes. METHOD: In this methodological paper we report the association of socio-economic disadvantage with (a) long-term health outcomes, before and after taking risk factors into account; (b) biological intermediaries that increase susceptibility to disease, such as childhood obesity; (c) intermediate circulating biomarkers and omic measurements (transcriptomics, DNA methylation, inflammatory proteins, allostatic load); and (d) immunity. In our Lifepath consortium, these analyses have been performed in several cohort studies, countries and contexts, and at different stages of the life course in up to 1.7 million subjects. The main goal is to test the assumption that each layer (death, functional outcomes, DNA, RNA, proteins, infections) is characterized by different types of bias and confounding, and that consistency across layers reinforces causality assessment. RESULTS: The findings show consistent associations of social disparities with unfavourable health outcomes spanning inflammatory biomarkers, DNA or RNA-based markers, infection, indicators of physical functioning and mortality. Although each of these associations has a different set of confounders, a dose-response relationship is nevertheless consistently observed, thus showing the power of our multi-layered approach. CONCLUSIONS: This new evidence supports biological embodiment of social disadvantage, in addition to the impact of known (mainly behavioural) risk factors for disease.

3.
Arch Dis Child ; 2020 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-31969352

RESUMO

OBJECTIVE: Early life adversity has been associated with increased risk of inflammation and inflammation-related diseases in adulthood. This study aimed to examine the association of childhood socioeconomic conditions with chronic low-grade inflammation over adolescence. METHODS: We used information on 2942 members (1507 girls and 1435 boys) of the EPITeen (Epidemiological Health Investigation of Teenagers in Porto) cohort that was established in 2003 in Porto, Portugal, and included 13-year-old adolescents were further evaluated at 17 and 21 years. Mother' and father's education and occupation were used as indicators of childhood socioeconomic conditions. High-sensitivity C reactive protein (hs-CRP) was measured at three points in time (13, 17 and 21 years). hs-CRP levels were categorised in tertiles separately for each wave; chronic low-grade inflammation in adolescence was defined as having hs-CRP levels in the highest tertile in at least two waves and never in the lowest tertile. RESULTS: Prevalence of chronic low-grade inflammation during adolescence was significantly higher among participants with low parental socioeconomic position. Low parental socioeconomic position was associated with chronic low-grade inflammation in adolescence, after adjustment for sex, perinatal and physical environment factors, health-related behaviours and health status in adolescence OR=1.6; 95% CI: 1.1 to 2.4 for lowest versus highest mother's education and OR=1.6; 95% CI: 1.1 to 2.3 for lowest versus highest father's occupation. CONCLUSION: Low childhood socioeconomic conditions are associated with chronic low-grade inflammation during adolescence. Our results suggest that the early life socioeconomic environment has an impact on inflammatory processes over adolescence.

4.
Praxis (Bern 1994) ; 109(1): 23-26, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910756

RESUMO

Socio-Economic Differences in the Lausanne CoLaus Cohort Abstract. The CoLaus study allowed to highlight the existence of broad social inequalities in health among the population of the city of Lausanne. In fact, participants with low socioeconomic status had a higher prevalence of cardio-metabolic risk factors, risk behaviors, sleep disturbances, and higher inflammatory markers compared to the more socio-economically advantaged participants in the study. In most cases, these inequalities are similar to those found in the neighboring cantons and countries.


Assuntos
Doenças Cardiovasculares , Transtornos do Sono-Vigília , Fatores Socioeconômicos , Biomarcadores , Doenças Cardiovasculares/epidemiologia , Estudos de Coortes , Humanos , Fatores de Risco , Transtornos do Sono-Vigília/epidemiologia
5.
Soc Sci Med ; 245: 112685, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31783227

RESUMO

Disadvantaged socioeconomic conditions in childhood heighten systemic inflammatory levels in adulthood; however, life-course mechanisms underlying this association are largely unknown. In the present observational study, we investigated the roles of adulthood socioeconomic and lifestyle factors in mediating this association. Participants were from two prospective Swiss population-based cohorts (N = 5,152, mean age 60 years). We estimated the total effect of paternal occupational position on adult heightened systemic inflammatory levels (C-reactive protein>3 mg/L), and the indirect effects via adulthood socioeconomic positions (SEPs: education and occupational position), financial hardship, and lifestyle factors (body mass index, smoking status, physical inactivity, and alcohol consumption). We estimated odds ratio (OR) and proportion mediated using counterfactual-based mediation models. Individuals whose father had a low occupational position had an OR of 1.51 [95% confidence interval (CI): 1.25, 1.84] for heightened inflammation compared to their more advantaged counterparts. This was jointly mediated (33 [95% CI: 14, 69]%) by adulthood SEPs, whereby the pathway through education followed by occupational position mediated 30 [95% CI: 11, 64]%, while the pathway via occupational position only mediated 3 [95% CI: 4, 13]%. Individuals with the lowest life-course SEPs had an OR of 2.27 [95% CI: 1.71, 2.98] for heightened inflammation compared to having the highest life-course SEPs. This was jointly mediated (63 [95% CI: 44, 97]%) by financial hardship and lifestyle factors. Our study supports a cumulative effect of life-course SEPs on adult heightened systemic inflammation along the pathway paternal occupational position -> education -> adult occupational position. Financial hardship and lifestyle factors in adulthood mediate half of that effect.

6.
Artigo em Inglês | MEDLINE | ID: mdl-31822567

RESUMO

OBJECTIVE: This study aims to investigate the association of life-course socioeconomic status (SES) with lung function during adulthood, by exploring the influence of life-course social mobility and of cumulative exposure to low SES. METHODS: Participants were 1458 individuals from EPIPorto study, a population-based cohort of Portuguese adults. The life-course SES was computed using participants' paternal occupation and own occupation, resulting in four patterns: stable high, upward, downward, stable low. A cumulative life-course SES index was also calculated using the participants' paternal occupation, own education and occupation. Lung function during adulthood was assessed with forced expiratory volume in first second (FEV1) and forced vital capacity (FVC) percentages predicted (higher percentages are associated with better lung function). Linear regression models were used to estimate beta coefficients and 95% CI for the association of socioeconomic indicators and lung function. RESULTS: Disadvantaged SES from childhood to adulthood was associated with lower lung function (FEV1:-6.64%,-10.68;-2.60/FVC:-3.77%,-7.45;-0.08), and the greater the socioeconomic disadvantage, the lower the lung function (FEV1:-2.56%,-3.98;-1.15/FVC:-1.54%,-2.83;-0.24) among men, independently of marital status and behavioural factors. Among women, SES effects were only observed in those experiencing a stable low life-course SES at older ages (-5.15%,-10.20;-0.09). Men experiencing a downward social mobility presented the lowest lung function, but there was attenuation to the null after accounting for marital status and behavioural factors. CONCLUSION: A life-course disadvantaged SES is an important predictor of lower lung function during adulthood. Downward social mobility was associated with the lowest lung function among men, although this association was mostly explained by behavioural factors.

7.
Clin Nutr ; 2019 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-31806396

RESUMO

BACKGROUND: People report many barriers that prevent them from achieving a healthy diet. Whether perceived barriers are associated with dietary behavior remains unclear. OBJECTIVE: To assess the association between barriers to healthy eating and adherence to the Swiss dietary guidelines. METHODS: Cross-sectional data from the Swiss Health Survey 2012 (N = 15,450; 53% women). Barriers included price, daily habits, taste, gluttony, lack of time, lack of willpower, limited options in restaurants, in supermarkets, no social support, and social opposition. The associations between barriers and adherence to Swiss dietary guidelines were assessed using multivariable logistic regression. RESULTS: Daily habits (odds ratio; 95% confidence interval: 0.91; 0.85-0.98) and taste (0.85; 0.79-0.91) were associated with lower adherence to the guidelines for fruits, while price (1.13; 1.06-1.21) and limited options in restaurants (1.33; 1.23-1.45) and in supermarkets (1.18; 1.03-1.35) were associated with higher adherence. Taste was associated with lower adherence to the guidelines for vegetables (0.72; 0.66-0.78), while price (1.20; 1.11-1.30), gluttony (1.17; 1.04-1.31), social group opposition (1.48; 1.18-1.85) and limited options in restaurants (1.56; 1.42-1.72) and in supermarkets (1.25; 1.07-1.47) were associated with higher adherence. Daily habits (0.82; 0.75-0.90), time (0.86; 0.78-0.94), lack of willpower (0.78; 0.70-0.87), and gluttony (0.86; 0.76-0.98) were associated with lower adherence to the guidelines for fish, whereas price (1.09; 1.01-1.19), and limited options in restaurants (1.26; 1.14-1.39) and supermarkets (1.40; 1.20-1.63) were associated with higher adherence. Daily habits (0.89; 0.82-0.97), taste (0.66; 0.61-0.72), lack of willpower (0.84; 0.76-0.92) and gluttony (0.66; 0.58-0.75) were associated with lower adherence to the guidelines for meat. Time (0.88; 0.78-0.99) was associated with lower adherence to the guidelines for dairy, while gluttony (1.26; 1.09-1.46) was associated with higher adherence. Daily habits was associated with lower adherence (0.91; 0.85-0.97) to the guidelines for liquids, while limited options in restaurants was associated with higher adherence (1.12; 1.03-1.22). CONCLUSION: In the Swiss adult population, several self-reported barriers to healthy eating appear to hinder adherence to the dietary guidelines, while other commonly reported barriers are linked to higher adherence.

8.
Cardiovasc Res ; 2019 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-31754700

RESUMO

AIMS: Sleep disturbances exhibit a strong social patterning, and inadequate sleep has been associated with adverse health outcomes, including cardiovascular disorders (CVD). However, the contribution of sleep to socioeconomic inequalities in CVD is unclear. This study pools data from eight European cohorts to investigate the role of sleep duration in the association between life-course socioeconomic status (SES) and CVD. METHODS AND RESULTS: We used cross-sectional data from eight European cohorts, totalling 111 205 participants. Life-course SES was assessed using father's and adult occupational position. Self-reported sleep duration was categorized into recommended (6-8.5 h/night), long (>8.5 h/night), and short (<6 h/night). We examined two cardiovascular outcomes: coronary heart disease (CHD) and stroke. Main analyses were conducted using pooled data and examined the association between life-course SES and CVD, and the contribution of sleep duration to this gradient using counterfactual mediation. Low father's occupational position was associated with an increased risk of CHD (men: OR = 1.19, 95% CI [1.04; 1.37]; women: OR = 1.25, 95% CI [1.02; 1.54]), with marginal decrease of the gradient after accounting for adult occupational position (men: OR = 1.17, 95% CI [1.02; 1.35]; women: OR = 1.22, 95% CI [0.99; 1.52]), and no mediating effect by short sleep duration. Low adult occupational position was associated with an increased risk of CHD in both men and women (men: OR = 1.48, 95% CI [1.14; 1.92]; women: OR = 1.53, 95% CI [1.04; 2.21]). Short sleep duration meaningfully contributed to the association between adult occupational position and CHD in men, with 13.4% mediation. Stroke did not exhibit a social patterning with any of the variables examined. CONCLUSION: This study suggests that inadequate sleep accounts to a meaningful proportion of the association between adult occupational position and CHD, at least in men. With sleep increasingly being considered an important cardiovascular risk factor in its own terms, our study additionally points to its potential role in social inequalities in cardiovascular disease.

10.
Nutrients ; 11(7)2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31336862

RESUMO

Socioeconomically disadvantaged people are disproportionally more likely to develop obesity and obesity-related diseases. However, it remains unclear to what extent diet quality contributes to socioeconomic inequalities in obesity. We aimed to assess the role of diet quality in the association between socioeconomic status (SES) and obesity. Data originated from the national nutrition survey, a cross-sectional sample of the adult Swiss population (N = 1860). We used education and income as proxies for SES; calculated the Alternate Healthy Eating Index (AHEI) as a measure of diet quality; and used body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) as obesity markers. We applied counterfactual mediation modelling to generate odds ratios, 95% confidence intervals, and the proportion mediated by diet quality. Individuals with less than a tertiary education were two to three times more likely to be obese, regardless of the marker (OR (95% CI): 3.36 (2.01, 5.66) using BMI; 2.44 (1.58, 3.75) using WC; 2.48 (1.63, 3.78) using WHR; and 2.04 (1.43, 2.96) using WHtR). The proportion of the association between educational level and obesity that was mediated by diet quality was 22.1% using BMI, 26.6% using WC, 31.4% using WHtR, and 35.8% using WHR. Similar findings were observed for income. Our findings suggest that diet quality substantially contributes to socioeconomic inequalities in obesity while it does not fully explain them. Focusing efforts on improving the diet quality of disadvantaged groups could help reduce social inequalities in obesity.


Assuntos
Dieta/normas , Inquéritos Nutricionais , Obesidade/epidemiologia , Obesidade/etiologia , Classe Social , Adulto , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Suíça/epidemiologia , Circunferência da Cintura , Razão Cintura-Estatura , Relação Cintura-Quadril
11.
Sci Rep ; 9(1): 8790, 2019 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-31217447

RESUMO

Living in deprived neighbourhoods may have biological consequences, but few studies have assessed this empirically. We examined the association between neighbourhood deprivation and allostatic load, a biological marker of wear and tear, taking into account individual's socioeconomic position. We analysed data from three cohort studies (CoLaus-Switzerland; EPIPorto-Portugal; Whitehall II-UK) comprising 16,364 participants. We defined allostatic load using ten biomarkers of dysregulated metabolic, cardiovascular, and inflammatory systems (body mass index; waist circumference; total, high and low density lipoprotein cholesterol; triglycerides; glucose; systolic and diastolic blood pressure; C-reactive protein). Mixed Poisson regression models were fitted to examine associations with neighbourhood deprivation (in quintiles, Q1-least deprived as reference). After adjustment for confounding variables, participants living in the most deprived quintile had 1.13 times higher allostatic load than those living in the least deprived quintile (Relative Risk, RR, for Q2 RR = 1.06, 95% CI 1.03-1.09; Q3 = 1.06, 1.03-1.10; Q4 = 1.09, 1.06-1.12; Q5 = 1.13, 1.09-1.16). This association was partially modified by individual's socioeconomic position, such that the relative risk was higher in participants with low socioeconomic position (Q5 vs Q1 1.16, 1.11-1.22) than those with high socioeconomic position (Q5 vs Q1 1.07, 1.01-1.13). Neighbourhood deprivation is associated with biological wear and tear, suggesting that neighbourhood-level interventions may yield health gains.

12.
BMJ Open ; 9(6): e027528, 2019 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-31227536

RESUMO

OBJECTIVE: Disadvantaged socioeconomic circumstances in early life have the potential to impact lung function. Thus, this study aimed to summarise evidence on the association between socioeconomic circumstances and respiratory function from childhood to young adulthood. DESIGN: Systematic review and meta-analysis. METHODS: Following the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines, Medline, ISI-Web of Science and Scopus were searched from inception up to January 2018. Original studies on the association between socioeconomic circumstances and respiratory function in early ages (ie, participants younger than 25 years of age) were investigated. Two investigators independently evaluated articles, applied the exclusion criteria, extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale. A meta-analysis of the standardised mean difference and 95% CI in respiratory function between participants from different socioeconomic circumstances was conducted, using a random-effects model. RESULTS: Thirty-three papers were included in this review and 23 showed that disadvantaged socioeconomic circumstances were significantly associated with reduced respiratory function. The meta-analysis including seven papers showed a significant difference of -0.31 (95% CI -0.42 to -0.21) litres in forced expiratory volume in the first second between children, adolescents and young adults from disadvantaged versus advantaged socioeconomic circumstances. Specifically a difference of -0.31 (95% CI -0.51 to -0.10) litres in girls and -0.43 (95% CI -0.51 to -0.35) litres in boys was observed. CONCLUSIONS: Children, adolescents and young adults from disadvantaged socioeconomic circumstances had lower respiratory function, and boys presented higher respiratory health inequalities. This information contributes to explain the social patterning of respiratory diseases, and might enable health policy makers to tackle respiratory health inequalities at early ages.

13.
Aging (Albany NY) ; 11(7): 2045-2070, 2019 04 14.
Artigo em Inglês | MEDLINE | ID: mdl-31009935

RESUMO

Differences in health status by socioeconomic position (SEP) tend to be more evident at older ages, suggesting the involvement of a biological mechanism responsive to the accumulation of deleterious exposures across the lifespan. DNA methylation (DNAm) has been proposed as a biomarker of biological aging that conserves memory of endogenous and exogenous stress during life.We examined the association of education level, as an indicator of SEP, and lifestyle-related variables with four biomarkers of age-dependent DNAm dysregulation: the total number of stochastic epigenetic mutations (SEMs) and three epigenetic clocks (Horvath, Hannum and Levine), in 18 cohorts spanning 12 countries.The four biological aging biomarkers were associated with education and different sets of risk factors independently, and the magnitude of the effects differed depending on the biomarker and the predictor. On average, the effect of low education on epigenetic aging was comparable with those of other lifestyle-related risk factors (obesity, alcohol intake), with the exception of smoking, which had a significantly stronger effect.Our study shows that low education is an independent predictor of accelerated biological (epigenetic) aging and that epigenetic clocks appear to be good candidates for disentangling the biological pathways underlying social inequalities in healthy aging and longevity.

14.
J Epidemiol Community Health ; 73(8): 703-711, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30967487

RESUMO

BACKGROUND: Early-life socioeconomic circumstances (SEC) are associated with health in old age. However, epidemiological evidences on the influence of these early-life risk factors on trajectories of healthy ageing are inconsistent, preventing drawing solid conclusion about their potential influence. Here, to fill this knowledge gap, we used a statistical approach adapted to estimating change over time and an outcome-wide epidemiology approach to investigate whether early-life SEC were associated with the level of and rate of decline of physical, cognitive and emotional functioning over time. METHODS: We used data on more than 23 000 adults in older age from the Survey of Health, Ageing and Retirement in Europe, a 12-year large-scale longitudinal study with repeated measurements of multiple health indicators of the same participants over time (2004 -2015, assessments every 2 years). Confounder-adjusted linear growth curve models were used to examine the associations of early-life SEC with the evolution of muscle strength, lung function, cognitive function, depressive symptoms and well-being over time. RESULTS: We consistently found an association between early-life SEC and the mean levels of all health indicators at age 63.5, with a critical role played by the cultural aspect of disadvantage. These associations were only partly explained by adult-life SEC factors. By contrast, evidences supporting an association between early-life SEC and the rate of change in health indicators were weak and inconsistent. CONCLUSIONS: Early-life SEC are associated with health in old age, but not with trajectories of healthy ageing. Conceptual models in life course research should consider the possibility of a limited influence of early-life SEC on healthy ageing trajectories.

15.
Artigo em Inglês | MEDLINE | ID: mdl-30753721

RESUMO

Objectives: This paper aimed to assess associations of childhood socioeconomic conditions (CSC) with the risk of frailty in old age and whether adulthood socioeconomic conditions (ASC) influence this association. Methods: Data from 21 185 individuals aged 50 years and older included in the longitudinal Survey of Health, Ageing, and Retirement in Europe were used. Frailty was operationalized as a sum of presenting weakness, shrinking, exhaustion, slowness, or low activity. Confounder-adjusted multilevel logistic regression models were used to analyze associations of CSC and ASC with frailty. Results: While disadvantaged CSC was associated with higher odds of (pre-)frailty in women and men (OR=1.73, 95%CI 1.34, 2.24; OR=1.84, 95%CI 1.27, 2.66, respectively), this association was mediated by ASC. Personal factors and demographics, such as birth cohort, chronic conditions and difficulties with activities of daily living, increased the odds of being (pre-)frail. Discussion: Findings suggest that CSC are associated with frailty at old age. However, when taking into account ASC, this association no longer persists. The results show the importance of improving socioeconomic conditions over the whole life course in order to reduce health inequalities in old age.

16.
Nat Commun ; 10(1): 773, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30770820

RESUMO

Chronic inflammation has been proposed as having a prominent role in the construction of social inequalities in health. Disentangling the effects of early life and adulthood social disadvantage on inflammation is key in elucidating biological mechanisms underlying socioeconomic disparities. Here we explore the relationship between socioeconomic position (SEP) across the life course and inflammation (as measured by CRP levels) in up to 23,008 participants from six European cohort studies from three countries conducted between 1958 and 2013. We find a consistent inverse association between SEP and CRP across cohorts, where participants with a less advantaged SEP have higher levels of inflammation. Educational attainment is most strongly related to inflammation, after adjusting for health behaviours, body mass index and later-in-life SEP. These findings suggest socioeconomic disadvantage in young adulthood is independently associated with later life inflammation calling for further studies of the pathways operating through educational processes.


Assuntos
Inflamação/imunologia , Inflamação/metabolismo , Índice de Massa Corporal , Proteína C-Reativa/metabolismo , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Análise de Regressão , Fatores de Risco , Fatores Socioeconômicos
17.
Sci Rep ; 9(1): 796, 2019 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-30692559

RESUMO

The status anxiety hypothesis proposes that systematic inflammation as a consequence of chronic psycho-social stress is a possible pathway linking socio-economic position (SEP) to premature ageing and is a possible explanation for cross-national variation in patterns of health and well-being. Harmonised data from the LIFEPATH consortium on 18,349 individuals aged 50 to 75 and 30,632 observations are used to measure variation in the association between inflammation measured as C-reactive protein and SEP across four countries (Britain, Ireland, Portugal and Switzerland) and five studies (ELSA, Whitehall II, TILDA, EPIPorto and SKIPOGH). Adjusting for population composition, mean concentrations of CRP are highest in Portugal, the country with the highest income inequality and lowest in Switzerland, a lower income inequality country. Across all of the studies, lower SEP groups have higher mean concentrations of CRP and, as predicted by the theory, absolute differentials between SEP groups reflect the pattern of societal income inequality. Adjustment for lifestyle indicators reduces SEP differentials by between 45% and 52% but cannot account for country variation in mean inflammation.

18.
J Sleep Res ; 28(5): e12799, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30474290

RESUMO

Sleep-disordered breathing is a common condition, related to a higher cardiometabolic and neurocognitive risk. The main risk factors for sleep-disordered breathing include obesity, craniofacial characteristics, male sex and age. However, some studies have suggested that adverse socioeconomic circumstances and lifestyle-related behaviours such as smoking and alcohol use, may also be risk factors for sleep-disordered breathing. Here, we investigate the associations between socioeconomic status and sleep-disordered breathing, as measured by sleep apnea-hypopnea and oxygen desaturation indexes. Furthermore, we assess whether these associations are explained by lifestyle-related factors (smoking, sedentary behaviour, alcohol use and body mass index [BMI]). We used data from the CoLaus|HypnoLaus study, a population-based study including 2162 participants from Lausanne (Switzerland). Socioeconomic status was measured through occupation and education. Sleep-disordered breathing was assessed through polysomnography and measured using the apnea-hypopnea index (AHI: number of apnea/hypopnea events/hr: ≥15/≥30 events), and the ≥3% oxygen desaturation index (ODI: number of oxygen desaturation events/hr: ≥15/≥30 events). Lower occupation and education were associated with higher AHI and ODI (occupation: AHI30, odds ratio (OR) = 1.88, 95% confidence interval (CI) [1.07; 3.31]; ODI30, OR = 2.29, 95% CI [1.19; 4.39]; education: AHI30, OR = 1.21, 95% CI [0.85; 1.72]; ODI30, OR = 1.26, 95% CI [0.83; 1.91]). BMI was associated with socioeconomic status and AHI/ODI, and contributed to the socioeconomic gradient in SDB, with mediation estimates ranging between 43% and 78%. In this Swiss population-based study, we found that low socioeconomic status is a risk factor for sleep-disordered breathing, and that these associations are partly explained by BMI. These findings provide a better understanding of the mechanisms underlying social differences in sleep-disordered breathing and may help implement policies for identifying high-risk profiles for this disorder.

20.
Lancet Public Health ; 3(8): e365-e373, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30030110

RESUMO

BACKGROUND: Neighbourhood socioeconomic disadvantage has been linked to increased diabetes risk, but little is known about differences in risk factors in childhood and adulthood in those with high and low neighbourhood socioeconomic disadvantage, or about the association between long-term neighbourhood socioeconomic disadvantage and incidence of diabetes in adulthood. We used data from the prospective, population-based Young Finns Study to address these questions. METHODS: We did a nationwide population-based cohort study in Finland using data from The Young Finns Study, which included 3467 participants aged 6-18 years followed up for over 30 years via eight repeated biomedical examinations and linkage to electronic health records. Participants were also linked to national grid data on neighbourhood disadvantage via their residential address from age 6-48 years. We used these data to examine differences in ten risk factors (dietary habits, physical activity, daily smoking, body-mass index, systolic blood pressure, fasting HDL cholesterol, fasting triglycerides, fasting plasma glucose, fasting serum insulin, and homoeostasis model assessment insulin sensitivity) from childhood (6-21 years) to adulthood (22-48 years) among individuals with high (>0·5 SD above the national mean) and low (≥0·5 SD below the national mean) neighbourhood socioeconomic disadvantage, and the association of cumulative neighbourhood socioeconomic disadvantage with six cardiometabolic risk factors (obesity, high waist circumference, fatty liver, hypertension, carotid plaque, and left ventricle mass index) and diabetes by middle age (22-48 years). We used logistic and linear regression analyses to assess the effects of neighbourhood disadvantage on cardiometabolic and diabetes risk, controlling for potential confounders (age, sex, and individual socioeconomic disadvantage). FINDINGS: We included data for 3002 individuals with risk factor assessment in childhood and adulthood. Of whom, 2048 underwent a clinical examination during the last follow-up at age 33-48 years. Differences in risk factors by neighbourhood socioeconomic disadvantage at the beginning of follow-up were small, but large differences emerged over the follow-up. High neighbourhood socioeconomic disadvantage was characterised by decreased fruit and vegetable intake as early as age 6 years, decreased physical activity, and increased prevalence of daily smoking from adolescence (12 years) onwards, and decreased homoeostasis model assessment insulin sensitivity and increased fasting glucose and insulin concentration from early adulthood (27 years; all p<0·03). Individuals consistently exposed to high neighbourhood socioeconomic disadvantage were more likely to be obese (odds ratio [OR] 1·44, 95% CI 1·01-2·06), hypertensive (1·83, 1·14-2·93), have a fatty liver (1·73, 1·11-2·71), and diabetes (3·71, 1·77-7·75), compared with those who were consistently exposed to low neighbourhood socioeconomic disadvantage. INTERPRETATION: Living in socioeconomically disadvantaged areas can shape health in childhood and adulthood. Neighbourhood socioeconomic disadvantage is associated with differences in health risks across the life course, including detrimental lifestyle factors from childhood and adolescence onwards and worse glucose metabolism from early adulthood. By middle age, cumulative neighbourhood socioeconomic disadvantage is associated with increased cardiometabolic risk factors and increased incidence of diabetes. FUNDING: Academy of Finland, NordForsk, UK Medical Research Council, European Commission, and European Research Council.


Assuntos
Diabetes Mellitus/epidemiologia , Áreas de Pobreza , Características de Residência/estatística & dados numéricos , Determinantes Sociais da Saúde , Adolescente , Adulto , Criança , Feminino , Finlândia/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Adulto Jovem
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