Impaired fecundity as a marker of health and survival: a Danish twin cohort study.

STUDY QUESTION: Is fecundity, measured as self-reported time to first pregnancy (TTP), a marker for subsequent health and survival? SUMMARY ANSWER: Long TTP was a marker for increased mortality among women and higher hospitalization rates for both women and men. WHAT IS KNOWN ALREADY: Poor semen quality has been linked to increased mortality and morbidity from a wide range of diseases. Associations among fecundity, health and survival among women are still uncertain and studies on actual measures of fecundity and health outcomes are rare. STUDY DESIGN, SIZE, DURATION: We performed a prospective cohort study of 7825 women and 6279 men, aged 18 and above with measures on first TTP, who participated in one of the Danish nation-wide twin surveys in 1994 (twins born 1953-1976) and 1998 (twins born 1931-1952). They were followed-up for mortality and hospital admissions from the interview until 2018. PARTICIPANTS/MATERIALS, SETTING, METHODS: Twins were identified in the Danish Twin Registry and linked to Danish registers. TTP was restricted to the first pregnancy as a categorical outcome with cut-off points at 2, 10 and 18 months. We analysed the association between TTP and survival using a Cox proportional hazards model estimating hazards ratios (HRs) with 95% confidence intervals (CIs). Fine-Gray survival models were used to estimate sub-hazard ratios for specific causes of death allowing for competing risks. Using negative binomial regression, we estimated incidence rate ratios (IRRs) with 95% CIs for all-cause and cause-specific hospitalizations. All analyses were stratified by sex and adjusted for age at interview, birth cohorts, age at first attempt to become pregnant, smoking, years in school and BMI. MAIN RESULTS AND THE ROLE OF CHANCE: In the total study population, 49.9% of women and 52.7% of men reported a TTP of less than 2 months, 30.8% of women and 29.6% of men reported a TTP of 2-9 months, 6.6% of women and 5.7% of men reported a TTP of 10-17 months, and 13.3% of women and 12.0% of men reported a TTP of 18 months or more. Among 1305 deaths, we found a higher mortality for women (HR = 1.46; 95% CI 1.15, 1.87) with a TTP of ≥18 months relative to those with a TTP of <2 months, while the highest mortality was indicated for men with a TTP of 10-17 months (HR = 1.31; 95% CI 0.98, 1.74). Among 53 799 hospitalizations, we found an increased hospitalization rate among women (HR = 1.21; 95% CI 1.0-1.41) and men (HR = 1.16; 95% CI 1.00-1.35) with a TTP of ≥18 months, and for men with a TTP of 2-9 months (HR = 1.14; 95% CI 1.01-1.30). A dose-response relationship was found for women regarding both mortality (P = 0.022) and hospitalizations (P = 0.018). Impaired fecundity was associated with a wide range of diseases and some causes of death, indicating a multi-factorial causal influence on fecundity, especially among women. LIMITATIONS, REASONS FOR CAUTION: A major limitation was that fecundity depends on both partners, which was not considered in this study. Moreover, we could not obtain information on a number of potential confounders. WIDER IMPLICATIONS OF THE FINDINGS: Fecundity seems positively correlated with overall health and may be a universal marker of future health and survival. These results add knowledge to the limited findings showing that reduced fecundity in women and poor semen quality in men may reflect worse health and a shorter life, particularly among women. STUDY FUNDING/COMPETING INTEREST(S): This study was funded by NIH grant HD096468 (M.L.E., T.K.J. and R.L.J.). The authors declare that they have no competing interests. TRIAL REGISTRATION NUMBER: N/A.

Religiousness and depressive symptoms in Europeans: findings from the Survey of Health, Ageing, and Retirement in Europe.

OBJECTIVE: Religiousness has been found to protect against depression based on studies conducted in the United States, though there are limited data in the European population. We sought to evaluate the associations between religiousness and six depressive symptoms in Europeans aged 50+ years. STUDY DESIGN: Longitudinal study. METHODS: Our sample consisted of participants (n = 23,864) in wave 1 (2004-05) of the Survey of Health, Ageing, and Retirement in Europe who were followed up in waves 2-6 (2006-07 to 2015). Analyses were conducted using multivariable logistic regression. RESULTS: Higher frequency of prayer was associated with lower odds of having no hopes for the future (odds ratio [OR] = 0.89, 95% confidence interval [CI]: 0.81-0.99) and of suicidal thoughts (OR = 0.84, 95% CI: 0.72-0.97). Attending religious service was associated with lower odds of having no hopes for the future (OR = 0.74, 95% CI: 0.67-0.83), of suicidal thoughts (OR = 0.69, 95% CI: 0.59-0.81), difficulty in concentration (OR = 0.80, 95% CI: 0.72-0.88), irritability (OR = 0.77, 95% CI: 0.71-0.85), fatigue (OR = 0.84, 95% CI: 0.78-0.91), and having no enjoyable activity (OR = 0.84, 95% CI: 0.76-0.94). Religious education was associated with lower odds of not having engaged in any enjoyable activities lately (OR = 0.86, 95% CI: 0.78-0.95). Restful religiousness was associated with lower odds of experiencing suicidal thoughts, of having been irritable recently, and of having experienced fatigue in the last month, compared with crisis religiousness. Crisis religiousness was associated with higher odds of having been irritable recently and of having experienced fatigue in the last month compared with non-religiousness. CONCLUSIONS: Our findings suggest that religiousness is associated with lower odds of depressive symptoms, particularly for those who attend religious service.

Religiousness and Diseases in Europe: Findings from SHARE.

Recent research in religiousness and health suggests that epidemiological forces can have opposed effects. Here we examine two forms of religiousness and their association with disease. We performed a cross-sectional study of 23,864 people aged 50+ included in wave 1 (2004-2005) of the Survey of Health, Ageing and Retirement in Europe and a longitudinal study including people from wave 1, who were followed up during 11 years. Results suggested that taking part in a religious organization was associated with lower odds of heart attack (OR 0.74, 95% CI 0.60, 0.90), stroke (OR 0.68, 95% CI 0.50, 0.95), and diabetes (OR 0.72, 95% CI 0.58, 0.90) and longitudinally associated with lower odds of cancer (OR 0.78, 95% CI 0.60, 1.00). Conversely, praying was longitudinally associated with higher odds of heart attack (OR 1.27, 95% CI 1.10, 1.48) and high cholesterol (OR 1.12, 95% CI 1.00, 1.26). The most religious people had lower odds of stroke, diabetes, and cancer than other respondents, and in the longitudinal model, people who only prayed had higher odds of heart attack than non-religious people. Our findings lend support to the hypothesis that restful religiousness (praying, taking part in a religious organization, and being religiously educated) was associated with lower odds of some diseases, whereas little evidence was present that crisis religiousness (praying only) was associated with higher odds of disease.

Religiousness and lifestyle among Europeans in SHARE.

OBJECTIVES: Religiousness is associated with longevity and better physical health, which may be due to lifestyle choices. Here, we examine associations between religiousness and health, explained by lifestyle. STUDY DESIGN: This is a longitudinal study. METHODS: Data came from 23,864 people aged 50 and above included in the Survey of Health, Ageing and Retirement in Europe in 2004-2005 and followed up during 11 years. RESULTS: Praying and taking part in a religious organization were associated with lower odds of smoking [odds ratio (OR) = 0.82, 95% confidence interval (CI): 0.73, 0.92 and 0.61, 95% CI: 0.53, 0.70], alcohol consumption (OR = 0.71, 95% CI: 0.64, 0.78 and OR = 0.76, 95% CI: 0.67, 0.85), physical inactivity (OR = 0.88, 95% CI: 0.79, 0.98 and OR = 0.54, 95% CI: 0.48, 0.61), and doing no vigorous physical activity (OR = 0.92, 95% CI: 0.85, 0.98 and OR = 0.63, 95% CI: 0.58, 0.68). Furthermore, religious organizational involvement lowered the odds of sleep problems (OR = 0.83, 95% CI: 0.76, 0.91), whereas being religiously educated lowered the odds of high body weight (OR = 0.87, 95% CI: 0.79, 0.96). The more religious (people who prayed, took part in a religious organization and were religiously educated) had lower odds of smoking, alcohol consumption, physical inactivity, and sleep problems than other respondents, and compared with people who only prayed, they had lower odds of smoking, physical inactivity, and sleep problems. People who only prayed had lower odds of alcohol consumption but higher odds of sleep problems than the non-religious. CONCLUSIONS: This study confirms that the positive relations between religiousness and health to an important degree can be explained by lifestyle.