Preventive medicine最新文献

Objective: Dementia has a large public health burden, and modifiable risk factors, particularly in midlife, may provide an opportunity for early prevention. We aimed to examine trends in age-adjusted prevalence of modifiable risk factors for dementia and the number of modifiable risk factors among midlife adults from 1999 to 2018.

Methods: A total of 14,851 participants aged 40 to 64 years without a history of cardiovascular disease in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 were included in the analysis. The age-adjusted prevalence of six modifiable risk factors consistently measured across all surveys, including hypertension, diabetes, hyperlipidemia, obesity, smoking, and heavy drinking, as well as the average number of these modifiable risk factors, were estimated and compared across survey periods. Subgroup analyses were conducted by sex, race/ethnicity, education, and family income.

Results: The age-adjusted prevalence of diabetes (p for linear trend <0.0001) and obesity (p for linear trend = 0.0001) showed increasing trends from 1999 to 2018 among midlife adults in the U.S. and in virtually all subgroups, while smoking showed a decreasing trend (p for linear trend <0.0001). The average number of modifiable risk factors remained around two (p for linear trend = 0.84).

Conclusion: The prevalence of diabetes and obesity increased in this large, nationally representative U.S. study population, while the prevalence of smoking decreased. More effective public health interventions are needed to mitigate the impact of these risk factors and ultimately reduce the burden of dementia in aging populations.

Objective: This study aimed to explore the associations between short-term air pollution exposure and acute exacerbation of chronic bronchitis (AECB).

Methods: AECB data were collected from hospital surveillance systems in Shanghai, China, during 2018-2022. Exposure pollution data were obtained from China high resolution high quality near-surface air pollution datasets and assigned to individuals based on their residential addresses. The time-stratified case crossover design combined with the conditional logistic regression model were used to estimate the associations between air pollution and AECB. Weighted quantile sum regression evaluated combined pollution effects and key pollutants.

Results: A total of 2202 hospitalized cases with AECB were included. On day 7 of the average lag (lag 07-day), the odds ratios (OR) of air pollution (Particulate matter with aerodynamic diameters of ≤2.5 μm (PM_2.5), 2.5-10 μm (PM_2.5-10), and ≤ 10 μm (PM₁₀), Ozone (O₃), Sulfur dioxide (SO₂), Nitrogen dioxide (NO₂)) with AECB increased by 10 μg/m³ were 1.07 (95 % confidence interval (CI): 1.02-1.12), 1.13 (1.06, 1.21), 1.06 (1.03-1.09), 1.03 (1.01-1.06), 2.05 (1.51-2.80) and 1.11 (1.05-1.18), respectively. Combined exposure was also positively associated with the risk of AECB (OR 1.04, 95 % CI 1.00-1.08), with O₃ being the most significant.

Conclusions: This study demonstrates that short-term exposure to air pollution was significantly associated with higher risk of AECB. O₃ might contribute the most to AECB. Policymakers should pay more attention to air pollution control.

Objective: Poor self-rated health (SRH) and physical frailty are both significant predictors of disability in older adults, but their joint association on health outcomes remain unclear. This study aimed to examine the relationship between SRH, physical frailty, and incidence of disability among community-dwelling older adults.

Methods: This longitudinal cohort study included 2838 older adults aged 65 years or older (mean age, 73.1 ± 5.9 years) living in Takahama, Japan, who participated in the baseline assessment from September 2015 to February 2017. Participants were followed prospectively until June 2021. SRH was assessed on a four-point scale, and frailty was evaluated using the Japanese version of the Cardiovascular Health Study criteria. Participants were categorized into four groups based on SRH (Good or Poor) and frailty status (Robust or Frail). Cox proportional hazard models were used to assess the association between these categories and the incidence of disability over a 5-year follow-up.

Results: During the median follow-up of 60 months, 349 of the 2838 participants developed a disability. The risk of disability was significantly higher in the Poor/Robust (HR 1.64, 95 % CI 1.20-2.25), Good/Frail (HR 2.58, 95 % CI 1.91-3.49), and Poor/Frail (HR 2.03, 95 % CI 1.37-3.01) groups than in the Good/Robust reference group.

Conclusions: Frail older adults who report good health were associated with the risk of disability, suggesting that discrepancies between subjective and objective health assessments may lead to adverse outcomes. Recognizing and addressing these discrepancies is crucial to promote successful aging.

Objective: Physical activity has protective effects on cardiometabolic diseases (CMDs), but the role of metabolism related to physical activity in this process is unclear.

Methods: In the prospective cohort study from UK Biobank between 2006 and 2022, participants free of CMDs at baseline were included (n = 73,990). We identified physical activity-related metabolites and constructed metabolic signature using linear regression and elastic net regression. Association between physical activity, metabolic signature, and CMDs (type 2 diabetes [T2D], coronary heart disease [CHD], and stroke) were explored using Cox and mediation analyses. Interactions between the metabolic signature and genetic susceptibility (categorized into "low" and "high" based on the median of polygenic risk scores) were assessed by additive hazard models and relative excess risk due to interaction (RERI). Multi-state models evaluated the association between metabolic signature and disease progression.

Results: We found 58 metabolites were related to physical activity, of which 17 were used to construct metabolic signature. The metabolic signature was associated with reduced risk of T2D (HR = 0.13[0.10-0.16]), CHD (HR = 0.40[0.34-0.47]), and stroke (HR = 0.67[0.53-0.86]), and mediated 40.56 % of the association between physical activity and T2D. The metabolic signature exhibited additive interactions with genetic risk for T2D (RERI = 1.57[1.09-2.05]) and CHD (RERI = 0.27[0.05-0.49]). Finally, the metabolic signature was associated with a reduced risk of transition from CMD to CMM (HR = 0.58[0.42-0.81]).

Conclusion: Physical activity-related metabolic signature is linked to reduced risks of CMDs and CMM. We once again emphasize the importance of physical activity for CMDs prevention from a metabolic perspective, especially for individuals at high genetic risk.

Introduction: Changes in up-to-date cervical cancer screening (CCS) over time by sexual orientation and race/ethnicity were estimated to identify trends in screening disparities.

Methods: This 2024 retrospective, cross-sectional analysis of National Health Interview Survey data (years 2013, 2015, 2019 and 2021) included 40,818 cisgender women aged 21-65 without hysterectomy. Joinpoint analysis was performed to calculate the annual percent change (APC) of up-to-date CCS from 2013 to 2021. Logistic regression (years 2019 and 2021) was used to describe the relationship between up-to-date screening and sexual orientation, race/ethnicity, and the interaction thereof.

Results: The adjusted odds of up-to-date CCS were 22 % lower for lesbian, gay, and/or bisexual (LGB) compared to heterosexual women (OR = 0.78, p = 0.01). Up-to-date CCS fell significantly from 80.50 % in 2013 to 75.00 % in 2021 for heterosexual respondents (APC = -0.97 %, p < 0.01), but was stable across years for LGB respondents. Up-to-date CCS decreased for Hispanic (APC = -1.52, p < 01) and non-Hispanic White only heterosexual women (APC = -0.63, p = 0.02). It also decreased for non-Hispanic Black/African American only LGB women (APC = -2.67, p < 0.01) falling from 85.22 % in 2013 to 67.91 % in 2021. By multiplicative interaction, LGB Hispanic women were more up-to-date than their heterosexual counterparts (p = 0.05).

Conclusions: In 2021 there were approximately 19.72 million women aged 21-65 who were not up-to-date with CCS. 1.76 million LGB women were not up-to-date for CCS, and a greater proportion of these women identified as non-Hispanic Black/African American. CCS must be improved for all cisgender women, and specific attention should be given to those who identify as LGB and/or Black/African American.

Objective: Differing from the overall consumption of alcohol, whether consuming large quantities of alcohol per drinking occasion is associated with higher risk of developing severe diabetic retinopathy remains unknown.

Methods: We examined whether the quantity per drinking occasion (QPO), including a large QPO, and the combinations of the frequency of alcohol consumption (FAC) and QPO were associated with higher risk of developing severe diabetic retinopathy or diabetic macular edema (DME) using adjusted Cox models. Severe diabetic retinopathy or DME was designated as a vision-threatening treatment-required diabetic eye disease (TRDED). For each man with type 2 diabetes who participated in this longitudinal retrospective cohort study, the date of the earliest health check-up during the inclusion period (April 2008 to August 2016) was set as the start date of follow-up.

Results: A TRDED was observed in 425 of 21,392 Japanese men aged 22-74 years with type 2 diabetes during a mean follow-up of 4.3 years (4.6/1000 person-years). Multivariable Cox analysis showed that a large QPO, defined as drinking three drinks or more per occasion, in low- (hazard ratio [HR], 4.76; 95 % CI, 2.06-10.97), intermediate- (HR, 1.58; 95 %CI, 1.001-2.50), and high-frequency categories (HR, 2.01; 95 % CI, 1.20-3.36) was significantly associated with elevated risks of TRDED.

Conclusions: In addition to the total amount of ethanol, these findings imply the necessity of avoiding the consumption of large amounts of alcohol on a single occasion to prevent severe diabetic retinopathy or DME.

Objective: The purpose of this cross-sectional analysis is to compare the degree to which adolescents and adults with and without impairments in the US engage in illicit drug use.

Methods: This cross-sectional study utilized data from the 2022 National Survey of Drug Use and Health. Impairment status (mobility, cognitive, hearing, vision, self-care, and communication impairments), illicit drug use (cocaine, crack, heroin, hallucinogens, LSD, ecstasy and molly, inhalants, and methamphetamine), and demographic variables were measured using self-report. Weighted prevalence estimates for illicit drug use across each category were provided. Group differences in drug prevalence between individuals with and without impairments were examined, then logistic regressions estimated crude and adjusted odds of drug use among impairment groups by age. Prevalence of use and age of first time use for illicit drugs were explored across impairment type.

Results: The sample comprised of 35,921 individuals, with an estimate of 12.9 % experiencing at least one impairment. Among emerging adults, hallucinogens were the highest reported used drug in the past year, with a significantly higher percentage of those with impairments (12.8 %, 95 % CI: 1.5, 9.6), compared to adults without impairments (7.1 %, 95 % CI: 6.3, 8.0), reporting recent use. Individuals with impairments (mean = 16.2 years) were significantly younger when they first tried an illicit drug compared to peers (mean = 18.1 years).

Conclusions: Overall, individuals with impairments were more than twice as likely to engage in illicit drug use compared to counterparts. People with impairments were younger, on average, when they first tried any illicit drugs.

Objective: To examine associations between passive exposure to opioid crisis information and public attitudes toward opioid use disorder (OUD) policies and stigma among United States (US) adults.

Methods: A nationally representative survey of 6543 US adults was conducted from December 2023 to January 2024. Participants reported passive exposure to opioid crisis information from various sources. Outcome measures included preferences for national and local harm-reduction policies, discriminatory practices, carceral approaches, and OUD stigma. Multivariable regression analyses were performed, controlling for demographic factors.

Results: Over half (n = 3863, 59.4 %) of participants reported passive exposure to opioid crisis information. Exposure from medical professionals (b = 0.143, p = 0.001), family/friends (b = 0.118, p = 0.013), print media (b = 0.135, p = 0.019), and web searches (b = 0.164, p = 0.002) was associated with increased support for local harm-reduction policies. Social media exposure was negatively associated with support for discriminatory practices (b = -0.101, p = 0.043). Exposure from medical professionals was negatively associated with OUD stigma (b = -0.090, p = 0.014). No significant associations were found between information exposure and support for national harm-reduction policies or carceral approaches.

Conclusions: Despite widespread media coverage of the opioid crisis, passive information exposure was only associated with increased support for local, not national, harm-reduction policies. The modest exposure rate (59.4 %) suggests an attention gap between information availability and public engagement. The differential effectiveness of information channels suggests that communication strategies emphasizing community-level initiatives and leveraging specific sources like healthcare providers and interpersonal networks may be particularly important for building public support for evidence-based OUD prevention policies.

Introduction: Recent studies suggest that ambient air pollution may contribute to osteoporosis; however, research focusing on populations with greater susceptibility is lacking. This study seeks to explore the association between air pollution and osteoporosis focusing on cancer survivors.

Materials and methods: We analyzed data from 8977 individuals (2245 cancer survivors, 6732 cancer-free population) obtained from the Korea National Health and Nutrition Examination Survey (KNHANES) during 2007-2009 and 2015-2021. Air pollution exposures to PM₁₀, PM_2.5, SO₂, NO₂, and CO were estimated using air quality models and satellite data. Moving average concentrations over 1-3 years prior to the survey were calculated. Logistic regression models adjusting for demographic and lifestyle factors were used to assess the association between air pollution and osteoporosis status. Analyses were stratified by cancer survivorship status and sex.

Results: Among cancer survivors, particularly female cancer survivors, higher long-term exposure to air pollutants was associated with greater odds of osteoporosis. Cancer survivors exposed to higher PM₁₀ over 1-, 2-, and 3-year periods had greater odds of osteoporosis (all p < 0.05). In female cancer survivors, 1-year exposure to PM_2.5 was associated with 25 % higher odds of osteoporosis (OR = 1.25, 95 % CI = 1.02-1.54), and NO₂ exposure showed a similar association (OR = 1.42; 95 % CI = 1.06-1.90). These associations were not observed in the individuals without cancer history.

Conclusion: The association between air pollution and osteoporosis was observed in cancer survivors, especially among female cancer survivors. Our findings emphasize the need for targeted interventions for at-risk populations such as cancer survivors.

Introduction: While preventive healthcare guidelines recommend that pregnant women or those planning pregnancy engage in preventive care and maintain healthy lifestyles, it is unknown whether women engage in these activities before conception. We examined the association between maternal status and participation in preventive health checks and healthy lifestyle practices.

Methods: We included 4447 women from 1989 to 95 cohort of Australian Longitudinal Study on Women's Health, categorised into three groups: pregnant women, women in preconception period, and women who were neither pregnant nor trying to become pregnant between surveys one to six. Generalised estimating equation was used for analyses.

Results: At the sixth survey when women were aged 24-29, 7 % and 32 % of women in the preconception period did not have their blood pressure and weight checked, respectively. Concerning healthy lifestyles during preconception period, 37 % of women did not meet the minimum physical activity guidelines; 64 % and 85 % of women, respectively, did not meet the recommended serves of fruits and vegetables; 92 % consumed any level of alcohol; and 31 % tried other illicit drugs. Women in the preconception period were more likely to have their weight checked (OR 1.83; CI 1.39, 2.41) and to abstain from using illicit drugs (OR 1.12; CI 1.01, 1.26) than other women who were not trying to become pregnant.

Conclusions: There were no differences in most behaviours between women in preconception period and in other women who were not pregnant. More awareness of preconception health is required to encourage women to engage in preventive activities.