Pub Date : 2024-08-01DOI: 10.1016/S2666-7568(24)00116-8
Jiale Zhong MBBS , Yanbo Zhang PhD , Kai Zhu MBBS , Rui Li MS , Xiaotao Zhou MS , Pang Yao PhD , Prof Oscar H Franco , Prof JoAnn E Manson , Prof An Pan , Prof Gang Liu
<div><h3>Background</h3><p>Social determinants of health (SDHs) are the primary drivers of preventable health inequities, and the associations between SDHs and health outcomes among individuals with type 2 diabetes remain unclear. This study aimed to estimate the associations of combined SDHs with life expectancy and future health risks among adults with type 2 diabetes from the UK and USA.</p></div><div><h3>Methods</h3><p>In an analysis of two nationwide cohort studies, adults with type 2 diabetes were identified from the UK Biobank from March 13, 2006, to Oct 1, 2010 (adults aged 37–73 years) and the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 (adults aged ≥20 years). Participants with type 2 diabetes at baseline were included in our analysis. Participants without information on SDHs or follow-up were excluded. The UK Biobank assessed 17 SDHs and the US NHANES assessed ten SDHs, with each SDH dichotomised into advantaged and disadvantaged levels. The combined score of SDHs were calculated as the sum of the weighted scores for each SDH. Participants were then categorised into tertiles (favourable, medium, and unfavourable SDH groups). Primary outcomes were life expectancy and mortality in both cohorts, and incidences of cardiovascular disease, diabetes-related microvascular disease, dementia, and cancer in the UK Biobank. Outcomes were obtained from disease registries up until Dec 31, 2021, in the UK Biobank and Dec 31, 2019, in the US NHANES cohorts.</p></div><div><h3>Findings</h3><p>We included 17 321 participants from the UK Biobank cohort (median age 61·0 years [IQR 56·0–65·0]; 6028 [34·8%] women and 11 293 [65·2%] men) and 7885 participants from the NHANES cohort (mean age 59·2 years [95% CI 58·7–59·6]; 3835 [49·1%, weighted] women and 4050 [50·9%, weighted] men) in our analysis. In the UK Biobank, 3235 deaths (median follow-up 12·3 years [IQR 11·5–13·2]), 3010 incident cardiovascular disease (12·1 years [10·8–13·0]), 1997 diabetes-related microvascular disease (8·0 years [7·1–8·9]), 773 dementia (12·6 years [11·8–13·5]), and 2259 cancer cases (11·3 years [10·4–12·2]) were documented; and the US NHANES documented 2278 deaths during a median follow-up of 7·0 years (3·7–11·2). After multivariable adjustment, compared with the favourable SDH group, the hazard ratio was 1·33 (95% CI 1·21–1·46) in the medium SDH group and 1·89 (1·72–2·07) in the unfavourable SDH group in the UK Biobank cohort; 1·51 (1·34–1·70) in the medium SDH group and 2·02 (1·75–2·33) in the unfavourable SDH group in the US NHANES cohort for all-cause mortality; 1·13 (1·04–1·24) in the medium SDH group and 1·40 (1·27–1·53) in the unfavourable SDH group for incident cardiovascular disease; 1·13 (1·01–1·27) in the medium SDH group and 1·41 (1·26–1·59) in the unfavourable SDH group for incident diabetes-related microvascular disease; 1·35 (1·11–1·64) in the medium SDH group and 1·76 (1·46–2·13) in the unfavourable SDH group for incident dementi
{"title":"Associations of social determinants of health with life expectancy and future health risks among individuals with type 2 diabetes: two nationwide cohort studies in the UK and USA","authors":"Jiale Zhong MBBS , Yanbo Zhang PhD , Kai Zhu MBBS , Rui Li MS , Xiaotao Zhou MS , Pang Yao PhD , Prof Oscar H Franco , Prof JoAnn E Manson , Prof An Pan , Prof Gang Liu","doi":"10.1016/S2666-7568(24)00116-8","DOIUrl":"10.1016/S2666-7568(24)00116-8","url":null,"abstract":"<div><h3>Background</h3><p>Social determinants of health (SDHs) are the primary drivers of preventable health inequities, and the associations between SDHs and health outcomes among individuals with type 2 diabetes remain unclear. This study aimed to estimate the associations of combined SDHs with life expectancy and future health risks among adults with type 2 diabetes from the UK and USA.</p></div><div><h3>Methods</h3><p>In an analysis of two nationwide cohort studies, adults with type 2 diabetes were identified from the UK Biobank from March 13, 2006, to Oct 1, 2010 (adults aged 37–73 years) and the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 (adults aged ≥20 years). Participants with type 2 diabetes at baseline were included in our analysis. Participants without information on SDHs or follow-up were excluded. The UK Biobank assessed 17 SDHs and the US NHANES assessed ten SDHs, with each SDH dichotomised into advantaged and disadvantaged levels. The combined score of SDHs were calculated as the sum of the weighted scores for each SDH. Participants were then categorised into tertiles (favourable, medium, and unfavourable SDH groups). Primary outcomes were life expectancy and mortality in both cohorts, and incidences of cardiovascular disease, diabetes-related microvascular disease, dementia, and cancer in the UK Biobank. Outcomes were obtained from disease registries up until Dec 31, 2021, in the UK Biobank and Dec 31, 2019, in the US NHANES cohorts.</p></div><div><h3>Findings</h3><p>We included 17 321 participants from the UK Biobank cohort (median age 61·0 years [IQR 56·0–65·0]; 6028 [34·8%] women and 11 293 [65·2%] men) and 7885 participants from the NHANES cohort (mean age 59·2 years [95% CI 58·7–59·6]; 3835 [49·1%, weighted] women and 4050 [50·9%, weighted] men) in our analysis. In the UK Biobank, 3235 deaths (median follow-up 12·3 years [IQR 11·5–13·2]), 3010 incident cardiovascular disease (12·1 years [10·8–13·0]), 1997 diabetes-related microvascular disease (8·0 years [7·1–8·9]), 773 dementia (12·6 years [11·8–13·5]), and 2259 cancer cases (11·3 years [10·4–12·2]) were documented; and the US NHANES documented 2278 deaths during a median follow-up of 7·0 years (3·7–11·2). After multivariable adjustment, compared with the favourable SDH group, the hazard ratio was 1·33 (95% CI 1·21–1·46) in the medium SDH group and 1·89 (1·72–2·07) in the unfavourable SDH group in the UK Biobank cohort; 1·51 (1·34–1·70) in the medium SDH group and 2·02 (1·75–2·33) in the unfavourable SDH group in the US NHANES cohort for all-cause mortality; 1·13 (1·04–1·24) in the medium SDH group and 1·40 (1·27–1·53) in the unfavourable SDH group for incident cardiovascular disease; 1·13 (1·01–1·27) in the medium SDH group and 1·41 (1·26–1·59) in the unfavourable SDH group for incident diabetes-related microvascular disease; 1·35 (1·11–1·64) in the medium SDH group and 1·76 (1·46–2·13) in the unfavourable SDH group for incident dementi","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 8","pages":"Pages e542-e551"},"PeriodicalIF":13.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824001168/pdfft?md5=f9ff43c829a3536d2937180581e83a7e&pid=1-s2.0-S2666756824001168-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141898525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/S2666-7568(24)00112-0
Prof Ji Hye Heo MD , Han Na Jung MD , Prof Eun Roh MD , Prof Kyung-do Han PhD , Prof Jun Goo Kang MD , Prof Seong Jin Lee MD , Prof Sung-Hee Ihm MD
<div><h3>Background</h3><p>The association between remnant cholesterol (remnant-C) and cardiovascular disease risk is well established, but its association with dementia remains unclear. We aimed to examine this association using a large-scale population dataset.</p></div><div><h3>Methods</h3><p>We did a nationwide, population-based cohort study in which we identified participants aged 40 years and older who underwent the national health examination in 2009 from South Korea's National Health Insurance Service. We excluded people who were younger than 40 years and those with a triglyceride concentration of 400 mg/dL or higher due to concerns regarding the accuracy of calculated low-density lipoprotein cholesterol concentration in individuals with extremely high triglyceride concentrations. People who were previously diagnosed with dementia before the index date, and those who had any missing variables were also excluded. To minimise the influence of possible reverse causation, we excluded individuals who had developed any type of dementia within 1 year of the baseline measurements. We calculated hazard ratios (HRs) for all-cause dementia, Alzheimer's disease, and vascular dementia in each quartile of remnant-C using the Cox proportional hazards model adjusted for age, sex, body-mass index, estimated glomerular filtration rate, income level, smoking status, alcohol consumption, regular exercise, diabetes, hypertension, statin and fibrate use, and total cholesterol concentrations. We also did subgroup analyses to investigate the association between remnant-C and the risk of dementia stratified by age, sex, obesity, glycaemic status (normoglycaemia, impaired fasting glucose, new-onset type 2 diabetes, type 2 diabetes with a duration of less than 5 years, and type 2 diabetes with a duration of 5 years or more), hypertension, chronic kidney disease, and dyslipidaemia, using likelihood ratio tests.</p></div><div><h3>Findings</h3><p>4 234 415 individuals who underwent the national health examination in 2009 were deemed eligible for inclusion. We excluded 1 612 819 individuals on the basis of age, triglyceride concentration, missing variables, or having dementia at baseline. We identified 2 621 596 participants aged 40 years and older (1 305 556 men and 1 316 040 women) who underwent the national health examination and followed them up until the date of any incident of dementia or the end of the study period of Dec 31, 2020. During a median follow-up of 10·3 years (IQR 10·1–10·6), 146 991 (5·6%) participants developed all-cause dementia, 117 739 (4·5%) developed Alzheimer's disease, and 14 536 (0·6%) developed vascular dementia. The risk of dementia increased progressively with higher remnant-C concentrations. Compared with the lowest quartile of remnant-C (quartile 1), HRs in the highest quartile (quartile 4) were 1·11 (95% CI 1·09–1·13) for all-cause dementia, 1·11 (1·08–1·13) for Alzheimer's disease, and 1·15 (1·09–1·21) for vascular dementia. Subgroup
{"title":"Association of remnant cholesterol with risk of dementia: a nationwide population-based cohort study in South Korea","authors":"Prof Ji Hye Heo MD , Han Na Jung MD , Prof Eun Roh MD , Prof Kyung-do Han PhD , Prof Jun Goo Kang MD , Prof Seong Jin Lee MD , Prof Sung-Hee Ihm MD","doi":"10.1016/S2666-7568(24)00112-0","DOIUrl":"10.1016/S2666-7568(24)00112-0","url":null,"abstract":"<div><h3>Background</h3><p>The association between remnant cholesterol (remnant-C) and cardiovascular disease risk is well established, but its association with dementia remains unclear. We aimed to examine this association using a large-scale population dataset.</p></div><div><h3>Methods</h3><p>We did a nationwide, population-based cohort study in which we identified participants aged 40 years and older who underwent the national health examination in 2009 from South Korea's National Health Insurance Service. We excluded people who were younger than 40 years and those with a triglyceride concentration of 400 mg/dL or higher due to concerns regarding the accuracy of calculated low-density lipoprotein cholesterol concentration in individuals with extremely high triglyceride concentrations. People who were previously diagnosed with dementia before the index date, and those who had any missing variables were also excluded. To minimise the influence of possible reverse causation, we excluded individuals who had developed any type of dementia within 1 year of the baseline measurements. We calculated hazard ratios (HRs) for all-cause dementia, Alzheimer's disease, and vascular dementia in each quartile of remnant-C using the Cox proportional hazards model adjusted for age, sex, body-mass index, estimated glomerular filtration rate, income level, smoking status, alcohol consumption, regular exercise, diabetes, hypertension, statin and fibrate use, and total cholesterol concentrations. We also did subgroup analyses to investigate the association between remnant-C and the risk of dementia stratified by age, sex, obesity, glycaemic status (normoglycaemia, impaired fasting glucose, new-onset type 2 diabetes, type 2 diabetes with a duration of less than 5 years, and type 2 diabetes with a duration of 5 years or more), hypertension, chronic kidney disease, and dyslipidaemia, using likelihood ratio tests.</p></div><div><h3>Findings</h3><p>4 234 415 individuals who underwent the national health examination in 2009 were deemed eligible for inclusion. We excluded 1 612 819 individuals on the basis of age, triglyceride concentration, missing variables, or having dementia at baseline. We identified 2 621 596 participants aged 40 years and older (1 305 556 men and 1 316 040 women) who underwent the national health examination and followed them up until the date of any incident of dementia or the end of the study period of Dec 31, 2020. During a median follow-up of 10·3 years (IQR 10·1–10·6), 146 991 (5·6%) participants developed all-cause dementia, 117 739 (4·5%) developed Alzheimer's disease, and 14 536 (0·6%) developed vascular dementia. The risk of dementia increased progressively with higher remnant-C concentrations. Compared with the lowest quartile of remnant-C (quartile 1), HRs in the highest quartile (quartile 4) were 1·11 (95% CI 1·09–1·13) for all-cause dementia, 1·11 (1·08–1·13) for Alzheimer's disease, and 1·15 (1·09–1·21) for vascular dementia. Subgroup","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 8","pages":"Pages e524-e533"},"PeriodicalIF":13.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824001120/pdfft?md5=ffafe5c66083ae34bd4cbbec516f10d2&pid=1-s2.0-S2666756824001120-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/S2666-7568(24)00130-2
Jinkook Lee , Erik Meijer
{"title":"Different reasonable methodological choices can lead to vastly different estimates of the economic burden of diseases","authors":"Jinkook Lee , Erik Meijer","doi":"10.1016/S2666-7568(24)00130-2","DOIUrl":"10.1016/S2666-7568(24)00130-2","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 8","pages":"Pages e504-e505"},"PeriodicalIF":13.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824001302/pdfft?md5=eba7dfb7428c1b574ce1713a8f8887c2&pid=1-s2.0-S2666756824001302-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/S2666-7568(24)00133-8
Nil Saez-Calveras , Makoto Ishii
{"title":"More than simply leftovers: a new link between remnant cholesterol and dementia","authors":"Nil Saez-Calveras , Makoto Ishii","doi":"10.1016/S2666-7568(24)00133-8","DOIUrl":"10.1016/S2666-7568(24)00133-8","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 8","pages":"Pages e506-e507"},"PeriodicalIF":13.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824001338/pdfft?md5=2f0f091f6a869cfc16afde190bf27303&pid=1-s2.0-S2666756824001338-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141789345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1016/S2666-7568(24)00114-4
Roxanna Short PhD , Prof Ben Carter PhD , Alessia Verduri PhD , Eleanor Barton MBBS , Prof Nick Maskell PhD , Jonathan Hewitt MBBS
Background
Pleural disease is common, representing 5% of the acute medical workload, and its incidence is rising, partly due to the ageing population. Frailty is an important feature and little is known about disease progression in patients with frailty and pleural disease. We aimed to examine the effect of frailty on mortality and other relevant outcomes in patients diagnosed with pleural disease.
Methods
In this cohort study in Wales, the national Secure Anonymised Information Linkage databank was used to identify a cohort of individuals diagnosed with non-malignant pleural disease between Jan 1, 2005, and March 1, 2023, who were not known to have left Wales. Frailty was assessed at diagnosis of pleural disease using an electronic Frailty Index. The primary outcome was time from diagnosis to all-cause mortality for all patients. Data were analysed using multilevel mixed-effects Cox proportional hazards regression adjusting for the prespecified covariates of age, sex, Welsh Index of Multiple Deprivation quintile, smoking status, comorbidity, and subtype of pleural disease.
Findings
54 566 individuals were included in the final sample (median age 66 years [IQR 47–77]; 26 477 [48·5%] were female and 28 089 [51·5%] were male). By the end of the study period, 25 698 (47·1%) participants had died, with a median follow-up of 1·0 years (IQR 0·2–3·6). There was an association between frailty and all-cause mortality, which increased as frailty worsened. Compared with fit individuals, there was increasing mortality for those with mild frailty (adjusted hazard ratio 1·11 [95% CI 1·08–1·15]; p<0·0001), moderate frailty (1·25 [1·20–1·31]; p<0·0001), and severe frailty (1·36 [1·28–1·44]; p<0·0001).
Interpretation
Independent of age and comorbidities, frailty status at diagnosis of pleural disease appeared to be useful as a prognostic indicator. Patients with moderate or severe frailty had a rapid decline in health. Future patients should be assessed for frailty at the time of diagnosis of pleural disease and might benefit from optimised care and advance care planning.
{"title":"The effect of frailty on mortality and hospital admission in patients with benign pleural disease in Wales: a cohort study","authors":"Roxanna Short PhD , Prof Ben Carter PhD , Alessia Verduri PhD , Eleanor Barton MBBS , Prof Nick Maskell PhD , Jonathan Hewitt MBBS","doi":"10.1016/S2666-7568(24)00114-4","DOIUrl":"10.1016/S2666-7568(24)00114-4","url":null,"abstract":"<div><h3>Background</h3><p>Pleural disease is common, representing 5% of the acute medical workload, and its incidence is rising, partly due to the ageing population. Frailty is an important feature and little is known about disease progression in patients with frailty and pleural disease. We aimed to examine the effect of frailty on mortality and other relevant outcomes in patients diagnosed with pleural disease.</p></div><div><h3>Methods</h3><p>In this cohort study in Wales, the national Secure Anonymised Information Linkage databank was used to identify a cohort of individuals diagnosed with non-malignant pleural disease between Jan 1, 2005, and March 1, 2023, who were not known to have left Wales. Frailty was assessed at diagnosis of pleural disease using an electronic Frailty Index. The primary outcome was time from diagnosis to all-cause mortality for all patients. Data were analysed using multilevel mixed-effects Cox proportional hazards regression adjusting for the prespecified covariates of age, sex, Welsh Index of Multiple Deprivation quintile, smoking status, comorbidity, and subtype of pleural disease.</p></div><div><h3>Findings</h3><p>54 566 individuals were included in the final sample (median age 66 years [IQR 47–77]; 26 477 [48·5%] were female and 28 089 [51·5%] were male). By the end of the study period, 25 698 (47·1%) participants had died, with a median follow-up of 1·0 years (IQR 0·2–3·6). There was an association between frailty and all-cause mortality, which increased as frailty worsened. Compared with fit individuals, there was increasing mortality for those with mild frailty (adjusted hazard ratio 1·11 [95% CI 1·08–1·15]; p<0·0001), moderate frailty (1·25 [1·20–1·31]; p<0·0001), and severe frailty (1·36 [1·28–1·44]; p<0·0001).</p></div><div><h3>Interpretation</h3><p>Independent of age and comorbidities, frailty status at diagnosis of pleural disease appeared to be useful as a prognostic indicator. Patients with moderate or severe frailty had a rapid decline in health. Future patients should be assessed for frailty at the time of diagnosis of pleural disease and might benefit from optimised care and advance care planning.</p></div><div><h3>Funding</h3><p>Cardiff University’s Wellcome Trust iTPA funding award.</p></div>","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 8","pages":"Pages e534-e541"},"PeriodicalIF":13.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824001144/pdfft?md5=2f401def887dd9f7d9c22595ef2fda05&pid=1-s2.0-S2666756824001144-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/S2666-7568(24)00113-2
Sophie Raeder
{"title":"Highlights of the 2024 Annual Scientific Meeting of the American Geriatrics Society","authors":"Sophie Raeder","doi":"10.1016/S2666-7568(24)00113-2","DOIUrl":"10.1016/S2666-7568(24)00113-2","url":null,"abstract":"","PeriodicalId":34394,"journal":{"name":"Lancet Healthy Longevity","volume":"5 7","pages":"Page e453"},"PeriodicalIF":13.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666756824001132/pdfft?md5=2bd40a251846d8639c8c7bf2b622459c&pid=1-s2.0-S2666756824001132-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141471220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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