Preventive medicine
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Preventive medicine · Jun 2021
Aspirin prescribing for cardiovascular disease in middle-aged and older adults in Ireland: Findings from the Irish longitudinal study on ageing.
Aspirin use for cardiovascular indications is widespread despite evidence not supporting use in patients without cardiovascular disease (CVD). This study characterises aspirin prescribing among people aged ≥50 years in Ireland for primary and secondary prevention, and factors associated with prescription. This cross-sectional study includes participants from wave 3 (2014-2015) of The Irish Longitudinal Study on Ageing. ⋯ Among those without CVD, older age, male sex, free health care, and more GP visits were associated with aspirin prescribing. Cardiovascular risk was significantly associated with aspirin use (adjusted relative risk 1.15, 95%CI 1.08-1.23, per 1% increase in cardiovascular risk). Almost four-fifths of people aged ≥50 years on aspirin have no previous CVD, equivalent to 201,000 adults nationally, however prescribing appears to target higher cardiovascular risk patients.
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Preventive medicine · Jun 2021
A cross-sectional and longitudinal study of neighbourhood disadvantage and cardiovascular disease and the mediating role of physical activity.
We investigate the prospective association between neighbourhood-level disadvantage and cardiovascular disease (CVD) among mid-to-older aged adults and whether physical activity (PA) mediates this association. The data come from the HABITAT project, a multilevel longitudinal investigation of health and wellbeing in Brisbane. The participants were 11,035 residents of 200 neighbourhoods in 2007, with follow-up data collected in 2009, 2011, 2013 and 2016. ⋯ Mediation analysis results revealed that 11.5% of the effect of neighbourhood disadvantage on CVD occurs indirectly through PA in the most disadvantaged neighbourhoods while the corresponding figure is 5.2% in the more advantaged areas. Key findings showed that neighbourhood disadvantage is associated with the incidence of CVD, and PA is a significant mediator of this relationship. Future research should investigate which specific social and built environment features promote or inhibit PA in disadvantaged areas as the basis for policy initiatives to address inequities in CVD.
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Preventive medicine · Jun 2021
Influence of chronic comorbidities on periodic colorectal cancer screening participation: A population-based cohort study.
Guidelines recommend regular screening for colorectal cancer (CRC). We examined the effects of chronic comorbidities on periodic CRC testing. Using linked healthcare databases from Ontario, Canada, we assembled a population-based cohort of 50-74-year olds overdue for guideline-recommended CRC screening between April 1, 2004 and March 31, 2016. ⋯ Having both medical and mental comorbidities was associated with lower testing rates than either type of comorbidity alone (HR 0.72, CI 0.71 to 0.72). In summary, chronic comorbidities present a barrier to periodic guideline-recommended CRC testing. Exploration of cancer prevention gaps in these populations is warranted.
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Preventive medicine · Jun 2021
Pre-and postnatal maternal smoking and offspring smoking trajectories: Evidence from a 20-year birth cohort.
Maternal smoking is associated with increased risk of smoking in the offspring. However, it remains unclear whether this association depends on the timing of exposure to maternal smoking. We investigated the association between prenatal and/or postnatal maternal smoking and offspring smoking during adolescence. ⋯ We also found that only youth whose mothers were persistent smokers had an increased risk of late-onset smoking. Regardless of timing, offspring exposure to maternal smoking is associated with increased risk of smoking during adolescence. More research is needed on how to create effective smoking cessation campaigns that span preconception, prenatal, and postnatal periods to help prevent intergenerational transmission of smoking behaviors.
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Preventive medicine · Jun 2021
Temporal changes in allostatic load patterns by age, race/ethnicity, and gender among the US adult population; 1988-2018.
The objective of this study is to provide an assessment of allostatic load (AL) burden among US adults across race/ethnicity, gender, and age groups over a 30-year time period. We analyzed data from 50,671 participants of the National Health and Nutrition Examination Survey (NHANES) years 1988 through 2018. AL score was defined as the sum total for abnormal measures of the following components: serum albumin, body mass index, serum C - reactive protein, serum creatinine, diastolic blood pressure, glycated hemoglobin, systolic blood pressure, total cholesterol, and serum triglycerides. ⋯ Age-adjusted mean AL score among NH-Black and Latinx adults was higher than for NH-Whites of up to a decade older regardless of gender. From 1988 through 2018, Adults aged 40 years old and older had over 2-fold increased risks of high AL when compared to adults 18-29 years old. After 30-years of collective data, racial disparities in allostatic load persist for NH-Black and Latinx adults.