[Show abstract][Hide abstract] ABSTRACT: Background:
Patients with low socioeconomic position have higher rates of mortality after diagnosis of acute coronary syndrome (ACS), but little is known about the mechanisms behind this social inequality. The aim of the present study was to examine whether any educational inequality in survival after ACS was influenced by comorbid conditions including depression.
From 2001 to 2009 all first-time ACS patients were identified in the Danish National Patient Registry. This cohort of 83 062 ACS patients and a matched reference population were followed for incident depression and mortality until December 2012 by linkage to person, patients and prescription registries. Educational status was defined at study entry and the impact of potential confounders and mediators (age, gender, cohabitation status, somatic comorbidity and depression) on the relation between education and mortality were identified by drawing a directed acyclic graph and analysed using multiple Cox regression analyses.
During follow-up, 29 583(35.6%) of ACS patients and 19 105(22.9%) of the reference population died. Cox regression analyses showed an increased mortality in the lowest educated compared to those with high education in both ACS patients and the reference population. Adjustment for previous and incident depression or other covariables only attenuated the relations slightly. This pattern of associations was seen for mortality after 30 days, 1 year and during total follow-up.
In this study the relative excess mortality rate in lower educated ACS patients was comparable with the excess risk associated with low education in the background population. This educational inequality in survival remained after adjustment for somatic comorbidity and depression.
PLoS ONE 10/2015; 10(10):e0141598. DOI:10.1371/journal.pone.0141598 · 3.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Mitochondrial bioenergetics, mitochondrial reactive oxygen species (ROS) and cellular levels of nucleotides have been hypothesized as early indicators of Alzheimer's disease (AD). Utilizing relative decline of cognitive ability as a predictor of AD risk, we evaluated the correlation between change of cognitive ability and mitochondrial bioenergetics, ROS and cellular levels of deoxyribonucleotides. Change of cognitive abilities, scored at ages of approximately 20 and 57 was determined for a cohort of 1985 male participants. Mitochondrial bioenergetics, mitochondrial ROS and whole-cell levels of deoxyribonucleotide triphosphates were measured in peripheral blood mononuclear cells (PBMCs) from a total of 103 selected participants displaying the most pronounced relative cognitive decline and relative cognitive improvement. We show that relative cognitive decline is associated with higher PBMC content of deoxythymidine-triphosphate (dTTP) (20%), but not mitochondrial bioenergetics parameters measured in this study or mitochondrial ROS. Levels of dTTP in PBMCs are indicators of relative cognitive change suggesting a role of deoxyribonucleotides in the etiology of AD.
[Show abstract][Hide abstract] ABSTRACT: Background
An association between education and preterm delivery has been observed in populations across Europe, but differences in methodology limit comparability. We performed a direct cross-cohort comparison of educational disparities in preterm delivery based on individual-level birth cohort data.Methods
The study included data from 12 European cohorts from Denmark, England, France, Lithuania, the Netherlands, Norway, Italy, Portugal, and Spain. The cohorts included between 2434 and 99 655 pregnancies. The association between maternal education and preterm delivery (22–36 completed weeks of gestation) was reported as risk ratios, risk differences, and slope indexes of inequality with 95% confidence intervals (CIs).ResultsSingleton preterm live delivery proportion varied between 3.7% and 7.5%. There were large variations between the cohorts in the distribution of education and maternal characteristics. Nevertheless, there were similar educational differences in risk of preterm delivery in 8 of the 12 cohorts with slope index of inequality varying between 2.2 [95% CI 1.1, 3.3] and 4.0 [95% CI 1.4, 6.6] excess preterm deliveries per 100 singleton deliveries among the educationally most disadvantaged, and risk ratio between the lowest and highest education category varying from 1.4 [95% CI 1.1, 1.8] to 1.9 [95% CI 1.2, 3.1]. No associations were found in the last four cohorts.Conclusions
Educational disparities in preterm delivery were found all over Europe. Despite differences in the distributions of education and preterm delivery, the results were remarkably similar across the cohorts. For those few cohorts that did not follow the pattern, study and country characteristics did not explain the differences.
[Show abstract][Hide abstract] ABSTRACT: To estimate the association between educational status and alcohol-related somatic and non-somatic morbidity and mortality among full siblings in comparison with non-related individuals.
Approximately 1.4 million full siblings born in Denmark between 1950 and 1979 were followed from age 28 until age 58 or censoring due to alcohol-related hospitalization and mortality.
Cox-regression analyses were used to estimate associations of educational status with alcohol-related outcomes. Results from cohort analyses based on non-related individuals and inter-sibling analyses were compared.
A lower educational status was associated with a higher rate of alcohol-related outcomes, especially among the youngest (28-37 years of age) and individuals born 1970-1979. Compared with the cohort analyses, the associations attenuated slightly in the inter-sibling analysis. For example in the cohort analysis, females with a basic school education born 1970-1979 had an increased rate of alcohol-related non-somatic morbidity and mortality (Hazard rate ratio (HR) =4.05, CI 95% 3.27-5.02) compared to those with a vocational education. In the inter-sibling analysis, the HR attenuated (HR = 2.66, CI 95% 1.95-3.63). For alcohol-related somatic outcomes the corresponding figures were HR = 3.47 (CI 95% 2.63-4.58) and HR = 3.36 (CI 95% 2.10-5.38), respectively. In general, the associations were stronger among females than males (aged 28-37) in the analyses on alcohol-related non-somatic outcomes. Health conditions earlier in life explained only a minor part of the associations.
The association between educational status and alcohol-related somatic and non-somatic morbidity and mortality is only to a small degree driven by familial factors. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
[Show abstract][Hide abstract] ABSTRACT: Background An educational gradient in preterm birth has been observed in many countries. The distribution of education and other characteristics of women giving birth are the end result of complex processes that play out over the life course. If these processes play out differently in different contexts, cross-cohort comparisons may be helpful in understanding the educational gradient in preterm birth. We performed a cross-cohort comparison of educational disparities in preterm birth based on European birth cohort data.
Methods The study included individual-level data from 12 European cohorts from Denmark, England, France, Lithuania, the Netherlands, Norway, Italy, Portugal and Spain. The studies covered the period 1990 to 2012 and included between 2434 and 99,655 pregnancies each. The association between maternal education and preterm birth for singleton live births was examined separately in each cohort by linear and logistic regression and reported as risk ratios, risk differences and slope indexes of inequality.
Results The percentage of singleton preterm live births varied between 3.7% and 7.5%. There were large variations between the cohorts in the distribution of education and other maternal characteristics. In spite of this, there were similar educational differences in risk of preterm birth in 8 of the 12 cohorts. In these cohorts, the slope index of inequality varied between 2.2 and 3.2 per 100 singleton live births, and relative risk between the lowest and highest education group varied from 1.4 to 1.9. In the remaining 4 cohorts from England, France, Italy and Portugal, one showed a weaker gradient (Slope Index of Inequality =1.5 (-1.0, 3.9)), two showed no educational differences (SII=-0.3 (-2.0, 1.5) and SII=0.9 (-1.3, 3.1)), and the gradient was reversed in the last cohort (SII=-1.2 (-4.6, 2.3)).
Conclusion Educational disparities in risk of preterm birth were found in birth cohorts from all over Europe. Despite differences in the distribution of education and level of preterm birth, the results were remarkably similar across the cohorts. For those few cohorts that did not follow the pattern, study and country characteristics were unable to explain the differences.
Journal of Epidemiology & Community Health 09/2014; 68(Suppl 1):A60-A60. DOI:10.1136/jech-2014-204726.129 · 3.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background and purpose:
Combined effects of socioeconomic position and well-established risk factors on stroke incidence have not been formally investigated.
In a pooled cohort study of 68 643 men and women aged 30 to 70 years in Denmark, we examined the combined effect and interaction between socioeconomic position (ie, education), smoking, and hypertension on ischemic and hemorrhagic stroke incidence by the use of the additive hazards model.
During 14 years of follow-up, 3613 ischemic strokes and 776 hemorrhagic strokes were observed. Current smoking and hypertension were more prevalent among those with low education. Low versus high education was associated with greater ischemic, but not hemorrhagic, stroke incidence. The combined effect of low education and current smoking was more than expected by the sum of their separate effects on ischemic stroke incidence, particularly among men: 134 (95% confidence interval, 49-219) extra cases per 100 000 person-years because of interaction, adjusted for age, cohort study, and birth cohort. There was no clear evidence of interaction between low education and hypertension. The combined effect of current smoking and hypertension was more than expected by the sum of their separate effects on ischemic and hemorrhagic stroke incidence. This effect was most pronounced for ischemic stroke among women: 178 (95% confidence interval, 103-253) extra cases per 100 000 person-years because of interaction, adjusted for age, cohort study, and birth cohort.
Reducing smoking in those with low socioeconomic position and in those with hypertension could potentially reduce social inequality stroke incidence.
[Show abstract][Hide abstract] ABSTRACT: Objective: The cyclin dependent kinase inhibitor p16ink4a, one of the two gene products of the ink4a/ARF (cdkn2a) locus on chromosome 9q21, is an important cell-cycle inhibitor and tumorsuppressor. p16ink4a upregulation has been linked to cellular senescence and results from studies on mammalian tissues suggest that p16ink4a may be biomarker of organismal versus chronological age. The objective of the present study was to determine the pattern in which p16ink4a is expressed by cells of human labial salivary glands and to analyse whether the level of its expression is associated with decline in midlife cognitive performance.
Methods: The expression of p16ink4a was analysed by qRT-PCR in samples of labial salivary gland tissue from 181 middle-aged male study participants all born in 1953 and selected on the basis of change in midlife cognitive scores. The participants were divided into one group of men with high versus one group of men with declined cognitive performance at approximately age 57. The localization pattern of p16ink4a in the tissue was evaluated by immunohistochemistry.
Results: Human labial salivary glands express p16ink4a in a selective pattern. The p16ink4a expression level is slightly up-regulated in labial salivary gland tissue samples taken from a group of men with decline in midlife cognitive performance.
Conclusions: p16ink4a may constitute a potential peripheral biomarker candidate for future studies of different trajectories of cognitive aging. Human labial salivary glands are a suitable model organ for the investigation of organismal versus chronological age.
[Show abstract][Hide abstract] ABSTRACT: Objective:
One aim of the present study was to investigate whether symptoms of oral dryness (xerostomia) during daytime, assessed in a study group of middle-aged male positive and negative outliers in cognition scores, were associated with age-related degenerative changes in human labial salivary glands and with quantitative measures of the glandular autonomic innervation. Another aim was to study the relation between the autonomic innervation and loss of secretory acinar cells in these glands.
Labial salivary gland biopsies were taken from the lower lip from 190 men, born in 1953 and members of the Danish Metropolit birth cohort, who were examined for age-related changes in cognitive function and dental health as part of the Copenhagen University Center for Healthy Aging clinical neuroscience project. The glands were routinely processed and semi-quantitatively analyzed for inflammation, acinar atrophy, fibrosis, and adipocyte infiltration. Sections of labial salivary gland tissue were stained with the panneuronal marker PGP 9.5. In a subsample of 51 participants, the autonomic innervation of the glands was analyzed quantitatively by use of stereology.
Labial salivary gland tissue samples from 33% of all participants displayed moderate to severe acinar atrophy and fibrosis (31%). Xerostomia was not significantly associated with structural changes of labial salivary glands, but in the subsample it was inversely related to the total nerve length in the glandular connective tissue. Acinar atrophy and fibrosis were negatively correlated with the parenchymal innervation and positively related to diffuse inflammation.
The results from the present study indicate that aspects of the autonomic innervation of labial salivary glands may play a role in the occurrence of xerostomia which in the present study group was not significantly associated with degenerative changes in these glands. The findings further indicate that the integrity of labial salivary gland acini is related to the parenchymal autonomic innervation, whereas inflammatory processes may compromise it by alternative mechanisms.