Association of Balance Function With All-Cause and Cause-Specific Mortality Among US Adults

Cao, Chao; Cade, W. Todd; Li, Shengxu; McMillan, Jacqueline; Friedenreich, Christine M.; Yang, Lin

doi:10.1001/jamaoto.2021.0057

Cited by 39 publications

(56 citation statements)

References 36 publications

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“…An often-cited study using the modified Romberg Test of Standing Balance on Firm and Compliant Support Surfaces reported an overall prevalence of vestibular dysfunction in just over one-third of adults aged 40 years and older in the United States (Agrawal et al, 2009). In this study and a recent follow up study (Cao et al, 2021), the odds of vestibular dysfunction were higher in individuals with lower educational status, lower physical activity, and with diabetes or cardiovascular disease. In this study, the odds of vestibular dysfunction were lower in individuals with greater education and higher in those with diabetes.…”

Section: Prevalence Of Arhl and Arvlmentioning

confidence: 44%

“…ARVL contributes to the increased likelihood and severity of falls (Herdman et al, 2000), which are the leading cause of fatal and trauma-related injuries among older adults (Scuffham et al, 2003;Stevens et al, 2006). Moreover, balance disorders were recently associated with all causes of mortality in older adults (Cao et al, 2021). Finally, recent work indicates that ARVL is associated with the increased likelihood and rate of cognitive decline in the aging (Semenov et al, 2016;Dobbels et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

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Age-Related Changes in the Cochlea and Vestibule: Shared Patterns and Processes

2021

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Both age-related hearing loss (ARHL) and age-related loss in vestibular function (ARVL) are prevalent conditions with deleterious consequences on the health and quality of life. Age-related changes in the inner ear are key contributors to both conditions. The auditory and vestibular systems rely on a shared sensory organ – the inner ear – and, like other sensory organs, the inner ear is susceptible to the effects of aging. Despite involvement of the same sensory structure, ARHL and ARVL are often considered separately. Insight essential for the development of improved diagnostics and treatments for both ARHL and ARVL can be gained by careful examination of their shared and unique pathophysiology in the auditory and vestibular end organs of the inner ear. To this end, this review begins by comparing the prevalence patterns of ARHL and ARVL. Next, the normal and age-related changes in the structure and function of the auditory and vestibular end organs are compared. Then, the contributions of various molecular mechanisms, notably inflammaging, oxidative stress, and genetic factors, are evaluated as possible common culprits that interrelate pathophysiology in the cochlea and vestibular end organs as part of ARHL and ARVL. A careful comparison of these changes reveals that the patterns of pathophysiology show similarities but also differences both between the cochlea and vestibular end organs and among the vestibular end organs. Future progress will depend on the development and application of new research strategies and the integrated investigation of ARHL and ARVL using both clinical and animal models.

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Section: Prevalence Of Arhl and Arvlmentioning

confidence: 44%

Section: Introductionmentioning

confidence: 99%

Age-Related Changes in the Cochlea and Vestibule: Shared Patterns and Processes

2021

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“…Since 1999, the National Center for Health Statistics (NCHS) began to conduct the National Health and Nutrition Examination Survey (NHANES) to monitor the health and nutritional status of the US national, civilian, noninstitutionalized population by using a continuous, complex multistage probability sampling design in 2‐year cycles 19 . All NHANES protocols were approved by the NCHS ethics review board.…”

Section: Methodsmentioning

confidence: 99%

“…Balance function was assessed using the modified Romberg test of standing balance on firm and compliant support surfaces performed by trained health technicians 19 . The modified Romberg test procedure is detailed on the NHANES website and available at https://www.cdc.gov/nchs/data/nhanes/ba.pdf.…”

Section: Methodsmentioning

confidence: 99%

“…Overall, balance impairment (no/yes) was defined by whether or not participants passed 4 test conditions (no) or failed at any condition (yes). Sensory‐specific balance impairments were further classified as visual/proprioceptive (ending the test at conditions 1‐3) and vestibular balance impairment (ending the test at condition 4) 19 . The severity of vestibular dysfunction was further defined by condition 4 failure time: 15 to <30 and 0 to <15 seconds 20…”

Section: Methodsmentioning

confidence: 99%

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Balance and vestibular function and survival in US cancer survivors

Medina

Liu

Cao

et al. 2021

Cancer

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Background Cancer and its treatment damage the musculoskeletal system and induce neurotoxicity, affecting the key sensory inputs for maintaining balance. The present study describes the pattern of balance impairment and evaluated its association with mortality among US cancer survivors. Methods Data on a nationally representative sample of cancer survivors from the US National Health and Nutrition Examination Survey from 1999 to 2015 was analyzed. Sensory‐specific balance impairment was measured at baseline by the modified Romberg test of standing balance on firm and compliant support surfaces. The linked mortality data were updated through December 31, 2015. Results Among 511 cancer survivors, 282 (48.3%) had a balance impairment, predominantly attributing to vestibular dysfunction (251; 89.0% of 282 and 44.5% of 511). A higher prevalence of balance impairment was observed among cancer survivors with advanced age, lower socioeconomic status or educational attainment, body mass index <25 kg/m2, and an inactive lifestyle. During up to 16.4 years of follow‐up (median, 11.3 years; 5088 person‐years), 253 cancer survivors had died. Cancer survivors with a balance impairment had a 63% higher risk of death from all causes (hazard ratio, 1.63; 95% confidence interval [CI], 1.12‐2.38) after adjusting for sociodemographic factors, comorbidities, and cancer type. Specifically, those with vestibular dysfunctions had approximately 1.54 (95% CI, 1.05‐2.27) times the risk of death compared to those without any balance impairment. These associations were stronger in males than in females. Conclusions In a US nationally representative sample of cancer survivors, balance impairment and vestibular dysfunctions were prevalent and associated with heightened all‐cause mortality.

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Association of Daily Sitting Time and Leisure-Time Physical Activity With Survival Among US Cancer Survivors

2022

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IMPORTANCE Sedentary behaviors, particularly prolonged sitting and lack of physical activity, may influence survival after cancer. OBJECTIVE To examine the independent and joint associations of daily sitting time and leisure-time physical activity with mortality outcomes among cancer survivors. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort of a nationally representative sample of cancer survivors, age 40 years or older (n = 1535; weighted population, 14 002 666), from the US National Health and Nutrition Examination Survey from 2007 to 2014. Participants were linked to mortality data from their interview and physical examination date through December 31, 2015. Daily sitting time and leisure-time physical activity (LTPA) were self-reported using the Global Physical Activity Questionnaire. Data analyses were performed from January 1 to May 1, 2021. MAIN OUTCOMES AND MEASURES All-cause, cancer-specific, and noncancer mortality. RESULTS Among 1535 cancer survivors (mean [SE] age, 65.1 [0.4] years; 828 [60.1%] females; 945 [83.1%] non-Hispanic White individuals), 950 (56.8%) reported LTPA of 0 minutes per week (min/wk) during the previous week (inactive); 226 (15.6%) reported LTPA of less than 150 min/wk (insufficiently active); 359 (27.6%) reported LTPA of 150 min/wk or more (active); 553 (35.4%) reported sitting for 6 to 8 hours per day (h/d); and 328 (24.9%) reported sitting for more than 8 h/d. Of note, 574 (35.8%) cancer survivors reported no LTPAwith concurrent sitting of more than 6 h/d. During the follow-up period of up to 9 years (median, 4.5 years; 6980 person-years), there were 293 deaths (cancer, 114; heart diseases, 41; other causes, 138). Multivariable models showed that being physically active was associated with lower risks of all-cause (hazard ratio [HR], 0.34; 95% CI, 0.20-0.60) and cancer-specific (HR, 0.32; 95% CI, 0.15-0.70) mortality compared with inactivity. Sitting more than 8 h/d was associated with higher risks of all-cause (HR, 1.81; 95% CI, 1.05-3.14) and cancer-specific (HR, 2.27; 95% CI, 1.08-4.79) mortality compared with those sitting less than 4 h/d. In the joint analyses, prolonged sitting was associated with an increased risk of death among cancer survivors who were not sufficiently active. Specifically, inactive and insufficiently active survivors reported sitting more than 8 h/d had the highest overall (HR, 5.38; 95% CI, 2.99-9.67) and cancer-specific (HR, 4.71; 95% CI, 1.60-13.9) mortality risks. CONCLUSIONS AND RELEVANCEIn this cohort study of a nationally representative sample of US cancer survivors, the combination of prolonged sitting with lack of physical activity was highly prevalent and was associated with the highest risks of death from all causes and cancer.

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Association of Balance Function With All-Cause and Cause-Specific Mortality Among US Adults

Cited by 39 publications

References 36 publications

Age-Related Changes in the Cochlea and Vestibule: Shared Patterns and Processes

Age-Related Changes in the Cochlea and Vestibule: Shared Patterns and Processes

Balance and vestibular function and survival in US cancer survivors

Association of Daily Sitting Time and Leisure-Time Physical Activity With Survival Among US Cancer Survivors

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