Vulnerability in Health Trajectories: Life Course Perspectives

Cullati, Stéphane; Burton-Jeangros, Claudine; Abel, Thomas

doi:10.1515/sjs-2018-0009

Cited by 6 publications

(2 citation statements)

References 62 publications

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“…[12][13][14] Indeed, from a life course vulnerability perspective, 6 exposures to biological, psychological, and social vulnerabilities influence disease risk throughout the lifecourse, and the differences in timing and intensification of exposures across populations further perpetuate differences in disease risk. As described by Culatti et al 15 lack of resources both generate differences in health trajectories and perpetuate them because resources provide the structural support for maintaining health.…”

Section: Introductionmentioning

confidence: 99%

Racial, ethnic and neighborhood socioeconomic differences in incidence of dementia: A regional retrospective cohort study

Becerril

Pfoh

Hashmi

et al. 2023

J American Geriatrics Society

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Background Evidence on the effects of neighborhood socioeconomic disadvantage on dementia risk in racially and ethically diverse populations is limited. Our objective was to evaluate the relative extent to which neighborhood disadvantage accounts for racial/ethnic variation in dementia incidence rates. Secondarily, we evaluated the spatial relationship between neighborhood disadvantage and dementia risk. Methods In this retrospective study using electronic health records (EHR) at two regional health systems in Northeast Ohio, participants included 253,421 patients aged >60 years who had an outpatient primary care visit between January 1, 2005 and December 31, 2015. The date of the first qualifying visit served as the study baseline. Cumulative incidence of composite dementia outcome, defined as EHR‐documented dementia diagnosis or dementia‐related death, stratified by neighborhood socioeconomic deprivation (as measured by Area Deprivation Index) was determined by competing‐risk regression analysis, with non‐dementia‐related death as the competing risk. Fine‐Gray sub‐distribution hazard ratios were determined for neighborhood socioeconomic deprivation, race/ethnicity, and clinical risk factors. The degree to which neighborhood socioeconomic position accounted for racial/ethnic disparities in the incidence of composite dementia outcome was evaluated via mediation analysis with Poisson rate models. Results Increasing neighborhood disadvantage was associated with increased risk of EHR‐documented dementia diagnosis or dementia‐related death (most vs. least disadvantaged ADI quintile HR = 1.76, 95% confidence interval = 1.69–1.84) after adjusting for age and sex. The effect of neighborhood disadvantage on this composite dementia outcome remained after accounting for known medical risk factors of dementia. Mediation analysis indicated that neighborhood disadvantage accounted for 34% and 29% of the elevated risk for composite dementia outcome in Hispanic and Black patients compared to White patients, respectively. Conclusion Neighborhood disadvantage is related to the risk of EHR‐documented dementia diagnosis or dementia‐related death and accounts for a portion of racial/ethnic differences in dementia burden, even after adjustment for clinically important confounders.

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Section: Introductionmentioning

confidence: 99%

Racial, ethnic and neighborhood socioeconomic differences in incidence of dementia: A regional retrospective cohort study

Becerril

Pfoh

Hashmi

et al. 2023

J American Geriatrics Society

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“…The longitudinal approach proposed by the life course theory considers the health of individuals as trajectories that evolve continuously following human development throughout the life span [ 6 ]. Health trajectories may represent a decline, as can be expected with ageing, involving the progressive loss of functional and cognitive abilities, or they may indicate an improvement, in the case of recovery from illness and associated disability [ 7 ]. These individual health trajectories are shaped through the long term influences of biological and social mechanisms but also by individual resources [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Toward a conceptual framework of health and its operational definition: an application in the 1958 British birth cohort

et al. 2023

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Background Defining and measuring Health presents a challenge, partly due to its conceptual pluralism. To measure Health as an ability to adapt and self-manage, we developed an approach within the theoretical framework of resources and reserves over the life course, recently proposed in the literature. We aimed to (i) use the conceptual framework developed to identify indicators of deteriorating health reserves, (ii) construct an overall health measure from these indicators, (iii) evaluate the association between the overall health measure and subsequent health outcomes and (iv) assess the robustness of our method. Methods We used data from 7,043 individuals born in 1958 in Great Britain included in the National Child Development Study. An overall health measure was constructed via the sum of three selected indicators of deteriorating health reserves in mid-life: chronic widespread pain (CWP), Clinical Interview Schedule - revised (CIS-r), and allostatic load (AL). A three-category variable was defined: impaired/medium/optimal overall health. We explored criterion validity by modelling the relationships between the overall health measure, or each reserve taken separately at 44–45 years, and self-rated health at 46 years and mortality up to 58 years, corresponding to 14 years of follow up, using Cox and logistic regressions respectively. We performed comparative analyses to assess the robustness of the method. Results Having an impaired overall health measure was significantly associated with all-cause premature mortality (HRimpaired = 2.74 [1.86; 4.05]) and an increased risk of later fair/poor/very poor self-rated health (ORimpaired = 7.50 [6.29; 8.95]). The overall health measure had a greater effect on the self-rated health estimates than each indicator of deteriorating health reserves considered separately (ORAL medium = 1.82 [1.59; 2.09]; ORAL high = 2.74 [2.37; 3.16]; ORCIS-r = 5.20 [4.45; 6.08]; ORCWP = 2.85 [2.53; 3.21]). CIS-r and allostatic load were also associated with premature mortality contrary to chronic widespread pain (HRAL medium1.82 [1.27; 2.61]; HRAL high = 3.10 [2.19; 4.40]; HRCIS-r = 1.77 [1.22; 2.56]; HRCWP = 1.32 [0.98; 1.76]). The multiple comparative analyses conducted allowed us to assess the robustness of our method within this cohort. Conclusions We proposed a method for measuring Health in mid-life in line with the concept of Health as the ability to adapt and self-manage and the concept of health reserves. This method may be applied and further developed within the field of social and positive epidemiology.

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Molecular Biomarkers of Health

Nehlin

Andersen

2020

Healthy Ageing and Longevity

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Vulnerability in Health Trajectories: Life Course Perspectives

Cited by 6 publications

References 62 publications

Racial, ethnic and neighborhood socioeconomic differences in incidence of dementia: A regional retrospective cohort study

Racial, ethnic and neighborhood socioeconomic differences in incidence of dementia: A regional retrospective cohort study

Toward a conceptual framework of health and its operational definition: an application in the 1958 British birth cohort

Molecular Biomarkers of Health

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