Adverse Childhood Experiences and Subsequent Chronic Diseases Among Middle-aged or Older Adults in China and Associations With Demographic and Socioeconomic Characteristics.

Authors: Li Lin, Harry Haoxiang Wang, Ciyong Lu...

IMPORTANCE

Associations between adverse childhood experiences (ACEs) and chronic diseases among middle-aged or older Chinese individuals have not been well documented. In addition, whether demographic and socioeconomic characteristics modify any such associations has been underexplored.

OBJECTIVES

To examine associations between ACEs and subsequent chronic diseases and to assess whether age, sex, educational level, annual per capita household expenditure level, and childhood economic hardship modify these associations.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cross-sectional study used data from the China Health and Retirement Longitudinal Study (CHARLS), a survey of residents aged 45 years or older in 28 provinces across China; specifically, the study used data from the CHARLS life history survey conducted from June 1 to December 31, 2014, and a CHARLS follow-up health survey conducted from July 1 to September 30, 2015. The study population included 11 972 respondents aged 45 years or older who had data on at least 1 of 14 specified chronic diseases and information on all 12 of the ACE indicators included in this study. Data analysis was performed from December 1 to 30, 2020.

EXPOSURES

Any of 12 ACEs (physical abuse, emotional neglect, household substance abuse, household mental illness, domestic violence, incarcerated household member, parental separation or divorce, unsafe neighborhood, bullying, parental death, sibling death, and parental disability), measured by indicators on a questionnaire. The number of ACEs per participant was summed and categorized into 1 of 5 cumulative-score groups: 0, 1, 2, 3, and 4 or more.

MAIN OUTCOMES AND MEASURES

Hypertension, dyslipidemia, diabetes, heart disease, stroke, chronic lung disease, asthma, liver disease, cancer, digestive disease, kidney disease, arthritis, psychiatric disease, and memory-related disease were defined by self-reported physician diagnoses or in combination with health assessment and medication data. Multimorbidity was defined as the presence of 2 or more of these 14 chronic diseases. Logistic regression models were used to assess associations of the 12 ACEs with the 14 chronic diseases and with multimorbidity. Modification of the associations by demographic and socioeconomic characteristics was assessed by stratified analyses and tests for interaction.

RESULTS

Of the 11 972 individuals included (mean [SD] age, 59.85 [9.56] years; 6181 [51.6%] were females), 80.9% had been exposed to at least 1 ACE and 18.0% reported exposure to 4 or more ACEs. Compared with those without ACE exposure, participants who experienced 4 or more ACEs had increased risks of dyslipidemia, chronic lung disease, asthma, liver disease, digestive disease, kidney disease, arthritis, psychiatric disease, memory-related disease, and multimorbidity. The estimated odds ratios (ORs) ranged from 1.27 (95% CI, 1.02-1.59) for dyslipidemia to 2.59 (95% CI, 2.16-3.11) for digestive disease. A dose-response association was also observed between the number of ACEs and the risk of most of the chronic diseases (excluding hypertension, diabetes, and cancer) (eg, chronic lung disease for ≥4 ACEs vs none: OR, 2.01; 95% CI, 1.59-2.55; P < .001 for trend) and of multimorbidity (for individuals among the overall study population with ≥4 ACEs vs none: OR, 2.03; 95% CI, 1.70-2.41; P < .001 for trend). The demographic or socioeconomic characteristics of age, sex, educational level, annual per capita household expenditure level, or childhood economic hardship were not shown to significantly modify the associations between ACEs and multimorbidity.

CONCLUSIONS AND RELEVANCE

In this population-based, cross-sectional study of adults in China, exposure to ACEs was associated with higher risks of chronic diseases regardless of demographic and socioeconomic characteristics during childhood or adulthood. These findings suggest a need to prevent ACEs and a need for a universal life-course public health strategy to reduce potential adverse health outcomes later in life among individuals who experience them.

Topics: Adverse Childhood Experiences; Aged; China; Chronic Disease; Correlation of Data; Cross-Sectional Studies; Demography; Female; Humans; Male; Middle Aged; Odds Ratio; Social Class

PubMed: 34694390
DOI: 10.1001/jamanetworkopen.2021.30143

Review

Authors: John P Allegrante, Martin T Wells, Janey C Peterson...

A majority of the US adult population has one or more chronic conditions that require medical intervention and long-term self-management. Such conditions are among the 10 leading causes of mortality; an estimated 86% of the nation's $2.7 trillion in annual health care expenditures goes toward their treatment and management. Patient self-management of chronic diseases is increasingly essential to improve health behaviors, health outcomes, and quality of life and, in some cases, has demonstrated effectiveness for reducing health care utilization and the societal cost burden of chronic conditions. This review synthesizes the current state of the science of chronic disease self-management interventions and the evidence for their effectiveness, especially when applied with a systematic application of theories or models that account for a wide range of influences on behavior. Our analysis of selected outcomes from randomized controlled trials of chronic disease self-management interventions contained in 10 Cochrane systematic reviews provides additional evidence to demonstrate that self-management can improve quality of life and reduce utilization across several conditions.

Topics: Adult; Aged; Aged, 80 and over; Chronic Disease; Female; Health Behavior; Health Expenditures; Humans; Male; Middle Aged; Quality of Life; Self-Management; United States

PubMed: 30601717
DOI: 10.1146/annurev-publhealth-040218-044008

Review

Authors: William C Cockerham, Bryant W Hamby, Gabriela R Oates...

This review article addresses the concept of the social determinants of health (SDH), selected theories, and its application in studies of chronic disease. Once ignored or regarded only as distant or secondary influences on health and disease, social determinants have been increasingly acknowledged as fundamental causes of health afflictions. For the purposes of this discussion, SDH refers to SDH variables directly relevant to chronic diseases and, in some circumstances, obesity, in the research agenda of the Mid-South Transdisciplinary Collaborative Center for Health Disparities Research. The health effects of SDH are initially discussed with respect to smoking and the social gradient in mortality. Next, four leading SDH theories-life course, fundamental cause, social capital, and health lifestyle theory-are reviewed with supporting studies. The article concludes with an examination of neighborhood disadvantage, social networks, and perceived discrimination in SDH research.

Topics: Chronic Disease; Health Status Disparities; Healthy Lifestyle; Humans; Residence Characteristics; Social Determinants of Health; Social Support

PubMed: 27989293
DOI: 10.1016/j.amepre.2016.09.010

Authors: Petra Maresova, Ehsan Javanmardi, Sabina Barakovic...

BACKGROUND

The phenomenon of the increasing number of ageing people in the world is arguably the most significant economic, health and social challenge that we face today. Additionally, one of the major epidemiologic trends of current times is the increase in chronic and degenerative diseases. This paper tries to deliver a more up to date overview of chronic diseases and other limitations associated with old age and provide a more detailed outlook on the research that has gone into this field.

METHODS

First, challenges for seniors, including chronic diseases and other limitations associated with old age, are specified. Second, a review of seniors' needs and concerns is performed. Finally, solutions that can improve seniors' quality of life are discussed. Publications obtained from the following databases are used in this scoping review: Web of Science, PubMed, and Science Direct. Four independent reviewers screened the identified records and selected relevant publications published from 2010 to 2017. A total of 1916 publications were selected. In all, 52 papers were selected based on abstract content. For further processing, 21 full papers were screened."

RESULTS

The results indicate disabilities as a major problem associated with seniors' activities of daily living dependence. We founded seven categories of different conditions - psychological problems, difficulties in mobility, poor cognitive function, falls and incidents, wounds and injuries, undernutrition, and communication problems. In order to minimize ageing consequences, some areas require more attention, such as education and training; technological tools; government support and welfare systems; early diagnosis of undernutrition, cognitive impairment, and other diseases; communication solutions; mobility solutions; and social contributions.

CONCLUSIONS

This scoping review supports the view on chronic diseases in old age as a complex issue. To prevent the consequences of chronic diseases and other limitations associated with old age related problems demands multicomponent interventions. Early recognition of problems leading to disability and activities of daily living (ADL) dependence should be one of essential components of such interventions.

Topics: Activities of Daily Living; Aged; Chronic Disease; Humans

PubMed: 31675997
DOI: 10.1186/s12889-019-7762-5

Review

Authors: Wai Yin Lam, Paula Fresco

WHO reported that adherence among patients with chronic diseases averages only 50% in developed countries. This is recognized as a significant public health issue, since medication nonadherence leads to poor health outcomes and increased healthcare costs. Improving medication adherence is, therefore, crucial and revealed on many studies, suggesting interventions can improve medication adherence. One significant aspect of the strategies to improve medication adherence is to understand its magnitude. However, there is a lack of general guidance for researchers and healthcare professionals to choose the appropriate tools that can explore the extent of medication adherence and the reasons behind this problem in order to orchestrate subsequent interventions. This paper reviews both subjective and objective medication adherence measures, including direct measures, those involving secondary database analysis, electronic medication packaging (EMP) devices, pill count, and clinician assessments and self-report. Subjective measures generally provide explanations for patient's nonadherence whereas objective measures contribute to a more precise record of patient's medication-taking behavior. While choosing a suitable approach, researchers and healthcare professionals should balance the reliability and practicality, especially cost effectiveness, for their purpose. Meanwhile, because a perfect measure does not exist, a multimeasure approach seems to be the best solution currently.

Topics: Chronic Disease; Health Care Costs; Humans; Medication Adherence

PubMed: 26539470
DOI: 10.1155/2015/217047

Authors: Collins O Airhihenbuwa, Tung-Sung Tseng, Victor D Sutton...

The Centers for Disease Control and Prevention (CDC) define chronic diseases as conditions that last 1 year or more and that require ongoing medical attention or limit activities of daily living, or both (1). Chronic diseases may be influenced by a combination of genetics, lifestyle and social behaviors, health care system factors, community influences, and environmental determinants of health (2). These risk factors often coexist and interact with each other. Therefore, a better understanding of determinants of chronic diseases such as tobacco use, unhealthy eating, and physical inactivity stands to benefit from effective strategies for improving primary, secondary, and tertiary disease prevention and management in diverse global settings (3). Strategies to prevent and manage chronic disease outcomes such as diabetes and cardiovascular diseases (CVDs) have global commonalities (4-7). The impact of chronic diseases is disproportionately evident in Black and Brown communities (8,9). Chronic disease prevention and management typically focus on behavioral interventions such as healthy eating, increased physical activity, and cessation of unhealthy practices such as tobacco and alcohol use (10-15). In 2020, the COVID-19 pandemic added to the fact that chronic diseases disproportionately affect low-resource communities, where many Black and Brown populations live (16,17). COVID-19 demonstrated that chronic disease disparities actually present as preexisting conditions in Black and Brown communities, who are disproportionately affected by COVID-19 outcomes. Although most of the articles in this Preventing Chronic Disease (PCD) collection were published before the pandemic, the insights they present, combined with the racial and ethnic data on the burden of COVID-19 thus far, support this reality. Many researchers and public health practitioners often consider the need to sufficiently address the relationships between chronic diseases and social, behavioral, and community factors (18). Global lessons in the prevention and management of chronic diseases, therefore, can help researchers and practitioners benefit from the shared lessons and experience derived from research and interventions conducted in different parts of the world. There are more than 7 billion people worldwide, who speak diverse languages and who have different nationalities, identities, and health systems. Yet, if we share challenges and opportunities for chronic disease prevention and management, many of the global adversities to improving health and well-being can be ameliorated, which is the purpose of this collection. The authors in this collection share lessons that represent experiences in diverse contexts across countries and regions of the world.

Topics: COVID-19; Causality; Chronic Disease; Global Health; Health Services Accessibility; Healthcare Disparities; Humans; Information Dissemination; Life Style; Psychology; Public Health; SARS-CoV-2; Social Determinants of Health

PubMed: 33830913
DOI: 10.5888/pcd18.210055

Authors: Pengfei Zhou, Shuai Wang, Ya Yan...

BACKGROUND

With the aging of the Chinese population, the prevalence of depression and chronic diseases is continually growing among middle-aged and older adult people. This study aimed to investigate the association between chronic diseases and depression in this population.

METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018 longitudinal survey, a 7-years follow-up of 7,163 participants over 45 years old, with no depression at baseline (2011). The chronic disease status in our study was based on the self-report of the participants, and depression was defined by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). The relationship between baseline chronic disease and depression was assessed by the Kaplan-Meier method and Cox proportional hazards regression models.

RESULTS

After 7-years follow-up, 41.2% (2,951/7163, 95% :40.1, 42.3%) of the participants reported depression. The analysis showed that participants with chronic diseases at baseline had a higher risk of depression and that such risk increased significantly with the number of chronic diseases suffered (1 chronic disease:  = 1.197; 2 chronic diseases:  = 1.310; 3 and more chronic diseases:  = 1.397). Diabetes or high blood sugar ( = 1.185), kidney disease ( = 1.252), stomach or other digestive diseases ( = 1.128), and arthritis or rheumatism ( = 1.221) all significantly increased the risk of depression in middle-aged and older adult Chinese.

CONCLUSION

The present study found that suffering from different degrees of chronic diseases increased the risk of depression in middle-aged and older adult people, and these findings may benefit preventing depression and improving the quality of mental health in this group.

Topics: Aged; Humans; Middle Aged; Chronic Disease; East Asian People; Follow-Up Studies; Longitudinal Studies; Retirement; Depression

PubMed: 37546300
DOI: 10.3389/fpubh.2023.1176669

Review

Authors: Rashid L Bashshur, Gary W Shannon, Brian R Smith...

The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/re-admissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings.

Topics: Chronic Disease; Disease Management; Humans; Telemedicine

PubMed: 24968105
DOI: 10.1089/tmj.2014.9981

Authors: Sam Manger

BACKGROUND

Mental illness is the single most common reason for patient visits to a general practitioner (GP). Prevalent mental illnesses include major depression disorder and dysthymia, anxiety disorders, bipolar disorders and schizophrenia. Patients with severe mental illness have a 10-20-year shorter life expectancy when compared with the general population, primarily due to physical chronic disease.

OBJECTIVE

The aim of this article is to provide a concise update regarding the evidence-based clinical lifestyle interventions in the management of both mental illnesses and the physical chronic diseases highly prevalent in people with mental illness.

DISCUSSION

Growing evidence shows that lifestyle interventions are an effective component of management for patients with mental illness to improve mental health, physical health and quality of life, which consequently assists in reducing the life expectancy gap between patients with severe mental illness and the general population. Measures can be taken to improve long-term adherence. The GP plays a crucial part in initiating and supporting patients with these measures.

Topics: Behavior Therapy; Chronic Disease; Diet, Healthy; Exercise; General Practitioners; Health Behavior; Healthy Lifestyle; Humans; Life Style; Mental Disorders; Patient Care Team; Patient Compliance; Physician's Role; Sleep Wake Disorders; Smoking

PubMed: 31569326
DOI: 10.31128/AJGP-06-19-4964

Authors: Susan M Czajkowski, Lynda H Powell, Nancy Adler...

OBJECTIVE

Given the critical role of behavior in preventing and treating chronic diseases, it is important to accelerate the development of behavioral treatments that can improve chronic disease prevention and outcomes. Findings from basic behavioral and social sciences research hold great promise for addressing behaviorally based clinical health problems, yet there is currently no established pathway for translating fundamental behavioral science discoveries into health-related treatments ready for Phase III efficacy testing. This article provides a systematic framework for developing behavioral treatments for preventing and treating chronic diseases.

METHOD

The Obesity-Related Behavioral Intervention Trials (ORBIT) model for behavioral treatment development features a flexible and progressive process, prespecified clinically significant milestones for forward movement, and return to earlier stages for refinement and optimization.

RESULTS

This article presents the background and rationale for the ORBIT model, a summary of key questions for each phase, a selection of study designs and methodologies well-suited to answering these questions, and prespecified milestones for forward or backward movement across phases.

CONCLUSIONS

The ORBIT model provides a progressive, clinically relevant approach to increasing the number of evidence-based behavioral treatments available to prevent and treat chronic diseases. (PsycINFO Database Record

Topics: Behavior Therapy; Biomedical Research; Chronic Disease; Humans

PubMed: 25642841
DOI: 10.1037/hea0000161