Estudio de enfermedades crónicas de salud y funcionamiento en personas de mediana edad y mayores desde una perspectiva epidemiológica

[spa] El incremento de la esperanza de vida suele traducirse en un mayor número de años vividos con discapacidad debido a una mayor prevalencia de enfermedades crónicas de salud. La multimorbilidad (MM) es cada vez más común y tiene consecuencias a varios niveles. Asimismo, funcionamiento físico y cognitivo están interrelacionados, pues las limitaciones físicas y el deterioro del estado cognitivo de la persona, consecuencia de la MM, repercuten en el curso y tratamiento de las enfermedades. El objetivo principal de esta tesis es lograr un mejor entendimiento de las enfermedades crónicas de salud y funcionamiento en población general de mediana edad (50-64) y mayores (65+) desde un punto de vista epidemiológico. La presente tesis analiza datos armonizados de diferentes estudios poblacionales sobre envejecimiento. El primer trabajo se identificaron tres clases latentes de MM, mediante análisis de clases latentes: “cardio-metabólica” (C-M), donde hubo una mayor prevalencia de diabetes, hipertensión, infarto de miocardio – angina de pecho y accidente cerebrovascular; “respiratoria- mental-articular” (R-M-A), caracterizada por mayores prevalencias de trastornos de las articulaciones, asma, EPOC y depresión; y clase “sana”, que se caracterizó por presentar prevalencias más bajas de enfermedades. Estas clases de MM fueron equivalentes en personas de mediana edad y mayores, así como en países con diferentes niveles de ingresos, aunque con diferentes proporciones. En el segundo trabajo se encontraron cuatro y tres trayectorias de memoria verbal distintas en ambos grupos de edad, mediante análisis de crecimiento de clases latentes en un periodo de seguimiento de 7 años. En general, aquellas trayectorias caracterizadas por un bajo rendimiento inicial y una mayor tasa de deterioro se asociaron a mayor edad, un nivel educativo inferior a educación primaria, un mayor número de enfermedades, así como a prevalencias más altas de diabetes, artritis, accidente cerebrovascular y depresión. Asimismo, estas trayectorias estuvieron asociadas a mayor discapacidad, peor calidad de vida y bajo nivel de actividad física. En el tercer trabajo se detectaron tres trayectorias paralelas de envejecimiento saludable en tres cohortes de nacimiento (≤1935, 1936-1945, >1945) basadas en la escala de salud funcional, física y cognitiva: “alto”, “medio” y “bajo” envejecimiento saludable. Tras ejecutar los modelos de regresión aditiva de Aalen, se observó que el riesgo de mortalidad en personas con enfermedad pulmonar obstructiva crónica (EPOC), sólo fue superior antes de ajustar por otras variables. Además aquellas personas clasificadas en trayectorias “alto” y “medio” tuvieron un mayor riesgo de mortalidad. Finalmente, la interacción entre EPOC y las trayectorias solo fue significativa en la cohorte ≤1935. En este caso, aquellas personas con EPOC y clasificadas en el grupo “bajo” tuvieron un mayor riesgo de mortalidad. El conjunto de los resultados confirman que las enfermedades tienden a agruparse en forma de patrones de MM y que estas agrupaciones son comunes entre los grupos de edad estudiados y entre regiones. Del mismo modo, la presencia de enfermedades y MM está asociada a un peor desempeño cognitivo, así como a un deterioro funcional más pronunciado. Dentro de las mejoras en la atención al paciente con múltiples condiciones de salud, debería ser incluida la evaluación de la capacidad funcional de la persona, considerando la capacidad intrínseca del individuo, es decir, sus capacidades físicas y mentales, y las facilidades y limitaciones del entorno, como el acceso a medicación, soporte y barreras funcionales.[eng] Increased life expectancy, together with changes in lifestyles or environmental exposures have contributed to increase the prevalence of chronic health conditions. As a consequence, multimorbidity (MM) and dementia are increasingly common and have multiple consequences. Furthermore, physical and cognitive functioning are interrelated, as the physical limitations and deterioration of a person's cognitive status as a consequence of MM have an impact on the course and treatment of diseases, which aggravates and increases the risk of MM. It is therefore essential to take into account the functional status of the person in interaction with chronic health conditions and cognitive difficulties, promoting healthy ageing. The present thesis analyses harmonised data from different population-based cohort studies on ageing, in order to achieve a better understanding of non-communicable diseases and functioning (healthy ageing) in a sample of middle-aged (50-64) and older (65+) individuals. Taken together, the results confirm that diseases tend to cluster in the form of MM patterns and that these clusters are common across the age groups studied and across regions. Similarly, the presence of disease and MM is associated with worse cognitive performance, as well as more pronounced functional impairment. Within the improvements in the care of the patient with multiple health conditions, the assessment of the functional capacity of the person should be included, considering the intrinsic capacity of the individual, that is, his or her physical and mental abilities, and the facilities and limitations of the environment, such as access to medication, support and functional barriers

Latent class analysis of multimorbidity patterns and associated outcomes in Spanish older adults: a prospective cohort study

Abstract BACKGROUND: This study sought to identify multimorbidity patterns and determine the association between these latent classes with several outcomes, including health, functioning, disability, quality of life and use of services, at baseline and after 3 years of follow-up. METHODS: We analyzed data from a representative Spanish cohort of 3541 non-institutionalized people aged 50 years old and over. Measures were taken at baseline and after 3 years of follow-up. Latent Class Analysis (LCA) was conducted using eleven common chronic conditions. Generalized linear models were conducted to determine the adjusted association of multimorbidity latent classes with several outcomes. RESULTS: 63.8% of participants were assigned to the 'healthy' class, with minimum disease, 30% were classified under the 'metabolic/stroke' class and 6% were assigned to the 'cardiorespiratory/mental/arthritis' class. Significant cross-sectional associations were found between membership of both multimorbidity classes and poorer memory, quality of life, greater burden and more use of services. After 3 years of follow-up, the 'metabolic/stroke' class was a significant predictor of lower levels of verbal fluency while the two multimorbidity classes predicted poor quality of life, problems in independent living, higher risk of hospitalization and greater use of health services. CONCLUSIONS: Common chronic conditions in older people cluster together in broad categories. These broad clusters are qualitatively distinct and are important predictors of several health and functioning outcomes. Future studies are needed to understand underlying mechanisms and common risk factors for patterns of multimorbidity and to propose more effective treatments

Healthy aging and late-life depression in Europe: Does migration matter?

Background: There is limited research examining the impact of risk and protective factors on late-life depression using large population-based datasets, particularly those examining differences among older migrants and non-migrants in Europe countries. Thus, the first aim was to analyze differences between migrants and non-migrants regarding socioeconomic status, depression, multimorbidity, healthy aging, and lifestyle behaviors. The second aim was to examine the impact of healthy aging on late-life depression in older migrants compared to their counterparts without a history of international migration in extensive and harmonized data from different population-based cohort studies. Materials and methods: We analyzed cross-sectional, predominantly nationally representative, community-based data from European participants in the Aging Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) cohort. The descriptive analyses included sociodemographic variables, somatic comorbidities, multimorbidity, healthy aging, and lifestyle behaviors according to migration status. The effects of these variables on late-life depression were examined in a multivariate logistic regression model, including migration status and years since migration as predictors. Results: Data of 122,571 individuals aged = 50 years were analyzed, of which 11,799 (9.60%) were migrants. The descriptive analyses indicated that compared to non-migrants, migrants showed a higher prevalence of diabetes (25.6%), hypertension (38.0%), coronary artery disease (49.4%), stroke (4.9%), and depression (31.1%). Healthy aging was also better in non-migrants (51.7; SD = 9.7) than in migrants (39.6; SD = 18.2). The results of the logistic regression showed that migration status [OR = 1.231 (CIs: 0.914–1.547)] and increased number of years since migration in the host country [OR = 0.003 (CIs: 0.001–0.005)] were associated with greater levels of depressive symptoms. Concerning health variables, multimorbidity was associated with higher levels of depressive symptoms [OR = 0.244 (CIs: 0.211–0.278)], whereas better healthy aging was associated with fewer depressive symptoms [OR = -0.100 (CIs: -0.102 to -0.098)]. The interaction between migration and healthy aging status was also significant [OR. = -0.019 (CIs: -0.025 to -0.014)]. Conclusion: Migrants reported higher risks for worse health outcomes compared to non-migrants. Significantly, worse healthy aging was associated with a greater risk of depressive symptoms in migrants than in non-migrants. Shedding light on migration and aging processes is essential for promoting a cross-cultural understanding of late-life depression in EuropeDF’s work was supported by grant 2017 SGR 622 (GRBIO) administrated by the Departament d’Economia i Coneixement de la Generalitat de Catalunya (Spain), by Marsden grant E2987-3648 administrated by the Royal Society of New Zealand, and by the Ministerio de Ciencia e Innovación (Spain) [PID2019-104830RB-I00/DOI (AEI): 10.13039/501100011033]Peer ReviewedPostprint (published version

COVID-19 after two years: trajectories of different components of mental health in the Spanish population

Aims: Our study aimed to (1) identify trajectories on different mental health components during a two-year follow-up of the COVID-19 pandemic and contextualise them according to pandemic periods; (2) investigate the associations between mental health trajectories and several exposures, and determine whether there were differences among the different mental health outcomes regarding these associations. Methods: We included 5535 healthy individuals, aged 40–65 years old, from the Barcelona Brain Health Initiative (BBHI). Growth mixture models (GMM) were fitted to classify individuals into different trajectories for three mental health-related outcomes (psychological distress, personal growth and loneliness). Moreover, we fitted a multinomial regression model for each outcome considering class membership as the independent variable to assess the association with the predictors. Results: For the outcomes studied we identified three latent trajectories, differentiating two major trends, a large proportion of participants was classified into ‘resilient’ trajectories, and a smaller proportion into ‘chronic-worsening’ trajectories. For the former, we observed a lower susceptibility to the changes, whereas, for the latter, we noticed greater heterogeneity and susceptibility to different periods of the pandemic. From the multinomial regression models, we found global and cognitive health, and coping strategies as common protective factors among the studied mental health components. Nevertheless, some differences were found regarding the risk factors. Living alone was only significant for those classified into ‘chronic’ trajectories of loneliness, but not for the other outcomes. Similarly, secondary or higher education was only a risk factor for the ‘worsening’ trajectory of personal growth. Finally, smoking and sleeping problems were risk factors which were associated with the ‘chronic’ trajectory of psychological distress. Conclusions: Our results support heterogeneity in reactions to the pandemic and the need to study different mental health-related components over a longer follow-up period, as each one evolves differently depending on the pandemic period. In addition, the understanding of modifiable protective and risk factors associated with these trajectories would allow the characterisation of these segments of the population to create targeted interventions"This work was supported by a grant from the Agència de Gestió d'Ajuts Universitaris i de Recerca (AGAUR) ‘PANDÈMIES 2020’ (ref. 2020PANDE00043) and a grant from ‘La Marató de TV3’ MARATÓ 2020 COVID-19 (ref. 202129–31). Supported in part by the Spanish Ministry of Science, Innovation and Universities (MICIU/FEDER; grant number RTI2018-095181-B-C21) and an ICREA Academia 2019 grant award to D. B-F. Partially, this research has received funding from ‘La Caixa’ Foundation (grant number LCF/PR/PR16/11110004), and from Institut Guttmann and Fundació Abertis. I.B-M. was supported by a postdoctoral fellowship related to ‘PANDÈMIES 2020’ (AGAUR; 2020PANDE00043). D.F. has been supported by grant 2021 SGR 01421 (GRBIO) administrated by the Departament de Recerca I Universitats de la Generalitat de Catalunya (Spain) and by the Ministerio de Ciencia e Innovación (Spain) [PID2019-104830RB-I00/ DOI (AEI): 10.13039/501100011033].. J.M.T. was partly supported by AGAUR (2018 PROD 00172), Fundació Joan Ribas Araquistain and ‘La Marató de TV3’ Fundation (201735.10). This research was furthermore supported by the Government of Catalonia (2017SGR748). We also acknowledge support from the Spanish Ministry of Science and Innovation and State Research Agency through the ‘Centro de Excelencia Severo Ochoa 2019-2023’ Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program"Peer ReviewedPostprint (published version

Trajectories of Immediate and Delayed Verbal Memory in the Spanish General Population of Middle-aged and Older Adults

(1) Cognitive decline differs among individuals and cognition function domains. We sought to identify distinct groups of immediate and delayed verbal memory in two age subsamples (50-64, 65+ years), and to analyze associated factors. (2) Latent class mixed models were used to identify verbal memory trajectories in a sample of Spanish community-dwelling individuals over 8 years' follow up. Chi-square and Kruskal-Wallis tests were used to assess differences among trajectories. (3) Different trajectories were identified. In the case of immediate verbal memory, these were: very low/decline (6.3%), low/stable (38.2%), medium/slow decline (43.4%), and high/slow decline (12.2%) in the middle-aged group, and low/decline (20.4%), medium/slow decline (60.4%), and high/slow decline (19.2%) in the older subsample. In delayed verbal memory, more distinct patterns were found: very low/decline (12.4%), low/stable (51.4%), medium/accelerated decline (24.7%), and high/slow increase (11.4%) in the younger group, and low/slow decline (34.4%), medium/decline (52.7%), and high/slow decline (12.9%) in the older group. (4) Overall, low initial performance and decline were associated with older age, lower education, and higher diabetes/stroke prevalence. Differences found suggests heterogeneity in cognitive ageing. The high prevalence of cardiovascular diseases in those with worse cognition suggests that early interventions to prevent those conditions should be targeted in midlife to delay cognitive decline

Risk of all-cause mortality associated with chronic obstructive pulmonary disease and the role of healthy ageing trajectories: a population-based study of middle-aged and older adults

Objectives The aims were to study the risk of all-cause mortality associated with chronic obstructive pulmonary disease (COPD) and healthy ageing trajectories (HAT) in three birth cohorts and to determine the moderating role of HAT in the association between COPD and all-cause mortality. Design Prospective cohort study. Setting Data from waves 1 to 5 of The Survey of Health, Ageing and Retirement in Europe. Participants The total sample was 28 857 community-dwelling individuals aged 50+ years. Main outcome All-cause mortality associated with COPD and HAT adjusting for covariates. We performed Aalen additive hazards models to explore these associations. Interactions between COPD and HAT were also explored. Analyses were conducted separately in three birth cohorts (>1945, 1936–1945 and =1935). Latent class growth analysis was used to classify participants into HAT. Results Three parallel HAT were found in the three birth cohorts (‘low’, ‘medium’ and ‘high’ healthy ageing). Participants with COPD had an increased mortality risk, but this effect was no longer significant after adjusting for covariates. The ‘low’ HAT was associated with increased mortality risk in the three subsamples, although this effect was lower after adjustment. The interaction between COPD and HAT was significant only in the =1935 birth cohort, indicating that those with COPD and a ‘low’ trajectory had a greater risk of mortality. Conclusions The healthy ageing scale may be a suitable tool to identify patients at higher risk to mitigate disease burden and improve patients’ quality of life.Peer ReviewedPostprint (published version

Multimorbidity patterns in low-middle and high income regions: a multiregion latent class analysis using ATHLOS harmonised cohorts

Objectives: Our aim was to determine clusters of non-communicable diseases (NCDs) in a very large, population-based sample of middle-aged and older adults from low- and middle-income (LMICs) and high-income (HICs) regions. Additionally, we explored the associations with several covariates. Design: The total sample was 72 140 people aged 50+ years from three population-based studies (English Longitudinal Study of Ageing, Survey of Health, Ageing and Retirement in Europe Study and Study on Global Ageing and Adult Health) included in the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) project and representing eight regions with LMICs and HICs. Variables were previously harmonised using an ex-post strategy. Eight NCDs were used in latent class analysis. Multinomial models were made to calculate associations with covariates. All the analyses were stratified by age (50-64 and 65+ years old). Results: Three clusters were identified: 'cardio-metabolic' (8.93% in participants aged 50-64 years and 27.22% in those aged 65+ years), 'respiratory-mental-articular' (3.91% and 5.27%) and 'healthy' (87.16% and 67.51%). In the younger group, Russia presented the highest prevalence of the 'cardio-metabolic' group (18.8%) and England the 'respiratory-mental-articular' (5.1%). In the older group, Russia had the highest proportion of both classes (48.3% and 9%). Both the younger and older African participants presented the highest proportion of the 'healthy' class. Older age, being woman, widowed and with low levels of education and income were related to an increased risk of multimorbidity. Physical activity was a protective factor in both age groups and smoking a risk factor for the 'respiratory-mental-articular'. Conclusion: Multimorbidity is common worldwide, especially in HICs and Russia. Health policies in each country addressing coordination and support are needed to face the complexity of a pattern of growing multimorbidity