Association of socioeconomic status with incidence and mortality of heart disease and stroke in older people in China

A thesis submitted in partial fulfilment of the requirements of the University of Wolverhampton for the degree of Doctor of Philosophy.Introduction: Over the past four decades, China has experienced increasing gap between the rich and poor, along with rapid economic development, and increased the numbers of heart disease and stroke. The population in Chins is ageing. It is unclear whether socioeconomic inequalities are associated with increased risk of heart disease and stroke in older people and their surviving in China. This PhD study aimed to investigate the associations of multiple measurements of socioeconomic status (SES) with incidence of heart disease and stroke in older Chinese people and all-cause mortality in those patients. Methods: Two prospective community-based cohort studies were conducted in Anhui province and in four other provinces in China. The Anhui cohort consisted of a random sample of 3,336 older adults, of whom 1,736 aged ≥65 years recruited from urban areas in 2001 and 1,600 aged ≥60 years from rural areas in 2003. In a standard questionnaire interview, they were recorded for sociodemographic, behaviours/lifestyles, social networks and supports, cardiovascular diseases and other related risk factors. SES was measured by urban-rural living, educational level, occupational class, satisfactory income, and any serious financial problems occurred in the past two years. Heart disease and stroke were documented based on self-reported doctor-diagnosis. The cohort members were followed up until 2011 to monitor vital status and causes of mortality, during which three waves of re-interviews were taken for survivors to further document incident heart disease and stroke. Following the same protocol as that in the last two surveys in the Anhui cohort study, the Four-province cohort study completed a baseline survey in 2008-2009 for 4,314 participants who were aged ≥60 years, who were randomly recruited from Guangdong, Shanghai, Heilongjiang, and Shanxi. The Four-province cohort study was followed up until 2012 to monitor the vital status and with re-interviewing survivors. The data of the Anhui cohort and the Four-province cohort studies were analysed in multivariate Cox regression models to examine the associations of SES with incidence and mortality of heart disease and stroke, respectively. Results: The data from the two cohort studies showed that low SES was generally associated with increased incidence of heart disease and stroke and all-cause mortality in older adults with these diseases, although the association varied with SES indicators. Pooled data demonstrated that while rural versus urban living was associated with reduced incidence of heart disease (multivariate adjusted hazard ratio 0.56, 95% CI 0.44-0.71), it increased mortality in participants with heart disease (3.57, 2.01-6.34). Rural living was associated with increased incidence of stroke (1.66, 1.08-2.57) and non-significantly all-cause mortality in participants with stroke (1.98, 0.70-5.59). While high occupational class was associated with increased incidence of stroke (1.56, 1.01-2.38), low level of education was significantly associated with mortality in participants with heart disease (1.59, 1.05-2.39). Low income or having financial problems was associated with increased incidence of heart disease (1.42, 1.00-2.00 in low family income) and all-cause mortality in people with heart disease (2.68, 1.08-6.65 in low personal income). Conclusions: In China older people with low SES had increased risks of heart disease (except for rural living) and stroke (except for occupational class). Impact of low SES on increased mortality in older people with heart disease and stroke appeared stronger. Strategies targeting different SES groups involving comprehensive approaches are needed to reduce incidence of heart disease and stroke and improve surviving in older people with heart disease and stroke

Prevalence and determinants of undetected dementia in the community: a systematic literature review and a meta-analysis

Objectives Detection of dementia is essential for improving the lives of patients but the extent of underdetection worldwide and its causes are not known. This study aimed to quantify the prevalence of undetected dementia and to examine its correlates. Methods/setting/participants A systematic search was conducted until October 2016 for studies reporting the proportion of undetected dementia and/or its determinants in either the community or in residential care settings worldwide. Random-effects models calculated the pooled rate of undetected dementia and subgroup analyses were conducted to identify determinants of the variation. Primary and secondary outcome measures The outcome measures of interest were the prevalence and determinants of undetected dementia. Results 23 studies were eligible for inclusion in this review. The pooled rate of undetected dementia was 61.7% (95% CI 55.0% to 68.0%). The rate of underdetection was higher in China and India (vs Europe and North America), in the community setting (vs residential/nursing care), age of <70 years, male gender and diagnosis by general practitioner. However, it was lower in the studies using Mini-Mental State Examination (MMSE) diagnosis criteria. Conclusions The prevalence of undetected dementia is high globally. Wide variations in detecting dementia need to be urgently examined, particularly in populations with low socioeconomic status. Efforts are required to reduce diagnostic inequality and to improve early diagnosis in the community

Collectin-11 detects stress-induced L-fucose pattern to trigger renal epithelial injury.

Physiochemical stress induces tissue injury as a result of the detection of abnormal molecular patterns by sensory molecules of the innate immune system. Here, we have described how the recently discovered C-type lectin collectin-11 (CL-11, also known as CL-K1 and encoded by COLEC11) recognizes an abnormal pattern of L-fucose on postischemic renal tubule cells and activates a destructive inflammatory response. We found that intrarenal expression of CL-11 rapidly increases in the postischemic period and colocalizes with complement deposited along the basolateral surface of the proximal renal tubule in association with L-fucose, the potential binding ligand for CL-11. Mice with either generalized or kidney-specific deficiency of CL-11 were strongly protected against loss of renal function and tubule injury due to reduced complement deposition. Ex vivo renal tubule cells showed a marked capacity for CL-11 binding that was induced by cell stress under hypoxic or hypothermic conditions and prevented by specific removal of L-fucose. Further analysis revealed that cell-bound CL-11 required the lectin complement pathway-associated protease MASP-2 to trigger complement deposition. Given these results, we conclude that lectin complement pathway activation triggered by ligand-CL-11 interaction in postischemic tissue is a potent source of acute kidney injury and is amenable to sugar-specific blockade

Association between fish consumption and risk of dementia: a new study from China and a systematic literature review and meta-analysis.

To assess the association of fish consumption with risk of dementia and its dose-response relationship, and investigate variations in the association among low-, middle- and high-income countries. A new community-based cross-sectional study and a systematic literature review.SettingsUrban and rural communities in China; population-based studies systematically searched from worldwide literature. Chinese adults aged ≥60 years in six provinces (n 6981) took part in a household health survey of dementia prevalence and risk factors. In addition, 33 964 participants from eleven published and eligible studies were included in the systematic review and meta-analysis. In the new study in China, 326 participants were diagnosed with dementia (4·7 %); those who consumed any amount of fish in the past two years v. those who consumed no fish had reduced risk of dementia (adjusted OR=0·73, 95 % CI 0·64, 0·99), but the dose-response relationship was not statistically significant. The meta-analysis of available data from the literature and the new study showed relative risk (RR) of dementia of 0·80 (95 % CI 0·74, 0·87) for people with fish consumption; the impact was similar among countries with different levels of income. Pooled dose-response data revealed RR (95 % CI) of 0·84 (0·72, 0·98), 0·78 (0·68, 0·90) and 0·77 (0·61, 0·98) in people with low, middle and high consumption of fish, respectively. Corresponding figures for Alzheimer's disease were 0·88 (0·74, 1·04), 0·79 (0·65, 0·96) and 0·67 (0·58, 0·78), respectively

Impact of older age adiposity on incident diabetes: A community-based cohort study in China

© 2022 Korean Diabetes Association. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.4093/dmj.2021.0215Background Obesity classifications vary globally and the impact of older age adiposity on incident diabetes has not been well-studied. Methods We examined a random sample of 2,809 participants aged ≥60 years in China, who were free of diabetes at baseline and were followed up for up to 10 years to document diabetes (n=178). The incidence of diabetes was assessed in relation to different cut-off points of body mass index (BMI) and waist circumference (WC) in multiple adjusted Cox regression models. Results The diabetic risk in the cohort increased linearly with the continuous and quartile variables of BMI and WC. The BMI-World Health Organization (WHO) and BMI-China criteria analysis did not show such a linear relationship, however, the BMI-Asian/Hong Kong criteria did; adjusted hazards ratio (HR) was 0.42 (95% confidence interval [CI], 0.20 to 0.90) in BMI <20 kg/m2, 1.46 (95% CI, 0.99 to 2.14) in 23-≤26 kg/m2, and 1.63 (95% CI, 1.09 to 2.45) in ≥26 kg/m2. The WC-China criteria revealed a slightly better prediction of diabetes (adjusted HRs were 1.79 [95% CI, 1.21 to 2.66] and 1.87 [95% CI, 1.22 to 2.88] in central obese action levels 1 and 2) than the WC-WHO. The combination of the BMI-Asian/Hong Kong with WC-China demonstrated the strongest prediction. There were no gender differences in the impact of adiposity on diabetes. Conclusion In older Chinese, BMI-Asian/Hong Kong criteria is a better predictor of diabetes than other BMI criterion. Its combination with WC-China improved the prediction of adiposity to diabetes, which would help manage bodyweight in older age to reduce the risk of diabetes.The data collection of the Anhui cohort study was funded by the Royal Society of UK, the BUPA Foundation (Grants Nos. 45NOV06, and TBF-M09-05) and Alzheimer’s Research UK (Grant No. ART/PPG2007B/2). The data analysis was supported by the Discipline Construction Project of Guangdong Medical University (4SG21276P) and the Basic and Applied Basic Research Foundation of Guangdong Province Regional Joint Fund Project (The Key Project) (2020B1515120021), China.Published versio

Determinants of fish consumption in older people: a community-based cohort study

Objectives: Habitual fish consumption and its determinants in older people have not been well investigated. We addressed these issues through a population-based cohort study. Methods: In 2001-2003 we interviewed a random sample of 3336 residents aged ≥60 years in China, documenting socioeconomic status (SES) and disease risk factors. In 2007-2009 we re-interviewed 1757 survivors, additionally surveying average self-reported intake of fish over the past two years. Results: Of 1757 participants, 1697 responded to the fish consumption questionnaire; 23.0% of whom had “never eat” fish, 43.4% “once a week”, 26.9% “more than twice a week”, and 6.7% “≥once a day”. There was an inverse association of fish consumption with older age (multivariate adjusted odds ratio 0.64 [95% CI 0.45-0.92] and 0.35 [0.24-0.52] at ages of 75-79, and ≥80 years), female gender (0.63, 0.47-0.84), smoking (0.65, 0.48-0.88), living in a rural area (0.10, 0.07-0.15), having educational level of ≤primary school (0.10, 0.05-0.19), occupation of peasant (0.08, 0.05-0.14), low income (0.11, 0.07-0.18), financial difficulties (0.25, 0.18-0.34), being never married/divorced (0.48, 0.28-0.81), having undetected hypertension (0.71, 0.55-0.91), depression (0.50, 0.29-0.84) and dementia (0.64, 0.41-0.98). However, participants with central obesity and heart disease at baseline had increased odds of fish consumption. Separate data analysis for different levels of fish consumption showed a dose-response trend for these associations. Conclusion: In older Chinese, there are large socioeconomic inequalities, and certain lifestyle, psychosocial factors and health-related conditions are strong determinants of fish consumption. Such information is important for future development or refinement of effective dietary interventions targeting older adults

Protective role for collectin‐11 in rheumatoid arthritis in mice

OBJECTIVE. Collectin-11 (CL-11) is a soluble C-type lectin, a mediator of innate immunity. Its role in autoimmune disorders is unknown. The goal of this study was to determine the role of CL-11 in a mouse model of rheumatoid arthritis (RA). METHODS. A murine collagen-induced arthritis (CIA) model, combining both gene deletion of Colec11 and recombinant (rCL-11) treatment approaches were employed. Joint inflammation and tissue destruction, circulating levels of inflammatory cytokines and adaptive immune responses were assessed in CIA mice. Splenic CD11c(+) cells were used to examine the influence of CL-11 on antigen presenting cell (APC) function. Serum levels of CL-11 in RA patients were also examined. RESULTS. Colec11(−/−) mice developed more severe arthritis than WT mice (as determined by disease incidence, clinical arthritis scores and histopathology; P<0.05). Disease severity is associated with significantly enhanced APC activation, Th1/Th17 responses, pathogenic IgG2a production and joint inflammation, as well as elevated circulating levels of inflammatory cytokines. In vitro analysis of CD11c(+) cells revealed that CL-11 is critical for suppression of APC activation and function. Pharmacological treatment of mice with rCL-11 reduced the severity of CIA in mice. Analysis of human blood samples revealed that serum levels of CL-11 was lower in RA patients (n=51) compared to healthy controls (n=53), a serum CL-11 reduction also displays a negative relationship with DAS28, ESR and CRP (P<0.05). CONCLUSION. Our findings demonstrate a novel role for CL-11 in protection against RA, suggesting the underlying mechanism involved suppression of APC activation and subsequent T cell responses

Role of corticotropin-releasing hormone in the impact of chronic stress during pregnancy on inducing depression in male offspring mice

This is an accepted manuscript of an article published by Elsevier in Brain Research on 30/07/2020, available online: https://doi.org/10.1016/j.brainres.2020.147029 The accepted version of the publication may differ from the final published version.This work was supported by the National Natural Science Foundation of China (grant no. 81773452).Published versio