Sex differences in mental health among older adults: investigating time trends and possible risk groups with regard to age, educational level and ethnicity

Objectives: Older women report lower mental health compared to men, yet little is known about the nature of this sex difference. Therefore, this study investigates time trends and possible risk groups. Method: Data from the Doetinchem Cohort Study (DCS) and the Longitudinal Aging Study Amsterdam (LASA) were used. General mental health was assessed every 5 years, from 1995 to 1998 onwards (DCS, n = 1412, 20-year follow-up, baseline age 55–64 years). Depressive and anxiety symptoms were assessed for two birth cohorts, from 1992/1993 onwards (LASA cohort 1, n = 967, 24-year follow-up, age 55-65 years,) and 2002/2003 onwards (LASA cohort 2, n = 1002, 12-year follow-up, age 55–65 years) with follow-up measurements every 3–4 years. Results: Mixed model analyses showed that older women had a worse general mental health (−6.95; −8.36 to 5.53; range 0–100, ∼10% lower), more depressive symptoms (2.09; 1.53–2.63; range 0-60, ∼30% more) and more anxiety symptoms (0.86; 0.54–1.18; range 0–11, ∼30% more) compared to men. These sex differences remained stable until the age of 75 years, where after they decreased due to an accelerated decline in mental health for men compared to women. Sex differences and their course by age were consistent over successive birth cohorts, educational levels and ethnic groups (Caucasian vs. Turkish/Moroccan). Conclusion: There is a consistent female disadvantage in mental health across different sociodemographic groups and over decennia (1992 vs. 2002) with no specific risk groups

The sex difference in gait speed among older adults: how do sociodemographic, lifestyle, social and health determinants contribute?

Background: This study explores whether a sex difference in sensitivity to (strength of the association) and/or in exposure to (prevalence) determinants of gait speed contributes to the observed lower gait speed among older women compared to men. Methods: Data from the Longitudinal Aging Study Amsterdam (LASA) were used. In total 2407 men and women aged 55–81 years were included, with baseline measurements in 1992/2002 and follow-up measurements every 3–4 years for 15/25 years. Multivariable mixed model analysis was used to investigate sex differences in sensitivity (interaction term with sex) and in exposure to (change of the sex difference when adjusted) socio-demographic, lifestyle, social and health determinants of gait speed. Results: Women had a 0.054 m/s (95 % CI: 0.076 − 0.033, adjusted for height and age) lower mean gait speed compared to men. In general, men and women had similar determinants of gait speed. However, higher BMI and lower physical activity were more strongly associated with lower gait speed in women compared to men (i.e. higher sensitivity). More often having a lower educational level, living alone and having more chronic diseases, pain and depressive symptoms among women compared to men also contributed to observed lower gait speed in women (i.e. higher exposure). In contrast, men more often being a smoker, having a lower physical activity and a smaller personal network size compared to women contributed to a lower gait speed among men (i.e. higher exposure). Conclusions: Both a higher sensitivity and higher exposure to determinants of gait speed among women compared to men contributes to the observed lower gait speed among older women. The identified (modifiable) contributing factors should be taken into account when developing prevention and/or treatment strategies aimed to enhance healthy physical aging. This might require a sex-specific approach in both research and clinical practice, which is currently often lacking

Impaired Genome Maintenance Suppresses the Growth Hormone–Insulin-Like Growth Factor 1 Axis in Mice with Cockayne Syndrome

Cockayne syndrome (CS) is a photosensitive, DNA repair disorder associated with progeria that is caused by a defect in the transcription-coupled repair subpathway of nucleotide excision repair (NER). Here, complete inactivation of NER in Csb(m/m)/Xpa(−/−) mutants causes a phenotype that reliably mimics the human progeroid CS syndrome. Newborn Csb(m/m)/Xpa(−/−) mice display attenuated growth, progressive neurological dysfunction, retinal degeneration, cachexia, kyphosis, and die before weaning. Mouse liver transcriptome analysis and several physiological endpoints revealed systemic suppression of the growth hormone/insulin-like growth factor 1 (GH/IGF1) somatotroph axis and oxidative metabolism, increased antioxidant responses, and hypoglycemia together with hepatic glycogen and fat accumulation. Broad genome-wide parallels between Csb(m/m)/Xpa(−/−) and naturally aged mouse liver transcriptomes suggested that these changes are intrinsic to natural ageing and the DNA repair–deficient mice. Importantly, wild-type mice exposed to a low dose of chronic genotoxic stress recapitulated this response, thereby pointing to a novel link between genome instability and the age-related decline of the somatotroph axis

Integrated genomic characterization of oesophageal carcinoma

Oesophageal cancers are prominent worldwide; however, there are few targeted therapies and survival rates for these cancers remain dismal. Here we performed a comprehensive molecular analysis of 164 carcinomas of the oesophagus derived from Western and Eastern populations. Beyond known histopathological and epidemiologic distinctions, molecular features differentiated oesophageal squamous cell carcinomas from oesophageal adenocarcinomas. Oesophageal squamous cell carcinomas resembled squamous carcinomas of other organs more than they did oesophageal adenocarcinomas. Our analyses identified three molecular subclasses of oesophageal squamous cell carcinomas, but none showed evidence for an aetiological role of human papillomavirus. Squamous cell carcinomas showed frequent genomic amplifications of CCND1 and SOX2 and/or TP63, whereas ERBB2, VEGFA and GATA4 and GATA6 were more commonly amplified in adenocarcinomas. Oesophageal adenocarcinomas strongly resembled the chromosomally unstable variant of gastric adenocarcinoma, suggesting that these cancers could be considered a single disease entity. However, some molecular features, including DNA hypermethylation, occurred disproportionally in oesophageal adenocarcinomas. These data provide a framework to facilitate more rational categorization of these tumours and a foundation for new therapies

Prevalence of musculoskeletal disorders is systematically higher in women than in men

OBJECTIVES: Many studies report a higher prevalence of musculoskeletal pain in women than in men. This paper presents an overview of sex differences in musculoskeletal pain with specific attention for: different parameters for duration of musculoskeletal pain (ie, 1-y period prevalence, point prevalence, prevalence of chronic pain, and prevalence of persistent chronic pain); and (2) different anatomic pain sites. METHODS: For the analyses, data from 2 general population-based prospective surveys (Dutch population-based Musculoskeletal Complaints and Consequences Cohort study and Monitoring Project on Risk Factors for Chronic Diseases-study) were used. The study population consisted of persons aged 25 to 64 years living in the Netherlands. Data on self-reported pain complaints were assessed by written questionnaires. RESULTS: The results of this study showed that prevalence rates of musculoskeletal pain were higher for women than for men in the Dutch general population aged 25 to 64 years on the basis of 2 population-based surveys. For musculoskeletal pain in any location, 39% of men and 45% of women reported chronic complaints. Highest female predominance was found for the hip and wrist/hand, whereas lowest and not statistically significant sex differences were found for the lower back and knee. All duration parameters of musculoskeletal pain showed a female predominance of musculoskeletal pain (1-y period prevalence, point prevalence, prevalence of chronic pain, and prevalence of persistent chronic pain). In those with persistent chronic pain, women tended to report higher severity scores. DISCUSSION: The present study shows that women have higher prevalence rates of musculoskeletal pain in most anatomic pain sites, no matter the duration of musculoskeletal pain. Future research should focus on explaining these sex differences with the ultimate goal to develop better prevention and management strategies for musculoskeletal pain in both men and women

Explaining sex differences in chronic musculoskeletal pain in a general population.

Many studies report a female predominance in the prevalence of chronic musculoskeletal pain (CMP) but the mechanisms explaining these sex differences are poorly understood. Data from a random postal questionnaire survey in the Dutch general population were used to examine whether sex differences in the prevalences of CMP are due to sex differences in the distribution of known potential risk factors for CMP (exposure model) and/or to the different importance of risk factors for CMP (i.e. show different strength of association) in men and women (vulnerability model). In the present analyses, 909 men and 1178 women aged 25-65 were included. CMP was defined as pain lasting longer than 3 months and was assessed for 10 anatomical locations (neck, shoulder, higher back, elbow, wrist/hand, lower back, hip, knee, ankle, foot). Sex differences in CMP could not be explained by a different distribution of age, educational level, smoking status, overweight, physical activity, and pain catastrophizing. Having no paid job was associated with CMP, explaining part of the sex differences, but its role seems complex. Risk factors with a sex-specific association were: overweight (all pain locations) and older age (lower extremities)--both having only an effect among women--and pain catastrophizing (upper extremities), which was stronger associated with CMP among men than among women. In conclusion, sex differences in prevalence of CMP may partly be explained by sex differences in vulnerability to risk factors for CMP. Future research towards sex-specific identification of risk factors for CMP is warranted. Eventually this may lead to sex-specific prevention and management of CMP

Sex differences in consequences of musculoskeletal pain

STUDY DESIGN. Cross-sectional population-based study. OBJECTIVE. To study sex differences in consequences of musculoskeletal pain (MP): limited functioning, work leave or disability, and healthcare use. SUMMARY OF BACKGROUND DATA. MP is a major public health problem in developed countries due to high prevalence rates and considerable consequences. There are indications that consequences of MP differ for men and women. METHODS. Data of a Dutch population-based study were used, limited to persons 25 to 64 years of age (n = 2517). Data were collected by a postal questionnaire. RESULTS. Women with any MP report more healthcare use for MP, i.e., contact with a medical caregiver and use of medicines than men, while men report more work disability (ever in life) due to low back pain only, irrespective of work status. None of the sex differences can be explained by age, household composition, educational level, smoking status, overweight, physical activity, and pain catastrophizing. Older age was related to more limited functioning due to MP (women), work disability due to MP (men), and healthcare use due to MP (men and women). A one-person household was associated with work disability (women) and use of medicines (men). Low educational level was associated with limited functioning (men), work leave (men), contact with a medical caregiver (men), and work disability (men and women). Smoking was associated with limited functioning (men), work leave (women), and healthcare use (women). Physical inactivity was associated with limited functioning due to MP in women. Pain catastrophizing was associated with limited functioning, work leave, and healthcare use (men and women) and work disability (men). CONCLUSIONS. Consequences of MP show a slightly different pattern for men and women. Women with any MPreport more healthcare use for MP, while men report more work disability due to low back pain only. These sex differences can not be explained by general risk factors, but associations between these factors and consequences of MP show some sex differences

Hormonal and reproductive factors are associated with chronic low back pain and chronic upper extremity pain in women--the MORGEN study.

STUDY DESIGN: Cross-sectional study of 11,428 women aged 20-59 years who were included in a postal questionnaire survey in the Dutch general population. OBJECTIVE: To examine how hormonal and reproductive factors are associated with chronic low back pain (LBP) and chronic upper extremity pain (UEP) in women. SUMMARY OF BACKGROUND DATA: Although LBP is suggested to be linked to hormonal and reproductive factors in women, results from previous studies are inconclusive. In addition, the association with chronic UEP is unknown. METHODS: Multivariate logistic regression models were used to examine associations between hormonal and reproductive factors (independent variables) and, respectively, chronic LBP, chronic UEP and combined chronic LBP/UEP. Associations were adjusted for age, level of education, working status, smoking, and overweight. RESULTS: Past pregnancy, young maternal age at first birth, duration of oral contraceptive use, and use of estrogens during menopause were associated with chronic LBP, while young age at menarche was associated with chronic UEP. Irregular or prolonged menstruation and hysterectomy were associated both with chronic LBP and chronic UEP. No positive associations were found for current pregnancy and number of children. CONCLUSIONS: In adult women, hormonal and reproductive factors are associated with chronic musculoskeletal pain in general. Factors related to increased estrogen levels may specifically increase the risk of chronic LBP

Hormonal and reproductive factors are associated with chronic low back pain and chronic upper extremity pain in women - The MORGEN study

STUDY DESIGN. Cross-sectional study of 11,428 women aged 20-59 years who were included in a postal questionnaire survey in the Dutch general population. OBJECTIVE. To examine how hormonal and reproductive factors are associated with chronic low back pain (LBP) and chronic upper extremity pain (UEP) in women. SUMMARY OF BACKGROUND DATA. Although LBP is suggested to be linked to hormonal and reproductive factors in women, results from previous studies are inconclusive. In addition, the association with chronic UEP is unknown. METHODS. Multivariate logistic regression models were used to examine associations between hormonal and reproductive factors (independent variables) and, respectively, chronic LBP, chronic UEP and combined chronic LBP/UEP. Associations were adjusted for age, level of education, working status, smoking, and overweight. RESULTS. Past pregnancy, young maternal age at first birth, duration of oral contraceptive use, and use of estrogens during menopause were associated with chronic LBP, while young age at menarche was associated with chronic UEP. Irregular or prolonged menstruation and hysterectomy were associated both with chronic LBP and chronic UEP. No positive associations were found for current pregnancy and number of children. CONCLUSIONS. In adult women, hormonal and reproductive factors are associated with chronic musculoskeletal pain in general. Factors related to increased estrogen levels may specifically increase the risk of chronic LBP