Does cognitive ability influence responses to the Warwick-Edinburgh Mental Well-Being Scale?

It has been suggested that how individuals respond to self-report items relies on cognitive processing. We hypothesized that an individual's level of cognitive ability may influence these processes such that, if there is a hierarchy of items within a particular questionnaire, as demonstrated by Mokken scaling, the strength of that hierarchy will vary according to cognitive ability. Using data on 8,643 men and women from the National Child Development Survey (1958 birth cohort; Power, & Elliott, 2006), we investigated, using Mokken scaling, whether the 14 items that make up the Warwick-Edinburgh Mental Well-Being Scale (Tennant et al., 2007)-completed when the participants were 50 years of age-form a hierarchy and whether that hierarchy varied according to cognitive ability at age 11 years. Among the sample as a whole, we found a moderately strong unidimensional hierarchy of items (Loevinger's coefficient [H] = 0.48). We split participants into 3 groups according to cognitive ability and analyzed the Mokken scaling properties of each group. Only the medium and high cognitive ability groups had acceptable (?0.3) invariant item ordering (assessed using the HT statistic). This pattern was also found when the 3 cognitive ability groups were assessed within men and women separately. Greater attention should be paid to the content validity of questionnaires to ensure they are applicable across the spectrum of mental ability

Inflammatory markers and incident frailty in men and women:the English Longitudinal Study of Ageing

Cross-sectional studies show that higher blood concentrations of inflammatory markers tend to be more common in frail older people, but longitudinal evidence that these inflammatory markers are risk factors for frailty is sparse and inconsistent. We investigated the prospective relation between baseline concentrations of the inflammatory markers C-reactive protein (CRP) and fibrinogen and risk of incident frailty in 2,146 men and women aged 60 to over 90 years from the English Longitudinal Study of Ageing. The relationship between CRP and fibrinogen and risk of incident frailty differed significantly by sex (p for interaction terms <0.05). In age-adjusted logistic regression analyses, for a standard deviation (SD) increase in CRP or fibrinogen, odds ratios (95 % confidence intervals) for incident frailty in women were 1.69 (1.32, 2.17) and 1.39 (1.12, 1.72), respectively. Further adjustment for other potential confounding factors attenuated both these estimates. For an SD increase in CRP and fibrinogen, the fully-adjusted odds ratio (95 % confidence interval) for incident frailty in women was 1.27 (0.96, 1.69) and 1.31 (1.04, 1.67), respectively. Having a high concentration of both inflammatory markers was more strongly predictive of incident frailty than having a high concentration of either marker alone. In men, there were no significant associations between any of the inflammatory markers and risk of incident frailty. High concentrations of the inflammatory markers CRP and fibrinogen are more strongly predictive of incident frailty in women than in men. Further research is needed to understand the mechanisms underlying this sex difference

Intelligence in youth and health behaviours in middle age

Objective: We investigated the association between intelligence in youth and a range of health-related behaviours in middle age. Method: Participants were the 5347 men and women who responded to the National Longitudinal Survey of Youth 1979 (NLSY-79) 2012 survey. IQ was recorded with the Armed Forces Qualification Test (AFQT) when participants were aged 15 to 23 years of age. Self-reports on exercise (moderate activity, vigorous activity, and strength training), dietary, smoking, drinking, and oral health behaviours were recorded when participants were in middle age (mean age = 51.7 years). A series of regression analyses tested for an association between IQ in youth and the different health related behaviours in middle age, while adjusting for childhood socio-economic status (SES) and adult SES. Results: Higher IQ in youth was significantly associated with the following behaviours that are beneficial to health: being more likely to be able to do moderate cardiovascular activity (Odds Ratio, 95% CI) (1.72, 1.35 to 2.20, p < .001) and strength training (1.61, 1.37 to 1.90, p < .001); being less likely to have had a sugary drink in the previous week (0.75, 0.71 to 0.80, p <.001); a lower likelihood of drinking alcohol heavily (0.67, 0.61 to 0.74, p < .001); being less likely to smoke (0.60, 0.56 to 0.65, p < .001); being more likely to floss (1.47, 1.35 to 1.59, p < .001); and being more likely to say they “often” read the nutritional information (1.20, 1.09 to 1.31, p < .001) and ingredients (1.24, 1.12 to 1.36, p < .001) on food packaging compared to always reading them. Higher IQ was also linked with dietary behaviours that may or may not be linked with poorer health outcomes (i.e. being more likely to have skipped a meal (1.10, 1.03 to 1.17, p = .005) and snacked between meals (1.37, 1.26 to 1.50, p < .001) in the previous week). An inverted u-shaped association was also found between IQ and the number of meals skipped per week. Higher IQ was also linked with behaviours that are known to be linked with poorer health (i.e. a higher likelihood of drinking alcohol compared to being abstinent from drinking alcohol (1.58, 1.47 to 1.69, p < .001)). A u-shaped association was found between IQ and the amount of alcohol consumed per week and an inverted u-shaped association was found between IQ and the number of cigarettes smoked a day. Across all outcomes, adjusting for childhood SES tended to attenuate the estimated effect size only slightly. Adjusting for adult SES led to more marked attenuation but statistical significance was maintained in most cases. Conclusion: In the present study, a higher IQ in adolescence was associated with a number of healthier behaviours in middle age. In contrast to these results, a few associations were also identified between higher intelligence and behaviours that may or may not be linked with poor health (i.e. skipping meals and snacking between meals) and with behaviours that are known to be linked with poor health (i.e. drinking alcohol and the number of cigarettes smoked). To explore mechanisms of association, future studies could test for a range of health behaviours as potential mediators between IQ and morbidity or mortality in later life

Assessment of Relative Utility of Underlying vs Contributory Causes of Death.

Importance: In etiological research, investigators using death certificate data have traditionally extracted underlying cause of mortality alone. With multimorbidity being increasingly common, more than one condition is often compatible with the manner of death. Using contributory cause plus underlying cause would also have some analytical advantages, but their combined utility is largely untested. Objective: To compare the relative utility of cause of death data extracted from the underlying cause field vs any location on the death certificate (underlying and contributing combined). Design, Setting, and Participants: This study compares the association of 3 known risk factors (cigarette smoking, low educational attainment, and hypertension) with health outcomes based on where cause of death data appears on the death certificate in 2 prospective cohort study collaborations (UK Biobank [N = 502 655] and the Health Survey for England [15 studies] and the Scottish Health Surveys [3 studies] [HSE-SHS; N = 193 873]). Data were collected in UK Biobank from March 2006 to October 2010 and in HSE-SHS from January 1994 to December 2008. Data analysis began in June 2018 and concluded in June 2019. Main Outcomes and Measures: Death from cardiovascular disease, cancer, dementia, and injury. For each risk factor-mortality end point combination, a ratio of hazard ratios (RHR) was computed by dividing the effect estimate for the underlying cause by the effect estimate for any mention. Results: In UK Biobank, there were 14 421 deaths (2.9%) during a mean (SD) of 6.99 (1.03) years of follow up; in HSE-SHS, there were 21 314 deaths (11.0%) during a mean (SD) of 9.61 (4.44) years of mortality surveillance. Established associations of risk factors with death outcomes were essentially the same irrespective of placement of cause on the death certificate. Results from each study were mutually supportive. For having ever smoked cigarettes (vs never having smoked) in the UK Biobank, the RHR for cardiovascular disease was 0.98 (95% CI, 0.87-1.10; P value for difference = .69); for cancer, the RHR was 0.99 (95% CI, 0.93-1.05; P value for difference = .69). In the HSE-SHS, the RHR for cardiovascular disease was 0.94 (95% CI, 0.87-1.01; P value for difference = .09); for cancer, it was 1.01 (95% CI, 0.94-1.10; P value for difference = .75). Conclusions and Relevance: Risk factor-end point associations were not sensitive to the placement of data on the death certificate. This has implications for the examination of the association of risk factors with causes of death where there may be too few events to compute reliable effect estimates based on the underlying field alone

Systemic inflammation and subsequent risk of amyotrophic lateral sclerosis: prospective cohort study

BACKGROUND: While systemic inflammation has been implicated in the etiology of selected neurodegenerative disorders, its role in the development of amyotrophic lateral sclerosis (ALS) is untested. Accordingly, we quantified the relationship of C-reactive protein (CRP), an acute-phase reactant and marker of systemic inflammation, with subsequent ALS occurrence. METHODS: We used data from UK Biobank, a prospective cohort study of 502,649 participants who were aged 37 to 73 years when examined at research centers between 2006 and 2010. Venous blood was collected at baseline in the full cohort and assayed for CRP, and repeat measurement was made 3-7 years later in a representative subgroup (N=14,514) enabling correction for regression dilution. ALS was ascertained via national hospitalization and mortality registries until 2021. We computed multivariable hazard ratios with accompanying 95% confidence intervals for log-transformed CRP expressed as standard deviation and tertiles. RESULTS: In an analytical sample of 400,884 initially ALS-free individuals (218,203 women), a mean follow-up of 12 years gave rise to 231 hospitalizations and 223 deaths ascribed to ALS. After adjustment for covariates which included health behaviors, comorbidity, and socio-economic status, a one standard deviation higher log-CRP was associated with elevated rates of both ALS mortality (hazard ratios; 95% confidence intervals: 1.32; 1.13, 1.53) and hospitalizations (1.20; 1.00, 1.39). There was evidence of dose-response effects across tertiles of CRP for both outcomes (p for trend ≤0.05). Correction for regression dilution led to a strengthening of the relationship with CRP for both mortality (1.62; 1.27, 2.08) and hospitalizations (1.37; 1.05, 1.76) ascribed to ALS. CONCLUSIONS: Higher levels of CRP, a blood-based biomarker widely captured in clinical practice, is associated with moderately increased future risk of amyotrophic lateral sclerosis

Interarm differences in systolic blood pressure and mortality among US army veterans:aetiological associations and risk prediction in the Vietnam experience study

Background Differences between the arms in systolic blood pressure (SBP) of ?10?mmHg have been associated with an increased risk of mortality in patients with hypertensive and chronic renal disease. For the first time, we examined these relationships in a non-clinical population. Design Cohort study. Methods Participants were 4419 men (mean age 38.37 years) from the Vietnam Experience Study. Bilateral SBP and diastolic BP (DBP), serum lipids, fasting glucose, erythrocyte sedimentation rate, metabolic syndrome, and ankle brachial index were assessed in 1986. Results Ten per cent of men had an interarm difference of ?10 and 2.4% of ?15?mmHg. A 15-year follow-up period gave rise to 246 deaths (64 from cardiovascular disease, CVD). Interarm differences of ?10?mmHg were associated with an elevated risk of all-cause mortality (hazard ratio, HR, 1.49, 95% confidence interval, CI, 1.04–2.14) and CVD mortality (HR 1.93, 95% CI 1.01–3.69). After adjusting for SBP, DBP, lipids, fasting glucose, and erythrocyte sedimentation rate, associations between interarm differences of ?10?mmHg and all-cause mortality (HR 1.35, 95% CI 0.94–1.95) and CVD mortality (1.62, 95% CI 0.84–3.14) were significantly attenuated. Conclusions In this non-clinical cohort study, interarm differences in SBP were not associated with mortality after accounting for traditional CVD risk factors. Interarm differences might not be valuable as an additional risk factor for mortality in populations with a low risk of CVD. <br/

Comparison of risk factor associations in UK Biobank against representative, general population based studies with conventional response rates: prospective cohort study and individual participant meta-analysis

Abstract: Objective: To compare established associations between risk factors and mortality in UK Biobank, a study with an exceptionally low rate of response to its baseline survey, against those from representative studies that have conventional response rates. Design: Prospective cohort study alongside individual participant meta-analysis of other cohort studies. Setting: United Kingdom. Participants: Analytical sample of 499 701 people (response rate 5.5%) in analyses in UK Biobank; pooled data from the Health Surveys for England (HSE) and the Scottish Health Surveys (SHS), including 18 studies and 89 895 people (mean response rate 68%). Both study populations were linked to the same nationwide mortality registries, and the baseline age range was aligned at 40-69 years. Main outcome measure: Death from cardiovascular disease, selected malignancies, and suicide. To quantify the difference between hazard ratios in the two studies, a ratio of the hazard ratios was used with HSE-SHS as the referent. Results: Risk factor levels and mortality rates were typically more favourable in UK Biobank participants relative to the HSE-SHS consortium. For the associations between risk factors and mortality endpoints, however, close agreement was seen between studies. Based on 14 288 deaths during an average of 7.0 years of follow-up in UK Biobank and 7861 deaths over 10 years of mortality surveillance in HSE-SHS, for cardiovascular disease mortality, for instance, the age and sex adjusted hazard ratio for ever having smoked cigarettes (versus never) was 2.04 (95% confidence interval 1.87 to 2.24) in UK Biobank and 1.99 (1.78 to 2.23) in HSE-SHS, yielding a ratio of hazard ratios close to unity (1.02, 0.88 to 1.19). The overall pattern of agreement between studies was essentially unchanged when results were compared separately by sex and when baseline years and censoring dates were aligned. Conclusion: Despite a very low response rate, risk factor associations in the UK Biobank seem to be generalisable

Pre-pandemic cognitive function and COVID-19 vaccine hesitancy: cohort study

Background Whereas several predictors of COVID-19 vaccine hesitancy have been reported, the role of cognitive function is largely unknown. Accordingly, our objective was to evaluate the association between scores from an array of cognitive function tests and self-reported vaccine hesitancy after the announcement of the successful testing of the first COVID-19 vaccine (Oxford University/AstraZeneca). Methods We used individual-level data from a pandemic-focused study ('COVID Survey'), a prospective cohort study nested within United Kingdom Understanding Society ('Main Survey'). In the week immediately following the announcement of successful testing of the first efficacious inoculation (November/December 2020), data on vaccine intentionality were collected in 11,740 individuals (6702 women) aged 16–95 years. Pre-pandemic scores on general cognitive function, ascertained from a battery of six tests, were captured in 2011/12 wave of the Main Survey. Study members self-reported their intention to take up a vaccination in the COVID-19 Survey. Results Of the study sample, 17.2% (N = 1842) indicated they were hesitant about having the vaccine. After adjustment for age, sex, and ethnicity, study members with a lower baseline cognition score were markedly more likely to be vaccine hesitant (odds ratio per standard deviation lower score in cognition; 95% confidence interval: 1.76; 1.62, 1.90). Adjustment for mental and physical health plus household shielding status had no impact on these results, whereas controlling for educational attainment led to partial attenuation but the probability of hesitancy was still elevated (1.52; 1.37, 1.67). There was a linear association for vaccine hesitancy across the full range of cognition scores (p for trend: p &lt; 0.0001). Conclusions Erroneous social media reports might have complicated personal decision-making, leading to people with lower cognitive ability being vaccine-hesitant. With individuals with lower cognition also experiencing higher rates of COVID-19 in studies conducted prior to vaccine distribution, these new findings are suggestive of a potential additional disease burden

Childhood intelligence predicts voter turnout, voting preferences, and political involvement in adulthood: The 1970 British Cohort Study

Little is known about the association between measured intelligence and how people participate in democratic processes. In the 1970 British Cohort Study, we examined the association between childhood intelligence and, at age 34: whether and how people voted in the 2001 UK general election: how they intended to vote: and whether they had taken part in other political activities. People with higher childhood intelligence were more likely to vote in the 2001 election (38% increased prevalence per SD increase in intelligence), and were more likely to vote for the Green Party and the Liberal Democrats (49% and 47% increased prevalence per SD increase in intelligence, respectively). The intelligence-Green party voting association was largely accounted for by occupational social class, the intelligence-Liberal Democrat voting association was not. Similar associations between intelligence and preference for the Green Party or Liberal Democrats were found as regards voting intentions, but neither of these associations Was accounted for by occupational social class. People with higher childhood intelligence were more likely to take part in rallies and demonstrations, and to sign petitions, and expressed a greater interest in politics (40%, 65%, 33%, and 58% increased prevalence per SD increase in intelligence, respectively). (C) 2008 Elsevier Inc. All rights reserved