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The COVID-19 pandemic offers opportunities to study effects of in-utero and early life exposure to environmental changes. However, inferences from such studies may be flawed if the pandemic has changed the socioeconomic composition of parents. Analysing over 77.9 million live births from 15 countries, we estimate changes in the socioeconomic composition of the cohort born between December 2020 and December 2021 using interrupted time series analysis. We find that, compared with their counterfactual compositions, the December 2020-December 2021 birth cohort has a higher proportion of babies born to socioeconomically advantaged parents in Austria, England, Finland, the Netherlands, Scotland, Spain, Wales, and the United States while we observe the opposite change for Brazil, Colombia, Ecuador, and Mexico. These changes in cohort composition may cause between-cohort differences in life course outcomes that are influenced by parental socioeconomic circumstances even if early life exposure to the pandemic had no direct effect on this birth cohort. The authors show that babies conceived during the COVID-19 pandemic have a different parental socioeconomic composition than expected had the pandemic not occurred.

IntroductionThis protocol outlines aims to test the wider impacts of the COVID-19 pandemic on pregnancy and birth outcomes and inequalities in Scotland.Method and analysisWe will analyse Scottish linked administrative data for pregnancies and births before (March 2010 to March 2020) and during (April 2020 to October 2020) the pandemic. The Community Health Index database will be used to link the National Records of Scotland Births and the Scottish Morbidity Record 02. The data will include about 500 000 mother–child pairs. We will investigate population-level changes in maternal behaviour (smoking at antenatal care booking, infant feeding on discharge), pregnancy and birth outcomes (birth weight, preterm birth, Apgar score, stillbirth, neonatal death, pre-eclampsia) and service use (mode of delivery, mode of anaesthesia, neonatal unit admission) during the COVID-19 pandemic using two analytical approaches. First, we will estimate interrupted times series regression models to describe changes in outcomes comparing prepandemic with pandemic periods. Second, we will analyse the effect of COVID-19 mitigation measures on our outcomes in more detail by creating cumulative exposure variables for each mother–child pair using the Oxford COVID-19 Government Response Tracker. Thus, estimating a potential dose–response relationship between exposure to mitigation measures and our outcomes of interest as well as assessing if timing of exposure during pregnancy matters. Finally, we will assess inequalities in the effect of cumulative exposure to lockdown measures on outcomes using several axes of inequality: ethnicity/mother’s country of birth, area deprivation (Scottish Index of Multiple Deprivation), urban-rural classification of residence, number of previous children, maternal social position (National Statistics Socioeconomic Classification) and parental relationship status.Ethics and disseminationNHS Scotland Public Benefit and Privacy Panel for Health and Social Care scrutinised and approved the use of these data (1920-0097). Results of this study will be disseminated to the research community, practitioners, policy makers and the wider public.

BackgroundLittle is known about education-related inequalities in late-life disability. Here, we use individual-level register data on the receipt of the Austrian long-term care allowance (ALTCA) to assess education-related inequalities in the duration of late-life disability.MethodsIn this retrospective mortality follow-back study, we analyse receipt of ALTCA, a universal cash benefit based on physician-assessed disability in activities of daily living, during the last 5 years of life among all decedents aged 65 years and over from 2020 in Austria (n=76 772).ResultsThe higher the level of education, the shorter the period for which ALTCA was received. Over the last 5 years of life, those with the primary/lower secondary education received ALTCA for 47% or 10 months (men), respectively, 38% or 12 months (women) longer than those with tertiary education. Education-related inequalities decreased with time to death and age at death.ConclusionWe found education-related inequalities in the duration of late-life disability, that is, higher education was associated with a prolonged ability to live independently during the last years of life. Inequalities in disability decreased with time to death and age at death, pointing to a gradual levelling due to mortality-related declines as well as selective mortality.

BackgroundFrailty is a geriatric syndrome closely linked to a variety of adverse health outcomes. Thus, it is important to identify factors associated with the development of frailty. It was the aim of this study to examine, if, and to what extent partner loss, a highly stressful life event, affects frailty trajectories of community dwelling adults aged 50 or older.MethodsUsing six waves of panel data from the Survey of Health, Ageing and Retirement in Europe (SHARE), we investigated the effect of partner loss on frailty trajectories estimating growth curve models. Our sample included 183 502 observations of 83 494 community-dwelling individuals aged 50 or older from 21 European countries collected between 2004 and 2017. Frailty was measured using the validated sex-specific SHARE-Frailty-Instrument including muscular weakness, unintended weight loss, decrease in walking capacity, low physical activity and exhaustion.ResultsOur sample contained 79 874 participants who lived in a partnership during their entire observational period and 3620 participants who lost their partner during their observational period. Both men (β=0.184 (95% CI: −0.017 to 0.386), p=0.073) and women (β=0.237 (95% CI: 0.106 to 0.369), p<0.001) showed initial effects of partner loss on frailty, but while only women gradually recovered over time (β=−0.023 (95% CI: −0.039 to −0.008), p=0.002), among men, the effect of partner loss persisted (β<0.001 (95% CI: −0.029 to 0.029), p=0.998).ConclusionThis study revealed that partner loss is followed by elevated frailty. However, while women’s frailty tended to recover from partner loss over time, men’s frailty remained elevated. Notable individual differences in the response of frailty trajectories to partner loss suggest the existence of effect modifiers.

Frailty is associated with adverse health outcomes in ageing populations, yet its long-term effect on the development of disability is not well defined. The study examines to what extent frailty affects disability trajectories over 15 years in older adults aged 50+. Using seven waves of data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the study estimates the effect of baseline frailty on subsequent disability trajectories by multilevel growth curve models. The sample included 94 360 individuals from 28 European countries. Baseline frailty was assessed at baseline, using the sex-specific SHARE-Frailty-Instrument (SHARE-FI), including weight loss, exhaustion, muscle weakness, slowness, and low physical activity. Disability outcomes were the sum score of limitations in activities of daily living (ADL) and Instrumental ADL (IADL). Analyses were stratified by sex. Over 15 years, baseline frailty score was positively associated with disability trajectories in men [βADL = 0.074, 95% confidence interval (CI) = 0.064; P = .083; βIADL = 0.094, 95% CI = 0.080; P = 0.107] and women (βADL = 0.097, 95% CI = 0.089; P = .105; βIADL = 0.108, 95% CI = 0.097; P = .118). Frail participants showed higher ADL and IADL disability levels, independent of baseline disability, compared with prefrail and robust participants across all age groups. Overall, participants displayed higher levels of IADL disability than ADL disability. Study findings indicate the importance of early frailty assessment using the SHARE-FI in individuals 50 and older as it provides valuable insight into future disability outcomes.

Abstract Background Frailty is a geriatric condition associated with adverse health outcomes. As physical inactivity, low protein intake and poor social network are known risk factors, we aimed to assess the influence of these parameters and their interaction in an 11-year follow-up study on a Europe-wide level. Methods Data from the Study on Health, Ageing and Retirement in Europe were used, including 22 226 community-dwelling robust and prefrail persons aged ≥50 years, from 11 countries. Frailty was assessed with the ‘Frailty Instrument for Primary care of the Survey of Health, Ageing and Retirement in Europe’. Additionally, self-reported physical activity (PA), protein intake and satisfaction with social network were assessed. The impact of these parameters on the development of frailty was calculated using multivariate cox regressions. Results Performing no regular PA, was associated with higher hazards ratio (HRs) for frailty compared with performing regular PA [men: 1.90 (95%CI: 1.50–2.42); women: 1.65 (95%CI: 1.25–2.18)]; HRs for low protein intake were 1.16 (95%CI: 0.93–1.46) for men and 1.05 (95%CI: 0.80–1.37) for women. And HR for poor social network were 0.92 (95%CI: 0.74–1.15) for men and 1.72 (95%CI: 1.31–2.27)] for women. In general, persons with a combination of two of the assessed risk factors had a higher risk for frailty compared with those with no or only one of the risk factors. However, no significant synergy index could be found. Conclusion The results illustrate the importance of PA, but also of nutritional and social network to prevent frailty.

Background: The prognosis for people living with HIV (PLWHIV) has improved tremendously in the past years, and life expectancy in PLWHIV is almost the same as in the general population. HIV now is regarded as chronic condition, and as PLWHIV age, additional age-related problems emerge. These seem to occur more often and earlier compared to the general population, due to the virus itself, due to antiretroviral therapy, or due to lifestyle factors. Among these problems are biological factors such as chronic non-communicable diseases, other communicable diseases, and frailty, mental factors like common mental disorders and substance use, as well as social factors like stigma, discrimination, prejudices, work disability and unemployment, and having no partner. It was the aim of this study to monitor medical health burdens in a cohort of PLWHIW over time with an emphasis on cardio-vascular risk factors in order to design a comprehensive, integrated, person-centred care model around the antiretroviral therapy. The study was carried out by researchers and caregivers together with PLWHIV, and supported by a pharmaceutical company. Methods: PLWHIV participated in a baseline study (2013) in an HIV treatment centre and in a follow-up study (2021). At baseline the study population comprised of consecutive patients with HIV, who visited their treating physicians for routine checks. Inclusion criteria were age >= 18 years, documented HIV-Infection and written informed consent. Risk factors were recorded as either having a corresponding diagnosis in the patient´s charts OR being treated with specific drugs, OR having laboratory values outside the normal range. Results: From the initially included 450 participants, 360 (80%) patients participated in the follow-up. The mean age at baseline was 41.4 years, 5.3% were female. 10.8% were affected by hypertension at baseline, and 19.6% at follow-up (P<0.001). Prevalence of type 2 diabetes mellitus was 3.1% at baseline and 5.3% at follow-up (P=0.039), and of dyslipidaemia 76.9% at baseline and 71.4% at follow-up (P=0.042). The proportion of smokers decreased from 42.6% a baseline to 37.1% a follow-up (P=0.007). Prevalence of overweight was 36.6% and of obesity 8.9% at follow-up (no baseline data available). Learnings and next steps: PLWHIV have a high prevalence of cardio-vascular risk factors in an early age, which will increase health problems as this population is ageing. Most cardio-vascular risk factors increased rapidly in PLWHIV and therefore they are a major challenge for comprehensive and integrated care. As an important next step not only medical, but also psycho-social, sexual, spiritual and lifestyle-related health burdens as well as health resources need to be assessed and monitored to ensure care for PLWHIV is truly person-centered. Furthermore, PLWHIV want to be perceived as a partner in their treatment and this needs to become an integral part of routine care.