Showing papers by "Brian Houle published in 2022"

Quantifying impacts of the COVID-19 pandemic on Australian life expectancy

Abstract: Global excess mortality caused by the COVID-19 pandemic 1 can be clearly assessed from the perspective of years of life expectancy lost. 2 The study by Aburto et al ., on quantifying the impacts of the COVID-19 pandemic through life expectancy losses, 2 presents changes in life expectancy between 2019 and 2020 for 29 populations with high-quality data, ranging from losses of (cid:2) 1.7 and (cid:2) 2.2years for American females and males, respectively, to small increases of 0.1 and 0.2years for females and males in Denmark and Norway, respectively. However Australia, with its relatively strict COVID-19 containment measures of international border closures and lockdowns, resulting in just 898 COVID-19-related deaths in 2020, 3 was not included in the study. Now official data are available (based on year of registration of death), 3,4 and we present the results for Australia, with a comparison with Denmark and the USA which were clearly strong and poor performers, respectively, in terms of changes in life expectancy between 2019 and 2020. 2 Given the relatively high number of deaths registered in 2019 in Australia that had occurred in earlier years, we used the average of 2017–19 to provide a clearer comparison of the past to 2020 attributable to official COVID-19 deaths and other causes of death. All sources and data points are in the Supplementary data, available at IJE online

Parental imprisonment as a risk factor for cardiovascular and metabolic disease in adolescent and adult offspring: A prospective Australian birth cohort study

Abstract: Parental imprisonment is linked with child health in later life. The present study provides the first prospective cohort analysis and non-U.S. based study examining parental imprisonment and cardiometabolic risk factors in adolescence and adulthood.The study followed 7,223 children born from live, singleton births from 1981 to 1984 in Brisbane, Australia. Data on parental imprisonment was collected at mother interview when the children were ages 5 and 14. Our sample analyzes offspring with biometric data collected by health professionals, including 3,794 at age 14, 2,136 at age 21, and 1,712 at age 30. Analyses used multivariate linear and logistic regression, and time-varying growth curve models.Among female respondents, parental imprisonment at ages ≤5 was associated with higher body-mass index (BMI) at ages 14, 21, and 30; higher systolic blood pressure (SBP) and diastolic blood pressure (DBP) at age 30; and increased sedentary hours, larger waist circumference, and odds of a high-risk waist circumference at age 30. Parental imprisonment when the child was aged ≤14 was associated with increased BMI and SBP at age 30 for females. In growth-curve models, parental imprisonment when the child was aged ≤5 and ≤ 14 among females was linked with increased BMI; parental imprisonment when the child was aged ≤5 was associated with increased SBP and DBP. No significant associations were observed for males.Using prospective cohort data, our results support research showing that parental imprisonment, particularly in early childhood, is associated with increased BMI, blood pressure, sedentary hours, and waist circumference in females in early adulthood. These findings implicate parental imprisonment as a risk factor for cardiometabolic health issues in later life among females.

Twin epidemics: the effects of HIV and systolic blood pressure on mortality risk in rural South Africa, 2010-2019

Abstract: Sub-Saharan African settings are experiencing dual epidemics of HIV and hypertension. We investigate effects of each condition on mortality and examine whether HIV and hypertension interact in determining mortality.Data come from the 2010 Ha Nakekela population-based survey of individuals ages 40 and older (1,802 women; 1,107 men) nested in the Agincourt Health and socio-Demographic Surveillance System in rural South Africa, which provides mortality follow-up from population surveillance until mid-2019. Using discrete-time event history models stratified by sex, we assessed differential mortality risks according to baseline measures of HIV infection, HIV-1 RNA viral load, and systolic blood pressure.During the 8-year follow-up period, mortality was high (477 deaths). Survey weighted estimates are that 37% of men (mortality rate 987.53/100,000, 95% CI: 986.26 to 988.79) and 25% of women (mortality rate 937.28/100,000, 95% CI: 899.7 to 974.88) died. Over a quarter of participants were living with HIV (PLWH) at baseline, over 50% of whom had unsuppressed viral loads. The share of the population with a systolic blood pressure of 140mm Hg or higher increased from 24% at ages 40-59 to 50% at ages 75-plus and was generally higher for those not living with HIV compared to PLWH. Men and women with unsuppressed viral load had elevated mortality risks (men: adjusted odds ratio (aOR) 3.23, 95% CI: 2.21 to 4.71, women: aOR 2.05, 95% CI: 1.27 to 3.30). There was a weak, non-linear relationship between systolic blood pressure and higher mortality risk. We found no significant interaction between systolic blood pressure and HIV status for either men or women (p>0.05).Our results indicate that HIV and elevated blood pressure are acting as separate, non-interacting epidemics affecting high proportions of the older adult population. PLWH with unsuppressed viral load were at higher mortality risk compared to those uninfected. Systolic blood pressure was a mortality risk factor independent of HIV status. As antiretroviral therapy becomes more widespread, further longitudinal follow-up is needed to understand how the dynamics of increased longevity and multimorbidity among people living with both HIV and high blood pressure, as well as the emergence of COVID-19, may alter these patterns.

Significant improvement in blood pressure control among older adults with hypertension in rural South Africa: findings from a prospective 5,000-patient cohort, 2014–2019

Abstract: Sub-Saharan Africa is undergoing an epidemiologic transition dominated by a widespread epidemic of hypertension (HTN). Since 2014, we began studying a cohort of 5,059 individuals in rural South Africa, to describe the evolution of HTN among older adults, and understand the impact of targeted interventions by local health systems. Characterize the updated prevalence and incidence of HTN in a prospective cohort between baseline (2014) and follow-up (2019), and describe changes in blood pressure (BP) treatment. HTN was defined as systolic blood pressure (SBP) ≥140 mm Hg, diastolic blood pressure (DBP) ≥90 mm Hg, or self-reported medication use. Prevalence and incidence rates were calculated using inverse-probability weights to account for mortality and attrition. Poisson regression was used to identify predictors of disease incidence. We calculated the percentage of individuals with controlled versus uncontrolled HTN (with 140/90 mm Hg as cutoff), self-reported medication use, and compared these values between 2014 and 2019. Compared to 2014 (n=5,059), study participants in 2019 (n=4,176) were expectedly older (mean age 61.7±13.1 vs 66.0±13.0 years) but had similar sex distribution (53.6% vs 53.5% females) and weighted rates of obesity (mean BMI 27.5±10.0 vs 27.0±6.5), with higher rates of smoking (9.1% vs 11.8%) and diabetes (11.1% vs 13.7%). The HTN prevalence did not increase over time (58.4% vs 59.8%), and there was a significant reduction in mean SBP (138.0 vs 128.5 mm Hg, p<0.001) and DBP (82.1 vs 79.6 mm Hg, p<0.001). In the subgroup of hypertensive individuals with measured BP and self-reported medication use in both 2014 and 2019 (n=796), the percentage who had controlled HTN on medications increased from 44.5% to 62.3% while the percentage who had uncontrolled HTN on medications or uncontrolled HTN not on medications decreased (48.5% to 32.2% and 7.2% to 3%, respectively) from 2014 to 2019 (Figure 1). The HTN incidence was 6.2 per 100 person-years, which was lower than prior reports from this area (8.4 per 100 person-years in 2010–2015); in multivariable models, age was the only significant predictor of incident HTN. In the subgroup of individuals who were healthy at baseline with measured BP and self-reported medication use in 2014 and 2019 (n=2,257), very few developed HTN by 2019 (15.2%); of those, the majority already had controlled HTN and was on medications by 2019 (Figure 2). The prevalence of HTN did not increase in this aging cohort; in fact there was a clinically and statistically significant decline in mean BP and a substantial increase in the proportion of hypertensive patients with controlled HTN taking medications between 2014 and 2019. The prevalence of obesity, smoking and other risk factors did not decrease over time, suggesting that the mean BP decrease in this cohort is likely due to increased access and adherence to medications, promoted by local health systems. Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute on Aging (P01 AG041710), and Department of Science and Innovation, the University of the Witwatersrand, South Africa.

Impact of diabetes on longevity and disability-free life expectancy among older South African adults: a prospective longitudinal analysis

Abstract: Objective We seek to understand the coexisting effects of population aging and a rising burden of diabetes on healthy longevity in South Africa. Research Design and Methods We used longitudinal data from the 2015 and 2018 waves of the "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa" (HAALSI) study to explore life expectancy (LE) and disability-free life expectancy (DFLE) of adults aged 45 and older with and without diabetes in rural South Africa. We estimated LE and DFLE by diabetes status using Markov-based microsimulation. Results We find a clear gradient in remaining LE and DFLE based on diabetes status. At age 45, a man without diabetes could expect to live 7.4 [95% CI 3.4 - 11.7] more years than a man with diabetes, and a woman without diabetes could expect to live 3.9 [95% CI: 0.8 - 6.9] more years than a woman with diabetes. Individuals with diabetes lived proportionately more years subject to disability than individuals without diabetes. Additional analyses separating individuals with diabetes based on whether they knew their disease status found that individuals with diabetes diagnosed by a healthcare worker had shorter remaining LE than those who were unaware of their status or those without diabetes. Conclusions Our findings highlight the large and important decrements in healthy, disability-free aging for people with diabetes in South Africa. This finding should motivate efforts to strengthen prevention and treatment efforts for diabetes and its complications for older adults in this setting.

The double-edged role of accessed status on health and well-being among middle- and older-age adults in rural South Africa: The HAALSI study

Abstract: Social capital theory conceptualizes accessed status (the socioeconomic status of social contacts) as interpersonal resources that generate positive health returns, while social cost theory suggests that accessed status can harm health due to the sociopsychological costs of generating and maintaining these relationships. Evidence for both hypotheses has been observed in higher-income countries, but not in more resource-constrained settings. We therefore investigated whether the dual functions of accessed status on health may be patterned by its interaction with network structure and functions among an older population in rural South Africa. We used baseline survey data from the HAALSI study (“Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa”) among 4,379 adults aged 40 and older. We examined the direct effect of accessed status (measured as network members’ literacy), as well as its interaction with network size and instrumental support, on life satisfaction and self-rated health. In models without interactions, accessed status was positively associated with life satisfaction but not self-rated health. Higher accessed status was positively associated with both outcomes for those with fewer personal contacts. Interaction effects were further patterned by gender, being most health-protective for women with a smaller network and most health-damaging for men with a larger network. Supporting social capital theory, we find that having higher accessed status is associated with better health and well-being for older adults in a setting with limited formal support resources. However, the explanatory power of both theories appears to depending on other key factors, such as gender and network size, highlighting the importance of contextualizing theories in practice.

Making Sense of Troubled Livelihoods: Gendered Expectations and Poor Health Narratives in Rural South Africa

Abstract: When men and women cannot attain idealized gendered forms of economic provision and dependence, how do they make sense of this perceived failure? In this article, we posit that poor health narratives serve as a gendered tool to make sense of inadequate livelihoods, even when that inadequacy is attributable to structural conditions. We draw on survey and life-history interview data from middle-aged and older rural South Africans. The survey data show that even after adjusting for biometrically measured health differences, working-age (40–59 years) men report poorer health when they are unemployed, and women (age 40+) and pension-age men (age 60+) report poorer health when they live without household earners. Life-history interviews show parallel patterns: When their economic circumstance is not troubled, individuals regularly minimize health concerns; conversely, when they have a troubled livelihood, individuals draw on poor health to explain it. When women and men cannot perform idealized gendered practices in the family, poor health becomes a tool to reduce the resulting cognitive dissonance. Poor health narratives recast perceived gender failures to an individualized, biological explanation. Our study illustrates how the epidemiological context can be a resource that forestalls a redefinition of gender norms when the gender order is in crisis.