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Conclusions

Data from a national representative sample of 1023 elderly and near-elderly Taiwanese were used to explore whether allostatic load is associated with health outcomes and mediates the association between socioeconomic status and health in a non-Western population. The information collected included: demographic characteristics; allostatic load scores; socioeconomic status, measured by education and income; health behaviours; health-related variables, including self-rated health, basic activities of daily living difficulties, instrumental activities of daily living difficulties, and physical activity difficulties. The adjusted prevalent odds ratios of higher allostatic load level were 1·25 (95% CI: 1·00, 1·56) for reporting one level worse in self-rated health and 1·43 (95% CI: 1·14, 1·82) for reporting one more physical activity difficulty. There were significant associations of lower education or less income with worse self-rated health and more difficulties with physical functioning. The associations between education, income and health status are not mediated by the conventional ten-point measure of allostatic load in older Taiwanese adults.

Study Objectives: Insomnia is influenced by psychosocial and environment factors. This study aims to examine the differential of insomnia symptoms between rural-to-urban migrants and non-migrants in China. Design: A cross-sectional study. Setting: Ten townships throughout China. Patients or Participants: One hundred and ninety-seven Chinese adults aged 18 to 64 years, with an oversample of migrants. Measurements and Results: Professional interviewers and community doctors used a questionnaire to collect information on migration, insomnia symptoms, and other variables. Multivariable binomial logistic regression models were used to examine the relations between migration status and presence of at least one insomnia symptom, while adjusting for age, sex, education, income, number of chronic medical conditions, depression, and other covariates. The numbers of permanent urban residents, rural non-migrants, and rural-to-urban migrants in the study were 93 (47%), 47 (24%), and 57 (29%), respectively. The probability of reporting at least one of the five insomnia symptoms measured was 40% for permanent urban residents, 62% for rural non-migrants, and 68% for migrants (P = 0.001). Using permanent urban residents as the reference group, the multiply-adjusted odd ratios of having at least one insomnia symptom were 3.00 (95% CI: 1.36 – 6.62) for migrants and 1.86 (95% CI: 0.73 – 4.74) for rural non-migrants. The adjusted odd ratio for insomnia symptoms predicted from each additional chronic medical condition was 1.71 (95% CI: 1.13 – 2.60). 2 Conclusions: Compared to permanent urban residents, rural-to-urban migrants in China have higher prevalence of insomnia symptoms. The number of chronic medical conditions reported is also independently related to sleep disturbance. Key words: migration status, insomnia, China

To examine the combined influence of alcohol use and comorbidity on 20-year mortality in older adults (average age 66 at the time of the baseline survey). DESIGN: Longitudinal analysis of a national probability sample-based cohort study. SETTING: Data sources were the National Health and Nutrition Examination Survey I (NHANES I), 1971-1974, and the NHANES Epidemiologic Followup Survey, 1992. PARTICIPANTS: Four thousand six hundred ninety-one adults aged 60 and older who provided data on alcohol use. MEASUREMENTS: The prevalence of at-risk drinking in older adults in the United States and the 20-year all-cause mortality risk associated with it. At-risk drinking status was determined from amount of alcohol consumed and comorbidities, using a previously validated method. RESULTS: The prevalence of at-risk drinking in the United States between 1971 and 1974 in older adults was 10% (18% of men, 5% of women). The majority of at-risk drinkers were identified as such because of their use of alcohol in amounts deemed risky in the presence of relevant comorbidities (69%) (e.g., drinking 2-3 drinks per day and having gout or anxiety or taking a medication for pain). In men, at-risk drinking was associated with higher mortality rates than not-at-risk drinking (hazard ratio=1.20, 95% confidence interval=1.01-1.41); abstinence was not associated with greater mortality. In women, neither abstinence nor at-risk drinking was associated with greater mortality rates. CONCLUSION: In this first, large population-based study of older adults examining the mortality risks of alcohol use and comorbidity, at-risk drinking was associated with greater mortality rates in men. These findings suggest that a lower threshold of alcohol use should be recommended for older adults with specific comorbidities to reduce mortality risks.