Lifestyle risk factors and all-cause and cause-specific mortality: assessing the influence of reverse causation in a prospective cohort of 457,021 US adults

Rezende, Leandro F. M.; Ferrari, Gérson; Lee, Dong Hoon; Aune, Dagfinn; Liao, Bing; Huang, Wentao; Nie, Jing; Wang, Yafeng; Giovannucci, Edward

doi:10.1007/s10654-021-00829-2

Cited by 15 publications

(20 citation statements)

References 20 publications

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“…We also excluded the first 5 years of follow-up to investigate the influence of confounding by preexisting diseases. 12 In our final sensitivity analysis, we also excluded participants with ≥600 min/wk of physical activity and ≥780 min/wk of physical activity were conducted to account for different exposure variability and to increase comparability between weekend warriors and regularly active participants (ie, relatively few weekend warriors exceeded this level). For statistically significant results in the main analysis, we calculated the E value to estimate the strength of the associations, on the risk ratio scale, of an unmeasured confounder with both exposure and outcome needed to explain away the observed associations.…”

Section: Discussionmentioning

confidence: 99%

“…We excluded participants who had been diagnosed with cancer, chronic bronchitis, emphysema, heart disease, and stroke at baseline (n = 104 345); with missing data for physical activity (n = 11 694); with limitations on their instrumental and other activities of daily living (n = 8345); or who were unable to perform moderate or vigorous physical activity (n = 3362). Of note, the rationale for excluding participants with chronic conditions at baseline was based on previous studies suggesting the influence of reverse causation bias (confounding by preexisting diseases) in cohort studies assessing the association between physical activity and mortality . Lastly, we excluded the first 2 years of follow-up to further mitigate the influence of reverse causation bias, producing a final analytical sample of 350 978 participants.…”

Section: Methodsmentioning

confidence: 99%

“…We also included the total amount of MVPA into the model, when we investigated whether, for the same amount of total MVPA, weekly frequency, duration of sessions, and intensity of physical activity were associated with mortality. We also excluded the first 5 years of follow-up to investigate the influence of confounding by preexisting diseases . In our final sensitivity analysis, we also excluded participants with ≥600 min/wk of physical activity and ≥780 min/wk of physical activity were conducted to account for different exposure variability and to increase comparability between weekend warriors and regularly active participants (ie, relatively few weekend warriors exceeded this level).…”

Section: Methodsmentioning

confidence: 99%

“…suggesting the influence of reverse causation bias (confounding by preexisting diseases) in cohort studies assessing the association between physical activity and mortality. [11][12][13][14] Lastly, we excluded the first 2 years of follow-up to further mitigate the influence of reverse causation bias, producing a final analytical sample of 350 978 participants. Participants were classified according to the level and pattern of their physical activity.…”

Section: Key Pointsmentioning

confidence: 99%

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Association of the “Weekend Warrior” and Other Leisure-time Physical Activity Patterns With All-Cause and Cause-Specific Mortality

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Key Pointsmentioning

confidence: 99%

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Association of the “Weekend Warrior” and Other Leisure-time Physical Activity Patterns With All-Cause and Cause-Specific Mortality

et al. 2022

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“…We conducted sensitivity analyses: 1) excluding participants who developed dementia during the first two years of follow-up, and 2) excluding participants who reported poor self-rated health to account for the potential influence of reverse causation [30]. We also performed a sensitivity analysis excluding all participants who reported day or night shift work to remove the potential work schedule bias.…”

Section: Methodsmentioning

confidence: 99%

Dose-response associations of device measured sleep regularity and duration with incident dementia in 82391 UK adults

Bian,

Biswas,

Ahmadi

et al. 2023

Preprint

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ObjectivesTo evaluate the associations of device-measured sleep duration and regularity with incident dementia, and to explore whether regular sleep might mitigate any association of sleep duration with dementia.MethodsThis population-based prospective cohort study of 82391 adults from the UK Biobank accelerometry subsample included adults aged 43 to 79 years old in England, Scotland, and Wales. Sleep duration (h/day) and Sleep Regularity Index (SRI, range 0-100) were calculated from the wrist-worn accelerometry data collected by participants over the course of one week. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and assess the independent associations between sleep and incident dementia after adjustment for common demographic and contextual covariates.ResultsOver a mean follow-up of 7.9 years, during which 694 incident dementia cases occurred, there was a U-shaped association between sleep duration and incident dementia. Short sleep (<7 h) was associated with increased dementia risk, while long sleep (≥ 8h) was not significantly associated with dementia risk. The median sleep duration for short sleepers (<7 h) of 6.5 hours was associated with an HR of 1.19 (95% CI 1.01, 1.40) for incident dementia. Sleep regularity was negatively associated with dementia risk in a near-linear fashion. The sample median SRI of approximately 73, compared to the reference point of 51, was associated with an HR of 0.76 (95%CI 0.61, 0.94). The SRI value where the risk reduction was 50% of the maximum observed of 66, was associated with an HR of 0.77 (95%CI 0.63, 0.95). Among individuals with sleep duration outside the optimal range (too short or too long), less regular sleep was associated with increased risk of dementia. Among those with optimal sleep duration (7-8h/day), there was no significant association between sleep regularity and dementia risk. Compared to the reference point (SRI: 51), an SRI value of 62 for non-optimal sleepers was associated with a 25% reduction in risk for dementia (HR: 0.75; 95% CI 0.63, 0.90).ConclusionsA regular sleep pattern may mitigate some adverse effects of inadequate sleep duration, suggesting that interventions aimed at improving sleep regularity may be a suitable option for people not able to achieve the recommended hours of sleep.

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Consumption of Total and Specific Alcoholic Beverages and Long-Term Risk of Gout Among Men and Women

Lyu,

Miao,

Wang

et al. 2024

JAMA Netw Open

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ImportancePrevious studies on alcohol consumption and incident gout have mostly included men or combined both sexes, and the sex-specific associations between alcohol consumption and gout are poorly understood.ObjectiveTo evaluate the consumption of total and specific alcoholic beverages in association with incident gout in men and women.Design, Setting, and ParticipantsThis prospective cohort study included 401 128 participants in the UK Biobank aged 37 to 73 years who were free of gout at baseline (2006-2010). Participants were followed up through December 31, 2021, and data were analyzed between August 2023 and June 2024.ExposureQuestionnaire-based consumption of total alcohol and specific alcoholic beverages.Main Outcomes and MeasuresThe outcome was incident gout, identified using hospital records. Multivariable Cox proportional hazards regression models were used to estimate sex-specific hazard ratios (HRs) and 95% CIs of incident gout associated with alcohol consumption, with a particular consideration of reverse causation bias.ResultsThe main analysis included 179 828 men (mean [SD] age, 56.0 [8.2] years) and 221 300 women (mean [SD] age, 56.0 [8.0] years). Current drinkers showed a higher risk of gout than never drinkers among men (HR, 1.69; 95% CI, 1.30-2.18) but not among women (HR, 0.83; 95% CI, 0.67-1.03). Among current drinkers, higher total alcohol consumption was associated with a higher risk of gout among both sexes and more strongly among men than women (men: HR, 2.05 [95% CI, 1.84-2.30]; women: HR, 1.34 [95% CI, 1.12-1.61]). The most evident sex difference in the consumption of specific alcoholic beverages was observed for beer or cider (men: mean [SD], 4.2 [4.8] pints per week; women: mean [SD], 0.4 [1.1] pints per week). Consumption of champagne or white wine, beer or cider, and spirits each was associated with a higher risk of gout among both sexes, with beer or cider showing the strongest association per 1 pint per day (men: HR, 1.60 [95% CI, 1.53-1.67]; women: HR, 1.62 [95% CI, 1.02-2.57]). Some inverse associations between light to moderate consumption of specific alcoholic beverages and gout were eliminated after adjusting for other alcoholic beverages and excluding individuals who had reduced alcohol consumption for health reasons, self-reported poor health, or had cardiovascular disease, cancer, or kidney failure at baseline, or developed gout within the first 2 years of follow-up.Conclusions and RelevanceIn this cohort study, higher consumption of several specific alcoholic beverages was associated with a higher risk of gout among both sexes. The sex-specific associations for total alcohol consumption may be associated with differences between men and women in the types of alcohol consumed.

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Lifestyle risk factors and all-cause and cause-specific mortality: assessing the influence of reverse causation in a prospective cohort of 457,021 US adults

Cited by 15 publications

References 20 publications

Association of the “Weekend Warrior” and Other Leisure-time Physical Activity Patterns With All-Cause and Cause-Specific Mortality

Association of the “Weekend Warrior” and Other Leisure-time Physical Activity Patterns With All-Cause and Cause-Specific Mortality

Dose-response associations of device measured sleep regularity and duration with incident dementia in 82391 UK adults

Consumption of Total and Specific Alcoholic Beverages and Long-Term Risk of Gout Among Men and Women

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