Objectives To examine the association between marital status and dementia in a cohort of young-old (50–64) and middle-old (65–74) adults, and also whether this may differ by gender. Design Prospective population-based study with follow-up time of up to 10 years. Setting Swedish national register-based study. Participants 2 288 489 individuals, aged 50–74 years, without prior dementia diagnosis at baseline. Dementia was identified using the Swedish National Patient Register and the Cause of Death Register. Outcome measures The influence of marital status on dementia was analysed using Cox proportional hazards models, adjusted stepwise for multiple covariates (model 1: adjusted for age and gender; and model 2: additionally adjusted for having adult children, education, income and prior cardiovascular disease). Results During follow-up, 31 572 individuals in the study were identified as demented. Cox regression showed each non-married subcategory to be associated with a significantly higher risk of dementia than the married group, with the highest risk observed among people in the young-old age group, especially among those who were divorced or single (HRs 1.79 vs 1.71, fully adjusted model). Analyses stratified by gender showed gender differences in the young-old group, with indications of divorced men having a higher relative risk compared with divorced women (HRs 2.1 vs 1.7, only-age adjusted model). However, in the fully adjusted model, these differences were attenuated and there was no longer any significant difference between male and female participants. Conclusions Our results suggest that those living alone as non-marrieds may be at risk for early-onset and late-onset dementia. Although more research is needed to understand the underlying mechanism by which marital status is associated with dementia, this suggests that social relationships should be taken seriously as a risk factor for dementia and that social-based interventions may provide an opportunity to reduce the overall dementia risk.
Introduction Alcohol consumption is a considerable public health problem that is especially harmful to young people. To develop effective prevention programmes targeted at adolescents, it is important to understand the social mechanisms triggering alcohol consumption. Among such mechanisms, peer influence plays an important role. The effects of peer influence are very difficult to evaluate because of the entanglement with social selection, that is, a tendency of people to befriend others with similar behaviour. The recently developed stochastic actor-oriented models (SAOM) approach is designed to disentangle social influence from social selection. The aim of this study is to conduct a systematic review and meta-analysis of studies employing SAOM methodology to evaluate the effects of social influence on adolescent drinking behaviour.
Methods and analysis In order to analyse the co-evolution of alcohol consumption and adolescent friendship networks, we will collect articles that use SAOM methodology through systematic electronic searches in Web of Science, Scopus, PubMed, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials), EBSCOhost (MEDLINE, SocINDEX, Academic Source, ERIC), ProQuest (ProQuest Dissertations and Theses Global), PsycINFO (PsycNET), Excerpta Medica database (Embase) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). We will collect the literature from academic journals, dissertations/theses, reports and conference materials. Three reviewers will retrieve and independently assess potentially relevant material in terms of whether they comply with prespecified criteria. Subsequently, we will summarise the results of the studies in a systematic review. If a sufficient number of studies can be found, SAOM quantitative results will be extracted and meta-analysed. The project will go from 1 December 2018 to 1 December 2019.
Ethics and dissemination Ethical approval will not be required as our work is based on published studies. A list of all the studies included in this work will be available for review. We plan dissemination in a peer-reviewed international scientific journal and through conference presentations. Our review will highlight the peer effect of peers in adolescent drinking behaviour and provide guidance for developing effective prevention and intervention programmes. We expect it to be informative for policy and practice, decision-making as well as for further research in public health and sociology of adolescents.
Objectives. To assess disparities in mortality by socioeconomic status in Germany.
Design and participants. We analyse a large administrative dataset of the German Pension Fund (DRV), including 27 million person-years of exposure and 42 000 deaths in 2013. The data cover the economically active population, stratified by sex and by East and West.
Outcome measures. Age-standardised mortality rates and Poisson regression mortality rate ratios (MRRs).
Results. The risk of dying increases with decreasing income: the MRRs of the lowest to the highest income quintile are 4.66 (95% CI 4.48 to 4.85) among men and 3.06 (95% CI 2.90 to 3.23) among women. The impact of income attenuates after controlling for education and other explanatory variables, especially for females. In the fully controlled model for females, individual income is a weaker predictor of mortality, but there is a clear educational mortality gradient. In the fully controlled model, the MRRs of the unemployed to the employed are 2.09 (95% CI 2.03 to 2.15) among men and 2.01 (95% CI 1.92 to 2.10) among women. The risk of dying is around half as high among foreigners as among German citizens. The socioeconomic disparities are greater among East than West German men.
Conclusions. Low socioeconomic status is a major determinant of excess adult mortality in Germany. The persisting East-West differences in male adult mortality can be explained by the higher socioeconomic status of men living in the West, rather than by contextual differences between East and West. These differences can be further monitored using DRV data.